Development of Job Standards for Nurse-Led Rapid Response Teams in the Republic of Korea

Nurse-led rapid response teams (RRTs) significantly improve patient safety. However, the absence of specific job standards can precipitate role ambiguity and compromise care quality. Therefore, establishing tailored job standards that reflect the distinct healthcare context of the Republic of Korea is imperative to optimize RRT performance and clinical outcomes.

To identify nurses' activities in nurse-led RRTs and to develop job standards that define the desired performance levels of RRT nurses and enable task evaluation within the Korean healthcare context.

This study used a two-step methodological approach, guided by a conceptual framework integrating Hamric's advanced practice nursing model with nine Korean advanced practice nursing core competency domains: (1) identifying the nursing activities of nurse-led RRTs through an integrative evidence review, benchmarking of domestic and international institutions, and in-depth interviews with domestic nurses; and (2) developing draft standards and validating them through a two-round Delphi survey and field verification of practical suitability.

A total of 210 potential activities were initially identified and refined into 55 nursing activities across nine core competency domains: advanced nursing practice, education, counseling, consultation, ethical decision-making, research, collaboration, evidence-based practice, and leadership. Draft job standards comprising 9 standards, 16 criteria, and 53 indicators were developed and validated through a two-round Delphi survey with eight experts; after Round 1 revisions and two added indicators, all items met the retention criteria in Round 2 (I-CVI ≥ 0.88, mean I-CVI = 0.96, S-CVI/Ave = 0.94). In field verification with 62 RRT nurses across 19 hospitals nationwide, all items showed practical suitability above 90%, and 9 standards, 16 criteria, and 55 indicators were ultimately confirmed. These standards integrate internationally accepted competency frameworks while reflecting the distinctive Korean context, such as EMR-based screening and the absence of independent nurse prescriptive authority.

This study identified nurse-led RRT work activities and developed job standards for desired performance levels of RRT nurses. This provides a foundational framework for performance evaluation and continuous quality improvement. As a methodological study, it did not empirically test clinical outcomes; rather, the developed standards may support future outcome evaluations using metrics, such as cardiac arrest rates, unplanned ICU admissions, and failure-to-rescue, and may thereby provide a basis for advancing nursing care quality and professionalism in managing ward patient deterioration.

The job standards provide practical guidance for new and experienced RRT nurses and offer a foundation for defining job skills, structuring task instructions, workforce planning, and conducting performance evaluations across diverse hospital environments, while also informing qualification criteria. They may also serve as a useful framework to inform future empirical research evaluating the impact of nurse-led RRTs on patient outcomes. To support consistent adoption, a phased implementation strategy involving nursing associations, professional bodies, and the Ministry of Health and Welfare is proposed.