This is a real big pet peeve of mine. This happened to me last week and I wondered if anyone else has been in this situation...
I had a patient who was admitted with diagnosis of GI bleed, low H and H, pending transfusion and GI procedure. The o2 sats were borderline low so I started the patient on 2 liters via NC. I was discussing this patient in the nurses station with my charge nurse when an RT overheard and threatened to "report me". My CN and I both thought he was joking but he said "you need an MD order to start a patient on oxygen!"
Despite our clarification that we did nothing outside of the scope of our practice, he remained adamant. It was a fruitless arguement. NEXT!!!!
PT returned a patient from the gym demanding that a patient be medicated for pain with MS prior to therapy. Patient is sitting in the hall in a wheelchair overhearing this conversation. Patients nurse explains that the patient has a documented allergy to MS and had been premedicated 30 minutes prior. Again a "I'm telling Mom!" threat verbally made to nurse. UGH. NEXT!!!!
It seems to be happening more frequently and I was wondering if there isn't a lack of knowledge on the part of ancillary staff regarding the RN's duties and authority. Just curious...
I have to put my thoughts in on this one as I was appalled by the comment by Angie O' plasty.
In regards to this ignorant comment:
**"Would the RT know that a patient with a GIB has less Hgb, and therefore less O2 in the blood, therefore is a candidate for cardiac arrhythmias without supplementary O2?
No. Why? Not in his scope of practice."**
WRONG, WRONG, WRONG!!! I take offense to this comment as I still practice Respiratory Care.
The RT would and should know that the patient with the GIB will have less Hgb, and honey common sense tells any Health Care Provider that it directly correlates with the SAO2, SaO2, and SPO2(go ahead and look those up so you can respond). As far as the cardiac arrhythmias, what do you think the RT does with that copy of the ekg they did. They know that O2 consumption and availability will affect the heart.
So... YES it IS in the RT's scope of practice! They should have reviewed that patients chart ask the director of any respiratory dept. they wil tell you the same.
Sorry you took offense to that statement, but if you go back to the original post, you'll see that the RT had a problem with the RN giving supplemental O2, even though another nurse verified that the OP was well within her scope of practice to do so.
As far as taking a little longer to respond, some nurses still dont get it! The RT does not have a ratio, in very few hospitals are the designated to just ICU, CCU, Med/Surg, Tele, and so on. They have patients on different floors on opposite sides of the hospital and ER calls. Now add a couple vents on top of that and a nurse calling for a spot check of the SPO2, EKG's, or even just to put a patient on a damn NC when its sitting there still unopened at the patients bedside, and they have to respond to every code in the entire hospital.
Organized Chaos!
Remember the next time you page an RT because the vent is alarming and they're a few minutes late, they have 20 patients and that code they just finished doing compressions and bagging for 30 minutes, yet they still come as soon as that MD calls the code and despite the fact that they're forearms are shaking and weak, while you're ordering lunch and getting ready to write them up(doesnt that sound familiar?), they dont/wont throw in your face that its not a respiratory issue that the vent is alarming it was just time for his ativan!!!:angryfire :wakeneo:
I have no idea whose post you're referring to here.
Angie is right. We are the coordinators of care and ultimately the patient is our responsibility. I am really surprised that an RT would freak out about 2L NC, the ones I know are generally lovely and easy to work with, but I am not surprised the RT is not aware of nursing scope of practice.
As for the PT, I think that professional was outside of her scope of practice. period.
When I started in med-surg, we didn't even have RT on the floor. The hospital didn't think it was important enough. RT only covered the ICUs. So we did everything for our patients, and believe me, those patients needed a lot. So, although I've since had extensive experience working with respiratory therapists, I've never been in awe of RT or what wonderful things they could do for me.
Specializes in Education, Acute, Med/Surg, Tele, etc.
In my facility if someone is oxygen starved or needs supplemental O2 I am allowed to give 2L/min start and watch pt carefully and call the MD. It is a clinical judgement that RN's are typically allowed to do, vs having the pt suffer while you get MD on the line! I know this as part of my protocol, and typically it is a standing order from all my MD's that has been lost in some dusty book no one looks at anymore...but I did because this is common!
If my pt needs O2 I give it...call MD...monitor carefully, and certainly go over that pts history and Dx beforehand so I can make a clinical decision that is safe!
So when RT's have snagged me on that...I am very poliet and tell them that, discuss the MD's parameters or what was discussed...or if I am calling/waiting for the MD, and if they wish to assist that that would be wonderful and would love their expertise and assistance!
But in all fairness, it isn't usually the RT's that get nurses on that...it is other nurses...so I say the same thing to them respectfully and talk with my charge nurse.
Anywhooooooo...so the RT saying that around others was bad form, and if they had a probelm they should have discussed this with you in private so you could have a discussion on the PTS CARE, vs 'tisk tisk nursie!".
The other...this I have been through countless times in the past (but not anymore thank goodness!). And simply put if a PT has an issue about pain control, then I refer them to the MD orders, my nursing notes, and if they still have a probelm after that, then I can call the MD when I am able to discuss further pain management...documenting the entire thing in my notes. Or if it is more urgent we can talk to my supervisor! I don't take pain managment lightly...so I am typically well informed and on the ball with pain managment...since I can despense medications...I make that call within the orders of the Physician!
Again...I haven't had to do this for a while because I get along so very well with all staff at my current facility...lots of respect and teamwork!
SAO2, SaO2, and SPO2(go ahead and look those up so you can respond).
I love how you talk about courtesy, and yet make such a stupid comment on so many levels. I might add that I rarely use the word stupid on the boards, but it was clearly indicated here. If you think that the knowledge of the about terms, such as Sao2 is so complicated that we need to look them up, then you are sorely out of touch!
Angie was totally right in everything she has said! I work in an ICU, and I rarely see the RTs. They come by evey hour or so and peek in on the pt. I can make my own vent changes, get my own cultures, increase or decrease the FiO2. I'll let the RT know, but I don't need their permission. Again, this patient is mine to take care of, and I am in charge of him. If I want to try my pt out on SIMV then I will.
In my facility if someone is oxygen starved or needs supplemental O2 I am allowed to give 2L/min start and watch pt carefully and call the MD. It is a clinical judgement that RN's are typically allowed to do, vs having the pt suffer while you get MD on the line! I know this as part of my protocol, and typically it is a standing order from all my MD's that has been lost in some dusty book no one looks at anymore...but I did because this is common!
If my pt needs O2 I give it...call MD...monitor carefully, and certainly go over that pts history and Dx beforehand so I can make a clinical decision that is safe!
So when RT's have snagged me on that...I am very poliet and tell them that, discuss the MD's parameters or what was discussed...or if I am calling/waiting for the MD, and if they wish to assist that that would be wonderful and would love their expertise and assistance!
But in all fairness, it isn't usually the RT's that get nurses on that...it is other nurses...so I say the same thing to them respectfully and talk with my charge nurse.
Anywhooooooo...so the RT saying that around others was bad form, and if they had a probelm they should have discussed this with you in private so you could have a discussion on the PTS CARE, vs 'tisk tisk nursie!".
The other...this I have been through countless times in the past (but not anymore thank goodness!). And simply put if a PT has an issue about pain control, then I refer them to the MD orders, my nursing notes, and if they still have a probelm after that, then I can call the MD when I am able to discuss further pain management...documenting the entire thing in my notes. Or if it is more urgent we can talk to my supervisor! I don't take pain managment lightly...so I am typically well informed and on the ball with pain managment...since I can despense medications...I make that call within the orders of the Physician!
Again...I haven't had to do this for a while because I get along so very well with all staff at my current facility...lots of respect and teamwork!
You sound very respectful and professional, and I bet you are wonderful to work with. :)
Frankly, I think my hackles rise on these threads is the attitude of "my way or highway, I'm in charge and you're not, etc." Everyone needs to be a team player.
I believe that oxygen is considered a medication, but where I worked in LTC there were standing orders to apply O2 per nasal cannula to promote comfort.
We have standing orders that an RN, based on sats, can administer up to 2L by NC as well. We can also wean based on sats as well.
Oh and by the way the remark to the student, uncalled for! Maybe you can learn some common courtesy from that student!
A pleasant attitude creates a pleasant day... for you and your colleagues!
The O.C. is also my stomping ground and despite the blatent lack of consideration you have for others I'd still get that IV started for you!
Relax. You're bordering on a personal attack which is a violation of the TOS.
However, you certainly highlight some of the problems inherent with nurses and other departments. It must be irritating to deal with nurses who think you are suppose to jump when they say jump with total disregard for what you're going through.
In defense of Angie, she was merely saying the RT who griped about reporting the nurse for practicing medicine without a license didn't have the full story. Perhaps he/she should have found out the full story prior to speaking up.
Perhaps the RT was right, that this institution doesn't administer 2L without an MD order ever and the nurse needs a wakeup call, and was only trying to cover her/his back. If someone is blantently breaking rules it shouldn't be overlooked because "it's only 2L". Rules are rules.
Specializes in Education, Acute, Med/Surg, Tele, etc.
Also, as a little thing I learned...I try to get parameters for O2 on high risk pts or dependant on condition/medictions/circumstances while I have a doc nearby! :) And I put that on the kardex. That started getting catchy and now, that is a very typical order on the kardex now for titration of O2 on s/sx and pulse ox (I don't rely heavily on Pulse ox alone...s/sx is a direct key!).
If you think of it...try it...it is soooooooo worth it! :) Then no one is confused or feeling like they are risking things if they use O2 per clincal judgement! :) Win Win for all! :)
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RT+RN
2 Posts
Oh and by the way the remark to the student, uncalled for! Maybe you can learn some common courtesy from that student!
A pleasant attitude creates a pleasant day... for you and your colleagues!
The O.C. is also my stomping ground and despite the blatent lack of consideration you have for others I'd still get that IV started for you!