Code Gray: Care for the Caregivers

Imagine having to return to work just minutes after the death of someone you care about — and being compelled to put your grief aside until the workday is over. That’s what many nurses face from time to time when one of their patients dies. In a busy hospital unit, often they don’t have even five minutes to stop and absorb the loss.

“Our patients become our family,” says Deborah Sendlak, RN, a member of the Roswell Park nursing staff for 27 years. “They’re troupers, and when they lose the fight, it’s devastating. But we have to hurry up and get back to work.”

After experiencing the fog of shock and sorrow that enveloped her after a patient’s death, Sendlak worried that other nurses under the same duress might make mistakes that could affect the care they deliver. She wanted to do something to help them cope. So, together with Roswell Park Medical Psychologist Kathleen Shanahan, PhD, she created a system that provides emergency emotional support for nurses immediately after a patient’s death.

Dubbed “Code Gray” for the emotional “gray zone” that pulls nurses between the need to grieve and the need to provide uninterrupted, quality patient care, the system allows the deceased patient’s primary nurse a “time out” to go to the hospital chapel, take a walk, go somewhere private to cry, or talk with another nurse or a member of Roswell Park’s Psychosocial Oncology staff. Colleagues fill in for the primary nurse during that time, “to remove the impulse to get back to work,” explains Shanahan. Other staff members volunteer to be on call 24 hours a day, seven days a week, to provide comfort at a moment’s notice for nurses who need it.

Karla Kirbis, RN, admits she was skeptical when she first heard about Code Gray. “I thought, well, I might be upset if that happens, but it’s not going to hit me that hard.” One week later, shortly after arriving for her Sunday shift, Kirbis became the first nurse to benefit from the program. “It did hit me hard, because the patient was so young, and it was unexpected,” she says. “I was in shock and upset; I needed to vent.” While Kirbis took a walk with another nurse, her colleagues filled in for her on the floor. “I appreciated the time I had,” she says. “I definitely needed it.”

“When a patient dies, we’re responsible for comforting the family,” notes Sendlak. “We have to take care of ourselves so we can help the families and also be there for our other patients.”

Sendlak and Shanahan gave a presentation about Code Gray at the Oncology Nursing Society Congress in May 2008 in Philadelphia, providing a model for other oncology nursing programs across the country.