What does a Respiratory Therapist Do That An RN Can't? - page 4
Hi All- I was just wondering what education/etc one needs to become a Respiratory Therapist, and what their role is in the ICU? In Australia, Registered Nurses manage almost all aspects of day to... Read More
Dec 7, '05Occupation: 20+ yr RN Specialty: 15 year(s) of experience in Critical Care ; From: US ; Joined: May '05; Posts: 7,520; Likes: 4,028Quote from fergus51I said nothing that contradicts your statement. I don't agree w/ territorial autonomy. I don't agree w/ AARTs position. But I can relate to it, considering the many RNs that claim their OWN autonomous superiority.There is no excuse for this type of territorial autonomy when it negatively impacts patient care. Jan's post is shocking to me. I can't imagine working somewhere that didn't allow me to adjust FiO2 on a patient who is desatting. That's just bad patient care.
I could care less about turf wars. I care about my pts. But RTs can and are essential elements and teammates in the provision of that care.
Yes, RT turf wars can degrade care. But that is a reciprocal relationship. RN turf wars against RTs are just as dangerous or detrimental. I'm an expert generalist. RTs are expert specialists. And that can be a synergistically positive relationship.
Dec 7, '05Occupation: RRT Joined: Dec '05; Posts: 12; Likes: 2Thank you airis, you said it so much better than I did. I was just fuming after reading some of the posts bashing and disrespecting RRT's. I love my job and am confident in my skills and knowledge as an RRT.
Dec 7, '05Occupation: HIT QA Editor, RN, Graduate Student MSN/MS Ed. Specialty: 15 year(s) of experience in ICUs, Tele, etc. ; From: US ; Joined: Aug '05; Posts: 425; Likes: 16The RT's I've worked with are uberspecialist and when they talk, I tend to listen and learn. I have high respects when it comes to the members of the healthcare team no matter what they do. I learn from PT's, Dietary, Social Workers, Pharmacists, and everyone else who's willing to teach.
Dec 7, '05Occupation: Dialysis Specialty: 11 year(s) of experience in Telemetry, ICU, Resource Pool, Dialysis ; Joined: Aug '04; Posts: 1,119; Likes: 284Just like with anything else - there are good ones and bad ones. A great, team-minded RT can be your best friend, and a bad one can ruin your whole night. Where I work, we have examples of both kind. The bad ones are the kind someone mentioned earlier in the thread who don't seem to realize that there is more to a patient than the resp system. I think a team approach is critical, and people need to know their limits of expertise - and try to stay off the other team member's toes.
Dec 8, '05Occupation: RRT Joined: Dec '05; Posts: 12; Likes: 2Just like with anything else - there are good ones and bad ones. A great, team-minded RT can be your best friend, and a bad one can ruin your whole night. Where I work, we have examples of both kind. The bad ones are the kind someone mentioned earlier in the thread who don't seem to realize that there is more to a patient than the resp system. I think a team approach is critical, and people need to know their limits of expertise - and try to stay off the other team member's toes.
The above post goes for nurses as well. There are good and bad nurses, who have the potential to ruin an RT's night. I can't tell you how many times a nurse has called RT to give a pt. a breathing treatment to a pt who is in CHF and full of crackles--albuterol is not indicated to treat chf and crackles. Hey, how about some lasix and Rt will set them up on Bipap!!!! In a few hours they should be much better. Or a nurse calls about a pt on RA whose sats are 82-84%, bs clear, and the nurse wants a stat hhn tx. Hey how about some c/db or some 02! HHN with albuterol tx wheezing, and decreased bs, not crackles(lasix), ronchi(cough/sx). These are just a few of my favorite things!!!!:roll :angryfire
Dec 8, '05Joined: Oct '00; Posts: 8,747; Likes: 8,444Quote from egoodAre these the "nursing" duties that you helped with?I am one of those Rt's who will put a pt on/off bed pad, feed them, get them water ect.
You have no idea.
Dec 8, '05Occupation: RRT Joined: Dec '05; Posts: 12; Likes: 2Yes, these are the "nursing" duties I have helped with, I hate it when a pt. says they have been lying in their stool for hours. I have also learned in school and am qualified to do some other "nursing" duties---vitals,draw blood, start iv's,art lines, swans, If it was under "my scope of practice", I coluld also put a med in a pt's mouth and give them a drink of h20 to wash it down. I could go on and on about the things(nursing duties I am capable of doing), but I don't want to waste my time on someone who seems to have so much dislike and disrespect for RRT's and other members of the healthcare team. No wonder you don't get along with the RRT's. oh, by the way, I am very well respected, liked and wanted at the hospitals where I work, especially by nurses.
Dec 8, '05Occupation: RN - College Health Specialty: Geriatrics/Oncology/Psych/College Health ; Joined: Jun '02; Posts: 6,584; Likes: 70Reopening this thread. Asking everyone to refrain from personal attacks. Thank you.
Feb 15, '06Joined: Feb '06; Posts: 3This type of attitude shows a lack of understanding and commitment to quality patient care in the new millenium. RTs and RNs are suppose to work together as a team and feed off each others strengths to provide good quality care. I could use the same argument of why not just have General Practitioners do all the work from A to Z versus have specialist in different fields to use the expertise in their field. You forget that many our core education is the same for both RTs and RNs. I work in the acute care setting and most of the nurses are to busy to try and do our job with the skills and thoroughness that we do. Likewise, the respiratory therapist are equally too busy doing their job to do the nurses job. RTs specialize in the emergent acute care setting starting from intubation to putting a patient on mechanical ventilation and following up with ABGs. Can you see a nurse doing that in the midst of their normal routine of giving medication. How about an RN being called to start an A-line during their lunch break on a new vent patient. How about a RN trying to understand the principles and mechanics of the pressures and volumes and waveforms and flow volume loops in the middle of giving an IV medication. How about a nurse being called stat to administer nitric oxide or put a 2000 gm premature neonate that has aspirated meconium on the vent and then being asked to do a stat capillary blood gas and interpret it. RTs are more than treatment jockeys. They are involved in numerous modalities that we cannot expect a nurse to do. You would have to go an additional 2 years of training if you want to do the RTs job. I could use the argument what does an RN do that a RT can't do; however, I find that a very ignorant view. In health care today it takes many different disciplines to take quality care of patients in this profession. For that kind of mentality to flourish would be detrimental to patient care abroad. Look at the nurse sitting beside you...would you feel comfortable letting them intubate your mother or child and set them up on the vent with all the possible things that could go wrong? Just remember, all it takes if 4 minutes for hypoxic brain injury to begin. I think that if we would give each other the mutual respect that each deserves that things would go a lot smoother for both you and the patient. Unless you just want to do more work!
Feb 16, '06Joined: Sep '03; Posts: 81; Likes: 1Quote from steve0123Hi All-
I was just wondering what education/etc one needs to become a Respiratory Therapist, and what their role is in the ICU? In Australia, Registered Nurses manage almost all aspects of day to day to care in the ICU, including ventilators (obviously in collaboration with physiotherapists and intensivists). Are RT's common in US ICU's, and if so how is their contribution to the patient more beneficial/cost effective/whatever than that provided by an RN? I'm not having a go at RT's, was just curious as I'm reading about all these diverse roles being undertaken by non-nursing staff in the US that are usually carried out by RN's in other countries (staff such as RT's, Anaesthesia Assistants, Surgical Technicians, etc etc etc).
When I asked this question (seems like over a year ago at least) my intention was to find out more about the role of the RT. Thanks to the many RT's who responded - I wasn't aware that so much preparation was required (I was skeptical having read so much about certain jobs being created and staffed with unqualified workers to cut corners/costs). It was not my intention to suggest that the role of the RT is any less worthwhile than that of the RN - I agree that the more specialised each member of the care team is, the better the treatment/outcome is for the patient.
However, as an RN (and even in my undergrad days), I have watched the nursing profession gradually cut itself loose of certain areas of expertise and naturally, I am concerned about what this means for the future of professional nursing. I am of the view that critical care nursing is a specialty area of nursing, and to deny nurses the opportunity to manage the airway/vents of a critically ill patient significantly diminishes their claim to expertise in this field.
Feb 16, '06Joined: Jul '00; Posts: 11,351; Likes: 388Rick, some of us nurses actually do a lot of those things (like insert A-lines, draw and interpret gases, etc). I've actually never seen an RT insert an a-line and the RTs at my current hospital can't even change vent settings without an order from the MD and they don't intubate at all. There is a lot of variety in what RTs and RNs do in different hospitals. In some places their jobs will overlap a lot, in others they will have very different roles. I've rarely seen RNs and RTs who don't work well together fortunately.
Feb 16, '06Occupation: 20+ yr RN Specialty: 15 year(s) of experience in Critical Care ; From: US ; Joined: May '05; Posts: 7,520; Likes: 4,028Quote from fergus51The only RTs that didn't play well were TBs (true believers) of the AART line that a vent is their exclusive property. I've had RTs throw fits because I wanted to know what the backup (apnea) settings were on low rate/CPAP pts. Yes, it IS my business, thank you very much. I've had RTs refuse to take my advice simply because it was an RN's advice - but that just means calling a doc at 3am to make my advice more non-negotiable.I've rarely seen RNs and RTs who don't work well together fortunately.
And the biggest turf war/sin of all: making an emergency vent change (rate change, if I remember - way too basic - and RT knew that, THEY drew the gas) with a dr's order (and said dr. present) - and to do so because the RT was at breakfast, and not available. Oh Boy! What a major fit. How dare I put the pt's well-being ahead of his independent autonomy! (It didn't matter to him that my problem was he put his breakfast over both.)
But those are just turf war games, and like fergus said before, they have no business coming between pt care.
I think the catchphrase is 'multidisciplinary approach'.
I consider RTs to be vital resources. I'm a huge advocate. Unlike what the previous poster that restarted this thread thinks, I think nurses CAN be taught those skills in short order, albeit with a much more significant time lag for the theory behind it. But that WOULD alarm me. I am already forced to cover 3 pts at times due to short-staffing. Do I want to cover RT's job, too? NO, NO, NO. It goes beyond whether or not I can be taught the skills, or even concern for the extra work. Critical care is too critical not to bounce ideas off my peers constantly. "What do you think about this?" is my tagline at work. I value that RT's independent assessment. . .
But not if I have to fight them for every inch of space to take care of my pts.
And believe me, I KNOW it goes both ways. The key is respect. I absolutely respect the RT at my bedside - or most of them anyway (but then again I respect my RN collegues - or most of THEM, anyway.)
Timothy.Last edit by ZASHAGALKA on Feb 16, '06
Feb 21, '06Joined: Feb '06; Posts: 3I agree with most that you said. A lot of it has to due with mutual respect for each other with in turns increases the efficacy of patient care. Both professions have bad apples. But the majority enjoy and take pride in what they do.
We respect that you have to sometimes take on three patients. I work very closely with the ICU nurses at my hospital and when this happens their heads start to spin around. They need all the teamwork and help that they can. Likewise, when we are short staffed we appreciate any help that we can get.
In the complicated hospital setting we would be pushed over the edge if we did not have each other to consult with.