Where is the Respiratory Therapist?
- 4Apr 22, '12 by BostonTerrierLoverRNI 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.
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
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- 5Apr 22, '12 by LostCauseCCRNI agree! This is a unique department if you think about it because we can do 90 percent of what they do and they KNOW AND TAKE ADVANTAGE OF THAT!!!
Write-em-up, and keep Writing-them-up, before someone dies of negligence. It's already stealing because I can just about guarantee they are charging for every missed treatment!
- 3Apr 22, '12 by VICEDRNI am not a big fan of RT for the reasons LostCauseCCRN mentioned. They know their scope is encompassed in ours and they abuse that fact, especially in the ER where they seem to just *love* to avoid doing anything other than bringing a ventilator.
I have already tried to bring this up to the manager but to no avail as he is sympathetic to the RTs. In the future, I plan to document all of it to the nurse manager and if necessary file an incident report form for "Delay in patient care."
SICK of doing EVERYBODY ELSE'S job for them! (sorry...vented)
- 4Apr 22, '12 by michelle126Sounds like you need to bring this up with you manager or maybe you have?
I haven't worked with an RT in years since I do LTC, but that sounds like a lot of patients for 2 RRTs to cover? Do they really go over to the nursing home section? Unless they have vents, why?
- 4Apr 22, '12 by hrodgersOh my goodness it is so bizarre that this is the first thread I am reading tonight, because I am actually right in the middle of dealing with poor RT behavior. Working in the SICU and both of my patient's had abdominal surgeries, have huge round distended bellies, on 3-5 L O2 NC with 88-92% sats...not impressive and they are both struggling to take those big deep breaths we all keep asking them to. Breath sounds rhonchi/coarse, very weak coughs, and poor incentive spirometry skills. They are basically identical with tenuous respiratory statuses. So the MD orders chest PT every 4 hours. Sounds great to me! Now at my last hospital we never needed an order for this, we just used our nursing judgment, clapped on those backs, and did what we had to do for our patient's! But here is different apparently. After paging the RT and bringing these new orders to his attention, he strolls in to the unit about 30 min later. He says that he thinks chest PT is contraindicated for one of the patient's because it makes his HR, which is already 100, increase to 110. And he gets dyspneic. Hmmm....I explain why I think he still needs it, and he suggests I call the MD to have him order neb treatments. So I do (I needed to ask the MD something else anyways), and he says that he doesn't think the neb treatments will hurt the patient but he still wants him to get chest PT. So I just told him that I'll do it with or without the RT's help, and he said thanks. Then the other patient is sleeping in the chair at the time, so he tells me he can't do chest PT on him now and walks away! He said to page him once he's back in bed. Arhhhhh! I feel like any excuse will do to get out of doing a little extra work to benefit the patient's. So frustrating! So I asked another nurse to give me a hand, we performed chest PT on both of my patient's, and now they are resting comfortably with better O2 sats and I'm weaning their O2. Thanks for nothing RT!
- 1Apr 22, '12 by KelRN215Have you noticed a problem getting Respiratory Therapy when you need them?
When I worked in the hospital, we didn't have Respiratory Therapists on the floor and whenever we needed them, we had to page them. They could either respond right away or take hours. If we had a patient who needed q 4 hr pulmonary mechanics (NIFs/VC), the respiratory therapists wouldn't just communicate with each other that this patient needed to be seen q 4hr. No, it was up to the nurse to page them each and every time that it was time for them to see the patient. Aggravating to say the least.
How can I address this issue without making it worse?
I don't have any advice for you here, sorry.
Do you ever do their Respiratory Treatments for them?
At my hospital, nurses did the respiratory treatments. We did all nebs as well as the majority of the suctioning and chest PT. Respiratory, in fact, didn't do any of the chest PT and if anyone other than nursing did it, it was PT. But they would only come once a day. Respiratory, I guess, preferred to spend their time in the ICU.
- 2Apr 22, '12 by BostonTerrierLoverRNWow, I knew from working several different facilities, that this problem is very trancending across the board.
To answer my previous poster's questions, Yes it would be a heavy load- if those bed's were to FULL Census (which I should have covered in my OP I admit). We are at the yearly slum in admits right now, and the Hospital wide census is 14.
We have 1 ICU patient (who the RN does most everything for anyway!) and only 4 Respiratory Patients on the floor now or "Respiratory Orders" patients.
I have the whole ER up to 5 beds, and 5 wall patients (curtains), with ONE tech (who is AWESOME)!
So, Basically, I had 6 patients this night, one code, two EMS transfers over a 3 hour period. I did EVERYTHING RRT DOES, except ONE ABG- he neglected the other! Plus, all my other Nursing Duties on the rest of the 5 patients after my EMS Transfer Out. It was in the middle of a 4 hour period for his due Nebs on the Floor. He had NOTHING Due for 2 more hours when I called him. I have since learned, 2 nurses circled their initials on MAR Nebs for the one's he was supposedly doing during the Overhead Page. (Also the floor is ALWAYS adequately staffed for the ability pull a nurse to ER for back-up.) Also, there is ALWAYs an on-call RRT, however, only the one on duty can make "that" call.
As for the 100 bed LTC area of the Hospital, the Supervisor ONLY does day NEBs, and at night this is contracted out to a third party (when necessary), or they are USUALLY admitted if it's an acute respiratory problem.
After finding out he neglected his floor duties TOO, this changes the whole picture. That means he basically has made a habit of lying to staff, not showing up in a timely manner, and his only Alibi is BS!!!
I just wish administration would give me the due Nebs, so I could handle it without chasing down an RTT!!!!
Thanks all posters for taking the time and consideration to Post.
- 3Apr 22, '12 by woohMost of our respiratory therapists are really great. But when it's shift change, don't expect help unless the patient is near coding. "Can't the nurse do it, we're giving report." Well what do you think we'd like to be doing????
- 5Apr 23, '12 by BostonTerrierLoverRNTOTALLY behind you Wooh!
This is one of those 1% things, as most of the RRTs are awesome! One helps me in the ER with tech duties often! I feel she should have an award for terribly difficult intubations as well. I would wash her car every week, and rub her feet to keep her at the Hospital I work at half the year! She responds to emergencies w/o use of overhead, and on first "Pager" page.
I hate to page (on pager), "NEED YOU NOW!" and get a phone call 5 minutes later explaining why they couldn't come, "Do you still need me?"
I would like to say "H%LL NO! The patient did! But don't worry about it, I just wish I could get your paycheck Friday- because I have done your job all week!"