8 Things I Wish I Knew Before My First Code Blue as a Nurse

Your first code blue is one of the most intense moments you’ll ever experience as a nurse. No matter how many simulations you’ve done, the reality of responding in a life-or-death situation can be overwhelming. Some nurses work for years before experiencing a code blue. Others are in the middle of one during their first week.

It may seem as though your peers can’t possibly understand how you feel when that alarm goes off because they aren’t panicked. However, the truth is that the experienced nurses who are calm under pressure were once where you are now. They’ve felt the same fear, made the same mistakes, and came through the situation having learned lessons that made them better nurses.

Honestly, nothing can fully prepare you for your first code blue – there’s no use in denying that. But knowing what to expect beyond what you practiced in the simulation lab can make the experience a little less frightening. Here are a few things I wish I had known before my first code blue as a new nurse.

1. Trust Your Instincts and Prepare Accordingly

A few months into my first nursing job on a pediatric unit, a senior nurse walked into my patient’s room to help with something. As she left, she said, “That kid is going to code today.” The patient’s vitals weren’t sounding alarms, but I trusted her instincts. Two hours later, she was right.

As you gain more nursing experience, you’ll begin to recognize subtle signs of a patient going downhill. Listening to that voice in the back of your head and preparing accordingly can make or break the outcome. In my case, we put the code cart right outside the room and let the doctors know to keep a close eye on the patient. When they coded, the whole team was in the room within a minute, and the patient survived, all because we were prepared.

2. The Scene is Louder and Faster Than You Expect

The moment a code blue is called, everything shifts into high gear. A quiet patient room becomes a cacophony of alarms and orders being called out from multiple directions. The sheer number of people who cram in can leave you feeling lost and in the way. As a new nurse, it often seems like the more experienced nurses and providers are performing a well-rehearsed dance that no one taught you the moves to.

The noise and intensity of the situation can be paralyzing. I learned quickly that finding one thing to do and doing it well is often the best way to contribute. If you’re given a task, do it confidently. If you don’t have one, find a way to help and stick to it. The more you focus on your part, the easier it becomes to block out the chaos and help your patient.

3. Your Training Takes Over If You Let It

Throughout nursing school, you’ll go through dozens of code blue simulations. They’re not a great representation of the real thing, as the adrenaline rush of an actual code is impossible to replicate. But training builds muscle memory, and when you’re in an emergency, your body knows what to do.

When doing compressions, giving medications, and communicating with your team, you don’t have time to stop and think through each step. You have to trust your preparation.

The automatic response you see from experienced nurses comes from repetition. It takes time to get to that level, but the first step in that direction is treating every simulation as a real code. If you review your basic CPR and medication administration skills until you know them like the back of your hand, your skills will likely kick in subconsciously when you and your patient need them most.

4. Communicate More Than You Think You Should

Communication during a code blue is the heartbeat of the operation. Without it, even a highly skilled team will make mistakes that could have devastating consequences. You’ll practice closed-loop communication in simulations, which becomes essential in the middle of a high-pressure situation.

As a new nurse, you might not feel like your voice is valued in the code room. But you’ve prepared for the situation and have valuable knowledge and skills to contribute. Silence and hesitation lead to confusion and errors, so never be afraid to speak up and communicate with your team.

If you see an opening, jump in and start doing compressions, maintaining the airway, or preparing medications according to your unit’s protocols. Communicate your role clearly and be sure everyone is on the same page.

5. The Patient’s Family Might Be Watching

During my second code blue, I experienced something that changed the entire dynamic. The patient’s family was in the room. As we tried to save the patient, their mother stood in the corner, hands covering her mouth with tears streaming down her face.

In the chaos of a code, it’s easy to forget that someone’s loved one could be watching and feeling powerless. It adds another layer of intensity, but it’s also a reminder of why we do what we do. If there’s a moment when you can do so, try to acknowledge their presence. It won’t always be possible in the hectic flow of tasks and assessments, but when it is, a little compassion goes a long way.

6. No One Talks About the Emotional Aftermath

Your first code blue isn’t just a test of your clinical skills. Even if everything goes perfectly, the adrenaline rush can leave you exhausted afterward. If the patient doesn’t survive, your emotions can be even more intense. Losing a patient is a heavy burden, and the pain can linger for a while. After my first code, my head was spinning, and I kept replaying the situation, wondering if I could have done anything differently.

Experienced nurses might be able to move on without missing a beat. It’s okay if you can’t. I thought about my first code for weeks, and it seriously hurt my confidence. Each shift came with intense anxiety and self-doubt. The emotions that come with being a new nurse can be intense. But remember that whatever you’re feeling is normal.

For me, seeking out therapy made all the difference. Everyone deals with emotions in their own way, but talking to a professional can be an extremely helpful outlet after your first code. Acknowledging what you’re feeling instead of pushing it down is essential to growing as a nurse and preparing for the next time you’re in a code.

7. Your First Code Blue Makes You a Better Nurse

Your first code blue can feel like a test of survival. But it’s also a foundational learning experience that will make you a better nurse. It pushes you to think critically under pressure, work seamlessly with your team, and build the confidence you need to handle future emergencies.

No matter how the code ends, you’ll walk away as a smarter and more capable nurse. The next time the alarm goes off, you’ll better know what to expect and how to act. Over time, responding to code blues will become second nature. For now, though, it’s okay not to know everything. Treat your first code as a learning experience, reflect on what you experienced, and use it to improve.

8. You Won’t Save Everyone, and That’s Okay

One of the hardest parts of being a nurse is that not every patient survives. Some outcomes are out of your control even when you do everything right. The patient in my first code blue was a toddler who didn’t make it after half an hour of CPR and medications. It was the hardest thing I’ve ever had to go through as a nurse.

It’s normal to feel a sense of loss or anger after an unsuccessful code. But as a nurse, your job is to give each patient the best possible chance and provide compassionate care no matter the outcome.

I’ve been part of several codes since my first one, some successful and others not. Losing a patient never becomes easy, but instead of carrying the weight with you, it’s essential to focus on what you can control and move forward by providing the best care you can.