Iovian

Yikes, I am RT, and I am really hoping it doesn't get too bad. We don't use N95s at my hospital. We use what we call a PAPR, kind like a mask with outward airflow. We only have 15 of these, and think the people hired in the last 4 years would need to be fit tested (not to mention everyone since we used to get tested every year) since they need to be charged, and most likely would run out of battery power if used too much. I have a feeling RNs that don't like RTs will be utilizing their RT more now:D Let's hope it's because they have had a change of heart, and not because they see it as a ploy to get rid of us!!! Becareful everyone!

I've wanted to write my take on RN vs. RT for a while now, but decided it wouldn't be a good idea to post a new thread on something repeated as much as this. First I'll describe school. I didn't attend your regular 2 year program for Respiratory Therapy. I attended the U.S. Army's RT program. 2 years condensed to about 11 months, Monday through Friday, 7am-5pm. I was attending school at the same time as one of my friends was attending the Army's nursing program (LVN). His program was a little longer than mine, and on top of the length, we both had to be a Combat Medic (EMT-B) first. During the 1st phase of our programs, I cannot count the times I had to study with my LVN buddy, and help him understand A&P, Pharm, and some specialty education on Cardio-Pulmonary path/phys. Now it may look like I am "downing" him with this post, but let me assure you I learned a little from him as well! (IV flow rates, more pharm) Both of us coming from being (active) combat medics, we were more than proficient in IV insertion, Foleys, injections, CPR, wound care, and other medical knowledge. But I have to say that I felt like I read everything he had to (to help him understand, and for my own knowledge) plus my work. He did get to glance at my books, and was pretty intimidated when he saw how in depth our A&P was. We had to know general and cardio-pulmonary A&P, which was very very focused. (BTW, guess who tutored some PA students in Cardio-Pulmonary Diseases and Pathophysiology? So, we both get through Phase 1, and it just so happens my phase 2 (clinical) is in the same place as his. He had the obvious rotations (ICU, Floor, Rehab, LTC, ED, CCL, Pedi/NICU). My rotations were: Floor, ICU, PFT lab, NICU, ICU again, Burn Unit. Needles to say, we both graduated from our respective programs. Now, both of us were in the Army Reserves, so we were able to get jobs as a civilian as soon as we left training. He worked as a medsurg LVN/LPN for a year, and was able to finish school online for his RN. Now he works Nuero ICU. Now this being said, I honestly believe ANYONE can physically be taught to do my job, but to understand it is a different story. I've proved this time and time again with MD/DOs, PA/NPs, RN/LVNs. I picked up a job at a local Hospital, and was thrown into ICU/ER pretty fast, being that the RT Director was a prior Army RT, and held the program in high regards. Within that year, I became proficient in ECMO, IABP, Swan, NO2, Worked under MDAs or CRNA/AAs during surgery manipulating gas/vent settings in response to orders/status of pt. Became one of the 4 RTs that had intubation privileges during my shift with a 0% failed intubation rate. At my hospital, the ventilator was RTs SOLE responsibility. That being said, if a pt was desating, the nurses knew when I was there (but not there in person) all they had to do was page me with information, and do what they had to do to keep pt out of distress or within proper saturation range. I never had a problem with RNs changing "certain" settings on vents, but would be a little put out if they messed with setting such as: rate, pressure, volumes, flow, PS or PEEP. It wasn't that I didn't believe the RNs didn't have the knowledge, but I do have a license, and having one indicates it can be taken away if someone under my care decides to sue and I don't have proper information (this is what RNs and RTs call the need to Cover Your A$$). But, I cannot count the times I have walked into a pts room with a high ICP and my PEEP has been changed to 10 from 5, and Volume increased to 750 from 500 due to Gases that the RN drew, read, and decided to change setting because they believed themselves able. (BTW, peak pressure on that specific case was increased from a peak of 32 to 61 because of those changes. There is also the time I had my favorite end stage COPD regular. I had just left him after giving him his scheduled treatment (room air). He was on a BiPap with O2 set at 30% and a saturation of 86% (which is fine for him, he mostly lived in the mid to high 80s on 2L nasal cannula at home). I come back 1 hour later because the nurse calls me and wants me to assess the pt before she decides to call a rapid response on him. When I walk into the room, I notice he is very chalky in color, head down to chest, and non responsive except to pain. HR normal, RR 5 per minute (machine was set at 5), and SPO2 99%. I take a look at my Bipap and notice the O2 increased to 80%, and removed the Bipap, and started to assist pt with ventilation via ambu and air. Pt starts to wake up, and I place him back on BiPap at Room Air. His SPO2 marks 87%, and the RN asks what I am going to increase O2 to!! Needless to say, I wrote him up. Now, do I expect all RNs to know and understand how quick the drive to breathe can be depressed on a COPD pt? No. But if they have been an RN for as long as he (5 years), and didn't know, I see a problem. On top of this, if he would have just followed hospital protocol, he would have called me, and I would have explained to him why it is ok for his saturation to be where it was. Now as far as work load, I do agree that nursing can be far more gruesome at time, but there are other times I have to manage vents in an ICU, and have 2 floors to cover as well. Mind you, some states do not allow concurrent therapy, and I have 22 treatments due in a 2 hour period. Normal treatment takes 7-10 min if the said hospital carries concentrated Albuterol or Xopenex. Lets Hope Pulmicort doesn't have to be given, since it cannot be mixed in with regular breathing tx. You do the math! Shared responsibilities at my hospital are: suction, trach care, ABG if pt has A-line, and the occasional breathing treatment if I am not available. Mind you, it is possible for an end stage copd'er to go through the above with something as simple as receiving a neb treatment through O2. Now, while practicing RT in the Army (when activated) I did ALL Foleys for my ICU, helped with IVs (mostly called to insert if RN needed help since it was known I was a combat medic before RT), inserted A lines (both Army and Civilian Hospital), and intubated with intubation protocol. Do I believe all RTs to be as proficient as myself? No. But I do believe every RT has the educational background to be. Salary and glass ceiling: Hourly wage: $41 per hour, differential for nights and weekends same as nursing. On top, we have special differential for "respiratory season". Last year it lasted from November to May. You get half of your hourly wage added during this season, plus any overtime and differential. For example, I make $41 an hour and work nights and mostly weekends. This ups my wage to $47 an hour, with overtime it goes up to $67.50 an hour. Add in respiratory season and I am making about $88 per hour! There are PA/NPs that don't make this. Actually, there are CRNAs that that don't make this. Why does my hospital pay so much, because they have realized how much more money they save utilizing RTs and other allied health to do extra jobs during their shift (such as ekgs, pfts, some nurse assisting if needed, transport). We don't have a transport team, we don't have CNAs (Nurses have a max of 4 pts on the floor and 2 pts in ICU if vented, 3 if none are vented), no perfusionist, and no ER tech. Nurses make about $35 per hour if staff, and I have seen some contract/travel nurses to make as much as $48 an hour. Now as far as that glass ceiling, I happen to know a member of the ADCOM for a local PA program. I talked to him about RTs not being able to climb vertically, and he explained to me, really, neither can RNs. Yes, they can go into Admin/management, but so can RTs. In fact I know of more than 10 occasions an RT is in the ranks as top admin at a hospital. I know of 2 RT CEOs and countless RTs that went into sales and education for equipment companies as reps that make over 80k a year. You may bring up RNs opportunity to go into NP or CRNA School, but you need to remember that they have to be accepted into these programs and they are very competitive! If that is the case, it is the same as a RT going into PA school. In fact, said member of ADCOM, stated, I would take a RT based on statistics of RTs passing PA school over ANY allied health or nursing applicant. That being said, you may think, "well as a RN, I don't want to go to PA school." You would be surprised to how many DO, and don't get in to either PA or NP school. BTW, my old RT director at a previous hospital is now a PA, and has independent surgical privileges under general anesthesia and with written consent from the surgical group he is a part of. But let's not get into PA vs. NP, which is another atom bomb!! (My mom is a NP and poster here at this forum so I know and see the flame wars!! Love Ya Mom! All this being said, I believe RT and RN to be on the same level as far as hierarchy is concerned. I believe RNs to be more of a generalist and RTs to be more focused and specialized than nurses. Can a ICU run without RNs? NO!! Can one run without RTs, sure, but the nurses at mine would quit the minute we were kicked out, rest assured! PS, I do know of 1 hospital that tried to remove RTs in San Antonio, Tx. It lasted 3 months. Nursing decreased 33% during said 3 months, and demanded RT to return. That hospital is not the 3rd highest paying hospital, right behind Select Specialty and Texas Heart in San Antonio!