[mattsmom81]

Originally Posted by steve0123

I suppose the reason countries like Australia don't have RT's is because ventilated patients still get 1:1 care from an RN - I didn't realise that US crit. care nurses are being overworked to the extent that they are assigned multiple ventilated patients in an ICU - how exhausting!!!

Interesting. So..RN's in Australia must get advanced training in ventilator modalities, setups and troubleshooting? Is it part of the standardized education system there?

Maintaining and troubleshooting the ventilator is generally a shared job, mostly managed by the RRT...but yes, with a little extra education I could manage it, and would love to if i were to have a 1:1 vented patient.(very few 1:1's in my parts anymore) Pretty routine to have 2 vented patients; and they might be unstable in other systems too.

Personally I'd love to have an extra RN in my ICU , lose the RT and pick up their workload but...cheaper for the hospital to hire the RT to work several unitsd vs hiring an extra RN for EACH unit.

I also remember the pre RT days and doing my own treatments...but in those days the basic Byrd vent was the extent of volume ventilation...its more complex technologies these days.

[mattsmom81]

[quote=canoehead...one more thing...it burns my butt when the RT dept decides they don't have enough money or staff to cover nights and passes it all over to nursing. If we can do it at night butt the heck out and let us take credit for being able to do it all the time. And, by the way, give us half your budget if you are only going to be working half the time.[/QUOTE]


This would definitely bother me too. The best RT's I've worked with are degreed professionals and team players...some of the CRT's basically function in technician mode, but want to be considered professionals...and actively complete with nurses. Some RT's are extremely territorial; some think they should 'delegate' to us what they don't wish to do. One hospital I do perdiem work at the RT tried to delegate to ME all the vent circuit changes for her...said it was MY job. I said if RT dept charged for it they could do the work, thankyouverymuch.

But...I also get burned when we must draw all the labs at night but lab gets the revenue for phlebotomy/processing fees...doesn't sit well with me. Nurses seem to pick up the slack for many depts.

[janfrn]

Our RTs don't make too awful much less than we nurses do. Their scale runs $25.53 - $32.80 Cdn per hour, with shift differential and charge pay, same as for us. Our pay scale, thanks to our newly ratified contract, runs $26.33 - $34.56. Considering that I'm caring for the whole patient, who may have an open sternum and be on any variety of vasoactive drugs, be bleeding from every orifice, have an intracranial pressure monitoring catheter, an EVD and a lumbar drain and/or be on dialysis or CRRT (which would be my responsibility) or even ECMO, while they run gases and fiddle with the vent, well, Capital Health is really getting a deal with me aren't they?

[steve0123]

Interesting. So..RN's in Australia must get advanced training in ventilator modalities, setups and troubleshooting? Is it part of the standardized education system there?

No not standard - crit. care nurses often have further training (grad. dip. or masters), but it's not covered in most undergrad programs (although most hospitals run inservices and orientations that cover vent. mgt. anyway). When I said RN's manage the ventilators, I should have said they manage them in collaboration with the intensivists and physiotherapists. For example, if the patient continually shows suboptimal PaO2 (etc), the nurse would make or suggest some adjustments to FIO/PEEP/etc, but keep everyone in the loop (so that if anyone wants to suggest a better solution they can be heard). The only thing is most places require a medical order for blood gases (if they are done in a lab) and RN's generally don't intubate, so we don't have complete autonomy (just biding our time... baby steps... ). It just seems like a more team oriented approach to patient care, where everyones skills and knowledge are better respected (that's in no way a criticism of the US system - it obviously works just fine). Perhaps its all a conspiracy to flog nurses like workhorses and increase profit - why pay 8 RN's to manage 8 patients, when you can pay 4 RN's + 1 RT (save about $200K per year)...

[canoehead]

Exactly, the RT is an excuse to load more patients on us. And then...perhaps the RT's will start delegating their tasks to nurses ("just call me if you have a problem") like they did in my hospital.

[ocankhe]

History history history. This is another example of RNs giving up portions of ther original professional responsibilities to allow the formation of other professions/careerers in health care, many of which now require more education than nursing to perform. And most even pay mre than an RN. Examples of this are dietary, physical therapy, occupational therapy, PA's, anesthesia assistants. etc. And in most cases have kept the more menial tasks like house keeping, and anything else management wants the RN to do because the RN is there 24/7 and always available so why hire someone to do it.
That said whether a RT manages the vent or respiratory treatments the RN is still responsible for for patient outcomes and needs to be thouroghly familiar with all the respiratory treatmants, medications, etc.

[Gotosleepy]

"A competent nurse knows respiratory stuff as well as any RT"... whatever...

i'd like to meet a nurse who can describe I:E ratios and why/when to make changes in ratio/flow, who can desribe flow slopes and why/when to change those... do nurses understand Vd/Vt ratios. There is a lot more to vent management then changing Volume/Rate/Fio2...

[SKM-NURSIEPOOH]

Originally Posted by steve0123

Hi All-

I was just wondering what education/etc one needs to become a Respiratory Therapist, and what their role is in the ICU? In Australia, Registered Nurses manage almost all aspects of day to day to care in the ICU, including ventilators (obviously in collaboration with physiotherapists and intensivists). Are RT's common in US ICU's, and if so how is their contribution to the patient more beneficial/cost effective/whatever than that provided by an RN? I'm not having a go at RT's, was just curious as I'm reading about all these diverse roles being undertaken by non-nursing staff in the US that are usually carried out by RN's in other countries (staff such as RT's, Anaesthesia Assistants, Surgical Technicians, etc etc etc).

Thanks,

Steve

Respiratory Therapist & Respiratory Techs. According to the US Board of Labor, one can either obtain a postsecondary diploma &/or Associates degree in order to become a Respiratory Tech. In order to become a Respiratory Therapist, one would have to receive a Bachelor's degree or beyond.

Respiratory Therapist work under the direction of a physician & also supervises the Respiratory Techs (who take directions from both the physicians & Respiratory Therapists).


Sounds familiar? The Respiratory Therapist would be like the RNs & the Respiratory Techs would be like the LPNs...many of their (the Techs & Therapists) job specifications overlap...but the Therapist is ultimately responsible for supervising the Techs. Of course the Therapist have more education/expertise than the Techs & will have the right to sit for their Registered Respiratory Therapist (RRT) beyond & addition to the general Certified Respiratory Therapist (CRT) licensure all graduates of any accredited Respiratory Program complete & have a right to sit for.

Respiratory Techs/Therapists are specialist in the field of lung function & have far more knowledge in this area than generalized nurses do. That's why the field is needed as the health-field has become more & more specialized & technical. I'm sure nurses who specialize in this area are also quite knowledgeable & qualify to make changes on vent settings accordingly...but the average nurse usually will not be required to calculate lung capacity, functions, & do ABG sticks in order to alter vent settings on a daily basis. Nurses are responsible to know the very basic in lung functioning....but as a rule...they're usually not qualified to make such changes without a physician's order or the assistance of a Respiratory Tech/Therapist....quite simply...to make vent changes on our own would be operating out of our scope of practice (unless of course one is certified in this area such as a CRNA).

Now...I'm not saying that you won't *see* nurses change vent settings in your practice...but as a rule...we don't do them. The most nurses can do is change the FI02 based on ABG's to a certain extent...but to alter the rest of the settings is not what we generally do.

Hope this helps ~ Cheers!
Moe

[SKM-NURSIEPOOH]

Originally Posted by janfrn

Our RTs don't make too awful much less than we nurses do. Their scale runs $25.53 - $32.80 Cdn per hour, with shift differential and charge pay, same as for us. Our pay scale, thanks to our newly ratified contract, runs $26.33 - $34.56. Considering that I'm caring for the whole patient, who may have an open sternum and be on any variety of vasoactive drugs, be bleeding from every orifice, have an intracranial pressure monitoring catheter, an EVD and a lumbar drain and/or be on dialysis or CRRT (which would be my responsibility) or even ECMO, while they run gases and fiddle with the vent, well, Capital Health is really getting a deal with me aren't they?

If all things being equal...the Respiratory Therapist goes through four years of undergrad & in some cases, postgrad...most Tech are now required to hold an Associates degree...don't you think you should be worth at least the same as nurses for that level of education if you were one of them? Heck...some nurses don't even have an 'degree'...yet still make that salary. Let's be fair here....I'm not trying to knock or take anything away from any nurses here...Lord knows I'm not like that! I'm just trying to get you to see things from the Respiratory Techs/Therapists' point of view. They're are educated healthcare professional team members & should & do deserve just as much respect as we nurses deserve. What makes these people any less brilliant? What cuz they specialize in the lungs? That's ridiculous! They know all about the pH vs. PaCO2/SaO2 factors & how that determines metabolic vs. respiratory alka/acidosis. One more thing...most Respiratory Techs/Therapists have more patient:tech/therapist ratios than critical care nurse : patient ratios. Many have to monitor most (if not all) vented patient on the unit(s) they're assigned to. I've seen RTs have to cover several units PLUS cover the ED. They're constantly being paged...that job isn't a piece of cake or a walk in the park! They deserve every single dime earned & probably some more. I don't understand your complaint regarding RT's salaries being remotely close to yours just cause you have to monitor more areas of the body. You knew this going into nursing...so I'm not quite understanding your displeasure with RT's salaries.

I don't know...may be I'm reading too much into your post cuz I'm offended by it & I'm not even a Respiratory Tech/Therapist...but I know they just don't walk around blindly pushing buttons & turning knobs cuz the physician told them to or for the hell of it. They must be knowledgeable enough to know or anticipate required vent setting changes, anticipate CPT/drainage, & other respiratory treatments. Please correct me if I'm reading your post incorrectly cuz the written word just doesn't quite bring across one's intent.

Cheers!
Moe

[SKM-NURSIEPOOH]

Originally Posted by mattsmom81

Originally Posted by canoehead

...one more thing...it burns my butt when the RT dept decides they don't have enough money or staff to cover nights and passes it all over to nursing. If we can do it at night butt the heck out and let us take credit for being able to do it all the time. And, by the way, give us half your budget if you are only going to be working half the time.

This would definitely bother me too. The best RT's I've worked with are degreed professionals and team players...some of the CRT's basically function in technician mode, but want to be considered professionals...and actively complete with nurses. Some RT's are extremely territorial; some think they should 'delegate' to us what they don't wish to do. One hospital I do perdiem work at the RT tried to delegate to ME all the vent circuit changes for her...said it was MY job. I said if RT dept charged for it they could do the work, thankyouverymuch.

But...I also get burned when we must draw all the labs at night but lab gets the revenue for phlebotomy/processing fees...doesn't sit well with me. Nurses seem to pick up the slack for many depts.

Now I totally agree with being annoyed when other depts can't 'cover' yet they get the credit or charge for services rendered. And I totally agree with making someone do THEIR job too!

I hate for professionals to push their work off on nursing just cuz they 'think' they can! Here's where nurses need to stand-up & take control over their shift. Nurses are known to 'take-on' too much as it is....taking on someone else's responsibility is a no~no.....especially when the task is going outside of our scope of practice. Now if a Respiratory Therapist tells me to make changes on vent setting/C or B-PAP equipment...I would have to refuse citing that's not in my area of expertise. Sure...I may *know* how the equipment work....but that doesn't mean that I'm going to pick-up a hammer & start nailing equipment down should the need arises...I'll call maintenance...Thx ya very much...LOL!

I blame the individual nurses & nursing management here. This can be nipped in the bud quite easily...but some folks don't want to rock the boat or challenge another manager/director/department head. That's just wrong!

Cheers!
Moe