RT says her scope is wider than mine. Ok? - page 5

I work in the ICU and we work very closely with our RTs. I love my RTs and get along and respect all of them. I even respect and love the RT I'm about to mention, her comment just makes me have more... Read More

  1. by   JWG223
    Quote from klone
    What are some things that RTs do that are outside the scope of practice of an RN?
    Well, for one, other than an ICU nurse, I don't know very many RN's who manage vents effectively, and most systems I work in, even ICU RN's do not mess with the "fine" settings on the vent, which is to say, they do not typically mess too much with tidal volume, etc.

    For two, ICU RN's probably would be a bit lost giving breathing treatments to a pediatric. RT's have to be capable of dealing with pediatric airway/pulmonary treatment as well as adult, which does mean they have a broader scope unless the RN is cross-trained.

    I am sure there are other things, as well, but I am not an RT, so I'd prefer not to go in-depth describing their profession to them, should one chance across my presumptions, lol!
  2. by   heinz57
    Quote from klone
    What are some things that RTs do that are outside the scope of practice of an RN?
    That might be more state dependent. Some states do not allow RN to do intubation, arterial sticks and A-line insertion. Ventilator management may also be defined by statute for proof of additional education and training. Complete PFTs may need an additional certification for nurses. Some labs in a few states restrict full PFT lab to RTs per that state's statute. For others it is more facility specific.
  3. by   klone
    Quote from JWG223
    Well, for one, other than an ICU nurse, I don't know very many RN's who manage vents effectively, and most systems I work in, even ICU RN's do not mess with the "fine" settings on the vent, which is to say, they do not typically mess too much with tidal volume, etc.!
    Right, but that wasn't my question. My question was, what are some things that RTs can do that is OUTSIDE THE SCOPE for an RN?
  4. by   klone
    Quote from heinz57
    That might be more state dependent. Some states do not allow RN to do intubation, arterial sticks and A-line insertion. Ventilator management may also be defined by statute for proof of additional education and training. Complete PFTs may need an additional certification for nurses. Some labs in a few states restrict full PFT lab to RTs per that state's statute. For others it is more facility specific.
    Okay, but the vast majority of those things CAN be done by an RN (with additional training, or dependent upon the state).

    Now let's ask the opposite question - what are some things that RNs do that is outside the scope of an RT?
  5. by   TheCommuter
    I think your RT coworker is playing a game of one-upmanship due to deep-seated insecurity issues. Secure, confident people do not constantly compare themselves to others.
    Quote from CardiacDork
    I work in the ICU and we work very closely with our RTs. I love my RTs and get along and respect all of them. I even respect and love the RT I'm about to mention, her comment just makes me have more sympathy than anything.

    Casually discussing nursing and respiratory education she interjects how her scope is greater than mine and can do more yet still gets paid less even as a head RT. I mean maybe she's bitter because she makes less than the Nurse Clinician 3-5? - and her way of justifying everything is by saying "I get paid less but my scope is larger I can do what you do and more".

    Okay sure. I'm not even gonna argue that. I'm sure you can. I'm just a lowly ICU nurse. I wipe booty.... das all guyzzzz.

    Peace out.
  6. by   CardiacDork
    Skills are skills. Skills are learned easily trough training. Skills are different across state lines. Skills are different per facility.

    What really makes the RN scope of practice is the amount of information that must be assessed, synthesized, and communicated.

    As an ICU Nurse, I may not be a pro at ventilators or pulmonary physiology.

    I do however have moderate knowledge in many areas to successfully and effectively care for my patients.

    I carefully assess my labs, lines, patients, medications. The moment I receive report my brain is juicing up a storm of pure synthesis. I am thinking proactively and ahead of the game.

    Because this is truly so broad and there are thousands of examples, I unfortunately cannot simply explain this in one simple paragraph or even a book.

    What we do as nurses is so much more than the physical aspects of our jobs. It is so much more than placing an IV. So much more than dropping a feeding tube. So much more than obtaining an ABG.

    What does all this data tell me? that is what nursing is truly about.

    Othwrwise hospitals would hire MAs that can legally do anything the MD gives them permission to do.

    But hospitals know they can't do this. They need the educated and trained synthesis performed by an RN.
  7. by   heinz57
    Quote from klone
    Okay, but the vast majority of those things CAN be done by an RN (with additional training, or dependent upon the state).

    Now let's ask the opposite question - what are some things that RNs do that is outside the scope of an RT?
    Having it in your scope of practice doe not always make you the best choice to doing a procedure. We can see evidence of that on this forum as some try to explain basic respiratory care like MDIs, asthma and suctioning. You can say you were "trained" but in reality it might be a 5 minute inservice which gives you just enough knowledge to be dangerous.



    Quote from llg
    I think this all comes down to "How do you define the word 'scope' ?" Yes, some RT's are allowed to do some physical tasks that most nurses are not allowed to do. Some people believe that gives those RT's a broader "scope of practice" than the RT's. Some EMT's think the same way about their scope of practice that allows them to do a lot at the site of an emergency.

    I don't see it that way. I see those physical tasks as just tasks -- and I am not as enamored with them as some people are. I think the higher pay that most nurses receive is reflective of the fact that they are expected to know more about more things and make certain types of decisions that integrate a lot of sophisticated information.

    And as I said in an earlier post -- and to any RT or EMT who brings up the topic with me. If you want the RN's higher salary, become a nurse and take on the RN's more comprehensive role.
    You are comparing an RT to an EMT? Seriously??!! The RT has at minimum an Associates degree and the other has 120 hours of first aid training.


    Quote from CardiacDork
    Skills are skills. Skills are learned easily trough training. Skills are different across state lines. Skills are different per facility.

    What really makes the RN scope of practice is the amount of information that must be assessed, synthesized, and communicated.

    *Snip*

    Othwrwise hospitals would hire MAs that can legally do anything the MD gives them permission to do.

    But hospitals know they can't do this. They need the educated and trained synthesis performed by an RN.
    Are RNs the only ones with education?

    Neither of you has any respect for the education an RT has or probably any other professional. RTs' education is in critical care medicine as Associates, Bachelors and Masters degrees Yes, they do have to look at the broader picture in the ICU since advanced ventilation strategies can do great harm including death if mismanaged. RTs usually operate under protocols for ventilator management rather than getting an order for every little thing. I would only hope someday you could get over yourselves to see how useful being a team player can be with other professionals.

    If my loved one has an asthma exacerbation, I would hope there are RTs at their side and not just an RN. The same goes for PT. I don't want someone who says they can walk a patient "just like a PT" 3x a day for a check box marked done "per doctor's order". I want someone who can evaluate that walk to speed recovery and prevent future issues.

    I hate only reading one side of the story and after reading more of the OP's posts, I have a feeling that RT might have a good reason to vent about a relatively new nurse who has a lot of learning to do. If the OP is going to survive in healthcare working with patients and other health care professionals who are going to annoy you more often than not but it is all part of being a team and learning/working together.

    There have been way too many "measuring" discussions like this on here. It seems when we run out of nurses to pick on, other professionals get caught in the cross hairs. ICU vs ER, ICU makes more than Med/Surg. ER doesn't understand Med/Surg. Then there is all the "I hate being a nurse" which means nobody should be happy.

    Happy holidays!
    Last edit by heinz57 on Dec 25, '16
  8. by   Stepney
    Quote from LovingLife123
    PICCS and Art Lines? What states are these?
    I haven't seen PICCS but they definitely put in ART lines with their eyes half way closed!
  9. by   Cola89
    Teehee. There's an NP and a PA at my job that go back and forth about which is better. I see it like this- you chose what you chose for a reason. You or she can always add to your education formally or informally.

    As others have said, she might feel undervalued, so just keep it kind and professional with her! There's no need to get upset!
  10. by   canoehead
    Quote from Libby1987
    Nursing diagnosis and intervention. Like Potential for skin impairment related to immobility secondary to pain? And then the nurse adds skin precautions and a turning schedule?

    Or do you mean any of the things that we observe and discover but then have to get an order for things as simple as I.S.? We can't apply a bandaid without an order.

    Without established protocols, standing orders and/or an understanding with regular providers who will sign our orders retroactively, it's more style over substance.
    Who cant apply a Bandaid? We don't need orders to initiate a dressing at my hospital. We need to report it to the doc and s/he might order something different though. We initiate IS too.
  11. by   yahoomagoo
    New York, I've done a few PICC lines and a ton of ART's. Im not bragging, but its covered under my license and studied how to do them vigorously. The hospital you work at may not allow RRT's to do ART lines, so you don't see them do it. But he/she might have been the go to art-line guy/girl at her previous hospital.
  12. by   applewhitern
    I have worked at small, rural hospitals that don't even have a respiratory therapist, the RN did it all. And I have worked at small, rural hospitals where the only respiratory personnel were known as OJT's, on the job trained, and not licensed at all. The RN's manage vents in all of the hospitals I have worked, including large ones. Not bashing RT's at all, just saying every place is different.

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