What does a Respiratory Therapist Do That An RN Can't? - page 3

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

  1. by   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...
  2. by   SKM-NURSIEPOOH
    Quote from 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
  3. by   SKM-NURSIEPOOH
    Quote from 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
  4. by   SKM-NURSIEPOOH
    Quote from mattsmom81
    Quote from 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. :angryfire
    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
  5. by   kids
    Quote from skm-nursiepooh
    in order to become a respiratory therapist, one would have to receive a bachelor's degree or beyond.
    this is not correct. an aa is the minimum requirement to become a respiratory therapist.
    http://www.aarc.org/patient_education/whatarcp.asp
    there are two levels of respiratory therapist: the certified respiratory therapist and the registered respiratory therapist.
    respiratory therapists are required to complete either a two-year associate's degree or a four-year baccalaureate degree. upon graduation they are eligible to take a national voluntary examination that, upon passing, leads to the credential certified respiratory therapist (crt).

    subsequently they may take two more examinations that leads to the registered respiratory therapist (rrt) credential.
    http://www.bls.gov/oco/ocos084.htm (us dept. of labor)
    formal training is necessary for entry into this field. training is offered at the postsecondary level by colleges and universities, medical schools, vocational-technical institutes, and the armed forces. an associate degree has become the general requirement for entry into this field. most programs award associate or bachelor's degrees and prepare graduates for jobs as advanced respiratory therapists. other programs award associate degrees or certificates and lead to jobs as entry-level respiratory therapists.
  6. by   steve0123
    Nursiepooh-

    I hear where you are coming from - nobody can be an expert in everything (except my mother, bless her ). However, in systems where RT's aren't common, critical care nurses have had no choice but to further educate themselves in regards to respiratory physiology (including acid/base balance, VQ studies, and all the other things you mentioned), and as a result they are accorded a higher professional status among medical and allied health colleagues than some other subdisciplines where there aren't as many opportunities for professional development (I know that is very un-PC, but its reality). It's all about upskilling and making one's profession indispensible (and to heck with the patient, lol). I don't begrudge RT's anything - from what I can tell they are well educated and earn every cent. I just see it more as a professional development issue.
  7. by   airis
    Quote from mattsmom81
    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
    By the way CRT are professionals. They go to school the same length as an ADN. You have to earn an associate degree in science respiratory therapy to be a certified respiratory therapist. If you are talking about the respiratory technician (certificate) which is NOT A CRT then yes they only do technical. To be a Certified respiratory you have to take prerequisites and general educations also just like an ADN.
  8. by   airis
    shame all of you!!! You should act like professionals and stop talking about RT's. Being an RN is not about who does more work and who does less. It is about giving total care to sick people and do your job as an RN.
    If you dont like what RT does , is that why you are an RN.......???
    If you talk behind peoples back it makes you not professional at all.


    Just be a good RN.
    If you think RT doesnt do more than you guys do then maybe you should be an RT. Do not criticize them. Go to work and just do what you gotta do. focus more on your patients than RTS.
  9. by   Dinith88
    Quote from airis
    shame all of you!!! .
    I have a suspicion you're a member of ALLRespiratoryTherapy.com...or a RT student Lighten up a bit. Nurses are just better.

    <joke>
  10. by   egood
    To canoehead, I'm an RT and an RN can give a neb too, but an RT can also do a lot of the duties nurses do too. It may not be under our scope of practice, but we are educated and have more skills and knowledge that a lot of nurses think we have. I've been in many situations where the I have known what to do and the nurse didn't, and it wasn't only respiratory related. I am going back to school for nursing and I know that with my RT backround and experience, I will be an excellent RRT/RN. I will make it my mission to respect ALL healthcare workers, we are all in this together as a TEAM. I am one of those Rt's who will put a pt on/off bed pad, feed them, get them water ect...I will do anything I can for the Pt's. it's all about Pt care. I think Pt's recieve better care with the different Therapys, If one person tried to do it all the pt's would suffer.
  11. by   fergus51
    Quote from steve0123
    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)...
    We have RTs and this is often how it works. We nearly always have some RTs that are floats from other units, so the nurse will "suggest" when to get blood gases and what to do about them:wink2: . We don't need an order to draw our blood gases. Otherwise, it sounds like the same team approach you guys have over there... except I have never worked somewhere when a vented patient is automatically a 1:1. We can have 2 patients on oscillators or jets. Honestly, I would be bored stiff if all our vents were 1:1.
    Last edit by fergus51 on Dec 7, '05
  12. by   ZASHAGALKA
    Quote from janfrn
    Our RTs are so territorial it's not even funny.
    I would say this thread explains alot of the territorialism.

    And this is an RN that has butted heads w/ RT before about EXACTLY whose pt it is attached to that vent. . .The AACN's old procedure manual made it clear that RNs must have a complete understanding of the equipment they use in the function of their jobs. So, yes, RNs should be thorougly enough prepared to operate a vent autonomously - or they shouldn't be competency verified to take care of a vented pt. Why? Because ultimately, the RN bears responsibility for any piece of equipment that affects the pt under his care. (for the same reason we cannot legimately claim that we only did what the doctor ordered when a prudent nurse would know to question . . .)

    But some of my better pt interventions have come only AFTER consulting and in conjunction with a respiratory expert. I personally don't consider these allies optional: and not only I, but the pulmonologists in practice in my community would have a fit if they weren't 24 hr caregivers. We have at least 1 f/t RT in our unit - at all times, and normally 2.

    I want that expert at my bedside. Why? Very simply: pt advocacy - they dramatically improve the provision of A and B in the ABCs of my care.

    But when some of us would say they are optional, is it no wonder that the AART aggressively advocates territorial autonomy?

    ~faith,
    Timothy.
  13. by   fergus51
    Quote from ZASHAGALKA
    But when some of us would say they are optional, is it no wonder that the AART aggressively advocates territorial autonomy?

    ~faith,
    Timothy.
    There is no excuse for this type of territorial autonomy when it negatively impacts patient care. Jan's post is shocking to me. I can't imagine working somewhere that didn't allow me to adjust FiO2 on a patient who is desatting. That's just bad patient care.

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