Where is the Respiratory Therapist? - page 3
I have the utmost respect for Respiratory Therapy, even at my current "contracted" facility. Most of them are right on target- and IF they have trouble making it on time for a treatment, or show up... Read More
Aug 2, '12I have to say that when I worked in an LTAC our R/T was wonderful. They were just as short staffed and over worked as we were. Despite this they would drop everything if there was an emergency or if I needed help with anything. I was ever so greatful for our team.
Aug 16, '13What a shock. All these "nurses" think they know respiratory. Dont get me wrong there are bad apples in every bunch. Just like I have come across my fair share of bad nurses. Just a friendly reminder stay on your side of the bed and I will stay on mine. There is a reason I have a job, that's because mortality rates were high and physicians asked for a specialist. Maybe next time demanding something from a therapist try asking them their opinion, you might be suprised. The bad ones, will burn themselves out, just like nurses have.
Aug 16, '13I work in a small community hospital. We do not have respiratory therapists. The primary care nurse does everything--except for the intubating--the MD or CRNA's do that. We have multi talented code and rapid response teams. And that is the key to success for the patient in these situations. And a strong leader of code/rapid response who can assign tasks and have follow through.
Point being that there should be an alternate policy should--for whatever reason--the RRT is not available in an emergency. Because the time to figure out that no one knows how to do things or doesn't have access to what is needed is not when a patient can't breathe.
I would get creative in alternates. Does your ER tech want to continue education to paramedic? Can anethestia be called to tube someone? Is there a rapid response protocol that other health care providers can be assigned by the leader of the rapid response to task? This is worth discussing with your NM on how it can be better. So if your RRT is not coming when paged, then alternatives need to be viable and immediate. It is interesting when discussing this with your nursing team. Some could have critical care experience that would help with an emergency. Some have emergency experience that perhaps you were not aware of. To have the team an active part of a solution is never a bad thing.
To cover yourself, I would assign both a code and a rapid response team at the start of a shift. IF the RRT is a no show, then there has to be another nurse, a paramedic, an MD, someone who can tube a patient. Who knows the vent and how to use it. Who has access to oxygen supplies and knows how to use them. Who knows how to give a breathing treatment.
It is something that needs planning. However, if you can count on your RRT's only 99% of the time, I would present plans to the powers that be for that 1%.
Aug 17, '13I think that's a brilliant idea...if you need an intubater, or someone to dedicate to just airway, call 911. You'll get extra hands and they have the equipment.
Aug 17, '13Write him up! Each and every time he's a no show. It's a pain in the butt, but you need to cover yourself too. He's a liability. I'm surprised his RT coworkers haven't tried to do something about him. I've worked with a couple of therapists like the one you described.
I've also started nebs myself when I knew it would take forever for RT to get there. In our ER, we usually give the nebs.
Aug 17, '13I must be blessed with excellent RTs. I know I can have them bedside in minutes if I tell them it's an emergency, they're always readily available by pager, and if we have a hypoxic patient or one with other respiratory issues, they often have good, innovative ideas for fixing it. They really are kind to the patients, and often have ideas to help them better tolerate things like bipap and abg's. They don't do our EKGs, but do a lot more. The times I have signed out inhalers they've asked me not to, because they like to do things like education and incentive spirometry when they come up to do their inhalers with the patients. One of them is a little rough around the edges, but overall nice enough. My biggest complaint is that they'll often sign off treatments as not done, "patient sleeping" even on people that obviously need them. Obnoxious. Should I not give lopressor because the patient was sleeping when it was due?