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Escalating care can mean a lot of things: it could simply be retaking vital signs in 10 minutes because you thought the change in the readings could be explained by their walk to the bathroom… or it could be calling for a Rapid Response Team (RRT) or Medical Emergency Team (MET) to review your patient.
I have attended RRTs for many years and participated in a large number of case reviews of clinical incidents, and I hope to leave you with a couple of tips.
Let’s park the RRT call for now, as each workplace should have specific criteria for when to call a RRT, as well as allowing any nurse to call a RRT review if they are concerned, without any risk of judgement. If you are met with dismissal or a poor attitude by the response team, don’t take it personally. You’ve done the right thing by advocating your concern and doing your best to keep your patient SAFE.
I think most of us struggle in the grey zone. You have a concern but are unsure if it’s serious enough to get help. I would say to anyone in this situation the answer is always to get HELP.
Think of the idiom: “A problem shared is a problem halved.”
The first line of support is going to be a senior colleague or the person in charge of the shift. They should give guidance and suggestions for the next step. Knowing when to escalate beyond that point, I think, comes down to how comfortable you feel with that advice. If you don’t understand why others aren’t concerned, you need to ask, in the most polite way:
“I am worried about this, can you explain to me why you’re not concerned?”
This invites conversation and will help you develop your clinical knowledge and critical thinking more rapidly.
Who wrote this Guide?
I am a nurse of nearly 20 years and working in education for more than a decade. I work with undergraduates from 2nd year through to people completing Masters level qualifications. I am very passionate about supporting and growing the profession of nursing to better care for our communities.
If you are still not satisfied, you can contact the medical officer/team responsible for the patient. Plan this conversation and try to use a framework like ISBAR (identification, situation, background, assessment, recommendation).
In healthcare, it can sometimes feel isolating when raising a concern and escalating care.
Why am I the only one that seems to be worried?
I assure you that you’re not alone. Beyond your colleagues on shift and treating teams, you are supported by nursing managers, department managers, a Rapid Response System such as a MET, workplace policies, Directors of Nursing, quality managers, Medical Directors or Heads of Units, and Chief Medical Officers. Over my career, I have escalated concerns to every one of these levels.
Interestingly, I’ve found the higher up the ladder you go, the more receptive they are to your concern for your patient, as they know healthcare is imperfect, patients are unpredictable, and even the most well-intentioned and intelligent people still get things wrong from time to time.
Don’t be worried about asking for help. You will be a better, safer, more capable practitioner for doing so.
Final Thoughts
Escalating care isn’t about overreacting — it’s about advocating for your patient when something doesn’t feel right. Trust your instincts, speak up, and lean on your support systems. Whether it’s seeking a second opinion or calling a full RRT, your actions could make all the difference. Every time you choose to speak up, you’re building not only your clinical skillset but also the kind of culture where safety, teamwork, and patient-centred care thrive.
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