What does a Respiratory Therapist Do That An RN Can't? - page 2
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... Read More
Jun 30, '04An RT is not a bad thing to have around, but two professionals that have whole-body knowledge would be even better.
Jun 30, '04Our RTs are so territorial it's not even funny. We have to call them to the bedside if the kid desats so that they can titrate the O2, we have to call them to the bedside to help with suctioning (even though we ONLY use inline suction catheters) because they have to increase the O2 for preoxygenation, we have to call them to the bedside to give the nebs/MDIs because although they know about them they don't bother to keep track, we have to call them to the bedside to do trach care because it's their responsibility but they don't keep track, we have to call them to the bedside before we turn a patient so that they can "manage" the tube, but I've never seen one do chest physio other than vibrations... There are usually three or four of them sitting around the RT station surfing the Web, having a snack (nurses and family members are not allowed to eat in the unit... I guess they're special), reading a magazine, chatting or napping. God forbid you should run a gas within the last half hour of their shift!! Some of them are very helpful and willing, others are not. I had a run-in with one over a tiny post-op Glenn who had orders to "keep sats between 75 and 85%" whose sats gradually crept up into the low 90s and hung there. The risk of significant vasoconstriction of the PAs was a very real possibility, and I told her three separate times over about 90 minutes that this baby needed her O2 decreased. She had a million reasons why she couldn't come do it, so I asked if I could do it myself... and got my head handed to me in a sack! I finally drew a gas and when the charge RT saw that the co-ox sats were 93%, the O2 was adjusted STAT. I documented all of this of course.
Yes, they do understand the physiology of ventilation better than I do, but like Dinith88 said, the ICU can run without RTs but not without RNs.
Jul 1, '04Yikes janfrn! RT present to hold the tubing while you turn the patient and to pre-oxygenate????
Is this your hospital's policy or just the way it has always been done?
Jul 1, '04I don't think it's a policy, more like a unit-specific practice. Where I worked in Winnipeg, we shared our RT with the wards and sometimes the neonatal resus team, so we fast became proficient in hand-ventilating with one hand and suctioning with the other while holding the patient's head still without contaminating our catheter. No inline suction there except in specific situations (PEEP >/= +8, oscillator, jet or highly infectious secretions). And our VAP rates were only a fraction of what we see here. We turned our patients with another nurse's help, if they were big enough to warrant help, or alone if not. And we titrated our O2 as needed. So it was a huge culture shock for me to come here and unlearn all that. To say nothing of all the bloody knuckles from having them rapped for giving O2 breaths or making adjustments to it. Only RTs can touch the ventilator, Jan!! :angryfire I never could quite grasp the point of inline suction when the RT would come to the bedside, take the patient off the vent and bag them while I suctioned. (This practice has been gradually phased out due to our extremely high VAP stats!!) AND the suction set-up is a shared one for both ETT and oral/nasal suctioning... meaning we disconnect the inline and drop the end on the bed, hook up the tonsil suction to the tubing, suction the mouth/nose and whatever else, give the tubing a quick rinse (at least I do) and then reconnect the inline. Hmmm...
Jul 2, '04Too many cooks... RT's in a consultancy or therapeutic role seems quite appropriate to me (and lets face it, thats all that really matters ). But mini demarcation disputes over who is and isn't allowed to do this/that/"the other" would drive me insane. As far as I'm concerned, the patient is *my* patient (my own... my very own...) and I'll be a monkeys uncle the day someone slaps me on the wrist for suctioning without permission. Jan, you must have a strong faith in the the principles of karma or ethanol-anxiolysis, cos I'd have blown every fuse in the proverbial switch box...
Jul 2, '04Quote from canoeheadI love to have an experienced RT to bounce things off of and to deal with the more mundane (but important) time consuming tasks.I was working pediatrics and a kid with asthma was tightening up about 2h into a Q3H neb schedule, so I called the RT (as required) to get another neb given. Took him 15 min and two phone calls to show up, then he says "just give him more O2." Stupid me, I asked if perhaps he would like to listen to the patient first. So he slams into the room spends 30 sec, and comes out saying how he didn't have time to trapise all over the hospital giving nebs (!) on a prn basis.
So by now it was 2 1/2 hours...lucky the kid didn't have his airway compromised.
Coming from Canada we gave nebs on the floor as often as Q1/2 hour according to the . I couldn't adjust to having a child with asthma and not being able to DO something about his main issue. Why couldn't nursing do ongoing assessments and titrate the frequency of nebs so the kids got out sooner?
But just like nurses I have encountered more than a few "bad" RTs. Ones who had just a tad too much ego, were territorial or forgot there are body systems other than respiratory.
I have never had to get permission from an RT to do a PRN neb never mind have them "over ride my assessment". Turn up the O2? Good intervention but not a solution. I would have ridden that RT like a pony all the way to the unit managers office.
Was this situation hospital policy or a "bad" RT?
Jul 2, '04I was hospital policy, as the same issue came up with almost every asthmatic patient overnight, and the same solution by the RT's. The manager was well aware of what was going on but she had been trained in that hospital, so thought that was the correct way to deal with it- after all, that's what the RT's told her, and they were the experts. Anyway, the kids at that hospital had their neb frequency reviewed twice a day by the residents unless something went really bad, where I was used to reviewing response with every neb- check lungs before and after, and sometimes at 15min intervals when I was trying to stretch the timing. In credibly poor care IMO.
Another time I was involved in preparing a newborn for transport and the RT's got so involved in getting blood gases that they pulled the IV line out. I nearly killed them! That's why I think two professionals with a more holistic view of what is going on would be more appropriate. We don't call them to difficult deliveries any more because the nurses are trained and capable to do all the resp interventions, and then some. The doc does intubation if needed; we are a low risk hospital so no neonatologists, etc.
AND...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.
Jul 2, '04Quote from steve0123Interesting. So..RN's in Australia must get advanced training in ventilator modalities, setups and troubleshooting? Is it part of the standardized education system there?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!!!
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.
Jul 2, '04[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. :angryfire
Jul 2, '04our 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?
Jul 3, '04Interesting. So..RN's in Australia must get advanced training in ventilator modalities, setups and troubleshooting? Is it part of the standardized education system there?
Jul 3, '04Exactly, 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.
Jul 3, '04History 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.