| Course | NU 305 Professional Role Transition |
|---|---|
| Unit | Unit 5 |
| Paper type | Clinical escalation account |
| Length | About 1,000 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | RN to BSN |
| Updated | October 2026 |
Free sample paper for NU 305 Unit 5
When the First Call Does Not Land: Escalating Concern About a Drowsy Patient on an Opioid Pump
Student Name
Department of Nursing, Herzing University
NU 305: Professional Role Transition
Instructor Name
February 16, 2026
When the First Call Does Not Land: Escalating Concern About a Drowsy Patient on an Opioid Pump
The Situation
This account is a composite based on a common kind of night shift. Mr. B., 68, had a total knee replacement that afternoon and was in his first postoperative night, receiving hydromorphone by patient-controlled analgesia pump. He had obstructive sleep apnea and had not brought his home breathing machine. At 1:10 a.m. I found him difficult to wake: he opened his eyes to his name but fell asleep mid-sentence. His respiratory rate was 9, his oxygen saturation 89% on 2 liters by nasal cannula, and his sedation score on our unit's scale was 3, meaning he dozed off repeatedly while I was talking to him. Our protocol for this score directed me to stop the pump and notify the prescriber, which I did.
The First Call
I paged the covering surgical resident and used the structured format our hospital teaches, situation, background, assessment, recommendation, which gives the listener the problem and the request at the start (Haig et al., 2006). I said: "This is the nurse caring for Mr. B., post-op day zero after a knee replacement. He's very drowsy with a sedation score of 3, respiratory rate 9, saturation 89% on 2 liters. He has sleep apnea without his CPAP and is on a hydromorphone pump, which I've stopped. I'm concerned about opioid-induced respiratory depression. I'd like you to come and evaluate him, and I'd like an order for naloxone if needed."
The resident replied: "He just had surgery, he's supposed to be sleepy. Turn his oxygen up to 4 liters and recheck in an hour." Then the call ended.
What I Did Next, and Why
I increased his oxygen, which was a reasonable step, but I did not accept the instruction to recheck in an hour, because the problem was not only his oxygen level but his breathing rate. More oxygen can raise the saturation reading while carbon dioxide continues to rise in a patient who is breathing too slowly, so a better number would not have meant he was safer. I stayed with him, tried to rouse him more fully, and reassessed in 10 minutes: respiratory rate 8, saturation 95% on 4 liters, still drowsy. That combination confirmed my concern.
I called the resident again at 1:25 and used the escalation language from our TeamSTEPPS training: "I am concerned, I am uncomfortable, and this is a safety issue. His respiratory rate has dropped to 8 on more oxygen. I need you to see him now." The two-challenge rule in the same training says that when a concern is voiced twice and still not addressed, the next step is to move up the chain of command (Agency for Healthcare Research and Quality [AHRQ], 2023). The resident said he was in the emergency department with a new admission and would come "when he could."
Using the Chain of Command as It Actually Works
Our hospital's rapid response criteria include a respiratory rate below 10 and a nurse's worry about a patient, so I activated the rapid response team at 1:28 rather than waiting for the resident. Rapid response systems exist precisely so that a bedside nurse can bring critical care expertise to a deteriorating patient without needing permission from the primary team (Jones et al., 2011). I told my charge nurse at the same time. The team arrived in four minutes; the respiratory therapist placed Mr. B. on noninvasive ventilation, and the critical care nurse gave a small dose of naloxone under the rapid response protocol. His respiratory rate rose to 14 and he woke fully. The resident arrived at 1:50, agreed with the plan, and changed his analgesia to a scheduled nonopioid regimen with a reduced opioid as needed. Mr. B. was transferred to a monitored bed for the rest of the night and recovered without further events.
What Made It Hard to Escalate
Escalating was not easy, and the difficulty is part of the account. It was the middle of the night, the resident was new to me, and he sounded tired and irritated on the second call. I worried that activating the rapid response team would look like I was going around him, and that he would remember it the next time I called. I also worried that I might be wrong: many postoperative patients are sleepy, and I had seen colleagues criticized for calling rapid responses on patients who turned out to be fine. What settled it was returning to the numbers I could see, a respiratory rate falling on more oxygen, and to the fact that our hospital's criteria explicitly included a nurse's worry. The criteria exist to take the social cost out of the decision, and I used them for that purpose.
Afterward
The next day I completed a safety report, not about the resident personally but about two conditions that made the night harder than it needed to be: our postoperative order set did not ask about sleep apnea when starting an opioid pump, and patients with sleep apnea were not routinely placed on continuous monitoring of breathing. I also asked the resident for a few minutes the following evening. I said that I had escalated because his instruction had not addressed the respiratory rate, and asked what would have helped him act on my first call. He said that hearing "respiratory rate 9 and sleep apnea" first, before the saturation, would have changed his response. I have used that order since.
What the Account Shows About Escalation
Structured communication frameworks work best when the first attempt lands. When it does not, the nurse's responsibility is to keep the patient safe while continuing to seek help, using the tools the organization provides: repeating the concern with clear language, activating rapid response when criteria are met, and involving the chain of command. None of these is insubordination. Accepting an instruction I believed was unsafe, and rechecking in an hour, would have been the greater failure of professional accountability.
References
Agency for Healthcare Research and Quality. (2023). TeamSTEPPS 3.0 pocket guide. Agency for Healthcare Research and Quality.
Haig, K. M., Sutton, S., & Whittington, J. (2006). SBAR: A shared mental model for improving communication between clinicians. Joint Commission Journal on Quality and Patient Safety, 32(3), 167-175. https://doi.org/10.1016/S1553-7250(06)32022-3
Jones, D. A., DeVita, M. A., & Bellomo, R. (2011). Rapid-response teams. New England Journal of Medicine, 365(2), 139-146. https://doi.org/10.1056/NEJMra0910926
NU 305 Unit 5 instructions, in plain terms
Unit 5 asks you to analyze a situation where you escalated a clinical concern. Expect to describe the situation, the first communication and its result, your next steps and reasoning, how you used the chain of command or rapid response, what made escalation hard and what happened afterward. Many versions ask what to do when a concern is dismissed and when it is appropriate to go past someone. Check whether your section allows a composite case. Use structured communication tools such as SBAR and CUS from TeamSTEPPS. Be honest about barriers like hierarchy and fatigue. A safety report afterward should focus on conditions, not individuals. The account should show both the clinical reasoning and the courage escalation requires.
How this NU 305 Unit 5 example is built
The account opens with the patient and the findings that raised concern: sedation, respiratory rate and the opioid pump. The first call is described with the SBAR used and the reply received. The next steps section explains why the instruction was not enough, citing the risk of opioid-induced respiratory depression. The chain of command section shows how the nurse used rapid response criteria rather than waiting. The barriers section is candid about doubt and hierarchy. The afterward section describes the safety report and its focus on two conditions, such as pump monitoring. The final section draws general lessons about escalation when the first attempt fails, supported by research on structured communication and rapid response teams.
NU 305 Unit 5 rubric: what full points look like
Herzing's rubric for an escalation account usually covers the clinical situation, the communication used, the reasoning for escalation, use of the chain of command, reflection on barriers and system follow-up. Reasoning for escalation draws the closest reading, since graders want to see why the concern justified going further. Communication points reward structured tools used correctly. Chain of command criteria look for appropriate steps, including rapid response. Barrier reflection earns credit for honesty. Follow-up points go to safety reporting focused on conditions. Writing covers a clear sequence. Haig's SBAR paper and the AHRQ TeamSTEPPS materials belong in the APA 7 references. Times and vital signs in the account help graders judge whether escalation was timely.
NU 305 Unit 5 help before you submit
Escalation accounts in Unit 5 commonly lose credit by ending with the first call, as if escalation stopped there. Another frequent problem is describing the physician negatively, which shifts focus from the system. Students often skip the clinical reasoning that justified further escalation. Rapid response criteria are not cited. Barriers are left out, though they are central. The safety report targets a person. The account lacks times and vital signs. Finally, show what you did when the first attempt failed, because graders reward accounts that demonstrate persistence through appropriate channels. Another gap is leaving out what the patient's condition was after the rapid response, which shows whether escalation mattered. Write the account in first person and past tense, since it describes what you did.
Get a NU 305 Unit 5 example written to your instructions
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NU 305 Unit 5 questions, answered
What do I do if my concern is dismissed?
Raise it again, differently, and then go up. Restate it with the specific finding and the risk you are worried about rather than the general concern, ask directly for what you want to happen, and say that you will need to escalate if it cannot. Most organizations have a defined route for exactly this, and using it is expected rather than disloyal.
When is it appropriate to go past somebody?
When the patient's safety cannot wait for the person you have asked. That is the threshold most policies use, and it is deliberately not about whether the person was rude or wrong. Say in your account what the risk was, what you had already tried, and how quickly the situation was moving, because those are what justify it.
How do I write about being junior?
Honestly. Frameworks for structured communication are useful and they do not remove the fact that raising a concern with somebody far senior is difficult, particularly for a nurse new to a unit. Naming your own hesitation, and what you did about it, is more useful to a reader than an account in which the hierarchy played no part.
Where can I find a free NU 305 Unit 5 sample paper?
You can read the whole NU 305 Unit 5 escalation account here for free, from the first call to the rapid response and the safety report. An account built on a different clinical concern can be written on request.
What should a nurse do if a physician dismisses a concern?
Restate the concern with specific findings, use CUS language if needed, follow the chain of command and call a rapid response if criteria are met. This sample shows a nurse escalating after being told to recheck a sedated patient in an hour.