If you’ve ever been in a code blue, you know it’s one of the most stressful and adrenaline-filled moments of nursing. Even seasoned RNs who have “been there, done that” can find themselves slipping into bad habits or missing critical steps. The truth is, none of us are perfect in a crisis. But the more we talk about these mistakes openly, the more prepared we all are when the next code hits.
Here are five of the most common missteps nurses make during code blues — and how to avoid them.
1. Delayed IV Access
We all know IV access is crucial, but when the room is buzzing with activity, it can get delayed or overlooked. Maybe the IV kit isn’t immediately at the bedside, or everyone assumes someone else is handling it. The longer it takes to get access, the longer it takes to administer life-saving medications.
• As soon as the code is called, identify who is responsible for IV access.
• If a peripheral IV is difficult, call for an IO (intraosseous) early instead of poking endlessly.
• Keep code carts stocked and make sure your team knows where the IO kits are stored.
I’ll admit — I’ve been in a code where we lost five valuable minutes because everyone assumed IV access was already established. That mistake stuck with me, and now I always confirm it early.
2. Not Delegating Compressions Quickly Enough
In the chaos of a code, one nurse may start compressions and keep going… and going… and going. The problem? After about two minutes, compressions lose quality. Fatigue sets in, even for the strongest nurse.
How to prevent it:
• Rotate compressors every two minutes, no exceptions.
• Assign a “compressions captain” at the start — someone whose only job is to watch the clock and call out when it’s time to switch.
• Don’t wait until someone is visibly tired; assume fatigue will happen.
I’ve seen new nurses hesitate to speak up because they don’t want to “boss around” a more experienced nurse. But calling for a switch isn’t bossy — it’s safe patient care.
3. Forgetting to Document in Real Time
In the middle of a code, nobody wants to step aside and chart. But failing to document meds, shocks, and times in the moment creates confusion and can compromise care. Trying to “remember later” is almost impossible once the dust settles.
How to prevent it:
• Assign a dedicated recorder. This person doesn’t do compressions or meds — their job is to document everything as it happens.
• Use pre-printed code sheets or electronic timers if your facility has them.
• Encourage the recorder to speak out loud: “Epi given at 10:05,” “Pulse check at 10:07.” This keeps everyone on the same page.
I’ve been the “lone documenter” before, scribbling on scraps of paper while trying to help with meds. It doesn’t work. Having a clear recorder role makes the whole team function smoother.
4. Overcrowding the Room
When a code is called, it can feel like half the hospital shows up. While extra hands are great, too many people crowding the room actually slows things down. You end up with blocked access, repeated tasks, and confusion over who’s in charge.
How to prevent it:
• Assign roles quickly: compressor, airway, meds, recorder, runner.
• Politely ask extra staff to wait outside until they’re needed.
• Keep the patient’s immediate space clear for only those performing direct interventions.
One of the most effective codes I’ve ever seen was when the charge nurse calmly said, “If you don’t have a role, step back.” It cleared the chaos instantly.
5. Focusing Too Much on the Algorithm, Not Enough on the Patient
Algorithms are lifesaving guides, but sometimes we get so wrapped up in “what’s next” that we forget to reassess the actual patient. Are we missing reversible causes? Are compressions effective? Is the airway truly patent?
How to prevent it:
• Step back regularly for a pulse and rhythm check.
• Keep “H’s and T’s” in mind — hypoxia, hypovolemia, hydrogen ion (acidosis), hyper/hypokalemia, hypothermia, toxins, tamponade, tension pneumo, thrombosis.
• Remember: the algorithm supports the patient, not the other way around.
I once watched a team deliver shock after shock without realizing the pads had poor contact. It wasn’t until someone paused to reassess that the mistake was caught. The patient deserves more than a checklist; they deserve eyes on their actual condition.
Final Thoughts
Code blues are chaotic, emotional, and often heartbreaking. None of us get them 100% right every time. But by talking openly about the common mistakes — delayed IV access, not rotating compressions, poor documentation, overcrowding, and losing sight of the patient — we can learn from each other and keep getting better.
If you take away one thing, let it be this:
Assign clear roles early and communicate constantly. It’s the difference between chaos and organized action.
And remember — even if you’ve been a nurse for decades, nobody is immune to slip-ups. The best we can do is prepare, practice, and keep supporting each other when those code calls come.
