PMFB-RN, how did you go about becoming a rapid response nurse? What do you do during the time that there is no need for a rapid response?
We are a small group in my hospital. 5 of us full time with another 3 or 4 MICU and SICU RNs who are cross trained to cover for sick calls, vacation, etc.
Turn over is very low. Because of that we don't really try to train anyone to RRT, but rather look for and hire nurses who already have the skill set we are looking for. There are two main skill sets we are looking for. The first (and easiest to find) is clinical skills. We like nurses who have extensive background in critical care, at least 5 years adult ICU experience. In addition we like some ER and PICU experience 2 oe 3 years in each would be perfect. The best experience is transport nursing. I came to the job from a transport nursing job. Only one RRT RN has been hired since I got my job and they had everything we were looking for except peds experience and so, because she was such a great candidate otherwise, the hospital invested quite a bit of time in training her in PICU and peds ER. Obviously they would prefer not to do that.
We are required to stay current with BLS, ACLS (instructor and or ACLS for the experienced provider), PALS, NRP, Emergency Nurse Pediatric course, TNCC or ATCN, Fundamentals of Critical Care course, and the Physician's Advanced Airway Management course. We only take that once then maintain our intubation competency through a hospital course taught by our chief CRNA. We do 30 supervised intubations a year as part of that. All of us are instructors in several of the above. In addition we take a hospital based training program for the insertion of PICCs, arterial lines, IO's and IJ central catheters. Another job we do is run the SimMan lab for nurses and residents, teach "The First 5 Minutes" course to new RNs and teach RNs and residents to place IOs.
There is only one of us scheduled at night. Days shift has two RRT RNs scheduled 2 or 3 days a week and the extra RRT RN takes classes, teaches classes, runs SimMan labs for residents or nurses, teaches in the Critical Care Nurse Residency, etc. In addition we all have students, nurse residents, or new hire ICU & ER orientees with us nearly every shift.
When not on RRT calls we do a variety of jobs. We also check on all ICU transfers q4 for 24 hours, and check on all new admissions to the hospital, occasionally help out in one of the ICU's or ER, especially when there is a trauma team activation. of course since we nearly always have a nurse resident or student with us there is always teaching going on. In addition on nights we will do the skills test portion of ACLS and BLS for night shift nurses and residents. who renewed online. In addition to all that every night several of the attending physicians or NPs will give us sign out on any patients they are worried about and want us to "keep our eye on". This varies from one or two patient, to getting sign out on all the adult and peds patients for a whole medical or surgical service, depending on who the night resident is and how much the attending trusts them. We also get a lot of "hey can I run something by you", or "hey do you know how to..." and "I called the doctor and he is being a jerk, can you talk to him/her" calls from staff nurses. We will also get called on any combative patient. Every once in a while we get to sit with our feet up and do nothing except wait for the phone to ring! It sounds like a lot when I write it out but we are not a very big hospital.
I am not sure why they call us the Rapid Response Team. When an RRT is called all you get is one of us, not like a while team shows up.
In our health system we are called "Expanded Roll RNs". We have our own policies and standing orders that do not apply to any other nurses in the hospital.
The other thing we look for, and what is harder to find and teach than clinical skills, is a person who has the right interpersonal skills. We are often in the position of telling residents that their patient must be transferred to a higher level of care. We have a protocol that allows us to transfer to step down or ICU on our own without doctors orders, BUT, we are not supposed to do it unless we have to in order to protect the patient. We are supposed to help the residents "see the light" and transfer the patient themselves. We are often talking to attendings on the phone who are not expecting to get calls from nurses at night because they are supposed to have residents to deal with these things. That takes tact.
We also need a person who will not belittle, or be condescending to staff nurses when we get a call for something that seems stupid for us. We need nurses who are nurturing and will treat those calls as teachable moments. We need people who are VERY approachable by all staff who need our help or advice.
Because of the autonomy and higher pay we receive there is very little turn over of the RRT team.
