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

  1. 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
    Last edit by steve0123 on Jun 30, '04
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  2. 114 Comments

  3. by   altomga
    IMHO....Respiratory therapists are an invaluable part of the team...their roles are to manage the vents, provide any breathing treatments, therapies ordered, intubate, assess trach patients, suction prn, have input on the plan of care, interact with the dr's, nurses on patient outcomes...and much much more.
    They go through 2 yrs minimum of schooling. Where nurses have a broad teaching RT's are more intense on the lungs and how they relate to the rest of the body. Their typed POC's are impeccable. If I get a crappy report normally all I need to do is read the RT's note. It gives a blow by blow of what has happened and what is the plan for the future.
    The nurse and the RT work side by side. Think of how much time you could save if you were not responsible for the vents, treatments, etc...to focus more on your other duties.
    The nurses must still understand the type of vent and settings their pt is on and how it works, etc...we do not "manage" the vent though.
  4. by   zambezi
    We work closely with our RTs. I work in an post open heart unit, but have intubated pts in the unit for other reasons as well...Our RTs manage the vents/do the treatments/do abgs (unless from an Aline--then we pull the ABG but the RT runs it)...We can extubate our hearts per a standing protocol....once the "nursing" criteria are met, we do a couple of other "RT" tests--short cpap trial/check respiratory rate, minute ventilation, tidal volumes, vital capacity (which the RN can initiate, but RT is notified and usually the one doing)--do an abg and if parameters are met we can pull the tube (which the RT usually does...)--it is a joint collaboration that both the RT and RN have to "sign off" on...We usually suction our own patients as necessary but (obviously) RT can do it as well...they are the ones that assess the vent parameters and make changes, though if a pt needs a higher/lower FIO2 I will make changes--It does save time not to have to do all the treatments, etc...our RTs do not intubate though...they will manage the airway in a code and prepare the intubation tray, but the doc puts the tube in...
  5. by   canoehead
    At our hospital the RT's go home for the night, so apparently the RN's are just as capable. We call them for a new vent set up, that's it. But during the day you don't dare give a neb without permission...complete rip off in my opinion.

    For those with good RT's- what if you got trained to do the vents, and then got 1-1 RN ratios with vent patients. That's what we did before RT's, and it certainly seemed nice.
    Last edit by canoehead on Jun 30, '04 : Reason: cat stepped on the keyboard
  6. by   IamRN
    Quote from canoehead
    At our hospital the RT's go home for the night, so apparently the RN's are just as capable. We call them for a new vent set up, that's it. But during the day you don't dare give a neb without permission...complete rip off in my opinion.

    For those with good RT's- what if you got trained to do the vents, and then got 1-1 RN ratios with vent patients. That's what we did before RT's, and it certainly seemed nice.
    What a different concept...just having RTs during the day hours

    The concept of a 1:1 ration which includes managing vents is an interesting one. However, wouldn't that mean that I would have to undertake the same education that the RTs took to fully and really understand what I would be doing? And isn't it the same situation when one tries to "train" non-licensed nursing personnel to accomplish the same duties that a licensed one would accomplish?
  7. by   canoehead
    RT's are relatively recent occurance, before them the RN's did everything with the same education we have now (or less). If you think about all the equipment you have to learn after you come to a hospital or ICU, learning vents would be the same thing. If we can do art lines and Swans and balloon pumps (not covered in school) there is no reason why we couldn't do vents.
  8. by   Gompers
    I personally like having RTs in the unit 24/7. We have some that are NICU based and others float from Peds and Adults after they've been NICU trained. While it's true that I have the time and could develop the skills necessary for ventilator management, I still like that the RTs are there. When we have unstable babies, they're invaluable! They're the ones switching out the vents, giving the docs ideas about what settings would work best, hand bagging the babies during nasty episodes when WE'RE too busy dealing with assessing the baby and providing STAT medications and transfusions. True, there are usually other nurses around but sometimes they're busy themselves and the RTs have the time to help. They know their jobs inside out, and have an understanding of ventilaton beyond what most RNs and MDs have. JMHO, according to what I experience in my unit.
  9. by   Dinith88
    We have RT's 24/7. They manage vents and do all the other stuff the above posters mentioned. The RN's can (and do) preform the same tasks as our RT's...but RT's do all the time-consuming vent-stuff,, nebs, CPT, etc. that would otherwise consume a significant amount of time. They're more of an 'ancillary' part of the team....though a very important one. They're very focused...(and thus very limited in their scope).
    It's A HUGE mistake for an RN to neglect the ventilator/respiratory stuff (thinking it's a job for the RT's....)...A competent nurse knows respiratory stuff as well as any RT.

    Can an ICU function without RT's? Yes.
    Can an ICU function without RN's? Absolutely not.

    (btw, they make alot less $$ than nurses do...where i work at least).
  10. by   canoehead
    What if you had the same number of people but they were all RN's and all qualified to do RN or RT duties? In my opinion it would be even better.
  11. by   Gompers
    Quote from canoehead
    What if you had the same number of people but they were all RN's and all qualified to do RN or RT duties? In my opinion it would be even better.
    To me, even when I'm 1:1 with a sick vented kid and the unit has enough staff, I still like having RTs around. They know all the babies and each has their own assignment, so when you need help during a crisis they're right there. Other nurses are busy with their own patient loads, even if we're well-staffed, and don't have time to leave their patients to sit with you and the doc at the bedside when the kid is hovering on the edge, making constant ventilator changes, while it's the RT's job to do just that. And like I said, when I'm busy with meds and such, I don't have time to stand there and handbag my patient through the crisis. Maybe it's different in adult ICU, as I've never worked there so I can't say.

    And I do make it a point to understand the vent and respiratory stuff pretty darn well, but it's still nice to have an experienced therapist there who knows all the quirks and tricks to get optimum ventilation. It's not like I'm not even bothering to think about the respiratory stuff - when I get results on an ABG, I usually know what changes need to be made on the vent before I even talk to the doc or RT.
  12. by   steve0123
    Ok, so an RT is like an expert in applied respiratory physiology? I can handle that - I suppose it can only be of benefit to the patients. But someone mentioned in a post that nebs aren't given without "consent" or whatever from the RT - that doesn't sit well with me. Aren't RN's supposed to be autonomous practitioners (within reason) - I would have thought that our education prepares us to use our own judgement when it comes to those sorts of decisions? 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!!!
  13. by   canoehead
    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 nursing assessment. 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?
  14. by   susi_q
    I like having RT around. True in the "old" days RNs did it all ... but there wasn't as much machinery to deal with - the pace of change was a lot slower. We need to recognize that we can't be experts in everything. RTs actually have a similar amount of education as an ADN (just don't have to take boards, yet). They can focus on respiratory interventions - and stay up to date in that specific area, while nurses focus in their areas of expertise.

    By the way ... in our facility RT is there 24/7. They intubate during a code, do breathing treatments & EKGs, vent management ... but work with RNs to evaluate patients. They're usually pretty responsive and receptive to requests. What is so "dangerous" about having someone else to bounce ideas/observations/concerns off? Two heads are better than one ... especially when each has some specialized information that they can share with the other (IMHO)

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