As a new nurse, I am VERY glad we have the MRT. I trust myself to see when a pt is having problems, but sometimes there are easy fixes that I am not yet totally aware of. Chart reviews--sometimes all I get to (and the other members of the staff as well) is reviewing the orders for the past 24 hours. In depth reviews may or may not occur depending on how the night goes and how well we are staffed.
Prior to the MRT, it was each person for themself. I found that since I was new usually I could get a more seasoned nurse to come give me their opinion, but they didn't always have time. So it ended up being call respiratory if appropriate, call the doc for orders, etc. Of course we still call the doc for orders if needed, call the code if needed, etc.
I work nights, and we don't have a charge nurse to turn to--not really. Someone takes responsibility for making the assignment, but beyond that, we all take care of our own things.
We have around 250 beds--I don't know the actual number. At night the nursing sup assigns beds, takes care of any "situations" that arise, is present for all codes (unless there are multiple at once which is very rare), keeps up with staffing levels, takes care of TB skin tests for night shifters, gets supplies from storage when necessary, and probably 10,000 things that I don't know about. We usually see the supervisor once a night when she makes her rounds, and then maybe a couple of other times depending on the way the night is going.
I am not really sure how things work in the ICU as far as who is assigned to the MRT that night. I think they rotated the assignment for a while, but lately we have seen the same nurse for both MRT calls and codes, so I think she enjoys that and has taken that responsibility. I don't know if she has a pt assignment, a lighter pt assignment, or what. From time to time there will be a comment like "I can't believe they called us for this" from an ICU nurse, but I really think that is because they don't realize that what may not be serious enough to be an ICU problem still may be more than what we can safely handle on the regular floor.
Anyway, when the MRT shows up the ICU nurse asks for a brief history/problem and starts assessing, also may work on getting additional IV access if needed. Respiratory is doing what they do--checking sats, starting treatments, changing from one O2 delivery system to another, etc. Primary nurse is calling the doc with info, taking orders, dealing with the rest of the assignment, etc. The supervisor usually is the last to show up unless she just happened to be on the floor at that time anyway, and she starts working out how to move the pt to a higher level of care if needed (our hospital is always packed, so moving a pt usually involves moving multiple patients around). Also because she has a LOT of experience she sometimes says "well did you try _______" (insert something that no one else thought of or has heard of) and sometimes that thing alleviates the problem.
It really works well. We tend to get problems taken care of much more quickly. When the system first started that was a lot of grumbling about it, but that really has died down quite a bit. I think we use the MRT more often on nights than on days, but it isn't very often that we have to call them--maybe once a week average.