Rapid Response - primary RN

RoyalPrince · Aug 9, 2012

Primary RN - gives her latest assessment of the patient, and a snapshot of their history in SBAR format during RRT. Primary RN should stay in room and not leave the patient, carry out orders if pt will be staying on floor, and help if not.

turnforthenurse, MSN, NP · Aug 9, 2012

Primary RN should gather assessment data when a RR is called and be there to give information about the patient's history, etc. Where I work the primary RN never leaves their patient to the charge RN and RR team when a RR is called. The primary RN knows their patient the best

BacktoBasics · Aug 10, 2012

Primary RN should stay. They know the patient the best.

And not to be rude, but as an ICU nurse, if I need to leave my patients to come to your RRT, you're staying at the bedside.

nrsang97, BSN, RN · Aug 10, 2012

When I worked the floor and called the RRT, I stayed with my pt. As a soon to be RRT nurse I expect primary RN to stay with the pt since they know them the best.

LouisVRN, RN · Aug 10, 2012

Oh yeah as charge its super annoying to have the icu charge rn, house sup and swat nurse there asking questions about the pt and have to pretty much run after the primary nurse who is trying to leave to go chart or when their questions are met with silence and blank stares. Yesterday had to do a crt after getting like a 30 sec report because when everyone was asking questions neither the primary nurse or day charge answered anything. I just really feel like the ability to advocate for out pts in these situations are extremely lacking.

wooh, BSN, RN · Aug 10, 2012

Our RRT doesn't have a patient assignment, so it may be different from OP's facility, but we've been told we can leave, the RRT is there to offer not just their amazing brains, but their assistance. Nurses on my floor don't leave the bedside of their closest to crumping patient, but I've had float nurses that would do so if they know someone is in the room that should be able to handle things (which one would hope that a RRT nurse could.)

In theory though, the expectation should be that primary stays at bedside, charge can help with other patients. But hospitals should also have staffing that allows for such assistance, and goodness knows that's never reality, so why should anything else go the way it should? But primary nurse knows what's going on better than anyone else, they know baseline (if it's at least a few minutes past shift change) and they know history/etc.

AggieNurse99, BSN, RN · Aug 11, 2012

Part of the problem is sometimes that RRT'd pt is draining too many resources on the unit - i.e. me, my tech, my charge, my mgr, staff bystanders and if that is the case after the initial 10-15 min I will go and check on my other 4-5 patients. I love our RRT RNs at my work because of the fact that they will tell me exactly what they need. One shift I had a RRT pt at the same time a fresh postop and sedation pt came off the elevators within 10 min of each other. The charge RN and I were circulating on all 3 rooms, assisting the RRT as directed.

Aeterna, BSN, RN · Aug 29, 2012

It's our practice that the primary nurse stays with their critical patient, as they are the ones who have the latest assessments, the history, the events leading to the critical situation, etc.

Our RRT (we have a different name for ours, but yeah...) pretty much handles everything with the primary nurse, so there isn't always a whole lot to do for the other floor nurses (unless the patient is actively coding), so they look out for the primary nurse's other patients.

iluvivt, BSN, RN · Aug 30, 2012

I guess the question would be how can we use our resources wisely while providing the standard of care. To answer this you need to define role of the RRT and know the process of how they are assigned. Where I work RRT does not have a patient assignment. When RRT is then activated the RRT nurse can focus on that call and not have to worry about if their ICU pts are being looked after I do notice that RT calls are often much longer than a code blue call and it is not a given that they immediately go to an ICU or different level of care.

So the primary nurse needs to give a succint summary of the problem and pt hx and be available to assist RRT as needed. If RRT then determines that you can be dismissed while they perform whatever it is they need to than it is acceptable for the primary to resume other tasks and check in periodically. Both the RRT and primary nurses have phones so they can call each other if more help is needed. So for example, if the RRT is giving a fluid bolus and monitoring the pt..does there really need to be another nurse just standing there...or if the pt has been stabilized and they are waiting for a bed in ICU..does the primary RN really need to be there. The primary nurse also has all the other pts they are assigned to so if they can break away once they are no longer needed we find that perfectly acceptable where I work.