RNs Replacing Registered Respiratory Therapists?

[LonghornChic, BSN]

At my current HCA hospital, we have an extreme shortage of Registered Respiratory Therapists. To help with that shortage, several nurses have been trained to assist the one RRT with things such as neb treatments, vent checks, suctioning, preparing for intubation, ABG’s, assisting with bronchoscopy, etc. 
Yesterday I overheard one RRT telling another RRT that he’s afraid that they will soon be replaced by RN’s and LVN’s (he was supposed to be training an LVN that day). 

I will say that if this is the case, I am concerned. A few days ago, I paged the RRT to come asses my vented adult ICU patient who kept desating into the 80’s despite suctioning and adjusting sedation/paralytics for vent synchrony. I increase O2 to maintain >92% while I waited on RRT. 

The RRT was occupied in ER assisting with an intubation so they sent an RN (whose specialty is mother/baby) to come asses my patient before he turned around and called RRT to come make vent adjustments. The reason I had called RRT in the first place is because I sensed that vent settings needed to be adjusted but I wanted to make sure the correct ones were adjusted such as O2, PEEP or TV. Sending another nurse was just a waste of valuable time. 

I am a new ICU nurse (not new to nursing) and feel that I rely on the special skills of RRT to help me stabilize my critical patients. But now I am worried that resource will be incredibly limited or not available at all. I will have to do my best in learning what I can in terms of vent/airway management. 

Is anything like this happening in your areas? 

[Wuzzie]

If training the RNs/LVNs to do the simpler tasks like nebulizers and suctioning allows the RRT to do the part of their job that we cannot do because we lack the education then I see no problem with it. Your situation proves that. Anybody can assist with an intubation but you needed your RRT's clinical expertise in ventilator management. That is not something that can be replaced by an RN/LVN that received a few days of training and a computer class. They are the experts and are irreplaceable. 

FTR: as a flight nurse I intubated and managed ventilators both with and without RRTs. When the poo hit the fan I was eternally grateful to have one of them with me. 

[LonghornChic, BSN]

8 minutes ago, Wuzzie said:

If training the RNs/LVNs to do the simpler tasks like nebulizers and suctioning allows the RRT to do the part of their job that we cannot do because we lack the education then I see no problem with it. Your situation proves that. Anybody can assist with an intubation but you needed your RRT's clinical expertise in ventilator management. That is not something that can be replaced by an RN/LVN that received a few days of training and a computer class. They are the experts and are irreplacable. 

FTR: as a flight nurse I intubated and managed ventilators both with and without RRTs. When the poo hit the fan I was eternally grateful to have one of them with me. 

I’m in awe of your flight nursing experience!! 

I am totally on board with having RN’s help RRT’s with manageable tasks when they are busy but what kind of threw me off is having someone else come assess my patient and then make the determination that vent settings needed to be made. I had previously given all of this info and requested their assistance in my original page to the RRT. I am not too sure what all the training involves but it makes me question what if the covering RN didn’t agree with vent settings? Or say if my patient was not an ICU patient but a Med-Surg patient? I could always insist on the RRT or doctor to asses if it did come to that but just seems like another unnecessary hurdle. I am fully aware that some nurses have extended understating and experience with vents and airway management but I don’t believe the crew being trained with the RT’s has that type of exposure.  
I just feel like the RN’s covering should stick to the manageable tasks and leave the actual pulmonary assessing/decision making to the RRT’s. 
I am probably just overthinking this but I’ve seen this situation play out more and more, especially since we’ve lost 2 more RRT’s to traveling. 

[Wuzzie]

2 minutes ago, LonghornChic said:

I am totally on board with having RN’s help RRT’s with manageable tasks when they are busy but what kind of threw me off is having someone else come assess my patient and then make the determination that vent settings needed to be made.

The covering person should have taken over assisting in the intubation and the RRT should have gone to the bedside. What you have going on sounds nuts.

[MaxAttack, BSN, RN]

Run from HCA as fast as you can.

From what you describe I have so many question but you said you're new to ICU and I don't think it would be unreasonable for RT to send someone they trust to check it out. Either way the patient survived. At the end of the day it's about your license and patient safety and it sounds like both are being jeopardized.

[OUxPhys, BSN, RN]

My first job was cardiac stepdown at a large hospital system. They had RT's for us to give breathing treatments like nebulizers and inhalers. When I left there to go to VA the floors handle the breathing treatments while the units had RT's. If you needed an RT you could always page one to come assist.

I don't think they will get rid of RTs in the units. Maybe the floors but definitely not the units. Everyone has a shortage right now. 

[Tweety, BSN, RN]

My first job as a tech 30 years ago the RNs were giving breathing treatments.

Where I work now we can't even give a puffer, much less a breathing treatment.  I think passing these medications should be shared with nursing.  I had a patient this weekend that said she wanted a breathing treatment and was anxious.  I called my RT and she asked "well is she in distress?" and my answer was "no she's not but she's anxious so the sooner the better".  RT:  "so you're telling me to give treatment for anxiety".   

So I got blown off and the patient didn't get her treatment.  I was able to calm her down and it was shift change and apparently her anxiety and breathing deteriorated resulting in multiple calls to the RT.

Had I been able to give a medication myself, a medication that people are entrusted to give themselves at home, then there would be no issue and the RT would be free to do their critical care and emergency stuff without being interrupted.  

End of rant.

I do hope RT's don't get phased out because they have a knowledge base RNs will never have and we need them.

[ghillbert, MSN, NP]

Wouldn't bother me, because I trained in a country that doesn't have RTs and the ICU nurses manage everything to do with the ventilator. Now, as an ICU NP I also make ventilator changes as necessary, but I have privileges to do so. I would be concerned if inadequately trained staff were permitted to adjust any machines without the proper knowledge.

[Jedrnurse, BSN, RN]

I certainly wouldn't be shocked if a for-profit corporation eliminated the specialty and dumped the lion's share of the additional duties on staff nurses...

[subee, MSN, CRNA]

3 hours ago, Jedrnurse said:

I certainly wouldn't be shocked if a for-profit corporation eliminated the specialty and dumped the lion's share of the additional duties on staff nurses...

CRNA's are good at ventilator management in a crisis and I'm sure that we already have a billing code for a respiratory consult:)

[ghillbert, MSN, NP]

14 hours ago, subee said:

CRNA's are good at ventilator management in a crisis and I'm sure that we already have a billing code for a respiratory consult:)

94002 or 94003 ?

[vanessaem, BSN, RN]

These hospitals are having RNs do way too much and we're not even being compensated for it.