Timely activation of the rapid response team (RRT) depends on the nurse's willingness and ability to make a rapid decision. The practice-focused questions for this DNP project sought to identify barriers that contribute to delays in activating the RRT when needed in medical-surgical patients. The self-efficacy theory was the guiding theory and was used to examine self-confidence and performance along with Donabedian's health care model. Qualitative data were obtained through focus groups and identified 2 prominent thematic barriers among nurses with less than 3 years' experience: a lack of self-confidence and the of lack of knowledge and experience. Results of a chart review included 34 charts to determine if the RRT were called appropriately and were inconclusive. Finally, an 11 item survey with 9 demographic questions showed a statistically significant difference on the summed survey score between nurses with less than 3 years of experience and more tenured nurses, indicating a lack of perceived support, self-confidence, and knowledge among the nurses with less than 3 years of experience (Pearson chi square = 7.403 with 2 df and p = .025). Results were presented to leaders at the site and the recommendations resulting from these observations include the use of high-fidelity simulation education. Nurse educators and senior leadership from the medical surgical units agreed to accept the recommendations and proceed with developing an educational solution to address the barriers. Building knowledge, skills and self-confidence in nurses reduces the barriers to effective use of the RRT, and results in better outcomes for hospitalized medical-surgical patients, a positive social change.

Emergency response team (ERT) member characteristics that contribute to High Reliability performance during patient care resuscitation events or other Critical Incident Management Situations are poorly understood. Findings from this study describe individual characteristics that experienced interprofessional ERT members perceive as contributing to High Reliability performance within the critical incident management context. This study supports the need for interprofessional research about emergency response teams’ High Reliability in hospital-based settings. ERT High Reliability, or “better than expected” team performance has been linked to overall patient care and safety. The purpose of this study was to identify and describe individual team member characteristics that contribute to High Reliability performance of ERT members and the overall emergency response team in a naturalistic setting during Critical Incident Management Situations. Using a qualitative descriptive design, data collection included participant observations, field notes, and interviews. Narrative data were audio-taped, transcribed and coded using Ethnograph v6©. Data content were analyzed thematically using inductive interpretive methods. Two major domains derived from the data were Self-Regulation and Whole-Team Regulation. The overarching theme, Orchestrating High Reliability at the Edge of Chaos, encompassed characteristics contributing to High Reliability performance of the ERT during Critical Incident Management Situations.