What does a Respiratory Therapist Do That An RN Can't?

**canoehead, BSN, RN** · Jul 2, 2004

I was hospital policy, as the same issue came up with almost every asthmatic patient overnight, and the same solution by the RT's. The manager was well aware of what was going on but she had been trained in that hospital, so thought that was the correct way to deal with it- after all, that's what the RT's told her, and they were the experts. Anyway, the kids at that hospital had their neb frequency reviewed twice a day by the residents unless something went really bad, where I was used to reviewing response with every neb- check lungs before and after, and sometimes at 15min intervals when I was trying to stretch the timing. In credibly poor care IMO.

Another time I was involved in preparing a newborn for transport and the RT's got so involved in getting blood gases that they pulled the IV line out. I nearly killed them! That's why I think two professionals with a more holistic view of what is going on would be more appropriate. We don't call them to difficult deliveries any more because the nurses are trained and capable to do all the resp interventions, and then some. The doc does intubation if needed; we are a low risk hospital so no neonatologists, etc.

AND...one more thing...it burns my butt when the RT dept decides they don't have enough money or staff to cover nights and passes it all over to nursing. If we can do it at night butt the heck out and let us take credit for being able to do it all the time. And, by the way, give us half your budget if you are only going to be working half the time.

mattsmom81 · Jul 2, 2004

I suppose the reason countries like Australia don't have RT's is because ventilated patients still get 1:1 care from an RN - I didn't realise that US crit. care nurses are being overworked to the extent that they are assigned multiple ventilated patients in an ICU - how exhausting!!!

Interesting. So..RN's in Australia must get advanced training in ventilator modalities, setups and troubleshooting? Is it part of the standardized education system there?

Maintaining and troubleshooting the ventilator is generally a shared job, mostly managed by the RRT...but yes, with a little extra education I could manage it, and would love to if i were to have a 1:1 vented patient.(very few 1:1's in my parts anymore) Pretty routine to have 2 vented patients; and they might be unstable in other systems too.

Personally I'd love to have an extra RN in my ICU , lose the RT and pick up their workload but...cheaper for the hospital to hire the RT to work several unitsd vs hiring an extra RN for EACH unit.

I also remember the pre RT days and doing my own treatments...but in those days the basic Byrd vent was the extent of volume ventilation...its more complex technologies these days.

mattsmom81 · Jul 2, 2004

I suppose the reason countries like Australia don't have RT's is because ventilated patients still get 1:1 care from an RN - I didn't realise that US crit. care nurses are being overworked to the extent that they are assigned multiple ventilated patients in an ICU - how exhausting!!!

Interesting. So..RN's in Australia must get advanced training in ventilator modalities, setups and troubleshooting? Is it part of the standardized education system there?

Maintaining and troubleshooting the ventilator is generally a shared job, mostly managed by the RRT...but yes, with a little extra education I could manage it, and would love to if i were to have a 1:1 vented patient.(very few 1:1's in my parts anymore) Pretty routine to have 2 vented patients; and they might be unstable in other systems too.

Personally I'd love to have an extra RN in my ICU , lose the RT and pick up their workload but...cheaper for the hospital to hire the RT to work several unitsd vs hiring an extra RN for EACH unit.

I also remember the pre RT days and doing my own treatments...but in those days the basic Byrd vent was the extent of volume ventilation...its more complex technologies these days.

mattsmom81 · Jul 2, 2004

This would definitely bother me too. The best RT's I've worked with are degreed professionals and team players...some of the CRT's basically function in technician mode, but want to be considered professionals...and actively complete with nurses. Some RT's are extremely territorial; some think they should 'delegate' to us what they don't wish to do. One hospital I do perdiem work at the RT tried to delegate to ME all the vent circuit changes for her...said it was MY job. I said if RT dept charged for it they could do the work, thankyouverymuch.
But...I also get burned when we must draw all the labs at night but lab gets the revenue for phlebotomy/processing fees...doesn't sit well with me. Nurses seem to pick up the slack for many depts. :angryfire

mattsmom81 · Jul 2, 2004

This would definitely bother me too. The best RT's I've worked with are degreed professionals and team players...some of the CRT's basically function in technician mode, but want to be considered professionals...and actively complete with nurses. Some RT's are extremely territorial; some think they should 'delegate' to us what they don't wish to do. One hospital I do perdiem work at the RT tried to delegate to ME all the vent circuit changes for her...said it was MY job. I said if RT dept charged for it they could do the work, thankyouverymuch.
But...I also get burned when we must draw all the labs at night but lab gets the revenue for phlebotomy/processing fees...doesn't sit well with me. Nurses seem to pick up the slack for many depts. :angryfire

Pediatric Critical Care Columnist · Jul 2, 2004

our rts don't make too awful much less than we nurses do. their scale runs $25.53 - $32.80 cdn per hour, with shift differential and charge pay, same as for us. our pay scale, thanks to our newly ratified contract, runs $26.33 - $34.56. considering that i'm caring for the whole patient, who may have an open sternum and be on any variety of vasoactive drugs, be bleeding from every orifice, have an intracranial pressure monitoring catheter, an evd and a lumbar drain and/or be on dialysis or crrt (which would be my responsibility) or even ecmo, while they run gases and fiddle with the vent, well, capital health is really getting a deal with me aren't they? :eek:

Pediatric Critical Care Columnist · Jul 2, 2004

our rts don't make too awful much less than we nurses do. their scale runs $25.53 - $32.80 cdn per hour, with shift differential and charge pay, same as for us. our pay scale, thanks to our newly ratified contract, runs $26.33 - $34.56. considering that i'm caring for the whole patient, who may have an open sternum and be on any variety of vasoactive drugs, be bleeding from every orifice, have an intracranial pressure monitoring catheter, an evd and a lumbar drain and/or be on dialysis or crrt (which would be my responsibility) or even ecmo, while they run gases and fiddle with the vent, well, capital health is really getting a deal with me aren't they? :eek:

steve0123 · Jul 3, 2004

Interesting. So..RN's in Australia must get advanced training in ventilator modalities, setups and troubleshooting? Is it part of the standardized education system there?

No not standard - crit. care nurses often have further training (grad. dip. or masters), but it's not covered in most undergrad programs (although most hospitals run inservices and orientations that cover vent. mgt. anyway). When I said RN's manage the ventilators, I should have said they manage them in collaboration with the intensivists and physiotherapists. For example, if the patient continually shows suboptimal PaO2 (etc), the nurse would make or suggest some adjustments to FIO/PEEP/etc, but keep everyone in the loop (so that if anyone wants to suggest a better solution they can be heard). The only thing is most places require a medical order for blood gases (if they are done in a lab) and RN's generally don't intubate, so we don't have complete autonomy (just biding our time... baby steps... :) ). It just seems like a more team oriented approach to patient care, where everyones skills and knowledge are better respected (that's in no way a criticism of the US system - it obviously works just fine). Perhaps its all a conspiracy to flog nurses like workhorses and increase profit - why pay 8 RN's to manage 8 patients, when you can pay 4 RN's + 1 RT (save about $200K per year)...

steve0123 · Jul 3, 2004

Interesting. So..RN's in Australia must get advanced training in ventilator modalities, setups and troubleshooting? Is it part of the standardized education system there?

No not standard - crit. care nurses often have further training (grad. dip. or masters), but it's not covered in most undergrad programs (although most hospitals run inservices and orientations that cover vent. mgt. anyway). When I said RN's manage the ventilators, I should have said they manage them in collaboration with the intensivists and physiotherapists. For example, if the patient continually shows suboptimal PaO2 (etc), the nurse would make or suggest some adjustments to FIO/PEEP/etc, but keep everyone in the loop (so that if anyone wants to suggest a better solution they can be heard). The only thing is most places require a medical order for blood gases (if they are done in a lab) and RN's generally don't intubate, so we don't have complete autonomy (just biding our time... baby steps... :) ). It just seems like a more team oriented approach to patient care, where everyones skills and knowledge are better respected (that's in no way a criticism of the US system - it obviously works just fine). Perhaps its all a conspiracy to flog nurses like workhorses and increase profit - why pay 8 RN's to manage 8 patients, when you can pay 4 RN's + 1 RT (save about $200K per year)...

**canoehead, BSN, RN** · Jul 3, 2004

Exactly, the RT is an excuse to load more patients on us. And then...perhaps the RT's will start delegating their tasks to nurses ("just call me if you have a problem") like they did in my hospital.

**canoehead, BSN, RN** · Jul 3, 2004

Exactly, the RT is an excuse to load more patients on us. And then...perhaps the RT's will start delegating their tasks to nurses ("just call me if you have a problem") like they did in my hospital.

OC_An Khe · Jul 3, 2004

History history history. This is another example of RNs giving up portions of ther original professional responsibilities to allow the formation of other professions/careerers in health care, many of which now require more education than nursing to perform. And most even pay mre than an RN. Examples of this are dietary, physical therapy, occupational therapy, PA's, anesthesia assistants. etc. And in most cases have kept the more menial tasks like house keeping, and anything else management wants the RN to do because the RN is there 24/7 and always available so why hire someone to do it.

That said whether a RT manages the vent or respiratory treatments the RN is still responsible for for patient outcomes and needs to be thouroghly familiar with all the respiratory treatmants, medications, etc.