A touchy subject perhaps, but...(long)

Specialties Pulmonary

Published

Specializes in Cardiac, Med-Surg, ICU.

Hello,

I have only been an RN since last September, but I was an LPN working in cardiac med surg for 6 years prior to that with a total of 10 years nursing experience. I moved to ICU late last year. I feel that I have learned a lot in a short amount of time, but I am very aware that I still have much to learn.

This being said, has anyone ever encountered respiratory therapists who are either paternalistic or just outright condescending towards nursing staff? Either in general or specific examples?

Further background: My fiancee is an RT student getting ready to graduate. He has had clinicals on my floor. I work night shift and he came in one morning with his instructor and another student. They were going to see a patient I had admitted less than two hours before. Without going into great detail, this patient was very sick, as in he was septic. Not on a ventilator at that point, but with rapid shallow respirations. I pointed this out and he apparently didn't agree with me and thought I was going by the respiratory rate showing on the monitor. Anyone could look at this patient and know he was going down the tubes. Anyway, he gave me the "look" as if to silently say, you don't know what you are talking about, but I'm gonna humor you anyways. By the way, this guy ended up being intubated later that day (far too late in my opinion, but that's an incompetent intensivist story which I will not even begin to explain).

Haha...later I find out from my fiancee that this instructor started to make a remark to him and a fellow RT student that "So and so (insert my name here) is one of our new ICU nurses." My fiancee interjected "Yeah, that's my fiancee." Although I am glad to be acknowledged, I kind of wish he hadn't interjected because I would be VERY interested in knowing what this guy was going to say about me...very interested indeed.

Yet another example: There is an RT who works on nights that likes to come up and socialize with the nurses. Fine and dandy, no problem. One night when I was off, our unit received a patient who was benzodiazepene overdosed. The med recon form was not done correctly to begin with and the patient received Xanax than she should have. Basically, he and another RN were dogging the nurse that administered the medicine. Now, I will have to agree that there was a definite lack of critical thinking on the part of this particular nurse, but the error didn't start with her. His comment was "I have nothing but contempt for floor nurses". Since I used to be a floor nurse and know the hell it can be and often is, I was not very happy with his comment and let him know it. I think the real truth is that he is arrogant and has nothing but contempt for nurses period. The only reason he hangs around is because a couple of the nurses stroke his ego.

I could point out some other examples, but I am going to stop there. What do I think the problem is? Part of it lies in education, at least in the two major colleges that teach RTs in my area (I realize that it would be foolish to make generalizations). These RT students are encouraged by both instructors and certain regulating committees to think that they are doctors. In fact, my fiancee noted an example on the patient cited in this post that RTs were charting "ARDS". There was never one mention of ARDS as a diagnosis in the progress notes. I know that RTs are trained to read chest x-rays and by patient assessment I also realize that ARDS was not a far-fetched conclusion. You see, the school associated with the hospital I work at has an MD as the director of the RT program. That's all well and good, but they have to do presentations on patients in which they "diagnose" and give recommendations for treatment. I am all for the development of critical thinking skills, but I disagree with the method. Furthermore, there is an instructor in this same program that makes no secret of her disdain for nurses. Quotes "Don't listen the the nurse" or "That stupid nurse did this". Etc, etc, etc...

Disclaimer: This thread is not intended to start a debate between nurses and RTs. I realize that there are nurses that are just as condescending towards respiratory therapists. I also believe and know that for every RT who has displays this attitude towards nursing staff, there are plenty more RTs who respect and work well with nurses. I just needed to vent a bit. Yes, the pun was intended. :chuckle

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A touchy subject indeed..........................however, I feel it's less touchy than it used to be. Judging by your version of things, there certainly appears to be some unnecessary 'tude on the part of the RT instructors. As your disclaimer said, you can't paint everyone with the same brush. I think part of the problem lies with the oldschool nurses and therapists. A lot of nurses seem to feel that because they are the primary caregivers, they are the only ones responsible for the Pt. Aside from OJT's, which are few and far between in most places, we are licenced and registered (sound familiar?) And our licenses are worded very similarly to an RN's. (in most places) So legally speaking our "scope of practice" is almot identical to an RN's, however RT's typically fill a different role. My pet peeve is an "us Vs. them" attitude in the hospital, when some of my fellow RT's roll thier eyes at a rapid response that turns out to be nothing, it drives my nuts! I would much rather respond to an "emergency" and everything turn out fine, than have to tube someone or start compressions. Bottom line..........we both have a lot to learn from each other. I think a lot of people are finally realizing this.:D

PS - Money comes up a lot in discussing RN's and RT's. I'll take 90% of the pay for 70% of the workload.....anyday!

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Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

As an agency nurse, I have had the opportunity of floating to a number of different facilities. I can say, with honesty, that I have liked every RT I have ever worked with. They are always respectful to me and are so responsive if things are going bad. I love having the backup of an RT when I think something is "not right." I can page them and have them listen to the patient too.

RTs are #1 in my book! Sorry you had to work with some rude ones.

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I work in a VDCU myself and have for quite some time. For the most part, the therapists I have worked with have been pretty good. Every once in a while though.....OOOOOO!!!!!! I just don't understand the thought processes the therapist especially when they predetermine a patient needs an anxiolytic before respiratory assist. Yes anxiety does cause a lot of respiratory distress, but then again anxiety is more often caused by the distress!!! More times than I can count a good suction relieves the anxiety......I have to laugh inside when the therapist comes back and thanks me for giving xanax when I didn't do more than suction the patient!

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Well, there's the classical patient assessment failure by the RT. I'm an RRT and have been faced with the same EXACT situation you mention. Plugging off vs. anxiety and agitation, can be tricky.

My advice is to suggest to the RT to remove the pt from the vent and bag him/her on 100%(of course). You can quickly examine the difficulty in bagging the patient, listen for secretions via exhalation through the ambu valve, ensure proper tube placement, ALL BY BAGGING. Instilling and deep bagging a few breaths and suctioning can do wonders!

......As we all know, some health care professionals are just lazy.

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Sorry, I was using the vent patient scenario. Either way, it takes proper patient assessment by both the nurse and the RT. Classic signs of resp distress, assessment findings and initiating proper treatments (IE suctioning, bronchodilators, BIPAP etc..). Unfortunately the quality of health care professions can vary and as we all know, there are some out there that are either 1. incompetent, and/or 2. willing to get out of doing work.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

attitude does not belong to any one particular group. however i will mention that i work with an rt commonly referred to by rns and mds as "dr. jones" because she's always pontificating on what she thinks should be done for the patient, indicating that the caregivers responsible don't know what they're doing.

i also work with an rt who has a well-deserved reputation for assessing breath sounds by esp. i've never seen him with a stethescope much less actually listening to breath sounds, but he still manages to chart breath sounds every four hours! (amazingly, he says they sound exactly as the nurse charted them!)

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attitude does not belong to any one particular group. however i will mention that i work with an rt commonly referred to by rns and mds as "dr. jones" because she's always pontificating on what she thinks should be done for the patient, indicating that the caregivers responsible don't know what they're doing.

i also work with an rt who has a well-deserved reputation for assessing breath sounds by esp. i've never seen him with a stethescope much less actually listening to breath sounds, but he still manages to chart breath sounds every four hours! (amazingly, he says they sound exactly as the nurse charted them!)

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ha! and i work with several nurses that don't know the difference between a venti mask and a nrb. and perhaps most ridiculously, i've never met a nurse that knew the only clinical indication for albuterol. hint: we don't give a bronchodialator to "loosen secretions"! ftr: "dr. jones" is just as responsible for her pt's as you are. you probably don't want to believe it, but my rt licencse allows me to perform absolutely any intervention that an rn is able to. gasp! omg! we're equals! now before you go judging an entire proffession by the actions of a few individuals, read this:

http://www.aarc.org/advocacy/resources/indiana_study.html

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mod's, please kill this thread.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
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HA! And I work with several nurses that don't know the difference between a Venti mask and a NRB. And perhaps most ridiculously, I've never met a nurse that knew the ONLY clinical indication for Albuterol. Hint: we don't give a bronchodialator to "loosen secretions"! FTR: "Dr. Jones" is just as responsible for her Pt's as you are. You probably don't want to believe it, but my RT licencse allows me to perform absolutely any intervention that an RN is able to. GASP! OMG! We're equals! Now before you go judging an entire proffession by the actions of a few individuals, read this:

http://www.aarc.org/advocacy/resources/indiana_study.html

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Mod's, please kill this thread.

Good post above. I don't ever appreciate when someone makes a blanket statement about a profession. I also find it hard to believe that you've never met a nurse that knows that a bronchodialtor is used for asthma/COPD repiratory conditions. No wonder many of your posts are negative about nurses, because you must work with some dumb ones. Also, I think I've mentioned this before, rather than make blanket statements yourself and offer hints, why don't you use this forum to educate us, because as you point out our education seems to be lacking. No arguements from me there.

We will not kill this thread as the poster clearly says they are venting and we allow that.

To the OP, no I've never met RT's as you've described. I love our RTs and couldn't function without them, don't have their knowledge base and appreciate their support and input.

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........No wonder many of your posts reeks are negative about nurses.........

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Not negative, I am quick to point out differences in our jobs however. I don't think I've ever posted anything blatanly negative about nurses, but I am guilty of having an overbearing sense of sarcasm. Doesn't one incendiary post deserve another? I think we all could rattle off a list of dumb people we work with in many different positions! LOL! OK, so technically speaking bronchospasm is the only indication for a brochodialator, typically indicated by wheezing upon auscultation. Obviously decreased WOB and facilitation of secretion mobilization have its benefits as well. And oddly enough, albuterol can treat hyperkalemia, but I havent seen that since pharmacology class. Never is a strong word, maybe I should've said; I don't recall meeting a nurse who understood albuterol does'nt "loosen secretions".

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..........because as you point out our education seems to be lacking........

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Not lacking, just different. I guess thats the point I was trying to make. A human being can only spread themselves so thin, teamwork is the key.

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HA! And I work with several nurses that don't know the difference between a Venti mask and a NRB. And perhaps most ridiculously, I've never met a nurse that knew the ONLY clinical indication for Albuterol. Hint: we don't give a bronchodialator to "loosen secretions"! FTR: "Dr. Jones" is just as responsible for her Pt's as you are. You probably don't want to believe it, but my RT licencse allows me to perform absolutely any intervention that an RN is able to. GASP! OMG! We're equals! Now before you go judging an entire proffession by the actions of a few individuals, read this:

http://www.aarc.org/advocacy/resources/indiana_study.html

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Mod's, please kill this thread.

would you be so kind as to explain "but my RT license allows me o perform absoluely any intervention that an RN is able to"

TIA:confused:

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