Do you hear nurses will take over respiratory work?

calivianya, BSN, RN · Jun 2, 2014

What is the role of RT? Assess respiratory status? Nebulisers? Oxygen therapy?
Can they prescribe O2 or nebs etc?
Does a nurse have to do anything respiratory wise for a patient or does RT do it all?
Interesting that US created this job.. Sorry for the questions!

No, knowledge is good. :) RTs assesses respiratory status (though we do that too) and do all respiratory treatments, whether the patient is on the vent or not. RT does not prescribe any more than nursing does, they need orders just like we do. I will do some things for my patients, like put on oxygen, I'll suction vents, trachs, etc., but largely that is RT's responsibility. RTs also know a lot more about the ventilators than I do - I can hit the O2 breaths button, and I know what the different modes do and how to find out what the vent is set at as far as tidal volume, PEEP, etc., but I don't know how to change things like that on the vent. If the doctor prescribes a change in the ventilator settings, RT will do it.

There are other things they can do that we can't - RTs can do arterial sticks, so they get our ABGs and drop arterial lines as needed. Radial ones, anyway. They are also allowed to intubate patients, so if someone is crashing and we have orders to put the patient on the ventilator, we don't necessarily have to chase down a physician if a RT is immediately available.

Quick question for you - who does ABGs in countries without RTs? Only RTs draw ABGs in my hospital - nurses and lab are not allowed to do it.

thenightnurse456 · Jun 3, 2014

No, knowledge is good. :) RTs assesses respiratory status (though we do that too) and do all respiratory treatments, whether the patient is on the vent or not. RT does not prescribe any more than nursing does, they need orders just like we do. I will do some things for my patients, like put on oxygen, I'll suction vents, trachs, etc., but largely that is RT's responsibility. RTs also know a lot more about the ventilators than I do - I can hit the O2 breaths button, and I know what the different modes do and how to find out what the vent is set at as far as tidal volume, PEEP, etc., but I don't know how to change things like that on the vent. If the doctor prescribes a change in the ventilator settings, RT will do it.
There are other things they can do that we can't - RTs can do arterial sticks, so they get our ABGs and drop arterial lines as needed. Radial ones, anyway. They are also allowed to intubate patients, so if someone is crashing and we have orders to put the patient on the ventilator, we don't necessarily have to chase down a physician if a RT is immediately available.
Quick question for you - who does ABGs in countries without RTs? Only RTs draw ABGs in my hospital - nurses and lab are not allowed to do it.

Interesting... Nurses, doctors or phlebotomists do our ABGs. It just depends on the facility and it's protocol.

So if an RT thinks the patient needs a specific treatment or change in vent settings, do they call the Dr or do they get the nurse to?

calivianya, BSN, RN · Jun 3, 2014

Interesting... Nurses, doctors or phlebotomists do our ABGs. It just depends on the facility and it's protocol.
So if an RT thinks the patient needs a specific treatment or change in vent settings, do they call the Dr or do they get the nurse to?

They usually call the physician directly, which is nice. Look, a specialty that actually communicates with doctors! Awesome!

HouTx, BSN, MSN, EdD · Jun 3, 2014

As long as the person doing a task is competent to do so & the task is within her/his scope of licensure it's no biggie.

The big concern is - ensuring that the task 'recipients' can provide the same level of care. The new tasks have to be incorporated into the job competence matrix & supported with adequate training & proficiency management.

The elephant in the room? Does the shift in responsibility also include a labor budget? One of the most common administrative 'shell games' is to dump additional tasks on nursing staff without any consideration of the additional time required to take on that task. This was the holy grail back in the day of "Patient Focused Care" in the 1990's... eliminating jobs and reducing labor costs while nurses took on everything from phlebotomy to housekeeping. It was a complete bust. It always is.

BBRANRN2013, ASN, RN · Jun 7, 2014

I work in a subacute ventilator unit and we have a full time RT on at all times - sometimes even 2! It is great!!!!!!

Lev, MSN, RN, NP · Jun 8, 2014

RTs can do arterial sticks, so they get our ABGs and drop arterial lines as needed. Radial ones, anyway.

Nursing can do arterial sticks too. At least in my state. More likely seen in critical care and recovery room than acute care units.

NicuGal, MSN, RN · Jun 8, 2014

We would not function well without our RTs! We have multiple vents and they take care of all the setting up, adjusting, etc. They do treatments, clap and suction. They draw our gases. We don't do art sticks on our unit anymore, only RT, residents or NNPs. They are a wiz on knowing all the adjustments. They set up our nitric and heliox. If they added all this to our patient load we'd all quit!

Here.I.Stand, BSN, RN · Jun 8, 2014

Interesting... Nurses, doctors or phlebotomists do our ABGs. It just depends on the facility and it's protocol.
So if an RT thinks the patient needs a specific treatment or change in vent settings, do they call the Dr or do they get the nurse to?

Where I work, RNs get our own ABGs (phlebotomists never touch arteries though!) Although I'm wondering if that's more of an SICU thing, because when floating to the MICU once the RT called and said she was running behind and was I able to get one or could it wait a while? I was like, "I just got it actually...I'm from the SICU and we get our own so I didn't plan otherwise."

In any case, I don't believe it's the norm as wherever else I've worked the RT gets the ABGs unless the pt has a line already. But it's not a universal, art-sticks-are-outside-the-RN-scope thing.

The RTs are generally VERY knowledgeable about ventilation intricacies. I've seen them look up the pt's labs and combined with their assessment, call the resident and either make their suggestion or depending on who the resident is just make vent changes themselves and tell the resident what they did. :) Technically they need an MD order, but our residents respect the RT's expertise and will usually go along w/ what the RT suggests.

I don't believe I'm overly dependent on them, the way some nurses sound on threads re: the RT's role... I mean I'll increase the pt's FiO2 if I feel they need it and then tell the RT that I did so, or the other night I changed a pt from O2 by face tent to humidified NC since she'd been satting in the high 90s for several hours...and again, I just told the RT what I had done so that he had current info on the pt. I know how to extubate. I know the basic vent modes pretty well and for what situations one might increase the PEEP or decrease the vT... but for more intricate things like bilevel settings or oscillating vent, dual lumen ETTs, etc. I am SOOOOO glad we have them! I'm a newish ICU nurse--my current job not quite 1 1/2 yrs, 2 yrs early in my career, and off and on in a very small LTACH ICU for the final 6 months of my time in the LTACH--so have definitely come to appreciate a discipline who is SO educated and knowledgeable about this one vital system.

On the floor, they were a nicety. In the SNF, they weren't there. The only time I saw an RT was during a trach inservice that they held when my rehab unit started taking trach pts. In the ICU, I consider them lifesavers!

Yes, I realize Wiki is not the go-to source for EBP articles, but this description is pretty thorough Respiratory therapy - Wikipedia, the free encyclopedia

Here.I.Stand, BSN, RN · Jun 8, 2014

I'll add, that if I didn't have a busy life already and money weren't an issue, I'd seriously consider going to RT school just to supplement my nursing knowledge. :)

TU RN, DNP, CRNA · Jun 8, 2014

I was trained to/could do the job of the RTs, but having them around is surely helpful for when I have to sit and document the mountains of crap that nobody will ever look at.

beckster_01, BSN, RN · Jun 8, 2014

I second what most people have said here. I don't think it would be unreasonable to go without RT, however their in-depth knowledge about ventilators/settings in general is very helpful. I think it is particularly important in a teaching hospital since until a couple years in most of the MD's don't necessarily know all the ins and outs of ventilators, and their measurements and settings. But honestly it certainly is not outside of my scope to learn these things. RN's where I work do not to ABG's, but I truly think that if we were required to learn it wouldn't be that hard.

KelRN215, BSN, RN · Jun 8, 2014

OP, what is it that you're concerned with? When I worked in the hospital, we nurses did most of what other hospitals apparently have respiratory doing. We did all nebs, trach care, suctioning, chest PT, oxygen, end tital CO2 monitoring. Respiratory therapists were only in the ICUs. The only time I ever saw them on the floor is if we had a patient on overnight CPAP or BiPAP and needed it set up or if we had a patient with a neuromuscular disease who needed pulmonary mechanics (NIFs/VCs). Even then, they didn't come unless you paged them and if the patient was ordered for pulmonary mechanics q 4hr, you had to page the RT every 4 hours and remind him to come.