Nurse vs Respiratory

Nurses General Nursing

Updated:   Published

Hey everyone. Quick question

So just recently I had a patient with a neb treatment that was due at 2100. Hours later and it's now a quarter to 0100. The room is right next to the nurses station and I never saw the respiratory therapist go in to administer the treatment. It is now outstandingly late on the emar and has not been documented that it's been given or refused. The patient tells me that they're short of breath and claims they never got a breathing treatment. At this point it's 0100 and the patient had another treatment due at 0200 so rather then letting the patient suffer I gave the breathing treatment and it looks as if the patient got the 0200 dose early. 20 mins later the respiratory therapist comes in pissed because I gave it and tries to start an argument with me while I was carrying for another patient in another room. I tried to avoid the conversation at that time because it was very unprofessional to try to discuss one patient in front of another patient and also HIPAA. The respiratory therapist said "you don't give my neb treatments", then walks out of the room. The current patient I was with made a comment of that being rude which put a bad taste the patient's mouth about the professionalism of the hospital. After I finished what I was doing with that patient I Left the room to confront the respiratory therapist. She then tries to tell me that she already gave the 2100 neb treatment and that the patient got double dosed. Once again I remind you that the patient claim to never have got it. But I told her that you didn't documented anything and in this world when don't document it you didn't do it. Was I wrong?

Specializes in SRNA.

Just some advice for future situations would be to close the loop on communication. If something is not clear to you (in this case, the RT dances around giving you a yes or no answer), be more direct in your questioning (without being accusatory) to get that answer. Maybe follow it up with suggesting that you would be happy to administer the treatment or say that you are concerned they receive it on time as they’ve had shortness of breath. It would be good practice to end your conversations with other clinicians by summarizing what is going to be done and when. Seems like the issue here was mainly miscommunication.

3 Votes
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
57 minutes ago, HappyCCRN1 said:

Just some advice for future situations would be to close the loop on communication. If something is not clear to you (in this case, the RT dances around giving you a yes or no answer), be more direct in your questioning (without being accusatory) to get that answer. Maybe follow it up with suggesting that you would be happy to administer the treatment or say that you are concerned they receive it on time as they’ve had shortness of breath. It would be good practice to end your conversations with other clinicians by summarizing what is going to be done and when. Seems like the issue here was mainly miscommunication.

This is the take home of it all. You both could have communicated better and handled the situation differently, but what is done is done. Going forward, it is your responsibility to make sure you are not confused at the end of a conversation. Ask directly, if you don't understand the response then clarify again and ask directly. Closing the loop makes things so much easier, and safer.

4 Votes

"I'm 1 of three travelers working at this hospital". Think this is the main problem here. In many cases, other disciplines, CNA's, lab, do not respect you as much as a regular staff nurse. They will take their frustrations out on you.

Certainly, you don't know all the policies and procedures. You tried to follow up, did what was right for your patient. Respiratory was rude and unprofessional. Pick your battles, do you hope to renew at that facility?

Always use the charge nurse in these situations.

Good luck.

3 Votes

I used to work at an LTACH and it was a big no no for nurses to do this. Technically, any breathing meds, even albuterol, fell on the RT and more often than not, they would document towards the end of the shift. Look up your policy and in the future, collaborate more with RT. I would have done my assessment on the patient and called the RT. If the assessment warranted more urgent treatment, I would call for any RT.

At my facility, we would almost never call a respiratory related rapid response without consulting RT first because there is actually so much that they can do for the patients.

I know everything has left a bad taste in your mouth but I would actually go back to that RT and apologize. Let them know that your only interest was on the patient and that you have learned that you can't do it all and that you will collaborate more with RT in the future.

1 Votes
19 hours ago, TheSixFootThree said:

Hey everyone. Quick question

So just recently I had a patient with a neb treatment that was due at 2100. Hours later and it's now a quarter to 0100. The room is right next to the nurses station and I never saw the respiratory therapist go in to administer the treatment. It is now outstandingly late on the emar and has not been documented that it's been given or refused. The patient tells me that they're short of breath and claims they never got a breathing treatment. At this point it's 0100 and the patient had another treatment due at 0200 so rather then letting the patient suffer I gave the breathing treatment and it looks as if the patient got the 0200 dose early. 20mins later the respiratory therapist comes in pissed because I gave it and tries to start an argument with me while I was carrying for another patient in another room. I tried to avoid the conversation at that time because it was very unprofessional to try to discuss one patient in front of another patient and also hippa. The respiratory therapist said "you dont give my neb treatments", then walks out of the room. The current patient I was with made a comment of that being rude which put a bad taste the patients mouth about the professionalism of the hospital. After I finished what I was doing with that patient I Left the room to confront the respiratory therapist. She then tries to tell me that she already gave the 2100 neb treatment and that the patient got double dosed. Once again I remind you that the patient claim to never have got it. But I told her that you didn't documented anything and in this world when don't document it you didn't do it. Was I wrong?

I don't believe you did anything wrong, RT should have documented the administration of the neb treatment. I see a lot of responses saying that a lot of RT's don't document on time or wait until the end of their shift. This still doesn't make it right or legal!

The scope of practice for RN's and RT's are very similar and the responsibility for the patient ultimately falls on the RN. Meaning if you were ever taken to court, saying that RT wasn't available WOULD NOT be a valid defense.

3 Votes
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
4 minutes ago, TwoLayi said:

I don't believe you did anything wrong, RT should have documented the administration of the neb treatment. I see a lot of responses saying that a lot of RT's don't document on time or wait until the end of their shift. This still doesn't make it right or legal!

The scope of practice for RN's and RT's are very similar and the responsibility for the patient ultimately falls on the RN. Meaning if you were ever taken to court, saying that RT wasn't available WOULD NOT be a valid defense.

There is nothing illegal about waiting until the end of the shift to document, whatever the reason may be whether it is legitimate or not.

1 Votes
7 minutes ago, JadedCPN said:

There is nothing illegal about waiting until the end of the shift to document, whatever the reason may be whether it is legitimate or not.

I did not mean legal as in breaking the law. But say a nurse administers medication and fails to document it right before her lunch break. The relief nurse comes, sees a medication is due, so he administers it and documents administration in the EMAR. And the patient dies from it. Who do you think will be charged with negligence?

4 Votes

Respiratory therapist going to nursing school here. Right now is flu season and RTs are often overloaded with treatments and often do not get to chart depending on system until after rounds. We can have anywhere 20-40 patients (not including the rest of the floor in the event a rapid response occurs). We carry 20-40 patients between November to April and often multiple floors.

2 Votes
Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.
On 1/26/2020 at 11:14 PM, TheSixFootThree said:

Also I've worked at other hospitals where nurses give the treatments. Also asked the staff who work here who tell me nurses can give the treatments.

I’ve been in a few hospitals and have observed various policies. In 1, RNs or RTs could administer breathing tx. Where i currently work, only RTs can give them.

And, the RTs are very obvious regarding their animosity when we call them. The belittle RNs, put them down when they call, etc.

That being said, I know the RTs are apparently spread thin, working all floors of the hospital: from ED to the floor to ICU. And I suppose they feel like they get called unnecessarily at times.

I'm not sure what the policy is where the OP works, but this info could shed light on the situation.

1 Votes

A patient was short of breath.

MAR indicated no TX had been given.

PT stated no TX had been given.

Nurse gave breathing treatment.

PT felt better.

Somebody got pissy.

Seems pretty straight forward.

4 Votes
On 1/27/2020 at 4:33 PM, TwoLayi said:

I don't believe you did anything wrong, RT should have documented the administration of the neb treatment. I see a lot of responses saying that a lot of RT's don't document on time or wait until the end of their shift. This still doesn't make it right or legal!

The scope of practice for RN's and RT's are very similar and the responsibility for the patient ultimately falls on the RN. Meaning if you were ever taken to court, saying that RT wasn't available WOULD NOT be a valid defense.

This is not true. I have never once administered a breathing treatment. The RT pulls the meds and administers. RNs do certain inhalers, where the pt inhales the powder from the split capsule. The RTs pull from the Pyxis.

This is why you must communicate well with your RTs.

1 Votes

Sorry, but if RT's are not documenting when meds are being given in real time then that needs to fixed STAT. If they are not held to the same standard as us nurses then that should change. In my hospital both RN's and RT's can give nebs. If they are not charting until they are about to finish their shift, how will I know that a treatment given by them could be a reason why my patient is tachy and having palpitations.

3 Votes
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