Respiratory Therapists Inserting PICC Lines

Vascular Access RN · May 7, 2014

@ tmv73: Your response would indicate that you did not read my post at all.

I know for an absolute fact that the RTs I work with would run circles around me when it comes to excellent respiratory care.

It is their specialty, they chose it, they focus on it. I am grateful for them.

I also know that I would run circles around RTs when it comes to knowledge of infusion therapy and vascular access devices. It is my specialty. And, the RTs at my facility have a great working relationship with the nurses and vice versa.

Healthcare is a shared responsibility and an area where tasks overlap. Delegation is inevitable and necessary. However, if tasks become so diluted as to lose the physiology and rationale behind the options available, we WILL see poor patient outcomes. Combine that with the bedside cuts that administration constantly makes (this is all bedside clinicians: RT, RN, CNA), and we have a recipe for disaster.

Look at the ranking of our outcomes and longevity in the U.S. compared to other countries as it is now.

And, BTW, outcome studies recently showed that RNs with experience at the bedside directly coorelate to lower length of stays and better patient outcomes.

tmv73, I am not saying that RTs are not valuable, they are, in fact, invaluable. But IV medication is outside their scope of practice, therefore, they have no direct experience with the ramifications of that IV catheter that they are placing. A slippery slope.

tmw73 · May 7, 2014

Like i told you as well.here we have pulmonologist that perform bronchoscopies.we have respiratory therapist pushing all the drugs.we do not have a nurse on our bronch team.i also know that there's more than just JACHO but JACHO can and will close your hospital doors.if you know what JACHO is then you know that NO OTHER entity compares to JACHO.if you receive medicare then you MUST be JACHO compliant.no if ands or buts about it.by some of your comments you must work at a small rural hospital that's out in the middle of nowhere..ask yourself why you don't get reimbursement. .because like you said doctor says you do..well we have alot of autonomy.we can make our own decisions and do what we fill is needed.i work with some very dynamic nurses whom i have the most respect for but it's people like you that makes this a ******* contest..i bet if here you'd be out of your league. I'm not sure what you do but everyone who works at a real hospital knows no one can do it alone so we help eachother.i think you need to stay where you cause these poor nurses in florida would show you a thing or too..i also thing you be surprised at what respiratory knows and what we can do..

tmw73 · May 7, 2014

Well as far as nurse being at the beside showing a decrease in patient stay isn't really true.in most states that's what they were doing.why do you think the government stated lower payments for patient readmission. Because a lot of patients were being readmitted on a constant basis..like I said it's a combined effort. .I've meet alot of very good nurses who I really trust with everything I hold dear but to say a nurse can do it all alone is simply not tru..even some of the best of them will tell you they can't do it all..that's not admitting your incompetent that's just knowing that we all have limits..even the doctors know their limits but to hear some of you I can't believe the arrogance. .your the kind of person who'd end up killing someone because you know it all.like I've told you I've work in every aspect of medical care and I've never been told we don't need you, we can do it all.thats not how it works my friend. I've been doing this for 20 years and do you think in 20 years all we do is just stay within the limits that you think we should..like I said legislation is changing and change will happen..

PMFB-RN, RN · May 8, 2014

Well as far as nurse being at the beside showing a decrease in patient stay isn't really true.

Whatever. When are you going to adress the false statements you made? You have already been asked several times.

tmw73 · May 8, 2014

Please let me know again and I'll address them all.if you look at just bedside nursing then why do you think there's a big emphasis on pt readmission. That's because just a nurse being at bedside alone doesn't change the outcome...Please put done all you fill I didn't address and I'll address them all right now..

Vascular Access RN · May 8, 2014

tmv73, I have not once attacked your competence at what you do, or your facility; though it is tempting, I still will not.

My facility is not small, is financially stable, and receives third party recognition on a regular basis for excellent patient outcomes.

As to me, I am modestly known in my field and have stellar patient outcomes.

Oh...and yes, I am at home, answering on my computer. When I am at work, I am taking care of patients.

tmw73 · May 8, 2014

Please my friend attack my competents and I will attack yours.i told you its not a contest but we can make it into one..i never came at you like that but if you ask me any of your nursing questions I can answer it correctly but I hope that you can do the same..i never said anything negative to you or questioned your ability but I see you'd like to question mine.please tell me what's so difficult about anything you've said..Please come with your hardest nursing question? Or anything for that matter.i hope that you can answer mine as well..

tmw73 · May 8, 2014

Plus i said i was at work a couple of days ago on what we call a break..may i ask which ICU do you work in? What exactly is it that you do? We have a number of them which we rotate throughout. .again i see there are some of you that can't stand the fact that respiratory being involved in PICC line insertion. My original question was why not and then i got hit with a bunch of statements saying how unable we are at handling this task..now i ready for your contest.ask away my friend.

FlyingScot, RN · May 8, 2014

My original question was why not and then i got hit with a bunch of statements saying how unable we are at handling this task.

No you got hit with a bunch of answers from people who disagree with you and you didn't like what you were hearing.

Really, continuing with this back and forth ( I can't even call it a discussion) is pointless.

Nobody here has said that RT's have no value.

Nobody has said that RT's aren't educated.

Nobody has said that RT's bring nothing to the table.

Nobody has said that collaboration isn't good.

Frankly, I think we have better things to do than continue this exercise in futility. I know I do.

tmw73 · May 8, 2014

Vascular Access RN..i agree with you whole heartedly. I have no argument with anything you've said. I agree with things becoming diluted..only to have knowledge of what one does but my argument was with your fellows who says they should be able to perform certain things in respiratory cause their license covers it but they don't have sufficient knowledge of is no different with things I was saying. .what i said is if they think they should then we should.the limits on scope of practice will become more loose..my argument isn't with those who understand the value with respiratory but those who think they know it all and are the first ones to call for things they don't understand. Believe me we get called for some very simple things that if they taught them in school they should know..If we'retalking about wwhat's taught in school then yes alot of those things were taught in respiratory. .so I understand where your coming from i just don't like know it all with no medical degree.

CraigB-RN, MSN, RN · May 8, 2014

You do realize it hasn't been called JACHO for years. When you post on public boards like this, you take the chance of coming across people who might actually know more about a subject than you do, because they actually do it. Although it's been 10 years, I was actually a surveyor and worked for state board. So I think I know a little bit about the whole process. JC is an accrediting body, just like DNV. It is optional, although politically it may be the only practical option for some.

JC has no authority to close anyones doors. All JC is doing is accrediting the fact that you are meeting CMS guidlines . The state licensing agency is the only one that can "close the doors" of a hospital. Now not getting MC reimbursement will close a hospital pretty quickly, but it's not a direct action. And JC isn't the only player. There are other players. Yes it's the biggest organization out there and it's been around the longest. Organizations such as JC & DNV are in place of the state survey. JC and DVNV accreditation are optional.

Hospitals - Centers for Medicare & Medicaid Services

As to RT's pushing medications, I can only speak to the state practice act were I am now. I'd like to see a copy of the practice act that allows this. Practice acts are complicated.

tmw73 · May 8, 2014

Sorry my friend but JACHO was just at our hospital. They didn't call themselves anything other than JACHO.which i know is Joint Commission. I've been in the medical field for over 20 years..Please don't tell me that you were a surveyor for joint commission and states they have no power to close your doors because that my friend isn't true at all..There was a hospital here some years back that was closed directly due to Joint Commission. As for laws across the land I can only speak as to what the as here I n Florida states..If you look at the laws they vary from states to state which is what I said along time ago.i said that other states will follow suit.what I also stated was that there's legislation to increase the limits that respiratory finds its self under that will be increased to involved alot more.I can tell you that it will happen due to the fact that COPD is added to the list of readmission penalties which it was not before.Alot of hospitals are afraid of the impact thus and all the others on that list is going to have.If you know about politics COPD readmission is over 30% of hospitals around the nation clientele. It will put a huge whole in any hospitals budget.the government is trying their best to cut down on reimbursement in the first place.if your an administrator and you get zero reimbursement for nurses other than a Rome rate and respiratory shows themselves competent to do alot more procedures based on their schooling and also experts in dealing with lung disease what would you do? In the end you say 'oh nurses make this they make that we'll i can tell you your salary will drop and continue to drop.why without reimbursement yours and most of the hospitals will close. There are things you do not understand my friend. I told this is not a contest but one of common sense. Over 20 years I've seen alot change and alot more will change.do you think a hospital placing respiratory in those positions actually save them money? No it makes them money.insurance companies say we won't pay what the nurse has done because the doctor says the nurse does.why do think Speech, Physical Therapy and Occupational Therapy always come trotting in? Those are therapies that get paid to work with these patients. The hospitals make money off of them..The difference with respiratory is that is really not just a therapy it's also a critical care department. Alot of administration's had really no idea of what we do.in some states they found out that alot of critical care things we do are reimbursable. With us going to ICD10 codes soon believe your gonna have to have your stuff together or your hospital won't get paid.theres a reason for the maddess.i can tell you about these laws why because I've been involved in getting themrecognized.these changes have been on the books even before i got into the medical field. So when i said that it'll help us both i meant that.a hospital with just nurses will not survive that i can promise you.you will get no reimbursement no matter what you do.plus all the law suits that will occur. Do you have any questions about what I said please let me know and I'll shine more light on it for you.