Rapid Response Team

conklip · Jul 11, 2005

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For myself- I work the ER- having a second person to explain the whole situation to, who didn't know the patient, where anything was, or the unit paperwork, it would make things more difficult, not less. Give me someone who knows the unit's supplies and policies, (like a charge) and someone that I've been keeping up to date as the situation unfolded so she would be ready to jump in and help when I needed her.

Please....the charge nurses are worthless, you need someone with critical care skills.

laurenD · Jul 19, 2005

There was an article about the Rapid Response Team idea in US World and News Report this past week. It's in the issue with the Top 50 Hospitals rankings.

justmanda · Aug 4, 2005

To those of you who are using the Rapid Response Team: Who is on the team? Everyone mentions an ICU nurse and a respiratory therapist, but are some teams including a physician? We're just now getting our inservice for instituting the RRT but there is no mention of a doc. The ICU nurse is supposed to do an assessment and "make a recommendation" to the physician?? Since when did my license make it OK for me to make a medical diagnosis? Yeah, I know we all call a doctor and ask if we can do so-and-so. But as a member of the RRT, I don't think it's my place to suggest intervention to a physician. The form we're to fill out actually says "suggested intervention" on it, and we're very uncomfortable with that.

Our hospital just started the RRT (We call it a Stat Team). I never use them unless the house supervisor makes me when I call for an ICU bed. It seems they only exist (in our hospital anyway) to prevent unnecessary transfers to the ICU. I work on Cardiac Tele and we maintain cardiac drips. I usually call the doctor when I need someone to give me orders, not another nurse. The nurses in our ICU are grumpy (because they have to leave their patients) and all they do is ask silly questions that any nurse would have already considered. Patient is hypotensive (did you give them any BP meds lately?) duh! They are in rapid a-fib with a bp of 80/40 (due to the HR) they need to be started on Cardiziem or the like. Why do I need to call another nurse down to tell me to call the doctor? Doesn't that just delay treatment? The nursing supervisor called the Stat team to our unit the other day--different patient. (I was charge) and we had already talked to the doctor, given 2 fluid boluses and started the pt on dopamine. WTF? But, on the ICU nurse's behalf, they are probably feeling silly asking us silly questions. I understand they are just doing what they were assembled to do. One ICU nurse, after she was given a verbal request on the phone to come down for a patient who had been having seizures on and off for a few hours, told us to pad the side rails. Didn't we learn that in week 2 of nursing school? Also, we had already given the meds the doctor ordered and gotten an order to transfer to ICU...so what is the purpose of the STAT team? :uhoh3:

ZASHAGALKA, RN · Aug 4, 2005

ie. your pt's crumping.. you call the stat nurse, they arrive.. you give them the MAR, chart and a quick report.... you can now attend to your other UMPTEEN pt's and let that nurse handle the crisis. You check in as frequently as possible. Your sick pt. now has an ICU nurse at the bedside... you aren't two hours behind and ALLLLLL the patients continue to receive care!

If someone expected ME to be their bail out monkey, I'd be the ICU nurse w/ an 'tude.

RRT is supposed to be a collaboration. But. It will end up being the ICU nurse swooping down to save the day. I'm sorry, it will.

It's another management 'tool' that never had the input of bedside nurses before being handed down from on high (oh and did I mention the vaunted ANA demands such input - fat lot of good their 'demands' are).

The nurses on the floor that can handle their own in a crisis won't use the RRT: the nurses that need bailing out will. So what is this time stressed ICU nurse with his/her own patients in ICU (and the RT w/ 60 nebs txs due) gonna do? Spend 2 hrs holding the floor nurse's hand? Or fix the problem so they can get back to their own patients?

We are working up a RRT. I (an ICU nurse) expect to avoid duty whenever possible, and go 'save the day' so I can get back to my own patients whenever necessary.

I'm sure this will be a good program. I'm sure it'll save lives. I'm glad about that.

I just don't like all this 'you ICU nurses have to play nice and go hold hands' mentality. I'll agree ICU nurses are assertive by nature, otherwise they wouldn't have gravitated to critical care. But when you initiate a hand holding program for the floor nurses, don't be surprised if all you end up doing is ingraining stereotypes - on both sides.

oh btw, first night of RRT: we coded the same 2 patients we otherwise would have, they just got them to ICU (unannounced) first: so, a code situation with no code team. Seems like RRT is more like dump and run.

~faith,

Timothy.

p.s. reread before you comment: I'm not opposed to the RRT - I'm opposed to creating circumstances that will absolutely and consistently cause bad feelings between the floor and ICU nurses with just a casual 'be nice' thrown in for good measure.

justmanda · Aug 4, 2005

If someone expected ME to be their bail out monkey, I'd be the ICU nurse w/ an 'tude.
RRT is supposed to be a collaboration. But. It will end up being the ICU nurse swooping down to save the day. I'm sorry, it will.
It's another management 'tool' that never had the input of bedside nurses before being handed down from on high (oh and did I mention the vaunted ANA demands such input - fat lot of good their 'demands' are).
The nurses on the floor that can handle their own in a crisis won't use the RRT: the nurses that need bailing out will. So what is this time stressed ICU nurse with his/her own patients in ICU (and the RT w/ 60 nebs txs due) gonna do? Spend 2 hrs holding the floor nurse's hand? Or fix the problem so they can get back to their own patients?
We are working up a RRT. I (an ICU nurse) expect to avoid duty whenever possible, and go 'save the day' so I can get back to my own patients whenever necessary.
I'm sure this will be a good program. I'm sure it'll save lives. I'm glad about that.
I just don't like all this 'you ICU nurses have to play nice and go hold hands' mentality. I'll agree ICU nurses are assertive by nature, otherwise they wouldn't have gravitated to critical care. But when you initiate a hand holding program for the floor nurses, don't be surprised if all you end up doing is ingraining stereotypes - on both sides.
oh btw, first night of RRT: we coded the same 2 patients we otherwise would have, they just got them to ICU (unannounced) first: so, a code situation with no code team. Seems like RRT is more like dump and run.
~faith,
Timothy.
p.s. reread before you comment: I'm not opposed to the RRT - I'm opposed to creating circumstances that will absolutely and consistently cause bad feelings between the floor and ICU nurses with just a casual 'be nice' thrown in for good measure.

I don't understand the "play nice" remark. I understand the hand-holding comment...most of us don't want that either...but play nice?

ZASHAGALKA, RN · Aug 4, 2005

I don't understand the "play nice" remark. I understand the hand-holding comment...most of us don't want that either...but play nice?

Because ICU nurses can be intimidating to floor nurses, we aren't supposed to direct the RRT situation, but instead, 'advise'. It was stressed that we had to 'play nice' and not be the assertive nurses that we tend to be.

So, I have to suggest solutions and 'collaborate' and explain what is being done and why. It's a happy teaching circle, hold hands and find your happy spot.

That's what I mean when I say the directives to the ICU nurses regarding the RRT has been to 'play nice'. We wouldn't want to seem like we are responding because we know what to do, that wouldn't be 'collaboration' (and that might hurt some feelings). Instead, we'll 'play' like we're putting our heads together to come up with a mutual plan of action.

(in reality neither the ICU nurse nor the Med/Tele/Etc nurse is going to have time for a happy 'advance the nursing profession' confab - it's gonna end up being a Rapid Response for Transfer to ICU team.)

It's the same ivory tower crap that leads to banning dodge ball because somebuddy might get their little feelings hurt . . .

I am normally appalled when ICU nurses act haughty and arrogant. But I won't get away from this thread without being tagged as being what I oppose: but my complaint is that this whole deal seems designed to create and sustain that stereotype.

So stereotype me. It's what I expect from the RRT and what I expect from being a realist on a RRT thread.

You put an ICU nurse in a position where they are supposed to be an ICU nurse without acting like an ICU nurse, and poof, hurt feelings and bad mojo abounds.

And saying 'play nice' isn't going to make it nice.

~faith,

Timothy.

ZASHAGALKA, RN · Aug 4, 2005

Let me apologize in advance (although I could just edit out my previous remarks, I won't)

I worked medical for 3 yrs before moving to ICU.

I'm generally opposed to the arrogance some ICU nurses have: moving to ICU was a serious 2 yr learning curve for me before I felt anywhere near comfortable w/ pts on vents, etc. And I realize it's a different skill set. I respect floor nurses because I've been one and know what a job it is.

Most ICU nurse have some serious experience under the belts, at least the ones that will be tapped for this RRT. And that should be the model: experienced nurses aiding inexperienced nurses.

It's not that the ICU nurse responding is going to be a 'better' nurse by position of being in the ICU; it's that they are going to more than likely be a 'better' nurse by means of experience.

And that's fine. That's what you need in an emergency: an experienced nurse that can pick up on things a more inexperienced nurse might miss (and by previous comment, I stated that the more experienced floor nurses aren't going to be likely to call someone to get in the way of what they already know to do).

But a near code situation is not the time or place to play up the teaching aspects of nursing: do you want us all to feel good about an encounter, or do you want a pt taken care of, in short order.

What rubs me wrong about this is that the RRT model everybody is working from stresses that this is a teaching opportunity, if only the ICU nurses will 'play nice' instead of 'showing off'. So lets pretend it's NOT about more experience being available in a close situation and instead it's about collaboration.

And I bristle at that thought. If I have to take time from MY patients to respond, then let me respond and get back to my job: this whole touchy feely aspect of the RRT is going to be its downfall.

And the model recognizes this but doesn't care: it just dismisses it with healthy doses of ivory-towered nursing 'theory' that we are all in it to advance each other. I'm surprised the nurses from both units aren't being advised to therapeutically touch each other. . .

This model just encourages having your feelings hurt - why?: because you are smart enough to know you need help. And that's garbage. It's garbage for the floor nurse that needs the help and recognizes it, and is garbage for the ICU nurse that can provide the help.

I'm not putting down the floor nurses by any means. I have a great respect for any nurse that knows when they need help and asks for it: it's the nurses that don't know when they need help that scares me.

But the touchy feely design of this program is going to create bad feelings, on both sides of the coin. And that's what frustrates me. A near emergency is not the time nor place to play ivory towered games.

~faith,

Timothy.

DidiRN · Aug 4, 2005

Where I am at, the RRT are a group of ICU-experienced nurses who do nothing but RRT. They are available to help out with codes, patients on the floor who are crumping, visitors who get into trouble themselves, or help transport ICU patients to procedures if they have time. They can also assist with IV starts, pull sheaths if the unit nurses aren't qualifiied to do so, help out the unit nurses if they need help as well as floor nurses, etc.

I think it's a great idea and a great asset to us. However, I could see big problems if it was staffed by ICU nurses who already have an assignment in the unit and also expected to do this too.

**canoehead, BSN, RN** · Aug 4, 2005

Please....the charge nurses are worthless, you need someone with critical care skills.

If the patient needs critical care they should be on a critical care unit.

If not...requiring some advanced education and knowledge of our charge nurses seems more realistic, and would benefit every unit on a 24/7 basis.

JustMe · Aug 4, 2005

Our hospital just started the RRT (We call it a Stat Team). I never use them unless the house supervisor makes me when I call for an ICU bed. It seems they only exist (in our hospital anyway) to prevent unnecessary transfers to the ICU. I work on Cardiac Tele and we maintain cardiac drips. I usually call the doctor when I need someone to give me orders, not another nurse. The nurses in our ICU are grumpy (because they have to leave their patients) and all they do is ask silly questions that any nurse would have already considered. Patient is hypotensive (did you give them any BP meds lately?) duh! They are in rapid a-fib with a bp of 80/40 (due to the HR) they need to be started on Cardiziem or the like. Why do I need to call another nurse down to tell me to call the doctor? Doesn't that just delay treatment? The nursing supervisor called the Stat team to our unit the other day--different patient. (I was charge) and we had already talked to the doctor, given 2 fluid boluses and started the pt on dopamine. WTF? But, on the ICU nurse's behalf, they are probably feeling silly asking us silly questions. I understand they are just doing what they were assembled to do. One ICU nurse, after she was given a verbal request on the phone to come down for a patient who had been having seizures on and off for a few hours, told us to pad the side rails. Didn't we learn that in week 2 of nursing school? Also, we had already given the meds the doctor ordered and gotten an order to transfer to ICU...so what is the purpose of the STAT team?

I commend you for a job well done! That's exactly what you should have been doing--but I also understand that many floor nurses are badly understaffed to take the time with a really sick patient. Preventing a transfer to the ICU should have started with holding the BP meds if the BP was marginal to begin with. We do this in our Unit all the time, but then again we're taking VS q15-30 mins, something the floors don't have time to do. I'm not saying the RRT doesn't have its place, but it seems the hospital is throwing pennies at a bigger problem--enough ICU space and appropriate admissions to those limited beds. :rolleyes:

justmanda · Aug 4, 2005

Because ICU nurses can be intimidating to floor nurses, we aren't supposed to direct the RRT situation, but instead, 'advise'. It was stressed that we had to 'play nice' and not be the assertive nurses that we tend to be.
So, I have to suggest solutions and 'collaborate' and explain what is being done and why. It's a happy teaching circle, hold hands and find your happy spot.
That's what I mean when I say the directives to the ICU nurses regarding the RRT has been to 'play nice'. We wouldn't want to seem like we are responding because we know what to do, that wouldn't be 'collaboration' (and that might hurt some feelings). Instead, we'll 'play' like we're putting our heads together to come up with a mutual plan of action.
(in reality neither the ICU nurse nor the Med/Tele/Etc nurse is going to have time for a happy 'advance the nursing profession' confab - it's gonna end up being a Rapid Response for Transfer to ICU team.)
It's the same ivory tower crap that leads to banning dodge ball because somebuddy might get their little feelings hurt . . .
I am normally appalled when ICU nurses act haughty and arrogant. But I won't get away from this thread without being tagged as being what I oppose: but my complaint is that this whole deal seems designed to create and sustain that stereotype.
So stereotype me. It's what I expect from the RRT and what I expect from being a realist on a RRT thread.
You put an ICU nurse in a position where they are supposed to be an ICU nurse without acting like an ICU nurse, and poof, hurt feelings and bad mojo abounds.
And saying 'play nice' isn't going to make it nice.
~faith,
Timothy.

I get it. And I understand it is management who is putting both of us (the floor nurses and the ICU nurses) in an awkward situation. Let me give you an example. A post cardiac cath patient suddenly has a bp of 210/110 (baseline 120/70). His urine output over the last 8 hours is minimal and he is has a fever of 102. My first thought would be he is in acute renal failure secondary to the cath dye. Do I call the doctor? No. I call you and you tell me that he is probably having a problem clearing the dye and you tell me to call the doctor. It's as if we have to clear it with the RRT before we actually do something. I think it is a waste of both of our time and it delays treatment. I mean, how many nurses does it take to screw in a light bulb? It also puts you guys in a precarious position, legally speaking. You don't know this patient. What if I charted that I called the RRT for assistance and the case goes to court? You know your name will be mentioned and you will have to get involved in the legal case. Perhaps the system needs a little tweeking like, say...have a team that's sole responsibility is to respond to these situations and, therefore, has the time to stabilize the patient for you. Even then, I would still be reluctant to hand over the care of my patient to someone else. I like handling a crisis and finding my way out of one. It's obvious that I just don't understand how it can be anything other than the hand-holding process you described.

ZASHAGALKA, RN · Aug 4, 2005

What if I charted that I called the RRT for assistance and the case goes to court? You know your name will be mentioned and you will have to get involved in the legal case. Perhaps the system needs a little tweeking like, say...have a team that's sole responsibility is to respond to these situations and, therefore, has the time to stabilize the patient for you. Even then, I would still be reluctant to hand over the care of my patient to someone else. I like handling a crisis and finding my way out of one. It's obvious that I just don't understand how it can be anything other than the hand-holding process you described.

Most hospitals aren't going to shell out for a dedicated team. Mine isn't.

Regarding liability:

1.Part of it is liability: from both ends. If it's your patient, turning a problem over to a RRT isn't going to relieve you of responsibility (I can just see a defense lawyer: 'so you admit the hospital put you in a situation that you couldn't handle . . .')

2. If you are the ICU nurse, then picking up a particular problem on the fly can mean you miss something significant about the whole picture (and this is why collaboration is important, but! the nurse that is out of his/her league w/ the particular problem might also be out of his/her league with understanding the ramifications of a particular treatment (for this problem that required assistance) on the whole patient - and only (s)he has knowledge of whole. But who's liability is it gonna be when the ICU nurse's problem oriented treatment creates worse problems for the patient as a whole?: a problem someone with the same level of experience AND knowledge of the whole patient would have avoided? Remember, this program is designed, I think, to be utilized by the inexperienced nurse and not the floor nurse with enough experience to handle a problem on his/her own.

3. I'm sure this program IS about liability: it's a way for management to state that they were taking proactive measures to avoid 'failure to rescue'.

I only have to hope that it's also about saving lives. Maybe I'm not quite so cynical to believe otherwise yet. And to the extent that it is about saving lives, I don't want to dismiss the idea in its entirety. But it's going to take a ton of tweaking before it's an effective idea.

And this is why the ANA and the AACN demand bedside nursing input on such ideas from drawing board to implementation: to allow for those that must implement the program to critique and have a hand in tailoring it so that it ACTUALLY works in the trenches. . .

But my biggest problem is still the concept that, because the patient hasn't coded quite yet, there should be enough time for the nurses to get together and have a happy hand-holding seance and make sure that everybody comes out of the experience emotionally enriched.

As a floor nurse, you might be a little tweaked when an ICU nurse comes in and 'takes over' a code, but everybody knows that is the ICU team member's role. When you try to deliberately confuse roles, as is being done in RRT, it's gonna create confusion and hurt feelings.

And I guess the thing that upsets me more than the liability dance being done is this 'We know you can't go talk to the floor nurses without being the rude ICU nurse you are, so here are the rules to make sure you 'be nice'.

~faith,

Timothy.