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Factors Influencing Registered Nurses' Decision to Activate an Adult Rapid Response Team in a Community Hospital
Shirley Jackson1, Barbara Penprase, Claudia Grobbel
1Shirley Jackson, DNP, RN, CCRN, CCNS, is a clinical nurse specialist at Elliot Health System, Manchester, NH. Her clinical specialty is adult acute and critical care nursing. Barbara Penprase, PhD, RN, CNE, ANEF, is a professor at the School of Nursing, Oakland University Rochester; and endowed professor, Oakland University School of Nursing/Crittenton Hospital Medical Center, MI. Her research interests include alarm fatigue, empathy vs systemizing traits in nurses and frequent users of the Emergency Department. Claudia Grobbel, DNP, RN, is an assistant professor at Oakland University, Rochester, MI. Her expertise is in the area of cardiac care, leadership and administration. Her research interest is caring practice and the impact on quality care.
Background:
One factor impacting patient outcomes in the acutely deteriorating patient is a delay by nursing staff to activate a rapid response team (RRT); however, a gap in knowledge exists concerning factors influencing activation of an RRT by nursing staff working in adult areas outside the medical-surgical and telemetry setting.
Objectives:
The purpose of this study was to examine beliefs and behaviors that influence registered nurses' decision to activate an adult rapid response team in a community hospital that includes 3 specialties: medical-surgical and telemetry, peripartum, and psychiatric areas.
Methods:
One hundred sixty-three nurses were surveyed using a 17-item Likert-style instrument to assess registered nurses' beliefs and attitudes on and barriers to utilizing an RRT.
Results:
The survey was analyzed yielding 3 factors: RRT barriers, RRT positive/intent to activate, and patient management beliefs. Barriers cited by other research to activate RRT including criticism by the team and perception that the RRT increases workload or reduces skills were not found to be influential considerations. A significant difference was found among the 3 specialty groups related to RRT positive/intent to activate (F2,159 = 6.09, P = .003) and patient management beliefs (F2,159 = 5.87, P = .003). A strong negative correlation was found between years of experience as an RN and RRT barriers (ρ161 = -0.250).
Discussion:
Organizations should examine RRT activation delays particularly in the area of calls to covering physicians prior to RRT activations. Differences between specialty groups highlight the need for education across specialties on the recognition of the acutely deteriorating patient. The findings indicate that the inexperienced nurse requires support from experienced colleagues and temporary adjustments to workload during situations of acute deterioration of a patient.
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