Degree Name

Master of Science in Nursing (MSN)

Document Type

Major Paper


Zvart Onanian School of Nursing



Date of Original Version

March 2022


Over 500,000 people suffer a cardiac arrest each year in the United States with approximately 290,000 of those being in-hospital cardiac arrests (IHCAs). Despite advances in medicine and improved survival rates over the years, survival from IHCA remains suboptimal. Literature has demonstrated that current American Heart Association (AHA) resuscitation guidelines are effective, but basic life support (BLS) and advanced cardiac life support training (ACLS) every two years is too infrequent for nurses to feel confident in their resuscitation knowledge and skills. After a literature search revealed little research exploring non-critical care nurses’ confidence levels participating in code blues, this quality improvement project sought to address this gap. Benner’s Novice to Expert model (1982) served as the theoretical framework. The project was conducted at a 247-bed urban teaching hospital. Twenty nurses from four medical-surgical units completed an electronic survey. The results demonstrated that nurses felt confident recognizing and initiating a code blue. Confidence levels of performing different skills during a code including chest compressions, bag-valve mask ventilation, applying defibrillator pads, and giving medications varied. The results support that training every two years is too infrequent to allow for confidence and skill retention. Nurses believed that multi-modal methods of education could improve their knowledge and confidence participating in codes. This is important for advanced practice nurses (APNs) because they provide direct support, education, and leadership to staff nurses. Improving non-critical care nurses’ knowledge and skills will improve confidence participating in codes and could lead to better patient outcomes.