What does a Respiratory Therapist Do That An RN Can't? - page 7

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   RN Randy
    Jesa's spouse... First, let me say that's a much more believable reply and I have to agree with your well-informed assessment of the big picture. Sad but true.

    And if you're addressing me directly, No, I'm not minimalizing my role, I'm something of a license-collector actually. The life-saving poke was another big turf issue that you must not be familiar with and was said half in jest. However; I have to stick to my assessment of a "hospital code" being a stat thing, not an emergency.
    Next, you don't need to try and prove your point or prowess with in-depth questions and scenarios. I don't question yours or anyone else's education and expertise. You and I have apparantly missed each other's points I think. Your first post reads out like "RN's have silly little IV pumps, and have no clue about the complexities of a vent." NOW.... I see that may not have been your intention, but that's how it reads, and that's how I replied. Apologies if we're crossing wires. I also need to say that in my postings I notice that I haven't fully explained myself either, and I apologize for that as well. My background is similar to yours, travel RT, etc, and my license list includes Paramedic, CRT, RPSGT and RN. I can remember changing Vt with a 6" crank wheel, and changing PEEP by making a trip to the sink for a cup of water.
    So trust me, I have seen it from all angles, and ye preacheth to the choir.
    I guess I've had several run-ins with angry RCP's lately and this thread caught my steam purge.
    Lastly, the question is not mine, it was asked quite a while back by the OP, and it is indeed the fastest way to tick off an RCP, so I understand the soreness of the replies. Any advice on fixing the problem???
    tnx,
    rb
  2. by   dfk
    Quote from jesa
    Ventilation isn't about achieving a acceptable acid-base balance or fixing hypoxemia. all of which can be accomplished by turning the knob to the left and back to the right. What to do with pt. dyssyn. rn/md induced fluid over-load, recruitment, how do you recognize over-distention, how exactly does PCV/PCV+, APRV, VV+ (for you 840 buffs), Bilevel, PSV, that useless and dangerous SIMV (I bet that's your default mode), a chimp can be taught when to turn knobs and push buttons (with the right snack.) By the way fluids follow laws of gravity, vent's follow the law of motion
    correct me if i'm wrong, but isn't this what the underlying issue was in the original post, or some responses thereafter? it's not about whether an RN can turn knobs and change some settings. it's the physiology of it all, and RTs have had that education, RNs haven't. plain and simple, unless extruded from some other source. so in closing, RTs have the physiologic training and experience that they bring to the table. if RNs want to push knobs and change settings, then get the proper education, otherwise, stop assuming one knows it all. apologize if this sounds cold and abrupt, but come on, this thread has been going on long enough about the same drivel. enjoy~
    fellow RN, SRNA
  3. by   she_devil128
    LOL, good one DFK.

    Truly Yours,
    RRT, RN
  4. by   mandymcnurse
    Wow, this is getting quite heated!!
    All I wanted to say is, I have been nursing for 21 years, 19 of which has been critical care, both surgical, medical and cardiovascular. I currently work in a tiny 6 bed ICU in a small town. We do not have RT coverage when I work my weekend worker position. I was trained in large teaching hospitals in Toronto for most of my career. I am now expected to start pts on Bipap, start up the vent, make vent changes, run my own gases, alot of times with only a family physician to back me up. Scary, this I know! Fortunately, I have alot of confidence in my knowledge base, and my critical thinking abilities. That is not to say I don't call in the RT who is on call to check my set up, make changes, basically make sure everything was done right. I have a new appreciation of RT's now that I have lost that luxury at work. I realize there is so much I DON'T know about ventilating pts. The turning of the knobs, that we have all referred to in this post, is so much more that. Remember, nuclear bombs have been set off with such small gestures. There really is a great wealth of knowledge behind it. I recently became certified with Canadian Nurses Association in critical care. I know my knowledge base is strong in cardiopulmonary nursing. But, I can still afford to learn more. RT's have taught me alot. And I hope they would say the same about me. We compliment each other when we work together.
    I think that is key, working together in mutual respect of each others abilities. And to not be afraid to learn from one another.
    Mandy:caduceus:
  5. by   JoanieRT2b
    i thought it goes like this excuse me if im wrong okay RT see his pt ,RT reports to the doc about the pt, doc writes order for patient, RN follow the order
  6. by   RN Randy
    Quote from jacqx21
    LOL, good one DFK.

    Truly Yours,
    RRT, RN
    Negative, not a good one at all. It's the same drivel....
    If an order is written by a physician, and a knob needs turned 3 degrees, anyone with knowledge of where that knob should be able to turn it. Your RN is generally qualified enough to see the possible negative effects if any. See, you're forgetting the physician should, and usually does, know better than you. Plus, HE/SHE is the responsible party and the only one ALLOWED to make the change. The phys says turn it, not RT; unless there is a protocol, [originating from physicians] and again, then anyone can do it, per FACILITY not licensure guidelines.
    DFK's argument appears based on the premise that an RN took it upon his/her self to decide to knob-turn for whatever reason. Why would one do that? They wouldn't, I hope.
    Despite your arguments, the fact remains that RT is not allowed to practice medicine as much as they seem to want to.

    In short, you guys are still arguing apples and oranges.
    All the RT people here are arguing that RN's don't have the in-depth respiratory knowledge as the RT. No argument there... never was one... read the thread.
    RN's argue that when a simple change is needed, and the RT says "Well, I have higher priorites right now." and doesn't show up, then the experienced RN [under orders for the Physician; as we ALL are.] can make the change.
    Yes, there are some losers out there in all fields, but that isn't the discussion here.
    Take a pill peeps, it's ok! :-)
    rb
  7. by   RN Randy
    Quote from mandymcnurse
    Wow, this is getting quite heated!!
    I think that is key, working together in mutual respect of each others abilities. And to not be afraid to learn from one another.
    Mandy:caduceus:
    Jacqx21,

    Now THIS is an example of a good one. :-)

    Kudos Mandy!
    rb
  8. by   RN Randy
    Quote from JoanieRT
    i thought it goes like this excuse me if im wrong okay RT see his pt ,RT reports to the doc about the pt, doc writes order for patient, RN follow the order
    Wow, excuse me if *I'm* wrong, but your post seems to suggest that RT is the driving force behind the physician for the pt's pulmonary care??

    Sorry but as said before, here in the USA RT's are not qualified to practice medicine. [Read the label on the back of your vent.. "This device restricted to use by qualified, trained personnel under the direction of a physician."]
    Sorry, no RT or RN in that.

    Practicing medicine is the doc's job, and apologies if I offend, but that post is an example of the entire problem.

    It goes more like this:
    Doc sees patient, everyone else follows the orders, and collaborates with suggestions for the best pt outcome.
    "Patient" being the center of concern, not who is trying to take anything away from whom.

    And one other point; it isn't "your" patient, it's "ours". And if anyone; it's the physician's.
    Those nasty possessive pronouns seem to be the irritants that start the inflammation.

    As with DFK, you are trying to create a 'chain of command' that does not, and cannot exist. It isn't about rank and file, it's about liability and responsibility. [aka, the legal system], not who's better, or knows more about a single subject.

    And as Mandy noted, too much 'me/mine' and not enough 'us/ours' from every department is where we're all wrong... ya know?
    Peace, :-)
    rb
  9. by   JoanieRT2b
    I really didnt mean to offend anyone and I do agree with you a RN's job is just as important as a RRT's .Acually everyone's job in the hospital field is important from the dietary department,housekeeping on up.
  10. by   dfk
    Quote from rmbelcher
    As with DFK, you are trying to create a 'chain of command' that does not, and cannot exist. It isn't about rank and file, it's about liability and responsibility. [aka, the legal system], not who's better, or knows more about a single subject.
    i guess it's my turn now to defend, er umm, express myself..
    rm, if u look from the beginning where all this 'junk' got started, you'll clearly see that what you propose others have said are getting quite slanderous. i wasn't personally saying what you implied, MERELY stating that RNs do NOT have the same training as RTs and that RTs training makes them more qualified than RNs at 'running' the vent according to pt status (and yes, dr.s orders as well) and their physiology education. some RNs feel they can "do" the same job as RTs, and to a degree, yes.. but the point is, is the scope and education are different, and for a reason.. again, i DON'T agree NOR condone RNs taking those matters into their own hands.. i WILL tell you that i have met and worked with MANY RTs and would trust their judgement over SEVERAL physicians.. any day.. period !
    just because one has a medical degree does not make you an expert (pulmonologist notwithstanding) ~
    so, go on and enjoy your grand-sounding day and we will go on continuing to strive for best pt outcome....
    thanks for listening.
  11. by   RN Randy
    Ok... one mo' time....

    Here is a bit from the OP:

    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).
    Looks like a pretty innocent and sincere question about a field he is unfamiliar with.
    Now lets talk about the semantics of the title, aka: the reason this post continues.

    DFK, before I say anything, let me say that your defensive and aggressive approach is indeed an example of the issue both here and in the field. The OP is in another country [not much private insurance to fund a hundred specialties] and the disagreement here has risen from his unintentionally poor choice of words in the topic title. Nothing more.
    Now, my point:
    That fact standing, I then submit that the few RT's here took offense to it and immediately jumped on it to preach about who has more rights where, and that my friend, is exactly why this thread lingers, and exactly why issues arise in the field. It's about personality and turf or rank and file. Period. If you can't see that your previous statement reads as "RN's aren't trained in RT and until they are, should not adjust a setting, etc." then you should now.
    That's my only disagreement. RN's at my facility take 8 hours on vent class, 8 hours on a balloon pump class, and 8 hours on a CRRT class. Want to argue whether RN's should be handling IABP or CRRT? I'm guessing not.
    Now in your last post quoting Jesa, you restate your position saying RN's may be capable of operating the machine. Fine, now we're on the same page and I agree with you. Pick a stance, don't wander.

    Originally, Jesa posted trying to display his RT prowess and knowledge in order to defend RT from Nursing, then summed it up by saying fluid isn't affected by the laws of motion, and gas is unaffected by gravity, and suggested I try and grasp the concept. I didn't even reach for it. [Obviously, that silly statement killed any point Jesa may have had, plus; that kind of attitude only adds fuel to the fire.] You then, post in general agreement to his view and toss more gasoline with opinions about how some RT's are better than physicians. [i.e. coming off as personality or individual issues, which aren't being debated here.]

    Then you say a medical degree doesn't make one an expert.
    Well.... neither does an RT or RN degree, but you never say that, nor does it matter. The doc is in charge, specialist or not.
    Then you sum it up by implying my position fails to take the pt's best interest into account. DFK are you reading my posts at all?
    Either way; Tell me what any of that has to do with this discussion?

    Now; going back, Jesa did say a chimp can operate a vent, but an RT is better suited for assistance in management. [Now THAT makes sense, and is indeed my only point as well.]

    I'm not, nor was I ever discussing management. I'm discussing equipment operation under the direct supervision of a physician.
    You and others continue to argue management in the face of my operation opinions, and it's a senseless debate. There's nothing to er, defend yourself from, bro. You're simply on the wrong page.

    So let's just let it pass and start over, shall we? :-)

    The short of it from rb's point of view:
    The title of this post is an irritant to RT's and has been misinterpreted.
    RT's manage vents better than RN's in most all cases.
    RN's making ordered vent changes should, in no way, offend an RT.
    RT [Allied Health as a whole] is not in charge, or liable for the patient's overall care.
    Nursing is not in charge, but is liable for the patient's overall care.
    The doc is the only one in charge.
    Any issues with that?

    Geez, I hope not.... lol.

    Finally,
    To answer your side topic, I'd advise you to look up the definition of slander vs libel, and also defamation. None have been committed. Worst case is misinterpretation on my part; and if it's happened, I apologize to whomever may have been offended.
    Y'all need to relax a bit, no one is attacking you or your turf.

    Goin' on with my "grand sounding day"!
    :-)
    rb
  12. by   augigi
    We don't have RTs in Australia, so we do all our own ventilator changes, weaning, suctioning, ABG interpretation etc.
  13. by   she_devil128
    In my hospital, we make RT notes that physicians look up before they do/order something for the patient. What I am saying is that, RT is more of a specific field in medicine. RT's can make suggestions to physicians regarding the patients pulmonary status, make physicians pulmo jobs easier, etc. Well that happens in my hospital, i dont know about what other hospitals' RT does. I am an RN too and i feel more confident handling the vents and all compared to other nurses.
    And to answer to the thread question, it depends on the institution's policy on the RT/RN job description. Ofcourse nurses can do most whatever RT's can do, if its about turning the knob or not, suctioning, pulmo rehab, etc. But an RN cant make RT's notes, nor an RT can make nurses notes. RT's also do more pulmonary analysis than RN's and that's why i agreed with what DFK said about the "physiology of it all", and sorry if i offended anyone with my post. Actually, the job is to assess and evaluate pulmo status, treat, and do rehab. We can suggest how many liters of O2 to be delivered and so with the vent numbers(and btw, ABG analysis is one of our majors in school). Be careful when you read the word "suggest" and not "order". Usually that is included in the RT's plan of care, which is later on ordered by the physician. The suggestions RT's make are found on the RT's notes where we also do assessment, diagnosis, and evaluation, which is more of medical compared to nursing diagnoses.
    Now im working as an RN, and i am just glad that i am an RT too, it helps in the team to be dual, and yeah cost efficient. But working as an RN will not allow me to write RT's notes on the chart now.
    As for my opinion, it's ok if a hospital won't have an RT, sure nurses can do the job, but with RT's on board, pulmonary care would be much easier, not just with the intervention, but with pulmonary planning, rehab, and follow ups.
    And just to make it clear, im talking about Respiratory Therapists and not respiratory technicians. Or to make it even more clearer with what RT's do, pls refer to this link: Respiratory therapists or Respiratory Therapist
    Hope this info helps. Peace to all!
    Last edit by she_devil128 on Nov 19, '06

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