Respiratory Therapists Inserting PICC Lines - page 2

Here in Arizona several of the hospitals have started an experiment, they are actively replacing PICC nurses with RTs and calling them "Vascular Access Specialists." These RTs will place PICC lines,... Read More

  1. by   lindarn
    Since when it in the scope of practice of an RT to place central lines, etc?

    They are waiting for a response from the nursing community. Nursings' silence is an approval for the State and Hospital Association to steal more of nursings' professional practice.

    You nurses in Arizona should have jumped on this the minute it was proposed. If you let this go, it will snowball, until there will be NO justification for having nurses at ALL. What does it take for nurses to act?

    If you are afraid for your jobs, it it time to call the National Nurses United, and get the ball rolling for a union organization campaign. What more are you/we, willing to give up? We have already allowed nurses aides to administer medications in nursing homes an ALFs. Now we are allowing RTs to place Central Lines. PTs and Ots are doing our dressing changes. What is left for us to do under our professional scope of practice?

    JMHO and my NY $0.02.
    Lindarn, RN, BSN, CCRN
    Somewhere in the PACNW
  2. by   SusanneS RN
    I contacted both the INS chapter in Washington and also the State Health Dept for RT's. The representative of INS stated they knew there were a couple of states where the RT's are starting to be trained and placing PICCs. I was told unless nurses stand together and put a stop to it, that RT's will get a foot hold into the vasular area and it will be very difficult to stop it. I was told INS has brought it up during one of their conferences but it has not been address agressively. While talking to the State Health Dept for RT's, which I believe is being ran by RT's, I was read what the scope of the RT consists of, which includes the approval to access a vein. When I stated there is a big difference between accessing a vein and placing a PICC I was informed the scope of practice in this area is written very vague, therefore it can be interpreted however an organization wishes it to be interpreted. Therefore if a facility wants to have their RT's place PICC's there is nothing within the scope of the RT's that prevents them from taking on the task.

    I was talking to an RT that places PICCs within a hospital and is now training other RT's to also place PICCs within their facility. I was told about the training that was being done and when I asked about the success rate of placing the lines I was told it was pretty good. During the discussion, I became very aware of the vast amount of holes within the training and the lack of monitoring of quality assurance. An example of this was, the person I was talking to, that had gone to the supposedly extensive training didn't even realize there is a limit on the amount of times you should attempt a line placement if you are having difficulty getting in. Which means, if you have no limits to the amount of times you poke, you will more then likely evently get in.

    It reminds me of a dangerous intersection that has no stop signs. Until there is a death related to an accident and a law suit is filed, there will not be a stop light put in to help prevent a serious accident from occuring. Nurses are suppose to be advocates for their patients. How is this within their patients best interest. What gets me is that much of the administers within hospitals are run by physicians and nurses. This is where the almighty buck becomes more important than the health and welfare of the patient. I do not believe it is all about nurses not wanting to work nights. Whats sad is most nurses don't even know this is occuring.

    So, what do we do to change things and bring it to nurses attention!!
  3. by   lindarn
    We need to go public with this, so the general public can have their say as well.

    RTs have a two year associates degree as entry into practice. Yes, RNs also have that option. HOWEVER, the education levels ARE NOT THE SAME! Not to mention, that the BSN is becoming only what hospitals are going to hire.

    I would compare the two in a letter to the editor, and include that the military, until recently, allowed Diploma and Associated Degree nurses to be commissioned in the reserves and active duty.

    NOW, only BSNs can commision in active duty and the reserves. Respiratory Therapy, X-Ray Techs, can only enter the military as enlisted. It has always been that way. That is because the military recognizes the differences in professinalism in and four year college degree, and a technical two year associates degree.

    We need to compare this to the public, as well as, it is a skill that nurses can and do, use to open a business, and market it to the public, Nursing Homes, Assisted Living Facities, and this is now being taken away from us. No one takes away, or suggests, that PTA, take over the practices of PTs or OTs, by PTA, and allow PTAs to open a business to do that. From what I have read previously, RNs doing PICC line placements have a lucrative business.

    An RNs professional practice is being slowly but surely taken away, and given to other individuals and departments. First in was nursing homes allowing LPNs to be the only licensed individual at all times, medicatation administration given to medication tech, or aides. PTs and OTs now doing dressing changes, that is a skill that is not taught in their schools, unless it is something that is being taught now to take it away from nurses. Nursing does not bill for their services in the hospital. RTs do. That means, if a staff nurse does a dressing change, or places a PICC line, her skill is included in the room rate. If the RT does it, they will bill for it. Hence, revenue for the hospital. Nursing is once again being placed in the negative column of the balance sheet. The hospitals DO not want nurses to bill for their services, as that would as value to our profession. They want us on the negative side of the balance sheet.

    Where is it going to end? With the removing of nurses from practice altogether. We will go the way of elevator operators, replaced by technnology, or HS dropouts. That, in my opinion, is the ultimate goal of hospitals and nursing homes. When our professional practice is being given to anyone who wants it, what will be left for nurses to do? Act as Chief Cook and Bottle Washer for the unit? Nothing more than a fugurehead?

    Can anyone even argue that it is what is happening slowly but surely. School nurses being replaced by the School sectretary and the janitor?


    JMHO and my NY $0.02.
    Lindarn, RN, BSN, CCRN
    Somewhere in the PACNW
    Last edit by lindarn on Sep 29, '12
  4. by   SusanneS RN
    I could not agree with you more. It would be nice to have more nurses involved in this topic.
  5. by   lindarn
    In addition to my above comments, WHY are the positions of PICC nurse not being offered to other nurses in the facility? Why is the knee jerk reaction to give a nursing department/position to another department?

    I find it hard to believe that there are not other nurses in the hospital who would jump at the chance to become a PICC line nurse. This is a marketable skill that a nurse can use to start his/her own business, and become a successful entrepeuner. Or has the option not even been enertained by the hospital, who is more than happy to take another skill from the department of nursing?

    JMHO and my NY $0.02.

    Lindarn, RN, BSN, CCRN
    Somewhere in the PACNW
  6. by   Asystole RN
    Just to clarify on the SOPs.

    In Arizona we have rather lose SOPs for all the healthcare professions. Most of the SOPs are defined by the comment "what the professional is educated in and trained for" which leaves a lot of room for interpretation. This here is the root of the problem, open ended SOPs.
  7. by   RRT_IN_2013

    From what i understand our association (AARC/NBRC) is heading in a direction that will require all RRT's to have a four year degree in 2015. This will have the effect of our profession to be more inline with RN's also requiring a four year degree as well. Hope this helps.

    2015 and Beyond Conferences |
    Last edit by RRT_IN_2013 on Oct 7, '12 : Reason: color code removal
  8. by   classicdame
    Texas is very specific in the NPA rules. Not even an LVN/LPN can do central lines. There is more to learn that the task. People need an EDUCATION about why and where.
  9. by   RT_Skyler
    Respiratory Therapy is placing PICC lines after hous at a several hospitals in Alabama.
  10. by   havacube
    I am quite upset with some of the comments here in this discussion. Although they were said a while ago let me educate everyone on what a Respiratory Therapist does in the background behind the scenes. Constantly is called for from RN's, new grads and old. "My patient's is coughing a lot, can you come give TX?" OMG, and hold on, "My patient has a lot of crackles, can you come give TX?." ETC, ETC, ETC. It's ALBUTEROL not ALLBETTERALL. I am now placing PICC lines in AZ as an RRT and work with respectable RN's daily to assist. Do not make RT's sound like a worthless job, we are mini physicians, CPR experts, and so much more. Respect your RT's. Yours truly,
    TD " A world without RT's is like a world without strings" I made that up ha lol
  11. by   jwk
    Quote from havacube
    we are mini physicians...
    You just lost all your credibility.
  12. by   mlbluvr
    Even the least amount of registered nurse education, the ADN, makes any RT program seem like remedial education. There is no comparison. Yet? Even an ADN (and in many places a BSN) registered nurse cannot insert central lines in most states, without further, specific IV training and certification. This is just another of the ongoing and successful attempts to reduce the status of licensed nurses while allowing lesser educated persons to take their places. Out of control, even as more nurses continue to believe that to obtain employment, they need to obtain advanced nursing degrees. Sad.
  13. by   mlbluvr
    Even practical nurses can do most of what an RT does (trach care, suction, vents, inhalation TXs, etc.). In fact, when the PPS system started in the late 1990's, tens of thousands of RTs were laid off from nursing homes because they became classified as 'unskilled care' (unbillable) , that could be performed by the nursing staff. BUT- in most places an RT can't even give a patient an ASPIRIN. For that poster to claim that RTs are mini physicians, scares me. And as far as CPR? Anyone on the street is allowed to do that, so what makes a person a "CPR expert"? Please elaborate, thanks.

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