What is Rapid Response Nursing? 

What is Rapid Response Nursing? 

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:

  1. Rapid Response Teams
  2. Improved Care for Acute Myocardial Infarction
  3. Medication Reconciliation
  4. Preventing Central Line Infections
  5. Preventing Surgical Site Infections
  6. 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.”

In Healthcare and Nursing, Relationships Matter

In Healthcare and Nursing, Relationships Matter

Healthcare is an industry where careers and patient care are both fueled by relationships. As you navigate the arc of your professional life, your multidisciplinary colleagues can be a special fuel for your future. At the same time, your connections with patients can bring meaning and purpose to your work. All in all, relationships could not be more critical to your career and your personal and professional fulfillment.

A Fuel Source for Your Future

While you may frequently be successful in finding new opportunities by responding to job postings and submitting applications, resumes, and cover letters, positions can also sometimes be found through connections and relationships.

There’s conflicting evidence  online regarding how many jobs are actually landed through networking. Still, we can say without a doubt that paying attention to relationships with valuable colleagues will never hurt you and can very likely be a benefit at some point in your career.

Let’s face it: someday, you may need a professional reference, an introduction to a key individual at a facility you’re interested in, some priceless career advice, a mentor, or maybe someone to serve as your preceptor during your nurse practitioner program.

There are many ways in which relationships can benefit you and your nursing career. A connection with a current or previous colleague could hold a key that unlocks something vital for you and your professional development.

You have everything to gain from maintaining collegial relationships, and it doesn’t need to take that much energy. Some of your connections with certain colleagues will easily lend themselves to friendship, being in touch via text or email, or perhaps just a Christmas card once a year. With others, it may look like being aware of one another’s career development on LinkedIn and checking in occasionally.

However, how you go about it, a small investment of time, energy, and positive attention can reap many benefits in the scheme of things.

Lessening the Toll

Beyond networking and keeping an eye on the future, your present experience also holds great importance. You want to feel good at work, and supporting and being supported by others makes hard work feel less taxing.

In your day-to-day work, your relationships with physicians, other nurses, social workers, chaplains, administrators, managers, preceptors, instructors — they all have a potential role to play. Positive interactions and camaraderie can make your days less stressful and more manageable. When you and your colleagues can rely on one another when the going gets tough, the difficult days can take less of a toll.

Professional relationships matter, and the rewards far outweigh the time and energy spent cultivating and nurturing them.

Meaning, Fulfillment, and Purpose

As mentioned above, your connections with colleagues can be critical to how you feel about your work and your day-to-day experience. Add to this the relational aspects of the nurse-patient relationship, and there’s a recipe for increased meaning, fulfillment, and sense of purpose that can add to your feelings of job and career satisfaction.

Relating to patients, communicating with empathy, expressing compassion, and being the kind of nurse who shows caring and kindness all point to the highly relational aspect of nursing. While nurses may provide much patient education, the art of conversation with patients and their families goes far beyond teaching about medications, side effects, diagnoses, and follow-up care.

A great deal of warmth can be generated in the context of the nurse-patient relationship, and we can’t overlook how the meaning behind nursing others back to health or comforting them during illness or the dying process is a significant motivator for many of us becoming nurses in the first place.

Keep Relationships Top of Mind

Whether cultivating connections with patients and their families or nurturing positive communication with your multidisciplinary colleagues, the importance of relationships in every aspect of your career is multifaceted and beyond measure.

Keep relationships top of mind, be aware of the quality of your interactions, and enjoy how connecting with other humans can be one of the most important fuels of a satisfying career.

Will the Real Nurse Please Stand Up? 

Will the Real Nurse Please Stand Up? 

Have you ever heard a nurse pass judgment on a colleague and say that another nurse isn’t a “real nurse”? Have you noticed some nurses looking down on those who choose to be school nurses or work in home health, dialysis, assisted living, medical offices, or ambulatory surgery?

Judgmental attitudes by one group of nurses against another don’t do anyone any favors, but such thinking is all too common.

So, given that there are still nurses who think in such old-fashioned ways, what then constitutes a “real nurse” anyway, and how do we know when a nurse is the real deal? (Hint: they’re all the real deal.)

That’s Not “Real” Nursing

When we’re in nursing school, it often seems that everyone and their mother has their sights set on “sexy” specialties like trauma, emergency nursing, and critical care. When a peer talks about having a goal of working in public health, school nursing, elder care, home health, community health, or some specialty that isn’t highly technical or soaked in adrenaline, some may scoff at such a notion.

“School nursing? That’s not real nursing — all you do is put band-aids on boo-boos and give kids aspirin for headaches.”

“Home health? Do you want to go from house to house checking blood pressures and filling little old ladies’ med boxes?”

“Why would you want to do public health? That sounds so boring.”

Looking down on nurses who don’t want to follow the straight and narrow path of the more fast-paced or complex acute care areas is an all too common way of thinking about others’ choices. When a nurse isn’t inherently drawn to the ICU or the ED, some nurses may be quick to judge that nurse for being lazy, not smart enough, or simply not a “real” nurse.

For those who think that school nursing is just band-aids and aspirin, think again: kids come to school with trachs, vents, complicated medication schedules, brittle diabetes, and all manner of chronic illnesses.

School nurses have to think on their feet, sometimes manage multiple schools, and also tend to the medical needs of teachers and administrators. And in rural and underserved areas, the school nurse may be a student’s primary connection with the healthcare system, not to mention parents.

In home health, patients can come home with complex surgical wounds, including a wound vac, IV antibiotics, and other medications administered by a programmable IV pump.

Home health nurses may also encounter patients receiving TPN and other complex situations necessitating expertise and highly skilled care. And when a home health nurse is out in the field, that nurse is all alone — there are no colleagues, doctors, or specialists to lean on with questions and concerns.

The home health nurse is by nature autonomous and independent and can face life-or-death decisions without the benefit of others to confer with.

According to the American Association of Colleges of Nursing (AACN), approximately 55% of nurses  work in general medical and surgical hospitals. So, where do the other 45% of nurses work if this is the case?

When it comes to “real” nursing, there’s nothing fake about home health, public health, ambulatory care, community health, or school nursing. All nursing is real, and those who think otherwise are gravely misguided.

The Big Tent of Nursing

Nursing is anything but homogeneous. Dozens of nursing specialties make it an exciting, fascinating, and varied profession, and these many choices give nurses multiple potential career paths. Nursing is a profession with a big tent under which nurses of all stripes and persuasions can find career satisfaction.

No nursing specialty or area of practice is more worthy than another. Under our big nursing tent, all nurses are welcome, and whatever each nurse chooses to do for a living is a valid choice.

When you hear another nurse talking negatively about another nurse’s valuable contributions to society, you can rest assured that that nurse’s opinion has no merit, and every colleague’s career choice has its role to play within a noble and highly respected profession.

Nurse Practitioners: #1 Job in 2024

Nurse Practitioners: #1 Job in 2024

As a popular career path, nurse practitioners have been in the ascendant for some time now, and 2024 is no exception. Every time you turn around, it can seem like someone else you know is in NP school or considering applying. No matter how you slice it, the nurse practitioner career has been enjoying its day in the sun, and the trend is destined to continue for the foreseeable future.

U.S. News Chooses NPs

As the year begins, many publications like to make their predictions and prognostications for the coming 12 months, and one area always worthy of attention is where the hot jobs are. U.S. News is one such publication that offers comprehensive lists, and their crunching of the economic numbers is generally highly trusted.

Nurse practitioners are familiar with making headlines, and the U.S. News has not disappointed. When they published their list of the top 100 jobs and their Best Jobs in America in 2024 profiles earlier this month, NPs emerged wearing the crown, with nurse anesthetists also making a commendable appearance. NPs also made the list of the best STEM jobs and the best healthcare jobs to boot.

There are many factors to consider when weighing which jobs are the most viable at any given time, and no measurement can tell the whole story. In their measuring, U.S. News includes several key metrics, among others:

  • Projected job growth
  • Rate of unemployment
  • Wage potential
  • Job safety and stability
  • Work-life balance

While not all NPs may agree with the rosy picture being painted by these reports, the fact remains that the numbers tell us quite a bit about the state of careers in our country.

What’s So Great About Being an NP? 

According to the editors at U.S. News, multiple factors have worked in concert to put NPs over the top.

Median salary: $121,610

Salary means a lot in these days of skyrocketing housing costs, not to mention the cost of most everything else, including food, transportation, consumer goods, education, travel, and healthcare.

The numbers show that nurse practitioners earn an admirable salary of $121,610, although not in the upper reaches of what’s possible. However, with the Bureau of Labor Statistics (BLS) reporting the mean annual salary for all occupations as $61,900, the fact that NPs earn about twice that amount might be a consolation for some nurse practitioners.

While the cost of living is something to consider when looking at salary data, the best-paying cities for NPs include the following:

  • San Jose ($199,630)
  • San Francisco ($190,070)
  • Napa, CA ($189,190)
  • Vallejo, CA ($180,990)
  • New York City ($170,320)

Unemployment rate: 0.6%

After spending money, blood, sweat, and tears on graduate school, no nurse practitioner wants to face the prospect of being unable to find work. U.S. News reports that NPs have an unemployment rate of 0.6%, which should encourage those entering the job market. Demand and jobs are there, and talented NPs with a solid work history, well-written resumes, and good interview skills should be able to find employment in the current climate.

Job growth: 44.5% or 118,600 jobs by 2032

As more and more people choose NP school as their career path, we want to see encouraging projections into the future. For quite some time, projected job growth for nurse practitioners has been positive, and the current numbers are just that: with the BLS projecting 6% job growth for RNs through 2032, we see a stark difference in the 44.5% for NPs.

What Can We Conclude? 

In terms of the U.S. News data, nurse practitioners have much to be happy about regarding job growth and salaries.

Meanwhile, nurse anesthetists aren’t doing too badly either, with a median salary of $203,090 and unemployment of 1.9%. However, job growth is only projected as being 8.9% through 2032, which makes this a much more competitive career path, with only 4,400 new jobs that will be created between now and then.

On the not-so-bright side, the stress experienced by NPs on the job is characterized as high. NPs also have average job flexibility regarding work-life balance and alternative work schedules (although self-employed nurse practitioners who run their practices have more control over their schedules and may have yet to be included in the U.S. News data).

As the best overall job in the U.S., the best STEM job, and the best healthcare job, nurse practitioners have done well for themselves in 2024. While not all NPs might agree with these conclusions, the comparative picture is positive.

Only time will tell if job projections hold up, and we must also acknowledge that economic changes brought on by war, climate change, recession, and other factors can’t be predicted.

That said, the nurse practitioner career path is having its day as 2024 gets underway, and there is no doubt many NPs feel quite good about their career choice as they scan the horizon for a glimpse of a promising future.

The Nurse as an Agent of Change

The Nurse as an Agent of Change

When we think of a nurse, we absolutely and automatically think of a nurse who works in some capacity as a clinician. We may also think of a nurse executive or administrator, writer, informaticist, case manager, health and wellness coach, or many other roles that 21st-century nurses commonly fill. Nurses care for the sick and dying, provide primary preventive care, and participate in research that can impact the health of countless people.

No matter what role you find yourself in as a nursing professional, there’s something that you can be based on your ability and desire to do so, and that is to serve as an agent of change.

History-Making Change Agents 

Being a nurse who is an agent of change is closer to the norm than you might first think. Nurses have often been at the forefront of change, with some making history.

In the 2023 book, The Black Angels: The Untold Story of the Nurse Who Helped Cure Tuberculosis , author Maria Smilios relates the history of brave Black nurses who fled the Jim Crow southern United States to care for patients in a Staten Island TB hospital where white nurses refused to work. As part of the Great Migration, these nurses changed history as they contributed to the eventual cure of tuberculosis and they also helped to integrate otherwise white neighborhoods where Black residents weren’t welcome. Did they see themselves as change agents? Perhaps many of them did.

Was Florence Nightingale a change agent? Without a doubt. Her revolutionary biostatistical practices are credited with saving the lives of numerous soldiers as she uncovered and documented preventable causes of death that were all too common in hospitals during the Crimean War.

Congresswomen Lauren Underwood (D-IL) and Cori Bush (D-MO) are nurse change agents who chose to run for Congress and advocate for their constituents and the American people in the policymaking world of Washington, D.C.

You Don’t Need to Make History to Make Change

While Nightingale, Underwood, Bush, and the Black Angels are nurses who’ve found their place in books, articles, and the history of nursing and the United States, you don’t need to make history as a nurse to make a change.

Nurse change agents can work anywhere, be any nurse, and bring about change in countless ways. No matter how large or small, any change can have significance. Here are some examples:

  • A new charge nurse on a nursing home unit decides to leave behind the intimidation, harassment, and bullying practiced by a predecessor, instead choosing to lead with kindness, compassion, and a firm yet fair form of leadership.
  • A nurse intent on helping provide food for members of their community meets with the mayor and city council members to present their plan for a new soup kitchen and food pantry. The plan is adopted by the council, endorsed by the mayor, and enacted with the help of volunteers from area houses of worship.
  • Observing that nosocomial infections have increased significantly on their unit, a nurse proposes a new protocol that could decrease the infection rate by 25-50% with no additional costs incurred by the facility. Management agrees to try the plan, and infection rates drop by 30% in the first month and 55% by the end of month two.
  • Tired of politics as usual in their state, a nurse takes part in a training program by a national non-profit that teaches women how to run for public office. After a long campaign, the nurse wins the primary and becomes the first nurse member of their state’s House of Representatives.
  • Learning of the number of people around the world living without access to clean water, two nurses formed a non-profit organization that uses the funds it raises through public outreach to dig wells in impoverished communities in sub-Saharan Africa.
  • Unhappy with the quality of preceptors available to fellow students, a nurse in their second year of an FNP program launches a shared database of fully vetted nurse practitioner preceptors willing to take on students each semester.

Nurse change agents don’t need to only push for change at work. They can create change that’s community-based, national, or even international in scope. Changes can be small, but they can also reach far and wide.

Be the Change 

It’s been said that we can choose to be the change we want to see in the world around us. Many nurse visionaries have impacted the lives of millions of people around the globe. As educators, healers, and advocates, nurses can reach others through compassionate communication, critical thinking, and a desire to do good in the world.

If there’s something that you’d like to change, remember that the nursing process can be a helpful framework. You can assess the situation, diagnose the problem, create a plan of action or intervention, implement the work needed, and then evaluate the results.

Nurses have changed the world for hundreds of years and will no doubt continue. Like the Black Angels, Florence Nightingale, and Congresswomen Underwood and Bush, there’s no way to stop a nurse dedicated to their mission.

If you see something in the world around you that needs to change, you may be the one to make it happen. Be the change and create the world you want to see. Nurses have always done so and likely always will.

Is Your Nursing Career a Good Fit? 

Is Your Nursing Career a Good Fit? 

When you think about the current state of your nursing career , does it fit like an old glove, or has it begun to chafe, itch, irritate, or otherwise make you feel uncomfortable? Are there buttons missing? If a shoe metaphor is more appropriate, have you developed career-based callouses, or is your career more like a thorn stuck in your clogs or sneakers?

Sometimes, we outgrow our careers, or they could have been better tailored from the start. If you’re unsure whether where you are now is working for you, maybe it’s time to consider if you’ve somehow outgrown your nursing career as it is or if there’s still some time to consider your next move before your career becomes threadbare.

Well-Made Suit or Straightjacket? 

The next time you go to work, check in with yourself and see if your current career choices still make sense. When you arrive at your place of employment, are you filled with dread? Do things feel monotonous and boring, or are there still novelty and new things to experience? Does work feel like a well-made suit, an old, worn-out coat, or even a straight jacket?

Work can quickly become stale, and this can happen for many reasons. You might find yourself in an environment that’s not very intellectually challenging. Or your employer may tolerate bullying, incivility, and a toxic work culture. They may also treat you like you don’t matter.

It’s also important to consider whether your attraction to a particular position or job no longer holds. Maybe you graduated from nursing school hell-bent on working in high-adrenaline environments like trauma or the emergency department. Still, after ten years of slogging it out, you’re ready for something more mellow, or maybe you want the luxury of time to get to know patients over the long term.

With how complicated and fast-paced life can be, it’s pretty easy to show up, do your work, and go home with barely a thought about how it all feels — or you may be too tired to care. Whatever is going on for you, it’s always better to check in, assess what you’re doing, and determine if your actions are still ticking enough boxes to be worthwhile.

Have You or Your Life Changed? 

The choices we make in the course of our careers are often strongly influenced by what’s happening in the rest of our lives. Maybe you graduated from nursing school when you were single, in your mid-20s, and had no dependents and few responsibilities outside of taking care of yourself and paying the bills. But now that you’re 39 with three school-aged kids, your awful hours and high stress now feel like that thorn mentioned above in your shoe.

When it comes to you and your lifestyle vs. your workstyle, consider questions like these:

  • How has my life changed since I took my current job/chose my current specialty? Do any of those changes make my current workstyle less attractive or practical?
  • Have my personal goals changed?
  • Have my family’s needs changed?
  • Has the nature of my area of nursing specialty changed in a way that’s less interesting to me?
  • Have my career goals shifted? Is there something I now want that I didn’t wish to do before?
  • Is there some aspect of my work that holds less importance for me now than it used to?

Ensuring your current work style matches your desired lifestyle may enlighten you about the need for change. Or you may realize that everything matches up, the fit is still perfect, and no tailoring is needed.

Is it Time to Call Your Tailor? 

If your life, desires, needs, or family’s needs have changed, your current work situation may no longer be a good fit. As mentioned above, your work may now chafe, irritate, or otherwise feel like a mismatch. Are those missing buttons? They’re telling you something. That threadbare feeling? It’s a sign.

Imagine your nursing career as a tailor-made suit you wore at nursing school graduation and never took off. As we all know, our bodies can change, and clothes that used to fit us perfectly no longer feel or look right anymore. Some things also go out of style, and what used to be fashionable can look dated. The same goes for your career. What seemed like it was made just for you can begin to feel completely wrong, like a pair of pants that shrunk in the wash and doesn’t fit anymore.

If the tailor-made suit of your career isn’t what it used to be, you may very well need to call your tailor. A nip here, a tuck there, a new lining, or some shiny buttons, and you could be good as new. It all begins with an honest assessment in the dressing room mirror. And if the shoe doesn’t fit or the suit is out of style, maybe it’s time to shop around, step into the dressing room to try something new, and find a perfect fit that’s right.