If you’ve ever taken care of a septic patient, you know how stressful it can be. The protocols, the bundles, the timers, the “did I miss something?” running in the back of your mind. I sat down with Jaclyn Bond, MS, MBA, RN, a former Director of Nursing with ER, ICU, trauma, informatics, and program development experience, who has spent years improving sepsis outcomes and rapid response workflows.
Instead of focusing on textbook sepsis definitions, we talked about something much more practical: How nurse driven sepsis protocols and smarter workflows can help bedside nurses escalate earlier, treat more precisely, and feel less alone when patients start to crash.
You can listen to the full conversation here 👇
This podcast is available on Apple Podcasts, Stitcher, PlayerFM, iHeartRadio, Libsyn, Spotify, and Amazon Music.
This post pulls out the big takeaways from that conversation, especially for nurse leaders, educators, and rapid response teams who want to make meaningful change without drowning staff in more policies and “please comply” emails.
Table of Contents
Rapid Response vs Code Blue vs “Nurse Consult”: What’s the Difference?
Most of us are familiar with a rapid response call (RRT) and a code blue. Jaclyn framed it really clearly:
- Rapid response (RRT): For patients who are decompensating, but not yet in cardiac arrest. You’re worried, the vitals and monitor look bad, you need help now, but you’re not doing CPR or full ACLS (yet).
- Code blue: The patient is in cardiac or respiratory arrest and you’re actively doing ACLS, compressions, meds, the whole team at the bedside.
What Jaclyn noticed in her own organization was alarming, but very relatable: They had too few rapid responses and too many code blues. In other words, nurses were escalating late. By the time they called, the patient was already circling the drain. Why? A big part of it came down to culture, fear, and criteria.
Nurses didn’t feel like the patient “officially” met RRT criteria yet, even though their nursing gut was screaming that something wasn’t right. And many new nurses were intimidated to call a rapid response team that felt way more experienced and confident than they did.
So Jaclyn tried something different. 👇
The “Nurse Consult” Call: a simple, nurse-driven escalation
Instead of waiting for a patient to hit strict RRT criteria, she built a new option: A “nurse consult” activation, essentially a rapid response consult that nurses can call based on concern alone.
Here’s how it worked:
- It was a silent activation (no overhead page) that went straight to the rapid response team via pager.
- Any bedside nurse on any unit could call and say, “I’m worried about this patient,” without having to prove anything first.
- The goal was to remove the fear of being wrong and create shared responsibility between the bedside nurse and the rapid response nurse.
This is such a powerful culture shift. Instead of:
“If I call and it’s nothing, I’ll look dumb.”
It becomes:
“If I’m worried, I’m supposed to call, and someone will come stand in this with me.”
For new grads, this was especially game-changing. They suddenly had permission to act on their concern instead of waiting until the patient met rigid criteria or was actively crashing. And the outcomes? Over time, they saw:
- More nurse consults and RRT calls
- Fewer code blues and fewer late escalations
That’s exactly what you want to see in a healthy rapid response and sepsis system.
Why New Nurses Hesitate to Call for Help
If you’ve ever delayed calling RRT because you didn’t want to “bother” them, you’re not alone. Jaclyn and I talked about how:
- Rapid response nurses can feel intimidating (even though many are the kindest humans around).
- As a new grad, you’re watching them walk in, take command, ask brilliant questions, and advocate assertively with the team… and you feel miles away from that level of confidence.
- You don’t want them to think you’re incompetent, overreacting, or “crying wolf.”
So what happens? Nurses hesitate. They watch just a little longer. They tweak a little more oxygen, recheck vitals, wait for one more set of labs. By the time they call, the patient is in far worse shape.
Sepsis protocols have to account for this human reality, not just the vitals and labs. If your system doesn’t address fear, intimidation, and psychological safety, it doesn’t matter how pretty your sepsis bundle is in the EHR. That’s what made the nurse consult so smart: it lowered the emotional barrier to escalating care.
How the Nurse Consult Worked Operationally
If you’re a nurse manager or leader wondering, “Okay but how would we actually implement this?”, here’s how Jaclyn structured it.
- The bedside nurse would call the operator or the rapid response nurse directly and say, “I need a nurse consult in Room X.”
- The activation went through the pager system only (no overhead announcement).
- The rapid response nurse would respond, assess, and then categorize the call in a separate database, not the main EMR.
They tracked things like:
- Which unit the call came from
- What type of call it was (transport help, deteriorating patient, sepsis concern, IV start, etc.)
- What happened next, did the patient:
- Stabilize and stay on the unit?
- Get escalated to an official RRT?
- Get transferred to ICU?
- Convert to a code blue?
This data became incredibly valuable. They noticed surprising trends, like how often the nurse consult was used for IV starts on med-surg floors (which actually made sense once they remembered how few chances some nurses get to practice IVs). And more importantly, they saw that as nurse consults increased, code blues decreased. That’s a win for patient outcomes and nurse confidence.
Nurse-Driven Sepsis Protocols: “Standardize the trigger, Not the treatment.”
One of my favorite concepts Jaclyn shared was this:
“Standardize the trigger, not the treatment.”
With sepsis, there’s constant tension between standardization (sepsis bundles, CMS measures, order sets) and clinical judgment (this specific patient, right now, with their comorbidities and response).
She broke it down like this:
- Standardization gives you consistency and a safety net.
- Clinical judgment gives you flexibility to treat the patient in front of you.
The sweet spot for nurse driven sepsis protocols?
✅ Standardize the trigger
Use clear, shared definitions for when sepsis is suspected or confirmed. For example:
- SIRS criteria (or qSOFA, depending what your hospital uses)
- Suspected or known source of infection
- Signs of organ dysfunction
Make it crystal clear when a nurse should:
- Start a sepsis huddle
- Call a nurse consult or RRT
- Trigger a sepsis pathway in the EHR
This clarity removes guesswork and guilt from the bedside nurse. It gives them cover: ‘I’m not overreacting; I’m following the sepsis protocol trigger.’
✅ Individualize the treatment
Once sepsis is recognized and confirmed, that’s where nurse driven sepsis care and provider judgment come together.
The team can decide:
- How much fluid is appropriate for this patient
- When to stop boluses instead of blindly chasing “30 mL/kg”
- Which pressors to start and how quickly to escalate
- When dynamic assessments and tools (like POCUS or Doppler-based devices) can guide choices
Over-standardizing the treatment can accidentally teach people to stop thinking, just clicking order sets and checking boxes. Standardizing the trigger keeps everyone aligned without shutting down critical thinking.
Using Data as an Ally (data is your best friend)
When Jaclyn worked on sepsis improvement, she didn’t just track “compliance” with bundles. She tracked impact.
For example, she looked at:
- Nurse-driven sepsis activations and what happened to those patients
- Time to antibiotics before vs after nurse consult implementation
- ICU transfers, ventilator days, and length of stay
- Mortality and whether earlier recognition changed outcomes
Then, she tailored how she shared that data:
- With physicians, she focused on physiologic rationale and patient outcomes.
- With executive leaders, she tied improvements to cost, length of stay, readmissions, and ROI.
- With bedside nurses, she showed the direct link between what they did and which patients avoided codes, ICU transfers, or worse.
Once people could see their fingerprint on the data, ownership grew. It stopped being “the sepsis project” and became:
“These are our sepsis standards. This is why we do what we do.”
If you’re trying to build or defend nurse driven sepsis protocols in your own hospital, data is your biggest ally! Especially when it tells a human story, not just a compliance percentage.
Fluid Overload: The hidden cost of sepsis bundles
One of the biggest “hidden costs” Jaclyn discovered was fluid overload. We’ve all seen the “30 mL/kg” fluid resuscitation language. But in real life, that often meant:
- Elderly or fragile patients getting large fluid volumes
- More pulmonary edema, renal stress, and longer recoveries
- Increased vent days, longer ICU stays, higher readmissions
Operationally, that translates into:
- Higher length of stay
- More ICU utilization
- Higher costs for the organization
Emotionally, it translated into nurses standing at the bedside thinking:
“I’m about to slam three liters into this frail patient and my gut says this is not right.”
Nurse driven sepsis protocols have to support bedside nurses in that tension, not force them to choose between their clinical judgment and a checkbox.
Dynamic Assessments: The future of nursing-led sepsis care
This is where things get exciting. Jaclyn described shifting from “just give 30 mL/kg” to nurse led dynamic assessments to see whether a patient would actually benefit from more fluid. Instead of relying solely on static measures (like one blood pressure or one lactate), they started incorporating:
- Carotid flow time using a small Doppler ultrasound sensor (like FloPatch)
- Point-of-care ultrasound (POCUS) to look at:
- IVC collapsibility
- Basic cardiac function
- B-lines in the lungs
Rapid response nurses were trained to perform these bedside assessments during sepsis activations. They’d gather real-time physiologic data, bring it to the provider, and then collaborate on what to do next. The goal: Nursing-led precision resuscitation. Give fluids when the patient will respond. Stop when they won’t. Use real-time data instead of guesswork.
The impact?
- Less unnecessary fluid
- Fewer intubations
- Fewer ICU admissions
- Shorter length of stay
- Improved mortality
This is where sepsis care is heading: nurse-driven, data-informed, individualized.
Low-Cost Changes For Smaller or Resource-Limited Hospitals
Not every hospital can stand up a 24/7 dedicated rapid response department or buy every shiny new device from a conference expo. Jaclyn emphasized that meaningful improvement often starts with low-cost, workflow changes, like:
- Clarifying exactly when nurses should escalate for suspected sepsis
- Defining who to call (nurse consult, RRT, provider) and in what order
- Making sure supplies needed for early sepsis care (blood culture bottles, IV start supplies, fluids, pumps) are actually available
- Removing extra steps between recognition and action
Two guiding questions she suggested for leaders:
- Where are my nurses getting stuck between recognizing sepsis and treating it?
- What barriers can we remove so acting early is the easiest thing to do, not the hardest?
That alone (without buying anything) can move the needle. Then, when you do consider technology, evaluate it like this:
- Does it improve nurse workflow and patient outcomes?
- Does it reduce hidden costs like vent days, length of stay, and readmissions?
- Is the training and upkeep realistic for your staff and setting?
The Future of Nurse Driven Sepsis Protocols
Looking ahead 5-10 years, Jaclyn sees sepsis care moving toward:
- Nursing-led precision resuscitation supported by real-time physiologic data
- Less “checklist compliance,” more dynamic, bedside assessment
- Nurse leaders who can connect metrics to mortality, cost, and capacity, not just show a dashboard of numbers
- Nurses who don’t just carry out the plan, but help create it using dynamic assessments and data
In other words, nurses at the center of sepsis decision-making, not just executing orders. As AI, bedside analytics, and tools like Doppler-based sensors and POCUS become more common, bedside nurses will need support and education to interpret that data confidently. But the upside is huge: more precise care, less harm, and better outcomes for some of our sickest patients.
Final Thoughts on Nurse Driven Sepsis Protocols
Sepsis is high stakes. For patients, families, and nurses. This conversation with Jaclyn is a great reminder that improving sepsis outcomes isn’t just about “being faster” with the bundle. True progress comes from building nurse driven sepsis protocols that respect and elevate nursing judgment, creating emotional safety so new nurses feel comfortable escalating long before it becomes a code, and using data as a narrative tool to bring physicians, executives, and frontline staff into alignment.
It also means shifting toward dynamic, individualized resuscitation rather than relying on rigid, one-size-fits-all fluid orders. Whether you’re at the bedside, part of a rapid response team, or in a leadership role, your voice directly shapes how your organization recognizes and treats sepsis. And every time you advocate, escalate, or push for a better system, you’re making a difference in real, human lives. ❤️
🧰 More Resources
- 📖 Learn more about FloPatch and sepsis resuscitation: https://flosonicsmedical.com/
- 📄 Rapid Response / FloPatch Case Study
- 🧑⚕️ For nurse leaders: Need a comprehensive residency program for your new grads and nurses? Learn about FreshRN Enterprise and how it can support your onboarding and education goals: https://www.freshrn.com/enterprise/
- Blog Post: What Nurses Need to Know About Sepsis
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