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

ZASHAGALKA, RN · Dec 7, 2005

Our RTs are so territorial it's not even funny.

I would say this thread explains alot of the territorialism.

And this is an RN that has butted heads w/ RT before about EXACTLY whose pt it is attached to that vent. . .The AACN's old procedure manual made it clear that RNs must have a complete understanding of the equipment they use in the function of their jobs. So, yes, RNs should be thorougly enough prepared to operate a vent autonomously - or they shouldn't be competency verified to take care of a vented pt. Why? Because ultimately, the RN bears responsibility for any piece of equipment that affects the pt under his care. (for the same reason we cannot legimately claim that we only did what the doctor ordered when a prudent nurse would know to question . . .)

But some of my better pt interventions have come only AFTER consulting and in conjunction with a respiratory expert. I personally don't consider these allies optional: and not only I, but the pulmonologists in practice in my community would have a fit if they weren't 24 hr caregivers. We have at least 1 f/t RT in our unit - at all times, and normally 2.

I want that expert at my bedside. Why? Very simply: pt advocacy - they dramatically improve the provision of A and B in the ABCs of my care.

But when some of us would say they are optional, is it no wonder that the AART aggressively advocates territorial autonomy?

~faith,

Timothy.

fergus51 · Dec 7, 2005

But when some of us would say they are optional, is it no wonder that the AART aggressively advocates territorial autonomy?
~faith,
Timothy.

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.

ZASHAGALKA, RN · Dec 7, 2005

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 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.

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.

~faith,

Timothy.

egood · Dec 7, 2005

Thank 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.

hrtprncss · Dec 7, 2005

The 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.

pricklypear · Dec 7, 2005

Just 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.

egood · Dec 8, 2005

Just 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

**canoehead, BSN, RN** · Dec 8, 2005

I am one of those Rt's who will put a pt on/off bed pad, feed them, get them water ect.

Are these the "nursing" duties that you helped with?

You have no idea.

egood · Dec 8, 2005

Yes, 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.

Nurse Ratched, RN · Dec 8, 2005

Reopening this thread. Asking everyone to refrain from personal attacks. Thank you.

sabadah · Feb 16, 2006

This 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!

Rick RRT

steve0123 · Feb 16, 2006

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 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).
Thanks,
Steve

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.