Why am I crying? My patient survived. Everyone on the code team sang our praises for catching the early decline of my patient, who suddenly struggled to breathe, turned extremely pale, followed by the cascading occurrence of plummeting blood pressures and irregular pulses. The code team responded quickly, and my patient had a return of spontaneous circulation within ten minutes. Why am I crying? An overwhelming wave of fatigue, guilt, and inadequacy engulfed me all at once. My patient load was heavy, and despite support from other nurses, I could not catch up. I was told earlier my patient was not ‘feeling good,’ but I did not have a chance to assess what that meant. I thought it was no big deal. Of course, he doesn’t feel good; he is recovering from pneumonia. I was of no help in the code because I was immobilized. After all, it was my first emergency. I was paralyzed by fear, and now I’m weighed down with regret. Why am I crying?
Every nurse has their own version of the story above. We care for people when they are at their sickest and most vulnerable. We see death, life, trauma, and happiness. We touch and see things that most will never touch or see. We do it because it’s what we signed up for. We do it because it’s our calling. We hold the mother who just gave birth to a lifeless baby. We bring that baby to her multiple times throughout the shift so she can grieve. We watch as an outsider, but often we feel the emotions as though it’s happening to us. At the end of the day, we walk to our cars, and we drive home. We walk in the house, and we get back to our lives, yet we carry the weight of that shift with us. Many times we carry the weight alone.
In January, we published Real Talk: Healthcare worker Burnout, where we examined hard questions like, “Who is responsible for curing burnout and creating resiliency?” The takeaway is that burnout and resilience are not the nurse’s burden alone. Organizations play an integral role in both. The Joint Commission published a Quick Safety Advisory in the summer of 2019 that identifies developing support systems within the hospital infrastructure as a critical component in developing resilient nurses, which might have organizations wondering where to start.
Meet Code Lavender. Code Lavender is a program that’s existed for decades but is not widely known in the healthcare industry. We want to take you through Code Lavender and tell you what it is, why it’s a vital program for nurses, and how organizations can take steps to implement such a program.
What is a Code Lavender anyway?
Code Lavender is a holistic, rapid response program designed to address the emotional needs of a member of the health team experiencing a stressor. It is initiated the same way any other code is, with a request placed by any team member on behalf of the individual experiencing a difficult time. Once a request is made, a member of the Code Lavender team, such as a chaplain, a member from the employee assistance program (EAP), and a nurse will respond within a set time, typically 30 minutes of the call. The response team provides 15 to 20 minutes of debriefing and respite for the staff member through stress relief tools like meditation, prayer, and breathing exercises. The program also incorporates music therapy, anxiety-reducing scents (like lavender), creative visualization, and snacks to enhance emotional support and treatment. After the initial debriefing session, the response team follows up with the team member to assess the need for additional emotional support (Tsai, 2017). If a staff member needs more resources after the initial debriefing, the response team can provide referrals to counselors or support groups.
Is Code Lavender an actual code?
Well, yes and no. As a response to emotional trauma and stress that nurses encountered daily, a group of innovative leaders developed Code Lavender. The term ‘Code Lavender’ was coined by Dr. Earl Bakken in 2004 in response to his staff’s need for holistic, mind, body, and soul care. “Code” stresses the importance of the program, and “Lavender” is an homage to the lavender plant as it is known for its calming and anxiety-reducing effect (Tsai, 2017). While it’s not a Code Blue, it is considered equally urgent for care staff (Tsai, 2017).
Why do we need programs like Code Lavender?
Healthcare is a stoic profession. In general, people don’t like to talk about their limitations. A recent ANA survey of over 10,000 nurses found that 51% of nurses experienced feelings of being overwhelmed, and 48% reported they felt anxious or unable to relax. What is even more alarming is that many said they have not sought outside support because they thought they should handle their mental well-being, or lack thereof, on their own. In general, nurses and other healthcare professionals should be encouraged to talk about their struggles and not feel they need to carry the weight alone.
We also know that research shows continuous stress turns into burnout (measured by feelings of inefficacy, detachment, and being overwhelmed), which turns into many nurses walking away from the profession. There are estimates that 17% of nurses walk away from the job in the first year and 35% walk away in the second year. With the current shortage, healthcare can’t afford to lose nurses at that rate. The time is now to implement sustainable programs that support the health and well-being of nurses. Resilient nurses can be a product of resilient organizations.
What organizations have implemented it?
Like any great creator, Dr. Bakken took his concept and shared it with his peers. The program received national attention in 2008 when the world-renowned Cleveland Clinic implemented it to help its staff with burnout. Since its inception and the healthcare industry’s focus on resilience, more organizations are piloting the program.
Other health systems such as Keck Medical Center in California and Presbyterian Healthcare Services in New Mexico have led the way with solid Code Lavender programs to help staff with compassion fatigue and burnout. Many other organizations throughout the nation are following suit and moving toward adopting Code Lavender programs. Literature shows that 100% of health workers who utilized services through a Code Lavender found it highly supportive, and 84% would recommend it to their coworkers and peers (Davidson et al., 2017).
How Do I Implement a Code Lavender program?
If you are working at the bedside, you might not be sure how you can influence the program to develop at your organization. Many leadership members want to hear your ideas, so here are a few simple steps.
First, create buy-in. Identify other nurses and members of the care team that see the value in a Code Lavender program. If your organization has a Shared Governance team, you can start there. Then, you want to gather data. Identify the number and types of stressful events that occur in your unit. Every unit is unique. Next, create a simple outline of your findings and a task list of items that need to be completed before rolling out your program. And finally, be prepared to participate in the task force and possibly pilot the Code Lavender program. Staff involvement is crucial to change unit culture, thereby creating a sustainable program.
If you’re a formal leader, the first step is to identify a core group of staff, also known as a task force interested in developing a Code Lavender program. Your task force can determine who will be part of the response team. Will your team consist of a chaplain, case manager, nurse supervisor, or other staff nurses? Then, the team determines the easiest way for your response team to be notified. Some organizations choose to call a Code Lavender over the intercom system, through the phone system, or enter it like an order through EMR. The task force can also provide education which helps create buy-in for Code Lavender.
As health practitioners, we require some form of emotional support, kindness, and compassion to alleviate the unexpressed emotions, feelings, and thoughts associated with some of the most challenging days faced on the job. Code Lavender provides the emotional cushion our team members need to make it through a shift, feel supported and connected, build strong work bonds, organizational ties, retain qualified staff, and achieve optimal team performance and employee engagement. Code Lavender embodies the sentiment of the author Steve Maraboli when he said, “A kind gesture can reach a wound that only compassion can heal.”
Davidson, J. E., Graham, P., Montross-Thomas, L., Norcross, W., & Zerbi, G. (2017). Code Lavender: Cultivating Intentional Acts of Kindness in Response to Stressful Work Situations. Explore: The Journal of Science and Healing, 13(3), 181-185. https://pubmed.ncbi.nlm.nih.gov/28668136/
Davidson, J. E., Graham, P., Montross-Thomas, L., Norcross, W., & Zerbi, G. (2017). Code lavender: Cultivating intentional acts of kindness in response to stressful work situations. The Journal of Science and Healing, 13(3), 181-185.
Maraboli, S. (2009). Life, the truth and being free. https://www.goodreads.com/book/show/9817952-life-the-truth-and-being-free
Tsai, S. (2017). Code lavender: Healthcare providers caring for themselves. https://www.hospitalrecruiting.com/blog/3983/code-lavender-healthcare-providers-caring-for-themselves/