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confessions of a RRT

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

Specializes in ICU. Has 9 years experience.

Feel better now?

Sour Lemon

Has 9 years experience.

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

Specializes in ICU / Urgent Care. Has 4 years experience.

better get a shaker for all that salt

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.

Edited by heinz57

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

Specializes in Med/Surg, Ortho, ASC. Has 17 years experience.

We're savages??

And you're moving onto working with surgeons?:roflmao:

Karma will out :cheeky:

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

Specializes in SICU, trauma, neuro. Has 16 years experience.

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

Specializes in Psychiatric Nursing. Has 18 years experience.

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

pixierose, BSN, RN

Specializes in ED, psych. Has 3 years experience.

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.

Thats a strange and unfortunate working relationship you have there.

As an ICU nurse, I love my RTs. A few of them are my golfing buddies.

I passed my boards and received my license to practice medicine with a focus in respiratory therapy.

You do not have a "license to practice medicine". You have a license to practice respiratory therapy. Huge difference. I'm thinking that may be part of the problem.


Specializes in Cardiac/Tele.

The only RRTs I don't get along with have attitudes just like this. I call our hospital's RRTs so I can learn from their expertise, and there's mutual trust between our interlinked professions. The very small minority who look at every RN like we all have a chip on our shoulder (whether we do or not), are never able to see how much we respect RRTs and value their input and assistance. I can't help that. I'd be lost with my RRTs teaching me so much over the course of my practice. Not saying all RNs are team players, but likely it's not just RRTs they treat that way and karma finds them too. But if you give most RNs the chance and benefit of the doubt... However, it's human nature to see what you expect to see in others, and you reap what you sow.

I can say where I work everyone has a mutual respect for one another. The observations and opinions of a respiratory therapist are valued by the nurses, as well as the pulmonologists. Sorry you've had such a bad experience. I tend to just drive right past condescending remarks, but I will concur with the others and warn you that surgeons can be very difficult to deal with (although most of the ones I work with are really nice). Anyways, best of luck!

P.S. If the scenario about the clogged/malfunctioning chest tube is true, you should really just go ahead and point it out, it's not that patient's fault you don't get along with that nurse.


Specializes in Critical care.

I work on a unit with a respiratory focus and I love our RRTs and pulmonary rehab people! I happily let them do their thing, ask questions, and ask them to help with patent teaching when it's something I don't deal with often that they know better than me. I trust and respect all of them except one (there was an incident where one didn't hook my patient back up to his oxygen properly and the patient became hypoxic as a result).

I hope you feel better after that rant. Your attitude doesn't seem the best, so good luck with your future endeavors.


a "savage" RN :sarcastic:

Edited by AceOfHearts<3

RNperdiem, RN

Has 14 years experience.

Best of luck in your new adventures.

I am sorry you didn't have good working relations with many of the nurses.

Personally, I think of the RTs as my brothers(and sisters) in arms. When things go south with a patient, who cannot be grateful when RT shows up? We have battled the forces of death and desaturation many times together.

bsyrn, ASN, RN

Specializes in Peds, School Nurse, clinical instructor. Has 21 years experience.

I understand that was venting but I don't understand why you felt the need to come to allnurses just to bash nurses. Best of luck with your new co-workers.

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

Hope you feel better with all that venom off your chest.

Everyplace I've ever worked in the last 40 years, relations between nurses and respiratory therapists have been cordial and collegial. I'm thinking that if you're experiencing that much difficulty getting along with nursing, the problem might be you. Perhaps you don't realize that you're not licensed to practice medicine and your difficulty ensues from thinking that you are.

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