RNs working as Resp. Therapists

  1. I am hoping someone can answer question for me, and excuse me in advance for the long post. I'm irritated and venting.

    I work in a 180 bed hospital that has been very busy lately. We've also had major financial problems, and will be bought within the next 4 months or so by a yet-to-be-named corporation. My manager is a Master's prepared nurse who has ONE year of Med-Surg experience. She is the Director over MICU, SICU (where I work), Telemetry, and the Respiratory Dept. She has NO critical care experience.

    Lately they've cut the respiratory staff, and their procedure count has been astronomical. Earlier this week there was only ONE therapist to cover the whole house, so they pulled one of the MICU nurses to "help out." Basically the RN did all of the treatments in the hospital while the RT covered ER call, did all the vents (including NICU), and ran all the ABGs. Needless to say, both were worn out and a lot was left unfinished.

    NOW, one of my coworkers (who works SICU with me) said last night that the manager had "fixed" MICU's schedule to make sure their core staff number was 3 (which pissed off a bunch of nurses AND 3 is NOT enough for an always full 13 bed ICU), and then asked her would she like to pick up any extra shifts working in MICU OR RESPIRATORY next week. It was also implied that the ICU nurses may be starting to get pulled to work as RTs when the hospital is short.

    Is this legal? I know we are capable of doing our own treatments and whatnot, but what are the implications, other than staff dissatisfaction, of RNs working as RTs? I work in Louisiana.

    Any opinion would be appreciated. Thanks for the ear.
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  2. 9 Comments

  3. by   suzannasue
    WELL...all I can tell you is "been there done that". I had a difficult
    time understanding the legalities of the situation...would they expect an OB/GYN to cover NeuroSurgery?????? THEY are saving money by thinking WE are capable of being all things to all people. This is not JUST a nursing issue. All done in the name of "patient focused care". HAHAHAHAHAHAHA!!!!!!! Since nursing is so quick to re-name our multilple responsibilities, I re-named this methodology " administration - has - Fu@&ed-us,they don't care"...and they don't...bottom line is the almighty dollar...as long as we continue accepting these extra duties,we will be expected to perform. I now work in a facility where lab is lab, respiratory is respiratory and nursing is allowed to be nursing (although the managers have decided we must become ancillary housekeeping, jcaoh is coming next year ....here we go again....)

    ADDENDUM....WERE THEY REALLY SAVING MONEY????? MANY CALL INS WHICH MEANT OVERTIME,THEN THEY HAD TO HIRE AGENCY NURSES TO COVER POSITIONS LEFT BY NURSES....

    ABSOLUTELY DELIGHTED I AM NOT NOT THERE ANYMORE!!!!!!!! THEY CAN BITE ME!!!!!!!!!


    I wish you the best of luck...heat up the hot plates,nursing's next assigned task will be meal preparation !!!!!!!
    Last edit by suzannasue on Mar 28, '02
  4. by   VickyRN
    Whew!!! This is unbelievable and so unsafe.... I don't even know where to begin to comment on this. A NURSE to take care of ventilators... even in the NICU!!!! Have you been trained for this???? Talk about legal liability and licensure issues. THREE nurses for 13 MICU patients!!!???? They have got to be kidding. We frequently have MICU patient overflow in our CICU (ratio 2:1) and just one MICU pt can be a handful (sometimes requiring 2:1 nursing care). Your story makes me VERY appreciative of my hospital and staffing. I would RUN, not WALK out of that unit and out of that hospital; not even let the door hit me on the way out!!!! With arrogant, controlling, incompetent, moronic managers like that, the only way nurses can counter IS WITH OUR FEET!!!
  5. by   mattsmom81
    This is what happens when letters after someone's name mean more than experience, unfortunately. She will run off her experienced staff quickly....

    I don't mind helping out the RT's and they help me too..with lifting, retaping ETT's, blood gas draws, etc. It's a team effort in my ICU. We both unhook the nebs but the RT sets 'em up. The RT does the initial vent check but I troubleshoot. If you are not comfortable assuming RT's duties and/or have never been trained to do their procedures, I certainly would not do so because it's a liability issue. The hospital needs to document competencies here or they assume liability as well...

    And 4:1 MICU ratio is unsafe. I only accept 3:1 under protest, and in special circumstances. No way can you give critically ill patients good care with a consistent nurse patient ratio like this, IME. Good luck, sounds like you'll need it in this facility...
  6. by   SICU Queen
    Yeah, I'm ready to hit the road.

    Usually they manage to pull a nurse out of their butt somehow and make it a 3:1 ratio. I don't work in the MICU, though. I work in the SICU, where our surgeons have hopped and hollered loud enough that our staffing is good. (1:1 for 12 hours on hearts, 1:2 otherwise)

    My problem is that I think it's not in the patients' best interest to use a nurse as an RT. Now, the one RT that is on will do the vents and the units (MI, SI, NI), and also ER call. That leaves the RN that floated into Respiratory for the night to do everything else. That's ALL treatments for SNF, Rehab, two med-surg units (at 36 patients apiece), Telemetry, and Peds/Postpartum.

    I have already informed my clinical coordinator that I will refuse ANY assignment as an RT, nor will I take more patients than I'm safely able to care for. Needless to say, they don't like me very much right now.

    Too bad, so sad...:chuckle
  7. by   night owl
    We have a respiratory therapist, but only works day shift??? Afternoons and nights do all of the nebulizer tx's. Thank God we have no vents!
  8. by   canoehead
    WE have RT's for just daytimes, nurses do most of it at night, and the ICU RN's are trained to work the vents with an RT on call. We call them in to set up new vents, or with an unstable pt, or if there is a traveller who is not OK with doing vent checks herself.

    Ridiculous, I think nurses should just do it and then we could take over the respiratory dept's budget. And FYI, when respiratory cuts back on their hours, or what they are willing to do they do not fork over a portion of their budget to us who have to cover for them.
  9. by   live4today
    Did them all the time when I worked on Pediatrics. Pedi RNs are "everything" to their patients. Yes, we had RTs come around as needed or as ordered, but if the supply of RTs was short, the RN had to do the treatments. I did so many RT treatments on pedi kids that I started to feel like a RN/RT. :chuckle
  10. by   kids
    Bad news is...
    the last I knew (could have changed) under PPS using an RT for lung assessments, resp treatments and O2 is not covered as they are NURSING functions (as is trach care).
  11. by   jamistlc
    Originally posted by night owl
    We have a respiratory therapist, but only works day shift??? Afternoons and nights do all of the nebulizer tx's. Thank God we have no vents!
    This is about where I draw the line, I will do a vent case one to one (Private duty) but in house I would be lost if all the alarms went off on all the different models whew wee:imbar
    I have to be trained for each client and I like it that way as I am a Nurse and not a RT!

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