Code Lavender: Supporting Physicians and Nurses at Work

There was a phrase you’d hear all the time during the pandemic: “healthcare heroes.”  And it was pretty easy to see why, given all the unending sacrifices our providers made. And yet – “hero” can seem too tidy a label for what our front-line teams go through every day. Healthcare is no Marvel blockbuster. Giving a patient a serious diagnosis or treating a victim of a gruesome accident or delivering bad news to family members is quotidian reality for nurses and physicians. More subtly, witnessing the painful realities of the health disparities and economic barriers of a broken healthcare system day after day can lead to depression and a sense of futility.

But through all of this, healthcare workers are expected to stay professional, even stoic. They must put the patient first and keep their game face on no matter how they feel or how they’re treated. Their own emotions must be delayed until they go home. Even then, they may feel alone amidst friends who can’t understand the stress and turmoil they live with every day.

Which is where Code Lavender comes in to offer healthcare workers emotional support and assistance.

Code Lavender 101

Called “psychological first aid,” Code Lavender was created in 2009 at the Cleveland Clinic. Today, similar programs are common at healthcare facilities across the country. As a crisis intervention tool, they are activated after an upsetting situation sparks anxiety, grief, or feelings of despair among the staff. “Bring your whole self to work” has been an aspiration in the corporate world for years now, but let’s be real – this has never been true for physicians or nurses.

“I have found that having a ‘debrief’ after stressful patient situations, like a patient passing away or a code blue, has been helpful,” says Isabella Swindasz, RN. “Codes are very chaotic and can be stressful, especially if it involves a pediatric patient. A debrief allows time for the team to decompress, discuss how the code went, and to reflect on the event(s). While I think this can be helpful clinically (i.e., how could we have improved), I think a debrief also helps us to destress and restore mental well-being.”

Code Lavender isn’t always about a specific patient incident. When front-line healthcare workers harbor chronic feelings of anxiety about their role or grow exhausted from being in a caregiver role both at home and work, their own emotional equilibrium can begin to slip. Code Lavender programs can focus on find ways to lighten staff burdens and burnout.

They can also support healthcare teams dealing with their own crises.

Vicente Figueroa, RN, shared an experience he had at a Florida hospital after Hurricane Maria hit Puerto Rico. “It was a moment of crisis for nearly 50% of the staff since we were from Puerto Rican backgrounds with families in Puerto Rico,” he said. “Communications were down in Puerto Rico and our stress levels were through the ceiling.”


Calling a Code Lavender

At most hospitals, anyone can trigger a Code Lavender – patient, family member, or staff. Sometimes a leader will step in; larger facilities may have a dedicated Code Lavender team, usually comprised of nurses, behavioral health workers, grief counselors, or a minister or chaplain.

Just as not every Code Lavender event is the same, outcomes can be different too. Sometimes the goal is to reduce stress and anxiety. Sometimes the focus is on teaching staff practical coping skills or emotional processing. Teams learn to not only collaborate at the bedside or in the ED but to support each other as well.

If your facility doesn’t have a similar program, you can try to start your own. A few words of advice:

  • Get leadership buy-in. Code Lavender is a collaborative effort and everyone must support the practical repercussions – such as calling a staff huddle in a busy environment.
  • Train staff. People may think of themselves as naturally supportive, but specific skills are needed in processing group distress and grief. In-house education can help both healthcare providers and administrative staff support each other more effectively.
  • Work toward a cultural shift. Facility dynamics that prioritize revenue, numbers, and efficiency may need to make room for a new focus on staff well-being.
  • Explore different support modalities. Team members may gravitate toward different options, from mandalas and reiki to prayer cards and chaplain visits. Some of the most common support pathways include 1:1 talks, silent reflection, listening rounds in which everyone expresses themselves without interruption, and check-in huddles. A trained Code Lavender leader can offer questions and prompts like, How do you feel? How have you been processing your feelings after this patient’s death? Do you wish you’d done anything differently? How can we help you?
  • Collect feedback. Comment sheets and surveys are an effective way to find out what your team really thinks of the hospital culture and your support efforts.
  • Measure results. Has your retention improved? Morale? Is patient safety better?

Code Lavender in Action

Luis E. Caso Vega, MBA, RN, shared a story of when he managed a Level II Trauma Center. One night, two trauma codes came into the ER at the same time: police officers with severe head wounds. One was a police officer who worked in their ER. The staff realized that the same coworker they had joked around with the night before was their patient tonight.

“We didn’t have a Code Lavender established in this facility, not a code that would have been appropriate in this situation,” Caso Vega recalled. “We did a debrief section, and a chaplain was there, of course. We reminded the staff of the HR resources available, but was that enough?”

In another case, staff cared for a pregnant patient for more than three weeks after she suffered a brutal attack. The staff were pleased to see her progress, and though there were a few setbacks, an ultrasound showed the baby was growing normally. But when the patient coded unexpectedly, attempts to resuscitate her and the baby were unsuccessful. The staff, who had spent almost a month caring for her by now, were devastated.

The ensuing Code Lavender included a debriefing session where staff were encouraged to openly express their thoughts and grief; the CNO contacted different unit heads to let them know their staff were experiencing intense turmoil. A chaplain facilitated prayers for those who were interested, while another person led meditation sessions.

Taking Care of the Caregivers

So you might be wondering – what does Tribal Health do in emotionally fraught situations?

While we don’t call our practices Code Lavender, we do prioritize the emotional support and wellbeing of our front-line team. Part of our commitment to healthcare transformation includes improving the provider experience, not just changing Indigenous healthcare. When our team goes through an emotionally grueling experience, our clinical leads call a debriefing session to give everyone an opportunity to work through their emotions, frustrations, and suggestions for future improvements. Our Employee Assistance Program and other benefit programs offer mental health support and counseling; our leadership is always available as well.

Under their scrubs and bedside manner, every healthcare worker is a human being with their own vulnerabilities. Code Lavender programs allow healthcare teams to express their vulnerability without censure, protecting their well-being and their patients.

Does your facility support your front-line team? What have you found effective?




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