Respiratory Therapists Inserting PICC Lines

tmw73 · May 5, 2014

And also i don't know what the comparison to pay is but look at the starting pay here.it depends on the facility you work.its also not always about pay.i want to learn.im currently finishing up classes required for PA.the more i know will help me with all that.like i told you as well if legislation passes for respiratory to be included in medicare reimbursement the pay will rise even more..may i ask what states are you guys in?

CraigB-RN, MSN, RN · May 5, 2014

Wow. Sounds like a text book definition of a turf war. Both sides acting like they are experts in the others fields.

First respiratory is only part of their profession. Cardio pulmonary is the complete title. On a daily basis cardio pulmonary techs access pt's vasculatures. In way that as a rule had a higher potential for injury than the average IV stick.

Whether we like it or not, health care is driven by dollars. And the name of the game is cost effectiveness. Just like it's not cost effective for an RN to do a 12 lead or give a breathing treatment, because it's not reimbursable. It is however reimbursable if cardio pulmonary does it. This can also hold true for PICC placement. If your talking about inpatients, if I do it as an RN, it's included in the room rate, we can't charge more than the equipment. Resp can charge professional fee. Now ideally one of the providers can get the most reimbursement.

It is a mechanical skill, that has been made easier by technology. The new systems don't even require an CXR after.

I would hazard to guess that a large number of RN's out there got into vascular access because it was cool, and some thought they could make money at it.

In my facility, I've got more bachelor prepared cardio pulmonary than I do BSN prepared RN's. When it comes to crashing patients on the floor, they are better prepared to deal with it than the floor buses are.

The whole concept revolves around a couple of things thought. Scope of practice being the 1st. Each state is different, with some states being more specific about what each can do. 2nd, hospital by-laws, 3rd reimbursement, Risk management/liability carrier, and availability of training.

Now is having cardio pulmonary do it always the best choice, probably not, but it may be the best that is available in a particular location and set of cicumstances.

tmw73 · May 6, 2014

I completely agree with you.ive stated one more than one occasion that i don't disrespect any one working in the medical field from pt techs on up to docs but there is a big lack of understanding of what respiratory does and like I told all of them.we were taught this procedure among others things.its not like we don't have knowledge of this.i think they were just upset that I would dare speak about Respiratory doing something they don't agree with.my question was what is tour reason for feeling that way.it shouldn't be because of lack of knowledge. M

PMFB-RN, RN · May 6, 2014

Pleas explain how that's condescending?

Explaining the obvious to people who are in the know IS condecending

lorida isn't behind the times.those things you are talking about as far as respiratory isn't only in this state.like I told the Carolinas, Texas and Arizona to name a few a

Those are the states you are holding up as examples? Kind of telling that the states famous for not being a good place for a nurse to work, and you have pretty much nailed 4 out of the worst 10, are the ones trying to give nursing jobs away to non-nurses.

why is it so hard for you to see a respiratory therapist being able to do those things is a good thing.

Vascular access is a nursing function. RTs are wonderful when they do RT related things. How would you feel if certain nurses where cross trained to do RTs job?

if you know hemodynamics any change you make on a vent can and will directly effect your co, and also may cause cardiac embarressment further impairing a compromised patient.

Explaining the obvious again.

when you say some states don't utilize RRTS do you really think they are ahead of the times?

I am wondering what your motivation is for making this false statement? Who is it who said some states are not using RTs?

we can make our own vent changes order as many ABG'S we need even place Alines if we need them.

Same for nurses. I do so daily.

the way things are going they will have to make cuts to survive and if you think they won't cut nurses your sadly mistaken.

Obviously they will cut nurses. Using the fake "nursing shortage" propaganda and allowing other professions to do our work is all part of the plan to put nurses in our place.

tmw73 · May 6, 2014

I agree with you on the whole nursing shortage thing but I think they have a shortage of good nurses.those states are utilizing respiratory therapist is no way a bad reflection on nurses.if we can help each other it's a good thing.i told you rather you like it or not things are gonna change and respiratory will have a greater impact on patient care.alot of nurses i know welcome this.i just don't know why you don't . florida treat the nurses here very well.its all about reimbursement. If we can get paid for those services then it's money in your pocket as well.look up the legislation that were trying to have passed.it helps all of us.you won't have to fill bogged down with all the things you have to do and we can help you in ways Noone else can.ive never seen a physical therapist, speech therapist, or occupational therapist at a code..have you.we are very different from those disciplines.

PMFB-RN, RN · May 6, 2014

those states are utilizing respiratory therapist is no way a bad reflection on nurses.

I agree it's not nurses who are reflected badly on.

if we can help each other it's a good thing.i told you rather you like it or not things are gonna change and respiratory will have a greater impact on patient care.a

RTs are great and I am all infavor of them doing RT jobs. Ask yourself how RTs would like if they were all fired and nurses took over their jobs. This is already the case in a few places.

florida treat the nurses here very well.

I guess you are out of toutch with nursing. You know that Florida has among the highest nurse to patient ratio, the lowest pay, and some large heath systems have cut way back on nurses pay. How that can be considered treating them well is beyond me.

tmw73 · May 6, 2014

I've never seen or heard of a place laying off the entire respiratory department. Like i told you before it's against the law for that to happen. You can not receive medicare reimbursement without being JACHO compliant.JACHO requires respiratory to be on the rapid response team and in ICUS. I think that you have this self image of what you want to happen.i think you need to read the bylaws for hospital administration. Please tell where have you heard that and I'll show you a place that's not acute care.please share this information if you have.

BuckyBadgerRN, ASN, RN · May 6, 2014

If you're an RT, WHY are you here on a NURSING board arguing with some members? It's clear that you have no desire to bounce ideas constructively around with people you certainly don't consider peers. I'm confused as to your purpose for continuing to engage the health care professionals here....

I've never seen or heard of a place laying off the entire respiratory department. Like i told you before it's against the law for that to happen. You can not receive medicare reimbursement without being JACHO compliant.JACHO requires respiratory to be on the rapid response team and in ICUS. I think that you have this self image of what you want to happen.i think you need to read the bylaws for hospital administration. Please tell where have you heard that and I'll show you a place that's not acute care.please share this information if you have.

PMFB-RN, RN · May 7, 2014

I've never seen or heard of a place laying off the entire respiratory department. Like i told you before it's against the law for that to happen. You can not receive medicare reimbursement without being JACHO compliant.

Wow, get a clue. Where do you live, 1995? You know that it's a small but growing trend for hospitals to seek accedation from bodies other than JACHO right?

JACHO requires respiratory to be on the rapid response team and in ICUS. I

We don't have RTs on our rapid response team. In fact out RRT "team" is one nurse.

think that you have this self image of what you want to happen.i think you need to read the bylaws for hospital administration. Please tell where have you heard that and I'll show you a place that's not acute care.please share this information if you have

You are way, way off base. I don't yet know if your missunderstanding is deliberate or caused by poor reading comprehension.

Still waiting for you to explain just who stated there were states that don't use RTs. You made the claim so back it up.

CraigB-RN, MSN, RN · May 7, 2014

Trolls are trolls, no matter what the board. It's always interesting to see the ideas that get dredged up. Ones that are easily debunked witha few keystrokes on google.

Having been a surveyor in my past (not current) the only profession actually mandated in CMS standards are RNs. It's not uncommon for people to misunderstand the actual function of JC. JC, DNV and state surveyors function isn't to "mandate" anything on their own. They are credentialed by CMS to make sure hospitals are meeting federal guidelines. CMS, OSHA, etc. JC can't "make" anything illegal on their own. They can make it a part of their accreditation but it's not illegal. None of those agencies have that authority. Accreditation itself isn't mandatory. Hospitals can choose to have the state survey them. There are some benefits to accreditation if your running things like sleep labs, etc.

As a profession RRTs are even worse off than nursing. There are "grandfathered" in RRTs, AS & BS level RRTs. And there is frequently no way to tell them apart. Either way they are a useful part of the health care team. In the states I have worked recently, there is nothing an RRT can do that a nurse can't do. Now the difference is, I can't charge for it. Anything I do is rolled into the basic room rate so even though I can do it, it's not cost effective for me to do it. If I intubate, do a gas, give a breathing treatment, manage the vent, it's a freebie for the patient. I don't know about your hospital, but mine can't afford it.

It's possible for all of us to be replaced. Not to many years back the AMA came up with a new level of caregiver. Would have replaced all OD us. RNs and RRTs.

Vascular Access RN · May 7, 2014

I've been reading over these "new" comments. Spelling, paragraphs, and grammar do reflect legibilty, which in and of itself is interesting to me.

I did learn the fundamentals of ventilator settings and controls in nursing school. However, my first several years as a nurse were outside the critical care arena. When I eventually did transfer to intensive care, I learned how to care for a vented patient from ICU nurses and RTs. Our RTs are excellent respiratory support and helped me save my patients many times. I always look to our RTs for expert respiratory care advice. Hospitals that do not have them are missing out on an excellent resource.

That being said, infusion therapy is outside of their scope of practice. RTs do not administer the medications that nurses do intravenously. Not only are nurses required to understand the medications they give and the effect on the body, but they have real time experience with the IV route. The vascular access NURSE uses this experience, plus in depth knowledge of dilutional pH, venous reaction/irritation, and osmoality to not only "place a line" but place the correct one for the patient at the time.

Do not try to say the this choice is "up to the doctor." While the physician does prescribe, the nurse treats. The doctors do not have the same focus that a vascular access nurse does. DAILY, when at work, I call a physician who has asked for my services to tweak the device he or she had ordered based on what is best for the patient at the time. Sometimes, they grumble, but they respect me for it.

Yes, we are all part of the healthcare team. What has not been balatantly stated by these posts is doing WHAT IS BEST FOR THE PATIENT. IF we think in this manner, the professional with an intravenous infusion scope of practice and experience is the one I want putting vascular infusion devices in my loved ones or me. AND, I want a respiratory therapist managing their airway and respiratory care.

tmw73 · May 7, 2014

Well my friend i told you this goes to my phone so no I'm not sitting at a computer at my house writing this.if my grammar is not up to participate it's because i thought you dget my point with acting like we're in english class.i actually have a phone that gets updates and receives email so i respond to them from my phone..it has auto correct which sometimes put words in that i didn't intend on having there but I'm typing to fast to really care about changing them..i hope we now have an understanding about that...As to me being on this board i responded because my hospital is actually leaning toward respiratory doing PICC lines.i thought I'd find some insight on this page but only found the majority NOT all of you against it.i ask why are you against it and this is what has cause the discussion between all of us..well as far as you going over vent settings in school we also went over alot of things that are covered in nursing. Like i told you its because of legislation my friend. The things we were taught makes us more than competent in doing most of what you do.you talk about reimbursement. .we only get half of reimbursement for things we do.if the legislation we have before congress passes then we will get more reimbursement and we will be asked to perform more duties.like I've told you before.ive seen the curriculum for nursing at the BS level and what you called going over vents is in no way a comparison to what we've studied..to tell me what i know..I'm not like you just stating things I'm telling you what i know to be true.i never said i was better than you but one thing i can say is that i DO know respiratory better than you without a doubt.. you dont think we should be able to do PICC lines for what cause you don't like it..cause you think we weren't taught..well we were and have knowledge of what needs to be do and the procedure. So you tell me everything you learned you should be able to do but I should be limited? Like i said if you actually saw the curriculum for respiratory you would be singing a different tune.we know alot more than you think.if you think respiratory taking over PICC lines your really gonna hate what the future holds.i don't know about Respiratory losing jobs . everywhere I read there alot of places hiring..i know we have at least 10 open just in the ICU here..