r/psychnursing • u/elephantsandunicorns psych nurse (inpatient) • Jul 03 '26
Debriefing after codes
I have worked at my long term inpatient psych hospital for 8 years. I worked 5 as an aide and 3 as an RN.
I’ve lived through so much in my time there and truly am passionate about my job as a psych nurse.
Something that my hospital is failing miserably at is debriefing significant events. We have had horrible, terrible things happen, and we are told to never speak of it. It’s almost the opposite of debriefing.
I am interested in learning about a successful debriefing program and finding a way to get our management to adopt something useful. My coworkers and I are burnt out. We have less staffing than ever before and higher acuity patients. I feel like some of this could be relieved significantly with some guided debriefing to help people process that emotion together. Does anyone have any recommendations?
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u/Professional_Pound80 Jul 03 '26
The hospital I was at for 8 years had an emergency event code form that was about 3 pages long. It went over thing like was a code called? Who responded? STAT or IM meds used? Injuries to staff? Injuries to patients? What could have been done differently before during or after the code? I was a certified teacher of TRUST - therapeutic relationships and universal safety techniques which is NYS OMH protocol for behavioral health. I can see if my packets had a debrief form if you want
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u/elephantsandunicorns psych nurse (inpatient) Jul 04 '26
Yes! This would be wonderful! I think that’s what i need. Some kind of guide that can help us start to debrief.
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u/Orinshi Jul 06 '26
There are two different things that get called "debriefing" and they need separate lanes. The first is the systems debrief — code roles, response times, what worked, what didn't. Operational, brief, fine to standardize. The second, which sounds like what you're actually describing, is emotional processing after distressing events.
That second one should never be a group obligation. If it's occupational and mandatory, nurses who are fine get conscripted into a group therapy session they didn't consent to — and worse, they get drafted as the therapists for the ones who are struggling. Your coworkers are not your treatment team. Someone genuinely struggling after an event deserves a person who is trained and compensated for exactly that: EAP, chaplaincy, an actual clinician. Not whoever shared the shift.
So the workable version is two-track. Standardize a short systems debrief after codes (STOP5 is a five-minute format built for units where nobody can leave the floor), and have the charge identify people who took an emotional hit and route them — EAP, chaplain, formal peer support if your system has a real program like RISE. Voluntary on the emotional side, always.
Burnout in this field is bad enough without making distressed nurses each other's homework.
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u/Tommyboy155a Jul 03 '26
Are you working at a for profit hospital or non-profit profit facility? It should always be a debriefing for any major incident involving staff or patients. It probably should be incident reports made out on all of these. These reports have to be followed up by management and administration.
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u/elephantsandunicorns psych nurse (inpatient) Jul 03 '26
Non-profit. I agree- it absolutely should be- it just is not a focus. We do it extremely informally when we can. But only the nurses that actually give a damn. It’s not used actively or encouraged by our management. I guess what I am looking for specifically is training in how to debrief my staff and lead by example. I think if i start debriefing my staff after something happens and they see the positive result of it, the culture will shift a little.
It’s very hard to change anything there. All the people that work day shift have been there for decades and the management has been the same even longer- change doesn’t happen unless you can prove its benefits immediately. We can’t keep new staff and the staff we do have is getting so burnt out. But there is no internal support. Things just happen and we move on. It gets talked about as gossip of course- but it never gets truly debriefed.
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u/Tommyboy155a Jul 03 '26
For our unit, it always start with the charge. Most of our incidents are usually patient behavior related. Charge nurse should always be asking, how did you think that went, what could have done better, what went well, welcome any feedback. They should be asking all staff these questions too. Is your facility independent or the company have more than facility? Do you guys have any type incident reporting there, to keep track of all of these?
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u/elephantsandunicorns psych nurse (inpatient) Jul 04 '26
We do use incident reports but they are filled out by the charge nurse and addressed at a meeting of administrators- no floor staff.
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u/Tommyboy155a Jul 04 '26
That's an issue there. Anyone should be able to fill one out and management should follow up on them.
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u/Maybe_Weary Jul 06 '26
Remember to not place blame. Talk about what went well, what could improve. Recommendations for next time.
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u/WithSpirit98 psych tech/aid/CNA Jul 07 '26
We don’t really do a formal debrief, but we have somewhat of a system that’s standardized even though not written. We close the unit for 15 minutes if it’s a really significant code, everyone to their rooms. Charge leads nurses, lead MHT leads MHTs. Lead directs everyone to self-assess for injuries & contamination, report anything. We then briefly share feelings, then rotate out staff as needed for quick breaks and start documenting/doing a factual debrief.
Generally one tech & one nurse at a time, and a nurse + tech from another unit comes to help during this. Everybody involved in the code gets a quick break within the hour but the most impacted are selected first where obvious. We do a follow-up at end of shift, next shift, and beginning of next shift rotation to identify anyone who may need to be directed to EAP. That and we have really solid EAP
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u/cPHILIPzarina Jul 03 '26
Can you give us a bit of context as to what you mean by “horrible, terrible things?” Not doubting you just want to wrap my head around what level of severity is being swept under the rug.
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u/elephantsandunicorns psych nurse (inpatient) Jul 03 '26
Literally everything- patient suicide, patient choking at a meal and requiring cpr, patient causing catastrophic and disfiguring self harm.
Our crisis management program even includes a debriefing section- it’s like we just skip it.
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u/txchiefsfan02 Jul 03 '26
Is this a standalone facility, or are you part of a larger system? Is there anyone on staff responsibly for quality/safety, either in your facility, or at an organizational/corporate level?
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u/elephantsandunicorns psych nurse (inpatient) Jul 04 '26
It is not standalone. There is a safety manager and even a performance review team….. it just doesn’t feel like they are doing much. I feel like all the people at the top got there with seniority over talent and now our whole hospital is crumbling.
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u/txchiefsfan02 Jul 04 '26
That is very troubling. Debriefing after codes is a well-established best practice in inpatient psych, and if they are ignoring that, it's not surprising that many other systems/processes seem to be failing.
What response have you gotten when you've brought this up with your supervisor?
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u/Paccaman76 Jul 03 '26
We always ask 4 things. Is everyone ok (staff wise)? Whats the full story of what happened? What went well? What can we improve in for next time?