1. Running head: THE ROLE OF NURSES 1
The Role of Nurses in the Activation of Rapid Response Teams
Mackenzie Moffatt, Jazmine Randolph, Andrea Ritchie, Elizabeth Siegrist, &
Jelena Tomljenovic
Oakland University

2. THE ROLE OF NURSES 2
The Role of Nurses in the Activation of Rapid Response Teams
The emergence of rapid response teams (RRTs) is a concept that dates back to 2004,
when the Institute for Healthcare Improvement launched an initiative to reduce morbidity and
mortality in the United States healthcare system. In addition, the Joint Commission instituted the
National Patient Safety Goals 16 and 16A in 2008, requiring hospitals to establish processes to
recognize and respond to patients with deteriorating conditions (Parker, 2014). RRTs emerged in
acute care hospitals to address a concept called failure to rescue (FTR), i.e. a situation in which
the medical staff fails to identify and intervene in a timely manner when a patient’s condition is
deteriorating. Evidence shows the FTR is correlated with an increased risk of death (Parker,
2014). Studies also show that early detection of warning signs, together with a proactive method
to deal with such signs, reduced deaths by a staggering 37% (Kapu, Wheeler, & Lee, 2014). The
role of nurses is not only to monitor and survey the patient’s condition, but also to react in a
timely manner when deterioration of physiological condition is observed. FTR can have very
serious consequences. Indeed, evidence suggests that 70% of patients who suffered from cardio-
pulmonary arrest had signs of respiratory deterioration within eight hours prior to the arrest
(Kapu, Wheeler, & Lee, 2014). Therefore, training and education on the proper nursing decision-
making process is imperative to patient care. The purpose of this paper is to write an empirically
based literature review related to the decision-making process that nurses should adopt in order
to minimize FTR when taking care of patients in acute care units.
Description of Clinical Issue
A 62-year old male patient was transferred to the neurological medical-surgical unit

3. THE ROLE OF NURSES 3
from the emergency department, where he was initially admitted after being found unconscious
after failing for acute alcohol (ETOH) intoxication. During morning report, the night shift nurse
reported the following: the patient was on a CIWA-Ar protocol and the most recent dose of
Ativan (0.5mg) had been administered at 0400; the patient had a low grade fever during the night
and Tylenol (2 tablets) was administered; the patient’s vital signs were within normal limits. The
initial assessment revealed characteristic symptoms associated with alcohol withdrawal,
including sleepiness, lack of appetite, no interest in communication, and a mild tremor.
Lisinopril (40mg) was administered, but Dulcolax was held due to low serum potassium levels
(3.0 mEq/L). In addition, 0.5mg of Ativan was deemed necessary based on the patient’s CIWA
score, to be administered after the preceptor and student nurse attended to the needs of other
patients that were identified as higher priority. Approximately 45 minutes post-administration,
one of the nursing assistants notified the student nurse and the preceptor about the patient’s
deteriorating vital signs (systolic blood pressure greater than 200 mmHg, diastolic pressure
greater than 100 mmHg, heart rate 135 bpm, O2 saturation 78%, respiratory rate greater than 30
breaths per minute, and visibly gasping for air. Based on these findings, the RRT was notified
and arrived within minutes. A seemingly normal situation quickly escalated into chaos, but with
the leadership of a well-organized team, the respiratory therapist was able to recognize the
symptoms of stridor, and administered a bronchodilator through a facemask. One of the
physicians ordered a beta-blocker (Lopressor, 50mg) to lower the patient’s blood pressure and
heart rate, as well as 1mg of Ativan to relax the patient. The patient’s condition improved and
stabilized within 15 minutes.
Review of the Literature

4. THE ROLE OF NURSES 4
In a study by Parker (2014), the purpose of the study was to pinpoint the relationship
between nurses’ decision-making model during activation of the RRT and the frequency in
which RRT is activated. The study sample was composed of 87 medical-surgical registered
nurses (RNs) from three community hospitals with RRTs located in southeastern Florida that had
activated the RRT at least once in the preceding 12 months. These hospitals ranged in size from
283 to 400 beds. The study design was a descriptive, cross-sectional, correlational quantitative
design. The data collection consisted of a 24-item version of the Nurse Decision-Making
Instrument (NDMI) used to measure and describe the decision-making model used by nurses in
the clinical setting. Participants were asked to recall a time they had activated the RRT for a
patient with a deteriorating condition and then complete the NDMI. The NDMI results were then
utilized to classify participant’s decision-making process during the RRT activation into one of
three categories: analytic, analytic/intuitive (mixed model), or intuitive decision-making. Of the
87 nurses in the study, 70.1% (n=61) used a mixed model of decision-making, 21.8% (n=19)
used an analytical decision-making model, and the remaining 8% (n=7) of the sample used an
intuitive decision-making model during RRT activation. A mean score of 4.7 RRT calls was
found for analytical decision makers. Mixed model decision makers had a mean score of 2.56
RRT calls and intuitive decision makers had a mean of 2.3 RRT calls. A one-way ANOVA
indicated differences in the number of RRT calls amongst all three decision-making models were
significant (p=0.003). The study findings indicated that RNs who used analytical decision-
making activated the RRT with significantly higher frequency than did nurses that used either a
mixed model or intuitive model of decision-making. In the aforementioned case of the declining
patient, the student nurse and preceptor were able to utilize analytical decision-making, which
requires highly effective critical thinking skills necessary for quick activation of the RRT.

5. THE ROLE OF NURSES 5
Increased frequency of RRT activation has been linked to decreased patient mortality rates and
positive impact on patient outcomes, which benefited the declining patient (Parker, 2014).
Nursing Implications
As addressed in Parker (2014), “effective, analytical, clinical decision making” can be
fostered within the nursing profession through quantifiable measures and efficient training
seminars. When faced with a patient in the clinical setting who is experiencing a rapid decline in
homeostatic functioning, and an RRT must be initiated, nursing professionals personally
incorporate one of three decision making approaches: analytical, intuitive, or mixed. During
clinical evaluation throughout the study, it was determined that “a difference exists in frequency
of RRT activation based on the decision-making model used by the nurse to activate the RRT”
(Parker, 2014, p. 163). When nurses implemented an analytical approach during a rapid
response, this yielded the greatest decrease in mortality. Analytical decision-making incorporates
five main components: data collection, hypothesis formation, further data collection, data
analysis, and decision-making (Parker, 2014). When caring for patients, it is the responsibility of
the staffed nurse to continuously collect data and synthesize trends regarding the state of the
individual’s health status. Two imperative implications relating analytical decision-making and
successful RRT outcomes are: the proficiency of the nurse to distinguish a patient’s decline and
effectively respond (Parker, 2014), and ambitious and timely hourly rounding for critical patients
(Braaten, 2015). In the case of missed or untimely activation of the RRT, due to non-adherence
of hourly rounds or incompetence in recognizing acute decline, the most severe consequence is
failure to rescue (Braaten, 2015). Furthermore, in the case of the declining patient previously
referenced, the RRT protocol was properly executed through proactive rounding and awareness,
and therefore, his vital signs were stabilized and brought to homeostatic norms. Hence, analytical

6. THE ROLE OF NURSES 6
decision-making and implementation yielded successful results.
Conclusion
In conclusion, nurses play a principal role in the activation of RRTs. However, without
efficient implementation of decision-making methods to initiate the RRT, patient outcomes
suffer. The use of an analytical decision making approach for initiating rapid response teams
leads to faster interventions and better patient outcomes (Parker, 2014). Nursing implications
relating analytical decision-making and successful RRT outcomes include the ability to quickly
recognize a patient’s decline in health and having the knowledge and skills to respond effectively
(Parker, 2014). These implications present a new perspective for the underutilization of RRTs by
taking into consideration the need for increased nursing knowledge and skill. A retroactive chart
review revealed that nurses only activated the rapid response team for three of seven identified
patients who met the criteria for RRT activation (McColl & Pesata, 2016). Nurses do not
consistently recognize the clinical significance or the urgency of abnormal vital signs, thus
requiring further educational advancement (McColl & Pesata, 2016).
Thorough nursing surveillance is another nursing implication, which offers a new
perspective for the underutilization of RRTs (McColl & Pesata, 2016). When compared to other
healthcare team members, nurses spend the most time with patients, and are in the best position
to recognize and prevent patient deterioration. Increased nurse surveillance, quick responses, and
early interventions will help nurses improve their role in RRT activation. Research supports the
connection between the broader issue of informal hierarchy within the hospital and the
underutilization of RRT and/or failure to rescue (McColl & Pesata, 2016). Nurses reported
feeling the need to justify RRT activation to responders and physicians. Nurses can empower

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themselves and avoid RRT activation barriers by using an analytic decision making approach,
advancing their education, completing thorough surveillance of patients, and incorporating
teamwork to take full advantage of the RRT and improve patient outcomes (McColl & Pesata,
2016).
References
Braaten, J. S. (2015). Hospital System Barriers to Rapid Response Team Activation: A Cognitive
Work Analysis. American Journal Of Nursing, 115(2), 22-33.
doi:10.1097/01.NAJ.0000460673.82070.af
Kapu, A. N., Wheeler, A. P., & Lee, B. (2014). Addition of acute care nurse practitioners to
medical and surgical rapid response teams: A pilot project. Critical Care Nurse, 34(1),
51-59. doi:10.4037/ccn2014847
McColl, A., & Pesata, V. (2016). When seconds matter: Rapid response teams and nurse
decision making. Nursing Management, 34-38. doi:10.1097/01.NUMA.0000479446.2028
6.83
Parker, C. G. (2014). Decision-making models used by medical-surgical nurses to activate rapid
response teams. Medsurg Nursing, 23(3), 159-164.