RapidRN

school, pediatric clinic, STD clinic, employee health, legal consultant nursing, telemedicine, education, poison control centers? just brainstorming ideas. good luck.

OK, I know this is several years old post, but in case people are searching... Something no one else has mentioned, a cool gadget I started carrying once I left ER and joined the Rapid Response/Vascular Team, a foldable scrub pocket clipboard. Look up White Coat Clipboards. I keep our code record/ rapid response note pages on it.

We are allowed to have a well groomed/ trimmed beard. We can be exempt from N95 fit testing due to facial hair, but have PAPR available.

With my coworkers input, I developed a note taking flowsheet which is now system wide in our facility and has been placed on every crash cart on a bright neon orange clipboard. I have attached a copy of the flowsheet for your use if you think it could help your facility. This flowsheet takes the place of grabbing a scrap piece of paper or paper towel. It makes it easy to track when interventions happened and when meds were given. The second page/back page is a mandatory debrief which takes less that 30 seconds to cover and allows for praise and improvement suggestions. The form allows us, as rapid nurses, to quickly see what has been done and take over lead role and then ultimately document the event. When finished documenting, a copy is made and given to the unit/floor nurse manager for review. If needed, re-education is performed/coordinated by the nurse manager. If a larger issue is noted such as failure to follow ACLS or failure of a process, the form is forwarded to our code blue committee. THIS FORM IS NOT considered part of the chart, is not scanned into the chart, and therefore destroyed after use. It is strictly a tool to use to organize and improve the flow/ process. Feel free to use it or modify it to fit your needs. CODE BLue Flowsheet- REVISED.pdf

We do all of our charting in the computer system, but our crash carts all have neon orange clipboards with Code Record Flowsheets for note taking. It is not entered into the Electronic record, but is used to standardize/organize note taking during code events. There is also a mandatory post code debrief with participants on the back. Then after documenting, it is given to the floor manager who reviews for education opportunities and forwards it to our Code Blue Committee if anything major needs addressed about our process. The Code Flowsheet sure beats a paper towel... as a rapid response nurse I keep them in a foldable clipboard in my pocket so I can write time code paged and arrival time too.

Hey all, I was trying to find practice exams for when I attempt my Vascular Access Board Certification and came across this little gem of a site. It has various practice exams for all kinds of medical fields, Physical Therapy, specialty nurses, APRN, EMT, paramedic, dietician... a large list. just thought I would share. https://practicequiz.com/category/medical

So I myself have never been a nurse manager. My older sister is a nurse manager at my hospital and has some of the best staff in the hospital and has a significantly lower turnover than most floors. Coming from an outside view looking in, she runs our cardiac "step-down" and oncology floors. She has become certified in both fields, so she can assist with education of her staff and is a resource for them to ask questions. She focuses on being there for her staff, she is professional in her relationships, but knows every employee on a personal level. She is an advocate for her staff in furthering their education and does everything in her power to build their knowledge base and to try to further their careers. She has built education into her budget for her experienced nurses to obtain their respective certifications even though our hospital does not currently specifically pay for certifications. She spends at minimum 30 minutes a day on each of her floors to listen to concerns from staff and patients, and then actually tries to provide for them when in need. She will answer call lights, bed alarms, help folks to the bathroom, she wipes butts and helps roll people. The best way to lead is alongside your team, be a part of the team. Don't hide in your office and only interact when staff requests you to or when you have fix an issue. She is the reason I got into nursing and is my role model.

At our 240 bed hospital we have CODE STARR paged overhead for verbal aggression/ combative pt. We use a program called STARR by a company named Mitigation Dynamics. A good amount of our floor staff and all of ER takes the 2 day course. There is a refresher 4 hour course every 2 years. STARR focuses on and prefers verbal de-escalation of the situation. But several hours are spent learning hands on physical manipulation of pts using a team approach for safety. It is a great program and we have used it for about 8 years. The techniques used have even saved one of our female ER techs from a male assaulter outside of work. She had a guy appear behind her in the parking lot wanting to cause harm and she was able to bring him to the ground and hold him until police arrived. (Using a move called the Clamp). Its not a martial arts class, but the information learned is excellent. We show up to CODE STARR calls in numbers (4-6 typically with one lead). Safety in numbers and the pt doesn't typically want to fight a whole crew. I worked ER for 10.5 of those 8 years and pts very rarely were hurt when take down methods had to be used.

As a rapid response nurse, it sounds like you did great. You recognized an issue/change in pt condition, notified RRT and got help. When I arrive to a rapid call, I can direct flow of activity and interventions. I want help from the nurse to do tasks, but especially want information. I have no idea who this pt is, what their history is. Activities and interventions are a "team sport". Your knowledge of the pt is not... That's what I need most from you. (I also welcome any suggestions you may have that I haven't said out loud.) Don't ever feel like you are in our way, or not helpful enough. We are there to assist you and your pt. For future events, after the event, remember to write down things that you didn't understand or didn't anticipate. Look up or ask someone to teach you about them. I carried a small notepad in my scrub top and wrote down anything I wasn't familiar with for the first few years of ER nursing. Look them up when (if) you get downtime. You will do great. There is a huge learning curve to nursing and you can't expect to be comfortable right away. I've been a nurse 6 years, but worked in our ER 10.5 years total prior to swapping to Rapid Response and I still have cases that throw me for a loop.

Also if anyone is willing to share their hospitals training criteria or policy on this, that would be a huge resource.

We are currently in the process of approval for this. Our Rapid Response team is also our vascular team. 240 bed hospital. We can already place midlines, PIV, US guided PIV, and PICC lines. With our frequent turnover of CRNA's we sought the approval for it. Unfortunately Missouri doesn't list anywhere whether it is in the scope of practice or not. We are a "decision tree" state, meaning if you have the appropriate training, supervision, and policy, it is up to your facility. So we are gathering research about it currently to present to admin.