Where is the Respiratory Therapist?

Nurses Relations

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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 a little late on an emergency, I know they are really busy and doing something with another patient on another floor or area. This is different.

Let me set up the Scenario.

Small 40 bed Acute Care 3 Unit Area, 5 Room ER, 8 bed ICU, 12 bed Post-Surgical. 5 Birthing Suites/10 Post Partum/Women's Care Rooms. 20 Swing Bed Rooms, 100 bed Nursing Home/20 of those bed Mental Health Senior Care. There are ALWAYS 2 RRT's (Registered Respiratory Therapists) on staff at ALL times!

One is ALWAYs stationed ONLY for ED and ICU beds. The other covers the 3 story, 3 unit acute care, and swing bed facility. During the day, the RRT Supervisors does the Treatments in the Nursing Home.

Of the 6 RRT's on staff here, (plus the practicing Supervisor=7), all but one are STELLAR! The one I have a problem with is RENOWNED for intubations, and is great "skill" wise. Dependability is NIL!

He is dating one of the Acute Care RRT's, so needless to say, it is starting to affect her as well- but NO WHERE NEAR as bad as him. It's nothing for him to never show up for routine ordered Treatments, I have seen him see a sleeping patient, and walk away. We don't know if he's charging or not- but if I am sure he didn't give one- I initial and circle on MAR for hold.

FRIDAY NIGHT.

Clocked in, started shift. It's Me, an ER Tech (CNA trained for ER), and the Doc. I see the RRT clock in, and leave the unit. 4 patients in rooms, 1 awaiting EMS transfer, 1 waiting for ICU bed (massive CVA)*, all stable but awaiting some orders *besides my transfer.

Admitted Asthma/COPD patient, Anxious/Trembling all over. Spo2 84%, BP 166/106. They wouldn't deny CP, and stated 4/10, pressure- but "better now." 3 lead EKG showed Sinus Tachycardia, no ectopy, 153 BPM, resps labored, wheezing, non-productive coughs/congested-31 RPM. Accessory Muscle Use. Pupils pinpoint, diaphoretic, cyanosis Obvious. Paged 3 times while working with patient. Told ER Tech to page over head.

RRT does EKG, Resp Tx's, Oxygen Set-Up, and blood gases (all of which were ordered stat)! No response from overhead, sent ER tech to RRT Sleep Room (3am), No Response!

Of Course, at this time I have started IV plus meds, O2, the first treatment, but am running crazy to get my EMS transfer ready (MVA), and I hear the alarm- CODE/MVA.

Call Code Blue- I get 2 Acute Care RNs (regular ER back-Up Nurses), and the floor RRT who saves the day. 11 minutes after the stat page, he shows up. We work code successfully, get EMS transfer, He did tx's on Asthma Pt, Spo2 95% on 2L NC, Sinus at 89 BPM now, I tell him what else I need, (needed), but it is handled now- "but don't run off." Fell on deaf ears! Found out 1 hour late, he never drew my second set of ABGs, I wrote it up! My first ever time to write up another department!

4 minutes later EMS report enroute Premie 1 1/2 months early, respiratory distress. Stat page over head (didn't even bother paging him- I told him NOT to run off), and by the time he get's there, Doc and I have baby intubated, IV, and in Incubator awaiting further orders, no distress. Mother's doing fine, but is anxious.

I can NEVER get him when I need him, he just "vanishes" for HOURS at the time. He smokes outside, and I have seen him sit in his car outside and just talk on cell.

I have dealt with the same issue at other hospitals where it looked more like understaffing, but feel this issue is just plain NEGLIGENCE! I have begged for the ones I know will not do the treatments to give me the medication so I can!

I know there are sometimes other things going on, but I am the kind of person who, when I finally ask for help, I NEED HELP NOW! I don't pull a nurse, or make a page unless it's out of my hands. I can go for weeks without pulling a nurse from the floor, or overhead paging any of the OTHER RRTs, it's just this guy!

I know working the floor it is common to get blessed out on the phone by an RRT because a patient is requesting a "PRN" treatment, and they are "Too Busy!" Yet I see them all on my next break smoking, and sitting in the courtyard!

Have you noticed a problem getting Respiratory Therapy when you need them?

How can I address this issue without making it worse?

Do you ever do their Respiratory Treatments for them?

ANY ADVISE ON DEALING WITH NO SHOW RESPIRATORY THERAPISTs PLEASE

Specializes in Med-Surg.

Where I used to work, our RTs would come for the regularly scheduled treatments, and were usually on time. They would have 2 RTs around for night shift, one to provide regular treatments, one for stat calls. It was a mid-sized facility, probably about 600-700 patients(but I might be way off, this is just a guess-timate). We rarely had problems with our techs. They had pagers on them, if we needed them for stats we would call with *911 message, and they would respond to give us ETA. I think I can count on one hand the amount of times we had issues with them...

i was really shocked to read this op. i worked in pacu and icu for years in several different hospital systems and never, ever had anything resembling this sort of problems with the rt folks. they were terrific resources, always around, and i learned a lot from them. i never, ever had one minute's undue delay in a code or other acute situation. i'm wondering if this particular rt has a drug problem or a gambling problem or a girlfriend/boyfriend problem that is obviously occupying so much of his attention.

i totally agree with the keep-statistics-and-write-him-up-repeatedly approach. your risk manager (and you do have one, somewhere in the organization) really wants to hear about this behavior because it substantially increases the risk of bad outcomes, and that means someday there'll be a huge lawsuit. to just put up with it and not have a paper trail makes you look complicit in what you know to be substandard care, and you sure don't want that. you might also make a call to the state agency that licenses him.

and what's with the intubation and oxygenation equipment being locked up??? that is just nuts. put charge slips on it or make it floor stock or whatever, but you can't possibly have no access to et tubes and wall oxygen in any acute unit, much less icu or ed. there are standards of practice for that.

* respiratory care

clinical practice guidelines

* medical standards of care and clinical practice guidelines

medmalrx

* agency for health care research and quality

health care: clinical practice guidelines subdirectory page

* ahrq (agency for healthcare

research and quality). medal.org (access and registration are free)

medal.org

I 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.

What 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.

I 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%.

Specializes in ER.

I 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.

Write 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.

Specializes in Oncology.

I 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?

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