confessions of a RRT

[yahoomagoo]

Dear fellow healthcare colleagues,

Growing up I had a father who had multiple diagnosed respiratory issues from working at the factory. I remember the night stand filled with inhalers and a machine that blasts air out through a mask. Later on in life after serving my country I had a child. Every so often my kid would have trouble breathing id stay up late at night using a machine that gives her breathing treatments to make it better.

I wanted to serve my community again. I had no clue what a respiratory therapist was until 2 weeks before I joined the program. I figured I could learn more about my kids respiratory issues and help my father cope with his. I remember my first clinical rotation, 8 hours of mundane tasks like Incentive spirometers and MDI teaches. Still, after 8 hours of this I would walk out that hospital with my chest high and proud that I did what I learned to do to the best of my ability. Fast forward 5 semesters, 300 hours of floor clinical's 500 hours of ICU clinicals it was time for me to graduate. Finally the days has come. I passed my boards and received my license to practice medicine with a focus in respiratory therapy.

got a job! I couldn't wait to work with my colleagues, I respect them as they respect me. Atleast, thats what I thought. slowly but gradually I started to realize my true role within the healthcare community. As a student I did an immense amount of studying pulmonary diseases and how to treat them properly, I would thoroughly enjoy doing patient research pertaining to the cardiopulmonary system and reporting my findings to the preceptors and MD's on improving patient care. Now, some days I cant even get 10 minutes to look into a patients chart to research because I have multiple patients on multiple floors with a varying degree of care. I never came into this profession with an ego but with an opened mind. I'm a new respiratory therapist, I know, but if I stay quiet and focus on my part of patient care Ill be fine once my face gets more familiar to those nurses on that unit on this floor and the other nurses on the other unit on the next floor up etc.

but I cant, everyday that nurse on that floor has to ruin my day. I know when you talk about me because it gets quiet when I walk in that room. If i'm 15 mins late for a PRN treatment for a patient in mild distress with bilateral vesicular breath sounds did you stop and think I might be helping another nurse on a different floor with a patient in severe respiratory distress? can you give me 10 minutes to hook up a naked Bi-pap with proper settings for that patient? If I make a liter-flow suggestion for a post extubation COPD patient it isnt because I think im smarter than you, its because I know why his respiratory rate was only 7 on CPAP and lethargic the MD was diminishing his hypoxic drive at 40% CPAP +5, now hes oriented and comfortable on a 2L N/C satting 89-93% RR @ 15 thats what his brain wants, but you still cant hear me can you? even when I try to explain. Its okay run off to the MD and your Nurse friends and talk about me for 5 minutes while i'm gone fixing the next patient.

I just sat down for lunch and you call me thinking a patient needs his trach suctioned, well if youve been suctioning him all day why isnt his sputum trap more crystal clear? If you think you can run a ventilator youre more than welcome to suction as well master of all trades. Your CF patient right chest is getting bigger? but you're firmly addressing for a stat respiratory treatment that "you" ordered, well thats not gonna do much for that developing tension pneumothorax but Ill give it anyway and let you figure out YOUR chest tube is clogged. I just got done doing my vent checks and someone decided to switch over a patient on CPAP and leave the room, thankfully I showed up just in time while the sats where dropping below the point of no return down the P50 curve, Oh whats that? a huge plug...dont forget to suction that patient nurse, thats under your license to you can do what I do remember? its ok dont play super hero now and start chest compressions with a HR at 54 not necessary plugs gone, face is pink, and those tidal volumes are returning. I cant even participate in patient rounds without being looked down upon as a button pusher by all of you, any suggestions I make its taken as mudane and irrelevant. But congrats youve told the MD his tidal volumes, 02 Sat, Co2, RR, PEEP etc youre basically an RRT! but Ive been keeping track o those blood gas trends over the passed 5 days and I assure you you have the wrong settings for that partially compensated metabolic alkalosis or what you like to call "almost fully compensated respiratory acidosis" but hey, what does my opinion matter during rounds. I let you keep him on that vent another 3 days to figure it out.

Yes you can press an alarm button and 100% fi02 but do you know if you increase this button it affects the other 4 buttons? did you know if you pressed that same button on a pediatric patient those lungs will pop instantly? I could tell their is too much water in the heated circuit before I enter the room, those zig zagged lines on those multi colored wave forms on that vent is telling me to suction and dump water, you must of not noticed sitting in front of the patient the whole time. if you have 10 vents running can you distinguish which one is beeping with a low or medium or high priority when 5 of them are going off? sorry if I popped my head in while youre turning your patient? its just because I making sure hes breathing. You called me for a pt. in respiratory distress hes on a 4L N/C breathing through his mouth at a rate of 32 bpm satting at 88-89% tachycardic with shallow tidal volumes, If I put on his "high flow" 40% venturi mask its because its going to meet the patients inspiratory demand 32 x shallow Vt of 200-300ml = 6400 (pt only breathing 6.4 ltr/min) x 4 = 25,600ml / 1000 = 25.6 L per min = ID, 25.6 - 6.4 = set venturi @ 4.8-5.0 L/sec for the 40% to perfuse correctly between 80-100mmhg of 02 on his Hgb oh look! his sat are now 99% hes not tachypneic and hs HR decreased on the same percentage of 02 on a 5L nasal cannula except in a high flow system. But you can run off and tell the MD he was fine on his N/C after SWAT shows up and rapid response. You fixed him,fine.

we have 5 different masks that accomplish 5 different things. 4 different vents that operate in different ways,3 different bi-pap machines that work is different ways,10 different circuits that do different things on those specific ventilators, 2 different CPAP machine. Dont bring this vent to MRI its gonna cost you 30,000 bucks. Dont put ths circuit on that peds vent its gonna cause severe respiratory acidosis, and not give out the true PEEP or PS, pressing buttons doesnt make you a respiratory therapist anymore than me unoccluding your lines makes me a nurse. I hope you future nurses gain more respect for YOUR RRT's. as for you Phd nurses who shun us away from the new MD's on your floor to let him know whos boss...good luck with getting those COPD'ers Asthmatics, CF'ers, CHF, Brohchitis,pnuemo's,pneumonias out quicker, healthier and keep em out. because all well do is press those buttons and say no more to you.

As for me I'm 2 semesters from becoming a cardiovascular perfusionist, so I can get away from you savages.

[Luckyyou, BSN, RN]

Feel better now?

[Sour Lemon]

I love the RTs I work with and rely heavily on their advice. I also make it a point to talk to them before I call a doctor for almost anything respiratory-related. I'm sorry that your working relationships are not more positive.

[malenurse69, MSN, NP]

better get a shaker for all that salt

[heinz57]

The nurses are in no win situations with you. The condescending remarks you make about nurses knowing nothing about respiratory are contradictory to you being upset wondering why a nurse is calling you for assistance with a respiratory patient.

Best of luck in your next profession. Surgeons want things their way always.

[vanilla bean]

Congratulations for doing your job. Sorry you don't get the accolades you think you deserve. You picked a truly apropos username; you most definitely are a yahoo.

[roser13, ASN, RN]

We're savages??

And you're moving onto working with surgeons?

Karma will out

[Wuzzie]

[LovingLife123]

Well, good luck you then??

The RTs on my unit are awesome. I don't claim to know your job, as you seem to know mine and what I do.

I would suggest you find another forum to bash people. This will not end well for you here.

[Here.I.Stand, BSN, RN]

You do realize that perfusionists work with CVT surgeons and ECMO nurses? You will need thicker skin...just saying.

And for the record, I am eternally grateful for our RRTs. They are the ones I consult with first; and actually our 3rd year residents trust their recommendations as well.

Fortunately, the respect is mutual

[fawnmarie, ASN]

Whoa, friend! That was quite a "vent!"

[pixierose, BSN, RN]

I actually requested to observe an RRT during my last clinical rotation so I can observe their expertise.

I've never observed anything but good rapports between the nurses and the RRTs at all the rotations I was at.

Not sure what you're hoping to accomplish here. However, you're targeting the wrong people. We are not the nurses you've been working with.