In the setting of acute care, immediate intervention is essential when critically ill patients decompensate. These situations require highly trained experts who can do the job while remaining calm under pressure. Enter the rapid response nurse.
Rapid Response Nursing
“Contrary to common misconceptions, rapid response nursing isn’t solely about dashing from one Code Blue to another,” says Sarah Lorenzini, MSN-ED, RN, CCRN, CEN, a rapid response nurse, educator, and host of the Rapid Response RN podcast. “Much of our focus revolves around preemptive interventions aimed at averting emergencies before they escalate.”
According to Lorenzini, we don’t want things to get to a crisis point if we can avoid it. “While managing crises is undoubtedly exhilarating, there’s equal satisfaction in identifying at-risk patients and implementing interventions to prevent crises. Rapid response nurses like myself serve as specialized resources available throughout the hospital to support colleagues in handling emergent situations.”
When asked if all hospitals have rapid response teams, Lorenzini responds, “Yes, but each hospital’s team might look different. The roles and responsibilities of rapid response nurses may vary from one institution to another, but their primary objective is always to intervene swiftly and effectively to prevent patient deterioration.”
She continues, “Each hospital has a different structure for who responds to emergencies, but they all have the core goal of providing bedside nurses with access to a team skilled in managing emergencies and critically ill patients.”
How Did the Rapid Response Concept Gain Traction?
In terms of how rapid response became prevalent, Lorenzini points to the 100,000 Lives Campaign launched by the Institute for Healthcare Improvement (IHI) several decades ago. The campaign highlighted six critical interventions:
- Rapid Response Teams
- Improved Care for Acute Myocardial Infarction
- Medication Reconciliation
- Preventing Central Line Infections
- Preventing Surgical Site Infections
- Preventing Ventilator-Associated Pneumonia
IHI reported in 2016 that the first ten years saw 75% of U.S. hospitals join the campaign, which is encouraging, even though their data shows that far too many patients still needlessly die.
Lorenzini states, “Hospitals were encouraged to implement these teams to convene at the bedside of declining patients, bringing ICU-level care to any unit.”
“Some hospitals have a system where staff are dispatched from different areas in emergencies (e.g., the ICU charge nurse might leave the ICU and meet up with the respiratory therapy supervisor in the patient’s room). Some hospitals have dedicated interdisciplinary teams whose only responsibility is emergency response.”
How do Nurses Become Adept at Rapid Response?
“While every hospital has different standards, having either ED or critical care experience is needed,” Lorenzini states. “Rapid response nurses need to be able to lead a team in a coordinated effort in emergency response. They need experience administering vasopressors and other high-risk medications, assisting with intubation or other resuscitation skills, and managing a critical patient independently (sometimes for hours) while waiting for an ICU bed to become available.”
While not all institutions require it, having CCRN (Critical Care Registered Nurse) or CEN (Certified Emergency Nurse) certification is one way a nurse can be prepared for the role.
“My best advice is to get really good in your specialty (e.g., ED or ICU),” advises Lorenzini. “Become a preceptor or a super user and be seen as a resource on your unit. If you’d like to be a resource for the entire hospital, start by being the person people call on when they have questions.”
When asked if this is a viable career path, Lorenzini responds, “Absolutely! It’s the perfect mix of ER, ICU, and nursing education rolled into one.”
A Rapid Response Story
Rapid response nurses have many stories about their work, and Lorenzini is no exception; that’s the purpose of her podcast, Rapid Response RN.
She relates this story.
“A nurse once called me for a consult. She was concerned that a patient was breathing faster than normal, and she ‘had a bad feeling’.
“The patient was several days post-op from a bowel resection and had so far recovered well. Their vitals were stable, but the BP had been trending down and was 90/50 with respirations of 28. The nurse had expressed her concern to the doctor and been told that the patient was just ‘the anxious type.’ She called me for a second opinion saying, ‘Should I be concerned, or is this normal?’”
Lorenzini intervened.
“I assessed the patient and felt that same bad feeling. Not only was she tachypneic, she was more lethargic than her baseline, and her tachypnea didn’t seem like anxiety. Her color wasn’t right, and her abdomen was tender and firm. I supported the nurse in advocating for the patient, calling the doctor, and pushing for further diagnostics.”
“We got the patient to CT and discovered a perforated bowel leaking into her peritoneum, causing septic shock. Within an hour, she declined rapidly, required vasopressors and intubation, and ultimately returned to the OR. As a rapid response nurse, I supported the bedside nurse in her assessment, taught her how to advocate for the patient with the provider, and facilitated getting the patient stabilized in ICU.”
Response and Proactive Vigilance
“Rapid response nursing isn’t just about reacting swiftly to emergencies,” says Lorenzini. “It’s about proactive vigilance, expert coordination, and unwavering patient advocacy. It’s a dynamic field that demands clinical acumen, leadership, and passion for making a difference in every patient encounter.”
She adds, “At my facility, we’re tasked with responding to a variety of alerts, from cardiac arrests to sepsis, STEMI, stroke alerts, and even unexpected births outside of L&D. But beyond mere response, we prioritize proactive measures. We utilize tools like the Modified Early Warning Score (MEWS) to identify at-risk patients and provide timely interventions. Our ‘nurse consults’ allow healthcare professionals to reach out for assistance even if vital signs don’t raise immediate concerns. This fosters a culture of early intervention and collaboration.”
“In summary,” Lorenzini concludes, “rapid response nurses exist both to respond to and prevent emergencies throughout the hospital.”
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