Episode Transcript
[00:00:00] Speaker A: This is the All One Nurse podcast, where we are bridging the gap between the stethoscope and the soul and getting back to the human side of healthcare.
Powered by Riverside according to the American Heart Association. Did you know that the primary goal of rapid response teams is to prevent unexpected death in patients in the hospital setting by providing prompt evaluation and treatment? Welcome to another All1Nurse episode. I'm your host, Chanel Tompkins, and I'm excited about this episode because today we have a special guest, Sarah Lorenzini, the Rapid Response nurse. And she is a highly skilled and experienced nurse who plays a crucial role in critical care situations, making sure that patients receive the immediate attention that they need. She is so passionate about her nursing role that she also shares her knowledge with fellow nurses. So much so that it inspired her to initiate the Rapid Response Academy. And in addition to her work with her academy, she shares her experiences and her insights on her podcast, Rapid Response rn. And for her outstanding efforts, she has been recognized by Nurse.org as the best of Nursing podcast host. And I am just honored to have Sarah with us today. And as with every episode, we're going to delve right into Sarah's professional journey, her personal insights, patient perspective, educational insights. And as for the educational aspect, of course we're going to explore the world of rapid response nursing, the daily responsibilities, critical care, critical situations encountered, the importance of teamwork, patient advocacy, and so much more. Now, whether you're tuning in or for the first time and you're a nursing student, a seasoned nurse, or someone who is just simply curious about health care, this episode is for you. And so sit back, relax, and go ahead and click that Follow or Subscribe button, depending on where you're tuning in from. And if you're already a subscriber, go ahead and share this episode with a friend or two, because we're going to get into Sarah's incredible journey, her dedication to saving lives. And be sure to stick around to the end of the episode so that you can find ways to connect with Sarah Larzini. Now, let's get right into it. Hi, Sarah. How are you today?
[00:03:02] Speaker B: I'm so good. So glad to be here, Chanel. Thank you for having me.
[00:03:06] Speaker A: Now, thank you for being here. It's such an honor to have you on All One Nurse with me today. And just getting right into it. Tell us your professional journey. How did who are you and how did you get into nursing? How did you get to where you are today?
[00:03:22] Speaker B: Well, I am Sarah Lorenzini. Currently, I'm a rapid Response nurse. And I'm the host of the Rapid Response RN podcast. How I got here started a long time ago. I've always known I wanted to care for the sick, but thanks to media, I thought that meant being a doctor because they don't really show. At least back in the 90s didn't show much nursing on television. So I was like, I'm going to be a doctor. So in high school, I actually volunteered at the hospital so I could, like, see some doctors in action.
And I quickly learned how much nurses actually do and know. I remember, like, in my naivete, like, week two of volunteering, I said to the charge nurse, I was like, hey, so like, when do the doctors come and, like, take care of the sick people and, like, give them their medicine, like, change the dressings, like, teach them about the diagnosis and, you know, all that stuff? And she just looked at me with such compassion and kind of chuckled a little bit. And she's like, sweetheart, the nurses are the ones that do that. The doctors already came and went before you got here. They've already done their rounds. The nurses are the ones that are administering the medications and caring for the patients and explaining their diagnoses and walking them through this whole process of recovery. And I was like, blown. And that's when I started kind of considering, well, I always thought I'd be a good doctor. Everyone's told me, you're so smart, Sarah, you're so kind. You'll be such a great doctor one day. But, like, I think I might be frustrated only seeing my patients once a day. I want to. I want to be with them. I want to do the thing right. And so that's when I started really paying attention to what the nurses were doing and not just waiting to see doctors do something. And I was blown away. Oh, my gosh, these nurses, they are so smart, they know so much about pathophysiology. They are so good at explaining this to the patient. They knew all these medications and, like, how to pronounce them and what they do. I was just. I was so impressed. And I could just see myself in that role more than the role of the doctor. And so it was somewhere in high school that I said, I think I'm gonna go to nursing school. And because I knew so early on what I wanted to do, I actually started nursing school in high school and got my cna. I did dual enrollment in high school. I graduated nursing school with my RN license at the ripe old age of 19. And right outta nursing school, I was a 19 year old emergency room nurse, which is so crazy that my friends are like working at Chick Fil A and I'm in the ER on Friday night working night shift. Anyways, I, I love the er. Everyone just assumes, oh, you're an ER nurse, you must be like an adrenaline junkie. I am not. I am boring. Like I barely do roller coasters that have to be, it has to be a certain kind of roller coaster. I'm not doing bungee jumping or skydiving. Like I crochet for fun. I like to like hang out by the water. Like, I love children and playing with kids. I'm definitely not an adrenaline junkie at all. But what I do love about the ER is the opportunity to care for people in crisis. When I say people, I mean patients and their families. I love being there in those high stress situations and trying to bring some calm or some hope or some clarity to all the chaos. That's what I love about the er. So I started out in the error, did that for many years, love being ER nurse. They quickly made me a charge nurse and a preceptor, even though I was the youngest one in the department.
So that was awesome. I found that I love teaching nursing as much as I love actually doing the work. I love teaching alongside the person I'm training. And so I decided I'm go back to school, get my master's degree in nursing education.
And in grad school all my professors are like, sweetheart, you need to see something outside of er. There's a whole other world of healthcare that you just don't have exposure to and you'd be a more well rounded nursing educator if you would work somewhere else. So I left the ER that I love so much and went, worked in the cardiac icu. Did cardiac ICU for a while. The nerd in me loved cardiac ICU because I got to really geek out about all of the hemodynamics and all of the parameters and all of the gadgets that we put in people to help them get better and to monitor how they are doing in the process. I loved all of that and I love the one on one or one to two ratio. I could really spend time with those patients. Love, love, love, love cvicu.
And then I was approached about being on the rapid response team at my hospital, which I was like, well, what's that? That sounds, I like the title. I like, I'm told I'm pretty fast, I can do rapid. And so rapid response was just the perfect mix of all the things I love. It's like the rapid response and figure out what's wrong and diagnosis and treat, like the er. But then it's like all of the critical thinking and analyzing and Sherlock Holmes of what's happening with this patient that ICU gets to have. So I got to kind of bring together the two worlds of nursing that I loved. And there is so much opportunity for teaching as a rapid response nurse. So the educator. We really love that. So I love rapid response nursing. And then I finally graduated with my master's degree in nursing education. It took me freaking ever. There's a lot going on in my personal life at the time. And so then I worked as a nursing professor for one year, which was great. With regards to nursing students, I love nursing students.
I wasn't quite ready for academia, faculty meetings, and nursing research and, like, all that stuff. I still had just so much, like, energy in me. Like, they called me energy Bunny. What is it? No, Energizer Bunny. And I was like, I don't really like that term. So I was a nurse person for one year, and then I became the ER nurse educator, actually, at the hospital that I had started out at as a new grad.
Loved being the ER nurse educator. What a great fit for me. I get to teach literally alongside nurses with their patients. It was so much fun. And then Covid hit, and that's when I was like, as much as I love teaching, I want to be in the trenches. I want to be doing the work. Give me the ppe. Don me up. I'm ready to go. And so the hospital I work at now did not have a dedicated rapid response team back whenever Covid all started in 2020. So if a rapid response was called, the ICU charge would have to leave the ICU and go respond to the emergency. Which was okay until Covid, when, like, the whole hospital sicker. The ICU has more ventilators. The nurses on the medicine floors have higher acuity patients. Nurses are leaving in droves. And so it was just a bad time to be pulling the ICU charge away from the ICU to go respond emergencies. So I actually pitched the idea to our hospital leadership to start a dedicated team, which I had done that role before at a different hospital. I knew what rap response nurses do.
So I started the team. I got to hire the best nurses in the hospital to come be on this team with me, Kind of raise them up, set the culture, started the foundation of it all. I loved rapid response nursing. Still do. But then I missed being an educator. I was like, man, I don't have educator on my badge anymore, but it is still running through my veins. I still want to teach, but, you know, whenever you're running to emergency for emergency emergency, there's not always time to, like, deep dive into pathophys and the why behind this particular pharmacology. And so I. I just felt like something was missing. Like, I still wanted to give more, but there's just no time in my shift to do that. It's actually my husband who said, why don't you start a podcast? Which I thought was hilarious, because anyone that knows me knows that I absolutely do not have any tech skills. I'm horrible. But thanks to YouTube, I figured out how to record myself and how to make a podcast. And I released some episodes where I got to, like, share real stories of patients I cared for, obviously, like HIPAA appropriate, and then use the story as like a case study to break down that pathophysiology and the pharmacology, all the nerdy stuff that I love to teach about. And I released them into the world of podcast. And I guess it was a need that nurses had is to feel empowered and equipped to respond to emergencies. And the podcast kind of just blew up. So that's a long introduction to where I am now. I work as a rep response nurse part time in the hospital, and I spend the rest of my time preparing for and recording episodes that teach nurses how to recognize and respond to emergencies.
[00:11:06] Speaker A: Awesome. Awesome. That's a lot, Sarah.
That's a lot. But very insightful, very informative. And I can just hear your passion for just sharing your experience and your knowledge with others, with fellow nurses and so much. So you have the rapid Response Academy do.
[00:11:26] Speaker B: Yeah.
[00:11:26] Speaker A: Yes.
[00:11:27] Speaker B: So it started out just a podcast, which is just me recording. Well, it started out with me recording literally in a closet, like, with coats all around me, literally in a closet with like a 15 bike from Amazon, just, like recording these episodes. And as the podcast grew, then I got better equipment and I actually tore down a wall in my closet and created like a bigger space, which you see me in right now. So it started out very small, grew a little bit bigger, and then I was like, man, as much as I love making these podcasts and I know they're so helpful, I hear about for nurses all the time how beneficial they are. I am an extreme extrovert. Like, I love interacting with people face to face and, like, just. I'm just a people person to the max. And creating podcasts can be a little solitary, you know, especially if you're Just doing a solo show, like, by myself, just, like talking into a microphone. I mean, I do love it, but I have this need to, like, support and equip and coach and, like, come alongside. And so that's when I started Rapid Response Academy, which is different than the podcast because it's not just me recording, editing, and then submitting. I actually teach live every single week in Rapid Response Academy. I have nurses from all over the globe, which is so cool, so crazy to me that I get to support these nurses I could have never met in person. And so nurses are over the globe for all different specialties. There's oncology nurses, there's pediatric nurses, there's ICU nurses, there's medicine nurses, there's ER nurses, there's rapid response nurses, there's critical care transporters. All, like, the whole gamut are in Rapid Response Academy. And I get to teach them again from real life stories. But I even deeper dive in the podcast, and because it's live, they can ask questions. You know, when you're teaching, you know this Chanel, sometimes you're like, going, going, going. Makes sense to you. But you see their faces and you're like, okay, I clearly I'm not making sense to them. And so I could, like, back it up a little bit, explain it a different way. You know, things that I just like, breeze to be like, hey, can you. Can you say that one more time? Can you slow that down? Can you explain that? I'm like, oh, okay. Yes. And I love the opportunity to kind of engage with the people that I'm teaching and make sure that what I'm saying is making sense and actually landing.
[00:13:34] Speaker A: Yeah.
[00:13:35] Speaker B: And then it's a chance to. To support, like, the whole community aspect. So nurses can ask questions not just about what I'm teaching at the time, but, like, throughout their week. Hey, I had this weird case. What do you guys think about this? Hey, here's a picture of a patient's ekg. What the heck is this? This is my patient's law values. Why is there sodium doing that? Like, I love being able to support nurses throughout the week as well. So that is Rap Response Academy. It's like this weird thing that I have never heard of before that I was kind of created for this community of nurses. And it's been so, so life giving to get to walk with these nurses on their nursing journey and see them thrive and celebrate their wins with them and walk them through the challenges. It's been so rewarding.
[00:14:12] Speaker A: Yeah. So just going all the way back, you started Nursing, basically you got your nursing license at 19 years years of age. So you've.
[00:14:20] Speaker B: Yeah.
[00:14:20] Speaker A: Overall, how many years of nursing would you say that you have?
[00:14:26] Speaker B: I'm coming up on 21 years. This April will be 21 years.
[00:14:31] Speaker A: Awesome. Awesome. You've been nursing for a long time.
[00:14:34] Speaker B: Yeah, it doesn't feel like it. Yes, this is flown by this 21 years. But yes, it's been a good, it's been a long time.
[00:14:41] Speaker A: Yes, I've been up, I've been nursing for about 13, a little bit over 13 years and I feel like the time just passes by and I feel like nurses nursing preserves us. Like you can't afford to get older because you're too busy taking care of others.
[00:14:55] Speaker B: Right. We got important work to do.
[00:14:58] Speaker A: Too busy saving lives. Too busy saving lives. And so with starting nursing so young, because I have to ask for my nursing students who may be tuning in. What would you say some of your biggest challenges were in nursing school as well as some of your, your motivation? Like what was some of your biggest challenges and on the flip side of that, your motivation?
[00:15:22] Speaker B: I think a lot of my biggest challenges were somewhat self imposed.
You know, as a, being the youngest person by far in my department, I wanted everyone to like me and to think well of me. I was such a people pleaser and honestly, I still struggle with this. It's not like, oh, I'm not anymore. No, I, I would say I am a recovering approval addict. It's always in there speaking to my subconscious and I have to be like, no, no, Sarah, that's not the priority. No, Sarah, that's. We don't have to please everybody. Right. And so I'm still working on this, but I think it was a bigger barrier when I was 19, 20, 21, wanting people to approve of me than it is now as a 41 year old where I'm like, I'm sorry if you don't like me. Sucks for you. It just doesn't bother you as much as it once did. So I think wanting to get everyone's approval was a big barrier because then I said yes to everything. I didn't have good boundaries, I didn't take care of myself. You know, I would sacrifice sleep, I would sacrifice food. I would say always self sacrificing, which is a good quality to have. But I think that there's, there's has to be some sort of balance where you recognize like what is the end goal, what am I trying to achieve, what really matters. And I finally have learned how to say no. And how to, you know, take care of myself so that I can take care of others. Right. I want to show up to work with a full cup, not just like scraping the bottom of the barrel trying to care for these sick people. If I show up full of life, full of love, full of compassion, I am a better nurse.
[00:16:53] Speaker A: Yeah.
[00:16:54] Speaker B: I have so much more patience, I have so much more empathy when people are maybe difficult or draining versus if, you know, I'm not taking care of myself and I'm hypoglycemic and I'm sleep deprived and I'm over caffeinated and I have a peed. I might be a little more snippy and a little less, maybe even a little less clinically competent because there's so much happening with my physical body that I can't recognize what's happening with their physical body.
[00:17:17] Speaker A: Yeah.
[00:17:18] Speaker B: I can't recognize those clinical changes in the patient.
[00:17:21] Speaker A: That's good.
[00:17:22] Speaker B: Okay, so I. One thing that I would say to a new grad is welcome to nursing. It is not going to be easy. But do not overwork yourself. This is a very challenging profession. And if you want to be able to do it well and do it well for a long time, which that is the goal. Right. It's a very rewarding profession. You had to, you have to take care of yourself. And that means maybe not picking up as much overtime as you feel pressure to pick up. That means maybe not being on every committee they want you to be on. I, I was on every committee, they're like, you want to be on this? Sure. Can you be on this committee? Yeah. Can you help us with this? Of course I can. Yeah. I said yes to everything, which is not, it's not horrible. My intent was good. I wanted to help. Right. But I've learned to say nope. I don't have the bandwidth for that. Nope. Because when I say no to something, that actually means I'm saying yes to something else. Maybe I'm saying yes to a full night's sleep. Maybe I'm saying yes to more time with my family members. I'm yes to, you know, more time for self reflection to slow it down. Right. It's okay to say no if I'm saying yes to something that's important in my life. And part of one of those important things is taking care of myself.
[00:18:28] Speaker A: Yeah.
[00:18:29] Speaker B: That is my advice for if I could go back to 19 year old Sarah, I would say, sweetheart, they don't all have to like you. You don't have to say yes to everything. Take care of Yourself, so you don't get burnt out. Because this profession, it will burn you out if you are trying to, like, operate on an empty tank. But if you got a full tank, man, it is to me the most rewarding profession in the world. So that's my advice to a younger nurse.
[00:18:55] Speaker A: Thank you so much for that. And just with the cup analogy, I even take it a step further because, you know, it's one thing to keep our cup full, but we also have to remember what's in the cup is for us. So you got to keep your cup full, but also when you keep your cup full, when it starts to overflow, the overflow is for everyone else. So I just show just how much more important it is to fill your own cup to make sure you're eating, resting, taking care of your own health, your own mental being before you get out there and start helping somebody with theirs, their health, their mental being. So thank you so much.
That was really good insight, really good insight. Getting into patient perspective because I, I can just hear the passion, the empathy and the compassion that you have on patients. And just in your role as a rapid response nurse, what is your perspective when it comes to caring for patients, like just being in the ED or the er? I know that you can get a lot of patients. I've never worked in the er, so I didn't get to see a lot of the patients that came into the hospital setting. I only got to see the ones that were worthy enough to be admitted.
[00:20:15] Speaker B: Right.
[00:20:15] Speaker A: But in the ed, you get everyone. Like you're the first line of communication for patients. So what, what is your perspective when it comes to taking care of patients and how you interact with patients from the ED to cvicu. More importantly now, rapid response nursing, which we'll dive into the world of rapid response nursing as well. So I think they all kind of like tie in, but what's your perspective?
[00:20:41] Speaker B: So I, to back it up a little bit, I feel like nursing is actually a calling and not just a profession. It is a profession. We had to work hard for a degree. It is not just missions work, it is, it is a profession. Right. But for me, it's more than just a job that brings home income, which I'm grateful that it pays me. I'm not volunteering, but because for me, it's a calling. I have to like, make the mental shift and the mental effort to see every patient as a human soul that God has put in front of me to care for.
Now some of those human souls are much easier to care for than others. That does not mean that I'm just like this perfect angel that's like, oh, come, come, everyone. I will. No. There are some times when people are being inappropriate and I have to put my foot down and set boundaries for the patient's behavior. But I think that if I can just kind of try to see through some of the facade, some of their gruffness, some of their rudeness, some of their straight up meanness, their drunkenness, their inappropriateness. If I can see through that and see this is a human soul that God made and God loves, how can I care for them? Well, you know, even like our example of Jesus, he was not just like soft and squishy to everybody. There were times when he called out wrong behaviors. There were times when he was tough. There are times like, we don't have to be like, lovey dovey all the time. There are times I've had to tell patients, you cannot talk to me that way. That is an inappropriate way to behave in the er. Let's talk about your behavior. Like, you cannot call me that. So I'm not saying that I'm just like, open arms and every single patient, no matter what they say, doesn't hurt me.
[00:22:23] Speaker A: No.
[00:22:24] Speaker B: I put my foot down when things are not right and recognize that I am also, you know, God's child and deserve, like, respect.
[00:22:32] Speaker A: Yeah.
[00:22:33] Speaker B: But I will also show that same respect to every patient. And so it's especially easy to get jaded in the ER because you really do see the worst of humanity. You know, people that just committed a crime just harmed someone else, just harmed themself. They're, you know, high on drugs, they're short on sleep. Like, people don't show up in their best form. And so you really get to see maybe a part of society that you hadn't been exposed to before. Especially as a 19 year old, I had not met so many mean people in my life. But I had to learn to be like, it's still someone that God doesn't trust in my care. So how can I show up for this patient and show up for myself in this moment? So I always joke that, like, I'm. I must have looked like such a chameleon to the patients because I go in one room and I'm like, hi, Ms. Johnson, so nice to meet you. I'm Sarah. I'll be helping take care of you today. How are you feeling? You know, holding their hand, speaking in my sweet Sarah voice. And then I go right across the curtain. I'm like, Mr. Johnson, you're gonna lay back in bed. You cannot be acting that way. Put your penis away. No, sir. You got. And then I go to the next room, and I'm like, joking around, and in the next room, I recognize this there's gravity situation. And so then I'm talking very seriously, you know, being. I can totally change how I am acting. It's not. I'm not a different person. I'm still the same Sarah. But I can kind of like sense the room and recognize what each patient needs. And some patients need humor, and some patients. It's not a time for humor. And some patients need firmness, and some patients need support, and some. Everyone needs something different. So what has God given me that I can then give to them in this situation, in this moment where they show up to the ER4, where they show to the ICU4, how can I support them through this season of their life? That is my calling. It is a constant challenge. But I am always up for a challenge. So I. I forgot what your original question was, but I might have answered it.
[00:24:31] Speaker A: I think you answered it. You answered it, Sarah. You answered it. Just your patient perspective. And you did such a good job. And for nurses, like you said, and I agree that for me, nursing is a calling.
And unfortunately for some, they think it's just a job. And when you look at the whole. The whole shebang, maybe it's a job for some, a calling for others, but we have to do the job well.
We still have to do the job well, which, like you said, we're taking care of humans.
We have. We have to see them and treat them how we would want to be treated, and hopefully we want to be treated well.
You know, that's the main thing. How do we treat ourselves? Hopefully, we want to be treated well. So how do we go into the workplace and in the workspace of nursing and treat people well? And I love how you said when you go into different rooms, you may have to be firm here, you may be a jokester in another room, you may, you know, have to be more serious or empathetic due to a situation. But either way, you have the ability to read the room, read the room. And I used to stress that all the time to nurses if I was training at the bedside, like being able to read a room, you can't go into each room and just start checking off tasks like they're human. Knock on the door, you don't. And my coworker will say, you don't just go to someone's house, open up the door, Go in and sit down or go moving around in there.
[00:26:06] Speaker B: Right.
[00:26:07] Speaker A: So we shouldn't do the same thing to patients who are grownups, depending on which setting you're in. They're grown ups who's confined to this room that doesn't have a lock on the door. And we just proceed in, don't introduce ourselves half the time, don't acknowledge them. So I'm just glad that you're able to break down your patient perspective in a way that the humanness comes across.
Thank you. Thank you. Now, Sarah, getting right into our last topic, which is your educational insights where I'm excited because we're going to dive right into rapid response nursing. And I just realized that because at the facility that I work for, we have the ICU nurse who's the rapid response nurse or the MRT nurse. I mean, there's probably, or I probably say one or two per shift. I mean, I'm not sure about other organizations, but you have a rapid response team.
So you're not confined to other roles and responsibilities of the icu. But we're about to figure it out because that's my next question when it comes to rapid response nursing. Tell me more about your role, your responsibilities, and what that looks like. Like, sure.
[00:27:28] Speaker B: So I don't have a team of patients I'm responsible for. I mean, technically I'm responsible for the whole hospital. Right. But I don't have patients that I'm supposed to be administering medications to and looking after.
So my job is to not only respond to emergencies, but also to prevent them. And so we respond to all rap response calls. Stroke alert, STEMI alert, sepsis alert, code blue, mtp, PE alert. Like basically every emergency that could happen, we show up and either lead the whole thing or we're actually set of hands wherever we are. So example, if an MTP happens in the icu, there's already ICU nurses there. So I'm just the second set of hands helping to run the rapid infuser. Right. If I show up to a stroke alert in the er, the ER nurse is trained to handle a stroke alert. I'm just exercet of hands to expedite getting the patient a CAT scan and getting the TNK if it's appropriate. Right. But if I show it to a code blue on the med search floor, I'm leading the whole thing. Yes, a provider will come, but as far as, like the facilitation of this whole code going down smoothly, that is the rapid response nurses role.
And then as far as preventing emergencies When I'm not responding to some call, I like to prevent them from ever happening. And so we round on the floors, we had this thing called nurse consult, where nurses can consult us if they have a question about a patient or a concern. So just like a doctor can consult a specialist when they want them to weigh in on the case, like, they'll call the cardiologist to come, you know, talk to me about my patient's heart condition. This is your specialty. See, my specialty is critical patients. And everyone on my team, we have years of experience in either ER or ICU nursing. We're all certified in our specialty. So CCRN or CEN or both. And so when nurses are like, is this patient getting worse? Should I be worried about the way they're breathing? Their eyes look different. Is that concerning? Questions like that, where the vital signs aren't quite terrible, but the nurse knows something's up, they'll call us and say, like, hey, Sarah, when you had a chance, will you come see 285. I don't know, his breathing's weird or his belly looks different today than it did yesterday. I'm just curious what you think. And let me tell you that nursing intuition has allowed us to catch so many patients before they decline. I feel like vital size is one of the later things to show up. But that nursing intuition, nurses who are really present with patients and know what their baseline is, they're able to say, like, he was much more with it yesterday. His breathing was much less labored yesterday. His belly didn't look like this yesterday. He's. He's not quite responding in the way he usually does. His speech is different. Right? All those little things that aren't going to show up on the vital signs machine, those are the things we want to catch early on. So we do nurse consults, catch a lot of patients that way. We also pull what's called the MUSE Modified Early Warning Score. So when vital signs are taken, our computerized charting system actually auto populates the score for every patient. And we have a way of pulling all of the high scores and just kind of going through those charts and kind of weeding out is, how's this patient doing? How are they trending? And that's a way to catch the patients that are like, not terrible, not maybe not needing a rapid response. Right. The heart rate is 115 and the blood pressure is 96 over 50. So not like, oh, my God, but it's kind of trending. The heart rate's getting a little faster and the blood pressure's getting a little bit lower. Like, maybe you got a little sepsis bruin, Right?
[00:30:46] Speaker A: Yeah.
[00:30:46] Speaker B: Or maybe the patient's getting fluid overloaded. Or maybe, like, we've been able to catch a lot of patients through Muse as well. So between just walking around and seeing people and nurse consult and the Muse, we're able to catch a lot of patients before emergencies ever happen. And what's really cool, at least for our hospital's data, we've been able to cut the amount of code blues that happen on the menstrual floors in half since we started our dedicated team. But I want to attribute that success not to the fact that we exist and that our clinical skills are great. It's that because we're being proactive.
[00:31:17] Speaker A: Yeah.
[00:31:17] Speaker B: And because nurses feel empowered to speak up and say something before it's a rapid response. Right before, like, oh, we don't want to bother the ICU nurse. I know they're busy. I don't want to pull them away from that. We'll wait till it's really bad and then we'll give them a call. We'll wait till the vital signs are tanking, then we'll call a rapid response. No. When we can. When they have access to a nurse consult and we can, like, get things taken care of before. It's a huge problem. We're preventing a ton of code blues. And so that's been really rewarding to be a part of not only seeing the culture shift around emergencies, but seeing patient outcomes improve because of it.
[00:31:48] Speaker A: So. Yes.
[00:31:49] Speaker B: So on a day to day, to answer your actual question, I am either responding to an emergency or preventing it. Preventing it either through a nurse telling me something's up with my patient or the muse flagging on the patient and me going and seeing the patient proactively. That's what I do all day long. Every day is different. I feel like some days are like cardiac days and some days are respiratory. It's like, it depends, but it's a. It's a whole mix. We respond to every single floor from labor and delivery to the front lobby to we have a duck pond in our hospital to the duck pond out right outside. Like, you just never know what you're going to get as a rapid response nurse.
[00:32:23] Speaker A: Yeah.
[00:32:23] Speaker B: But the way that I'm wired, I love that. Yeah. Like, I remember I was training one of our rap response nurses, and he's like, hold on. So when you get the rap response page, it doesn't tell you, like, what you're going to like. It's respiratory or like it's a hypotension and there's no way they could, like, tell you what you're. What it's going to be or like what the patient's name is. We look them up. I was like, no, bro, it just says Rapid Response 331. You'll figure it out when you get there. He's like, oh, my gosh. But there's no way to, like, prepare. I just, I'm like, yes, I know. I don't want them to take time to tell the operator I have a rap response at 331. It's a hypotensive patient, 75 year old, with a history of. I'll figure it out when I get there. Just call the rap response and I'm gonna come running. And so for some people, maybe they don't like that. They wouldn't like the absolute surprise. Not know what you're walking into. But I'm the weirdo that loves that kind of stuff. And so I love property spots nursing. It's. It's so much fun.
[00:33:21] Speaker A: I love it. I actually had a friend who had to do a rapid response on two of her patients, and she's a new nurse and she just, she was beating herself up for having to use the rapid response team. And I was like, no, that's what they're for. And I was like, I commend you because you actually utilize rapid response team. The rapid response team. And the patient outcome was better because of it.
[00:33:50] Speaker B: Right, Right. That's the difference. Yeah. I tell.
[00:33:52] Speaker A: The reason why you're.
[00:33:53] Speaker B: There is no apologizing for calling around for response. I hear it all the time. Oh, I'm so sorry. I had to call you. But no, girl, take it back. You are not sorry. Instead, you get a high five for recognizing your patient's declining, for speaking up and advocating for utilizing your resources. This is not an apology. No apology exception. No apologies. Instead, strong work. When you call rep response, it's a sign that you are paying attention to your patients and you're speaking up for them and getting all hands on deck. This is not something we apologize for. Absolutely.
100%.
[00:34:21] Speaker A: Thank you. Thank you.
Now, how can nurses better collaborate because of that. That new nurse, or I want to say more like new nurses, I think you just gave him that, that push to say, hey, it's okay to call a rapid response on your patient. That lets us know you're paying attention. But how do they communicate to that rapid response nurse that's not as nice or welcoming as okay, so the art.
[00:34:56] Speaker B: Of the sbar is just so valuable, I feel like. Because nurses maybe feel bad about calling. What I hear all the time when I show up, say, hey, guys, what's going on? They say, he was fine. He was fine. He was just fine. He was fine. I can't tell you how many times did I hear he was fine. I'm like, I'm sure. I believe you. I'm sure he was fine. What I really want to know is, what's he here for? What happened last hour? What concerns do you have? You don't even have to have it figured out as to what happened. People, they're like, I didn't want to bother you. I was waiting until we get the labs back. I was waiting to see if the blood pressure got better. Don't wait. No, call me whenever you're concerned, and we will figure it out together. I don't know either. When I show up, what's wrong, it takes me a minute to, like, gather the details and, you know, do some critical thinking and put the pieces together, figure out what is wrong with this piece. And even then, I don't always figure it out. Right. You do not have to have all the answers before you call the rapid. You just, you know, something's up, you call a rapid. We show up. We. We will figure this out together. So that's my thing there. Don't wait till you know what's wrong. Don't wait till you've tried to fix it. Like, the nurse is like, yeah, we've been taking the blood pressure for the last 20 minutes, and it's just not cycling. I'm like, no, no, just. If you can't get a blood pressure read in two taps, it is time to call a raptor's class, right? There's something wrong if you can't get the blood pressure machine to read.
And so, yeah, don't wait. Just go ahead and call. And then when we show up, maybe just instead of trying to defend yourself, just try to give us details you feel like are important, what they come in for, what's happened in the last couple minutes, anything that we should know that might be concerning. Like, they just came back from surgery, they just had a new dose of antibiotics. They just. That anything that might be. Just happened recently we'd want to know about. But you do not have to have their whole medical history memorized. Like, and then in. In 1987, they had an appendectomy. And then they also. I want to say it's their left.
Left toe. Like, no, no, I. They're having chest pain. I just want to know, like, have they recently had a medication for blood pressure and now the blood pressure's low? Like, just stuff that kind of relates to this particular case. And then you don't have to tell me what you think it is. You can, but don't feel like you have to have the answers. Just tell me what you know so far, and we will figure out the rest together. Nurses will apologize, like, I'm sorry, I didn't know, you know, about his. Blah, blah, blah. I'm like, buddy, you just got the patient this morning. Like, I don't expect you to peruse the entire chart, and you've been here for an hour and a half. Like, it's okay. Yes, I know that. I just read it in the chart. But, like, you haven't got to go read the chart yet. You've been busy on the floor. Like, I totally understand that. And then as far as, like, handling maybe a not so friendly rapid response nurse, I have lots of thoughts there. As far as handling them, I think just, like, stick to the facts and try to, like, lower your defensiveness and just try to give the information. And if they get a little aggressive and say things like, why would you in college for this? Or like, this is not an emergency, you just say, thank you so much for teaching me. You do not apologize. We do not apologize for doing our job. You will never hear me say, hey, doctor, so sorry to bother you. No, I'm not. I'm not sorry. It's your job to answer the call when your patient's declining, right? You will never hear me say, oh, so sorry about that. I just say, thank you so much. Thanks so much for taking my call. When the nurses tell you this is not an emergency. Thanks for letting me know. You just say, thank you for them providing education, providing whatever they're providing. But you don't have to apologize for calling a rapid. You don't have to apologize for being a patient advocate. It's okay to call a rapid response and it not be an emergency. What's not okay is to not call a rapid response because you don't want to hear the, you know, pushback from them. And then your patients actually have an emergency and no one is there. So I would rather you call and it be nothing at all than to not call for fear of some sort of backlash from the team.
So that's my take on it. And they don't all have to like you. It's not a bad. It's not Like a people pleasing game. If they're upset because you advocate for your patient, that is their stupid problem. That is their own stuff. They gotta deal with themselves. Your job is to advocate for your patients, not to make the rapid response team like you. So you keep doing your thing, keep being an advocate. That's what you are called to do.
[00:39:01] Speaker A: That's awesome. That's awesome. When, when I hear you say that it's, it's okay when they, if they don't like you. I try to tell new nurses and interns, because I work in staff development, that that's between them and God when they have a bad attitude, you know, as you go out in these units, especially as interns, because you're not necessarily in clinicals and you're not necessarily in the role as an employee as far as like in licensure role. But get to know your unit, get to communicate with them, show up, speak, and get to know them because you're interviewing them just as well as they're interviewing you. And speak to the physicians. Because my next question I got for you, and how you advocate for patients and nurses when it comes to speaking with providers, when it comes to your role as a rapid response nurse. Because a lot of times you have to provide interventions. But going back to those interns, I tell my interns, try to form those relationships with the people that you're working with and the providers. And when you get that mean nurse or that mean provider, they have to take that up with them. God, like it's not on you, their bad attitude. Absolutely, yes.
[00:40:12] Speaker B: You know, one thing I discovered is I feel like it's impossible to say I don't care what people think. If you don't care if people think you are either a psychopath or you're lying right now, because everybody cares what people think. That's just human nature, right?
[00:40:27] Speaker A: Yeah.
[00:40:28] Speaker B: What I've discovered in my older wisdom, if you want to call that, is that I don't have to care about what everyone thinks. I can pick and choose whose opinions I actually am concerned about. So, for example, my husband, he's a, he's a saint. I adore him. And I, I do want him to think well of me. Right? So it's whenever he's upset, whenever I offended him or said something that maybe hurt him that I'm upset about. I do care what he thinks. My boss, Brian, I look up to him so much. He's one of the smartest people I know. And I work hard to develop that relationship and to make sure that we're, you know, communicating well. But like Dr. Jerk who doesn't care about my patients or me who is acting annoyed at my advocacy, I don't have to care. Like, his opinion of me does not matter because he's someone I have not chosen to try to get them to think highly of me. He can think whatever he wants about me. It doesn't. It ain't my business. So it's okay to still care what people think, but just ask yourself, is this that I actually care what they think? Is this someone whose opinion actually matters of me? Is it someone who I look up to, someone who has looked out for me before, someone who is kind, someone who's an example of what I want to be? Those are the people that it's okay to care what they think. But if it's someone that you're like, man, this doctor is always me. This doctor doesn't even care about my patients. That's not someone you need to worry about them finding you annoying or that you find them thinking that you're being bothersome. Okay, whatever. They can think whatever they want. It doesn't affect you.
[00:41:54] Speaker A: Right?
[00:41:55] Speaker B: Okay. That being said, whenever it comes to at the bedside, how we act, it's still important that we look like a team to the patient. Because if I'm being all sassy nurse with the doctor, and I think that's advocacy, that is actually not helpful for the patients to see that. The patients need to see that we are on one team. So if you have some pushback about what's being ordered or not being ordered, the patient, you gotta find a way to do that in the hallway. So my phrase is, hey, doc, I have a question for you. Can we just talk in the hallway real quick? Or hey, can we sidebar over here? Or I wanted to share something else with you. Can we. You just step over here with me. I will never do it in front of the patient. Because then that makes the patient question that they're getting the best care. Because these two can't agree.
I never want them to see that. But that doesn't mean I don't. I don't share what I'm concerned about. Right. I'll just pull them to the side and kind of have that conversation over there. And then you learn ways to that are more effective in advocacy. If I say, doctor, we need to do, blah, blah, blah, blah, blah, blah, I mean, maybe that's effective. Probably not, because that's going to hit their pride and they're going to push back. Instead, I'll say, hey, I've noticed this, this, and this. And I was concerned about this. What are your thoughts about blah, blah, blah? How would you feel about doing this? Have you considered this? At what point would we want to do X, Y, and Z? So. And basically, I just don't take no for an answer. I just keep asking questions until they straight up tell me we're not doing it because of blah, blah, blah. And then if, for whatever reason, I still feel like this is not okay for the patient and this is very rare that I get to this point, then I take it above their heads. But for the most part, whenever doctors are, like, hesitant to order things or hesitant to respond, I just keep pushing back and say, okay, so you don't want to do a CAT scan, but at what point would you want to do the CAT scan? At what point would the patient's vital signs be concerning enough for you to order this lab value? At what point would we upgrade to the PC? Are we waiting for the oxygen saturation to get to the 80s? Or, like, what is the cutoff for you? At what point would you want to. Like, I just want to be very clear and I want them to think about it. Maybe we're at that point.
[00:44:00] Speaker A: Yeah.
[00:44:02] Speaker B: So I never just feel like, okay, doctor said no. Like, I just, like, keep pushing back until they straight up tell me their rationale for not doing the thing that I feel like is important.
[00:44:11] Speaker A: Yeah.
[00:44:12] Speaker B: So I try to reserve those for when I have to use them. But for the most part, honestly, the docs I work with are awesome, and we collaborate so well, and I think the patients can see that. But every once in a while, there's a couple little bad apples that I have to be like.
Not on my watch, but, yeah. You ever heard the phrase you have to cuss at the doctor? Have you heard this before? C U, S. C U, S. C. Okay, so C U S is an acronym. So cheesy. But it's so helpful when the doctor is. Or the provider, nurse practitioner, PA, Whoever is not really responding the way you feel like the patient deserves or needs. The first level of cussing of the doctor is C, and that's dropping the C word, which is concern. I am concerned about the way the patient's breathing. I have concerns about the patient's change in mental status. I'm really concerned about their blood pressure, how it's done this. I'm concerned about giving this medication. Knowing this history, I'm concerned. And when they hear concern, they should be like, okay, if that don't work, the Next thing you do is you drop the U word, which is, I am uncomfortable. I feel uncomfortable with proceeding, doing. I feel uncomfortable not doing this. I feel uncomfortable giving this medication because of blah, blah, blah. I feel uncomfortable leaving the patient here on med surg and not going to pcu. I feel they drop the U word. I feel uncomfortable. If you feel uncomfortable, the doctor should question, am I doing the right thing?
[00:45:31] Speaker A: Right.
[00:45:32] Speaker B: And then finally, if the C word and the U word aren't working, then I drop the S bomb, which is, this is unsafe. I do not feel safe proceeding because of blah, blah. This is unsafe for the patient. Patients deserve safe care, and this is not safe. Now, I rarely use the S bomb, but when I have to, I will bust that thing out. So sometimes you got to cuss at the doctors, but respectfully and with your intention always being to advocate not to prove your point and to like, you know, one up them, that doesn't go anywhere. But if your intention is always advocacy, if your intention is always the patient's best interest, that will shine through. And then one last tidbit, little, little tidbit of wisdom here. Sometimes you can, like, implant the characteristic that you want to see in the physician. And the way that you, the way you speak. For example, I would say, doctor, because I know you care so much about this patient, I was thinking you might want to do blah, blah, blah. Doctor, because you are always such an advocate of safe care. How do you feel about blah, blah, blah? Doctor, Because I know that you are somebody who always responds so promptly to the nurse's concerns. I wanted to let you know.
[00:46:47] Speaker A: Yeah.
[00:46:48] Speaker B: So basically you just, like, put whatever quality you want them to show.
[00:46:53] Speaker A: Yeah.
[00:46:53] Speaker B: And then they're like, oh, yeah, I am that kind of doctor. I am the kind that, like, shows up when the nurse is concerned. I am the kind that responds to the patient's needs. I am the one who, you know, is an ally for blah, blah, whatever it is that you want them to do. You kind of like, because I know you are blah, blah, blah. That's a little, little tidbit.
[00:47:12] Speaker A: That's good.
[00:47:13] Speaker B: Call manipulation or just call it wisdom, I don't know. But I've definitely seen that be helpful.
But you know what? I've never wanted to be like, well, the doctor said no, moving on with my day, Right?
[00:47:26] Speaker A: Yes.
[00:47:27] Speaker B: I was walking past a patient's room and I happened to see on the monitor the heart rate was like 180. It was really hot.
I was like, looks like my robot. So I like, backed it up and I walked in the room, I was like, hey, there. I'm Sarah. I'm the rapid response nurse. I noticed your heart rate's really. Hi. How are you feeling? She goes, I feel a short breath, but I feel okay. But, yeah, my heart. I feel it just racing on my chest. So I cycle the blood pressure. Blood pressure's okay. It's like 105 over 60. So kind of low, but not, like, terrible low. And so I went. Got the nurse. I was like, hey, your patient's just tacking away in there. How can I help? Because. Oh, I already told the doctor. I was like, God. Okay, cool. What are they. What are they ordering? Can I grab it for you? She's like, he didn't want to give anything. I'm sorry. Doctor knows their patient's heart rate is in the one. Everyone's 161. It was fast, right?
[00:48:19] Speaker A: Yeah, it's.
[00:48:19] Speaker B: What's about 170? The doctor knows the patient's heart rate is 170, and they didn't want to give anything. She's like, yeah, he said it was going to. There's nothing he could give. That went and lowered the blood pressure, and the blood pressure is already kind of soft. And I was like, okay, so. So what's the game plan? She's like, he said they would be doing rounds soon, so. Okay, so that's a great example of nurses just doing the minimum. Like, I noticed a change in the patient. Notify the doctor. Done.
[00:48:48] Speaker A: Yeah.
[00:48:48] Speaker B: No, you're not done. Your patient could continue to decline. Right. So I called the same doctor, and I told him the same information that she did, and he's like, yeah, I just. I didn't want. This is a resident, by the way. I didn't want to order anything, you know, because everything that I could give for the heart rate is going to lower the blood pressure, too. The blood pressure is already low. It's like, okay, all right, I hear you. I. I have concern for blood pressure, too. My concern, though. Here's my C word. My concern is if we don't give anything, the blood pressure will keep dropping because there's no field time for the ventricles, and cardiac output is going to continue to go down. So either we give something to lower the heart rate and prevent this whole problem, or we're going to end up having no blood pressure to work with at all, and then we're going to be shocking the patient out of this. So which medication would you like to give? A beta blocker or a calcium channel blocker? I Did not give him an option. It was just, which one are we giving? And he's like, well, they're both going to lower the blood pressure. I was like, yes, doctor. Here's the thing. We have things to treat blood pressure, right? I can give volume. I can give vasopressors if needed. But what I can't fix is when the patient has no cardiac output, no perfusion to their end organs. So which one would you like to give? I'm happy to have some fluids ready to go to raise that blood pressure. I also know how to have, like. I can start vasopressors, but what I can't do is allow this patient to keep tacking away the 1-80s without some intervention.
[00:50:09] Speaker A: Yeah.
[00:50:09] Speaker B: And he's like, hold on one second.
Okay, now again, Usually I would be like, no, but because the patient is still talking to me and wide awake, I have some time. So I'm like, waiting, holding, and I hear him talking to, I guess, his attending. And he comes back the way he goes, is this Sarah? I was like, yes, Sarah from the rapid response team. And he goes back to the doctor. He goes, yeah, it's Sarah. Okay. Okay. My attending says just to give whatever you want to give. Well, I would give 15 of cardism. He said, okay, hold on. She said 15 of cartism. All right, go ahead and give it, and we'll be there soon. I was like, okay, you got it. And I'll also. Can I get fluids and blood pressure drops? He said, yes. 500cc's okay, got it.
[00:50:50] Speaker A: There we go.
[00:50:51] Speaker B: So whatever. The point is, I wasn't just like, all right, doctor notified, done.
I feel like my patient needed a little more. And so I kept pushing until I finally got what was needed. Yes, do that what you will.
[00:51:02] Speaker A: Yes, that's a good example. And the nurse and. And they just may not know. I've seen it in CVICU where the newer nurses, of course, they go all night, and in the morning, I'm getting reports, and they're like, oh, their blood pressure been stable all night. Their blood pressure stayed at the systolic at 90 or above 90. But yet their vasopressor, they've been doing something to maintain that systolic blood pressure. And I was like, okay, well, let. Let's talk about this. Something is going on because you're having to intervene to keep this blood pressure up. And even in addition to that, when we talk about respiratory status, patient's intubated, and we're constantly pressing the O2 breaths.
[00:51:45] Speaker B: Right?
[00:51:46] Speaker A: The 100% O2 for two minutes.
And it's like, wait a minute, you're having to do something to help this patient. Something is going on. Call respiratory, you know, so I'm glad you mentioned that. That's awesome. That's a great example. Thank you for sharing. Now, Sarah, as we wrap up this episode, because you've given us just some great insights on rapid response nursing, your patient perspective, your nursing journey just starting at 19. It's just so much that my listeners can just take away from this episode. And so I just want to say that I really appreciate you. Yes. And so with wrapping up this episode, how can my listeners connect with you, Sarah?
[00:52:33] Speaker B: Sure. Well, I do have a free podcast like yours. I have 130 episodes. I want to say every episode is a real story of a patient I cared for. And then I use the story to teach, you know, the important stuff you have to know about the pathophysiology, that condition, the pharmacology, the nurse's role, and I hope every present a little sprinkling of like the heart of nursing too. So not just how do we have the clinical competence to care for this patient, but like, how can we show up for them and support them and play that important role that nurses play in patients, you know, recovery? So that's, that's my podcast. It's free. It's called Rapid Response rn. You can find it all podcast players. I also have Rapid Response Academy, which I talked about. It's like a monthly subscription. Nurses love it because it's a chance to connect with the nurses across the country, across the globe, actually. They get access to me as a coach and mentor, teacher, but also all these other nurses and all of their great minds that contribute to helping us all on this journey to being excellent nurses. And then I'm also on Instagram. I am the rapid Response RN on Instagram, not because I'm the only one, but because Rapid Response RN was already taken when I tried to make my account, so I had to like change it up a little bit.
[00:53:39] Speaker A: Cheer.
[00:53:40] Speaker B: So, yeah, on Instagram you get every week like a snippet of my podcast episode. Like a one minute little snippet. So it's not the whole episode, but the whole episode. I got listen to the whole podcast, but there's little like teasers, I guess, if you want to say that I post on Instagram that you can follow and share with your friends. And so if I'm on Instagram, do you have a TikTok? I haven't posted on TikTok in like two years. But if you want to see some of my old stuff from a long time ago, you're welcome to find me.
Um, yeah, I think that's the main, main ways to find me. And then there's several conferences that I speak at across the country if you go to like critical care, ER nursing conferences. But that's me. The Rap Responsor n on Instagram and Rapid Responsor n podcast wherever you listen to your podcast.
[00:54:20] Speaker A: Thank you so much and thank you for just being here with us today.
Thank you. And I'll even drop your different ways to connect with you in the description below the podcast. Link the link to this episode. So for my listeners, be sure to listen in, click, follow or subscribe, depending on where you're tuning in from.
And go find Rapid Response RN podcast since you're listening to this podcast and go ahead and follow as well. And if this episode has blessed you, go ahead and share it with someone so that it can bless them as well. And I just want to say thank you again, Sarah for being on here.
[00:55:02] Speaker B: Thank you, Chanel. Thanks so much for having me. It's such a joy to connect with another podcaster, another nurse that really cares about our profession. It's just, it's so life giving to talk with you. So thanks for having me on your podcast.
[00:55:12] Speaker A: Oh, you are welcome. Thank you. As I officially wrap up this episode with Sarah, don't forget that you can follow me, your host, nurse Chanel Tompkins on Instagram, Facebook, YouTube and TikTokl. One nurse. And on IG, I'm actually one nurse Chanel. And if you're interested in other interview style episodes like this one, be sure to go ahead and click that subscribe button so that you don't miss another episode. And as my subscribers grow, the podcast grows and my ability to reach more listeners grow. Thank you so much for tuning in. I hope that you enjoyed this podcast and if it brought you so much insight, be sure to share this episode with a friend or two. And until next time, let your light shine.
