Does anyone work as Rapid Response?

thesundowner · Jul 12, 2012

*** I am a full time rapid response RN. I LOVE IT, LOVE IT, LOVE IT! I have a vast number of standing orders and protocals that allow me to intervene in nearly any situation. I have privlages to write for any diagnosic tests such a labs, x-rays, doppler studies, CTs. Can order lots of medications like Lopressor IV, Amioderone, nebs, NTG and lot of others on specific protocols. Can order many interventions like bi-pap or intubate (CRNA actually preforms intubation) I don't really know why it is called RRT, it really should be called RRN since there isn't a team, just the RRT RN.
I am also allowed to transfer patient to step down or ICU without an order from the resident. I am supposed to work with the residents but in cases where the resident refuses to do the right thing, or doesn't know and isn't taking "suggestions" I can transfer on my own, and do occasionaly. Our hospital has E-ICU and they give me orders for transfer after I get the patient to ICU.
The other job we do is to assess each patient that transfered out of any of the ICUs every 4 hours for 24 hours. This has greatly decreased the number of bounce back patients who come back to ICU as a crash.
The hospital has policies that RRT MUST be called in certain situation. Our "triggers" for RRT call are:
SBP
HR 130
RR 25
SPO2 ,90% on any amount of O2 (unless different parameters are ordered, like for COPDers)
Visibly labored breathing or respiratory distress
New neurological change or deficit
Suspected CVA
Chest pain
other:
I get a huge variety of calls. Everything from post surgical or trauma patient bleeding, chest pain, respiratory distress, unresponsive patients and anything you can imagine that makes the primary nurse nervous. In addition we are the code "administrators" means we lead codes until the physician gets there (if they do) and monitor the code for qualiety, offering suggestions as needed. We have gained a good reputation and have started getting calls from physicians to "keep an eye on" certain of their patients, or they may request one of us stand by for a cardio version or other procedure if done on the floors.We are a smaller hospital, 275 beds and a teaching hospital. We (the RRT RNs) have as much autonomy as I can imagine any hospital RN having. The only time I had more autonomy was doing transport. The job is very much a customer service job. I get many really silly calls but I don't ever want to have a nurse NOT call me cause I was rude to her when she called me for something silly. There is tons and tons of coaching and teaching in this job and that's fun for me too.
If you have good customer service skills and enjoy variety, and have confidence in your assessment and critical care skills, and are a strong patient advocate you will enjoy it.

You sound like an awesome resource to have - wish you were at my hospital!

nrsang97, BSN, RN · Aug 1, 2012

I did take the position. I transfer in September. I can't wait.

PMFB-RN, RN · Aug 1, 2012

I did take the position. I transfer in September. I can't wait.

*** COOL! Please keep me/us in the loop as far as how it's going. I have no oppertinity to speak with any other RRT RNs besides my co-workers, there just arn't many yet. I would LOVE to hear how things are done in other full time RRT jobs.

Ivanna_Nurse, BSN, RN · Aug 3, 2012

*** I am a full time rapid response RN. I LOVE IT, LOVE IT, LOVE IT! I have a vast number of standing orders and protocals that allow me to intervene in nearly any situation. I have privlages to write for any diagnosic tests such a labs, x-rays, doppler studies, CTs. Can order lots of medications like Lopressor IV, Amioderone, nebs, NTG and lot of others on specific protocols. Can order many interventions like bi-pap or intubate (CRNA actually preforms intubation) I don't really know why it is called RRT, it really should be called RRN since there isn't a team, just the RRT RN.
I am also allowed to transfer patient to step down or ICU without an order from the resident. I am supposed to work with the residents but in cases where the resident refuses to do the right thing, or doesn't know and isn't taking "suggestions" I can transfer on my own, and do occasionaly. Our hospital has E-ICU and they give me orders for transfer after I get the patient to ICU.
The other job we do is to assess each patient that transfered out of any of the ICUs every 4 hours for 24 hours. This has greatly decreased the number of bounce back patients who come back to ICU as a crash.
The hospital has policies that RRT MUST be called in certain situation. Our "triggers" for RRT call are:
SBP
HR 130
RR 25
SPO2 ,90% on any amount of O2 (unless different parameters are ordered, like for COPDers)
Visibly labored breathing or respiratory distress
New neurological change or deficit
Suspected CVA
Chest pain
other:
I get a huge variety of calls. Everything from post surgical or trauma patient bleeding, chest pain, respiratory distress, unresponsive patients and anything you can imagine that makes the primary nurse nervous. In addition we are the code "administrators" means we lead codes until the physician gets there (if they do) and monitor the code for qualiety, offering suggestions as needed. We have gained a good reputation and have started getting calls from physicians to "keep an eye on" certain of their patients, or they may request one of us stand by for a cardio version or other procedure if done on the floors.We are a smaller hospital, 275 beds and a teaching hospital. We (the RRT RNs) have as much autonomy as I can imagine any hospital RN having. The only time I had more autonomy was doing transport. The job is very much a customer service job. I get many really silly calls but I don't ever want to have a nurse NOT call me cause I was rude to her when she called me for something silly. There is tons and tons of coaching and teaching in this job and that's fun for me too.
If you have good customer service skills and enjoy variety, and have confidence in your assessment and critical care skills, and are a strong patient advocate you will enjoy it.

I was going to put in a hella long post and write out all kinds of stuff but this is my job in a nutshell :). I love my job! Silly calls, Codes, troubleshooting, you name it... I'm here!

agcaruso · Oct 14, 2014

This is a wonderful and detailed description of your job. I just took a rapid response job a month ago and we currently do not have any standing orders. I was wondering if you would share those standing orders with me so I can work to get them implemented here.

leomak · Jul 28, 2016

PMFB-RN, do you have protocols for what the rapid response nurse is responsible for? I am trying to gather research based evidence for my hospital to open this kind of position to critical care nurses. Currently we are a level 1 trauma center and our crit care nurses are expected to manage 2 crit care patients and respond to rapid response situations.

leomak · Jul 28, 2016

Hi, what electronic documentation system does your facility use? I'm wondering if my hospital could generate these reports with EPIC medical record system. Does your hospital have a RRT that solely monitors or responds to RRTs? Do you have protocols for this? thanks.

leomak · Jul 28, 2016

Hey do you have protocols for this position? I am trying to start a position like this/advocate for our critical care nurses at my hospital. I need more information on RRT nurses having no other assignments or responsibilities and and it has been difficult to find the info. There aren't many evidence based articles on this. It would be helpful to get protocols from other hospitals that are already utilizing this service and have this position. Thanks!

blondy2061h, MSN, RN · Jul 28, 2016

*** I am a full time rapid response RN. I LOVE IT, LOVE IT, LOVE IT! I have a vast number of standing orders and protocals that allow me to intervene in nearly any situation. I have privlages to write for any diagnosic tests such a labs, x-rays, doppler studies, CTs. Can order lots of medications like Lopressor IV, Amioderone, nebs, NTG and lot of others on specific protocols. Can order many interventions like bi-pap or intubate (CRNA actually preforms intubation) I don't really know why it is called RRT, it really should be called RRN since there isn't a team, just the RRT RN.
I am also allowed to transfer patient to step down or ICU without an order from the resident. I am supposed to work with the residents but in cases where the resident refuses to do the right thing, or doesn't know and isn't taking "suggestions" I can transfer on my own, and do occasionaly. Our hospital has E-ICU and they give me orders for transfer after I get the patient to ICU.
The other job we do is to assess each patient that transfered out of any of the ICUs every 4 hours for 24 hours. This has greatly decreased the number of bounce back patients who come back to ICU as a crash.
The hospital has policies that RRT MUST be called in certain situation. Our "triggers" for RRT call are:
SBP
HR 130
RR 25
SPO2 ,90% on any amount of O2 (unless different parameters are ordered, like for COPDers)
Visibly labored breathing or respiratory distress
New neurological change or deficit
Suspected CVA
Chest pain
other:
I get a huge variety of calls. Everything from post surgical or trauma patient bleeding, chest pain, respiratory distress, unresponsive patients and anything you can imagine that makes the primary nurse nervous. In addition we are the code "administrators" means we lead codes until the physician gets there (if they do) and monitor the code for qualiety, offering suggestions as needed. We have gained a good reputation and have started getting calls from physicians to "keep an eye on" certain of their patients, or they may request one of us stand by for a cardio version or other procedure if done on the floors.We are a smaller hospital, 275 beds and a teaching hospital. We (the RRT RNs) have as much autonomy as I can imagine any hospital RN having. The only time I had more autonomy was doing transport. The job is very much a customer service job. I get many really silly calls but I don't ever want to have a nurse NOT call me cause I was rude to her when she called me for something silly. There is tons and tons of coaching and teaching in this job and that's fun for me too.
If you have good customer service skills and enjoy variety, and have confidence in your assessment and critical care skills, and are a strong patient advocate you will enjoy it.

Do you only have one RR RN on at a time? Do you get called for IV start assistance also? Who else goes to your rapid responses- anyone? House supervision, hospitalist, intensivist? My hospital is even smaller than yours. I wish our rapid responses were that smooth. Does your EMR have any kind of notification system for patients meeting those triggers?

Mr. Figglesworth · Jan 12, 2017

Hey leomak and PMFB-RN,

Any luck with your search and development of the RRT position? I too have been interested in developing a model similar to this and would be interested in any information you may have! TIA

Mr. Figglesworth · Jan 12, 2017

Hey PMFB-RN,

I am very interested in learning more about the specifics of your job and any evidenced based practice support you have. Even statistics since implementation would be wonderful. Where do you work? Please PM me more information, as I would love to speak with you more about your position and hospital. I am a current RRT Nurse as well; however our hospital does not have independent RRT, just charge nurses in critical care. TIA

Ughhh101 · Mar 21, 2017

as a respiratory therapist i'm the one who gets called STAT to a patients room when they're in distress. Before the rapid response team, anesthesia or calling a code, they want a registered therapist there first to assess the situation. Recently, I was called to a patients room because his sat's were dropping to the low 80's. Regardless, rapid response was soon called in afterwards. Naturally, a flood of nurses flock in to save the world and the first thing everyone starts doing is looking at numbers instead of the patient and whatever equipment they're. When I ask the nurse what signs and symptoms the patient was having right before this happened I get brushed aside and ignored by the all mighty rapid response team and delta force nurses. As everyone struggles to figure out the problem I over heard one nurse say "I cranked up the flow meter on his oxymask to 15L". Shortly afterwards I looked at the flowmeter and notice the oxymask is attached to a bubble humidifier. Instantly, I knew that was the problem. As everyone ignores me, I quietly take out the bubble humidifier and re-attach the oxymask to the flowmeter and even "cranked" down the flow to 7L. I stood back slowly watching the patients Spo2 climb back up into the 90's. I then waited how long it would take all the nurses to notice the patients SOB is better, Spo2 is better and overall status is better. I took a minute but finally, when the MD arrived for a status update all the nurses quickly started staying we managed to get his Spo2 back the 90's. The doctors were happy, the nurses were happy the rapid response nurses were happy that they healed their patient. And I? well... I left the room quietly without saying a word and let them think they did fixed the problem, take all the credit etc. Later hearing gossip the respiratory was in there and didn't say anything or do anything, just looked at the flowmeter and left. this is why my hospital calls RRT's first. and im not saying this to brag or anything because im humble, but some of you guys get way in over your heads on whatever prestigious positions as a nurse you may have but dont know how a low flow cannula works.