RT refused to give NEB!

RNsRWe, ASN, RN · Mar 28, 2007

My personal favorite story along these lines was when I called RT because my patient was in great distress, he was ordered to have treatments PRN Q1hour if needed, he was a real train wreck. Anyway, got told "I'm very busy, I'll get there when I can" and got hung up on. Mind you, this patient was a known quantity and I was trying to NOT have him die on my shift! After half an hour, called again, got same rank RT who said "I TOLD you I was BUSY" and before she could hang up I said "if you don't get here soon, you're going to be busy explaining to the MD why he's DEAD". :angryfire

She managed to get there. I'm STILL mad about it!

TazziRN, RN · Mar 28, 2007

Did she actually refuse to give the neb? You didn't state that in the thread, just in the title. If she refused, then it's time for a write-up.

Gromit · Mar 28, 2007

wow! I'm glad our RTs aren't like that -sure, I know they get overloaded just like the rest of us, and there are times I've had to wait and worry but I never doubt that they will get there as quick as possible.

RN BSN 2009 · Mar 28, 2007

That's not good, RT's are busy yes, but if that's what is ordered, they have to give it just as if it is a medication.

prmenrs, RN · Mar 28, 2007

I'd get in touch w/their shift co-ordinator, nursing supervisor or write an Incidient/Occurance/whatever report.

Recently, we had a 26 weeker on a ventilator waiting for the tertiary care to get there, they were on another transport. We are a level 2 nursery, we don't keep babies on vents. I called RT to take blood gas, when he came, I told him I needed him to stay after he brought the results back. He asked if he could make rounds 1st. "how long will that take" "2 hours" "No, a baby on a vent needs your att'n til it's transferred out, you need to stay down here." Next time I saw the RT dep't head, I verified w/her that that is what the prioritizing was. I felt a little bad that he would probably be behind all, shift, but, if the RT can't prioritize correctly, I'll do it for him.

You're in the same position if you have a pt in distress. If the RT can't break free to do the treatment, ask them if another therapist is available. I think you can do it yourself, too.

Good Luck!

TinyNurse, RN · Mar 28, 2007

nah, i doubt it........something must be going on here, because a neb is an MD's order. The RT HAS to give the neb unless it is standard practice in your unit to give the neb.

RTstudent · Mar 28, 2007

Wow I'm going to start Rt school in june and I hope I never become like that Rt you described. I've read on this board before that nurses express themselves very good about their Rt's but i guess there are people like that in all professions.

queenjean · Mar 28, 2007

Our RT department is awesome. I depend heavily on their opinions and assessments of our patients.

I have run into the situation where when I called RT, I said something like "My pt is coughing pretty hard, could you come down and give him a treatment please?" and have gotten the response, "A treatment isn't going to help a cough." What? You mean that aerosolized saline isn't going to help break up the mucus he's trying to hack up? The coughing won't improve if his narrowed airways open up in response to a bronchodilator?

Of course, I haven't actually said anything like this; instead I say, "Well, I'd like you to come down and assess him then, because everything I have tried isn't working, and if I call the doc the first thing he's going to say is, Have you contacted RT, so I'll wait to call until I get your assessment and recommendation." I've noticed that almost always they end up giving a treatment.

It seems like I'm hearing this "A treatment won't help a cough" more in the last couple of months. I wonder if there is any new trends in RT that recommend holding off on aerosolized treatments and instead giving oral meds? Or if it is just a couple of otherwise great RTs being lazy or overworked or just grumpy?

cheshirecat · Mar 28, 2007

We do not have RTs. The RN gives all nebs during her/his med round. If a patient needs 2 hrly or prn nebs we give them. Why can't you give nebs?

kate1969 · Mar 28, 2007

I'm an RT and I'm very sorry that that happened to you, last noc I was called in to my PRN job and there was a patient there that is a "No code" comfort measures only. I gave him a TX at the scheduled time and he had no PRN orders for nebs, but a nurse, not his nurse, called me and asked if he could have a tx, I looked on my sheets and explained to her that I just gave him a tx 2 hrs prior to the current time in which she called, I also explained to her that he had no prn tx's ordered, but if she could get me an order, I would come and give a tx. Mind you, I was in my office on another floor. She hung up the phone and apparently tried to call the physician. In the meantime, I decided to go up (on my own) and reassess the patient, I was worried about him. I went up there and I could hear him just gurgling on his own secretions..I went to the nurse and explained to her that I could give him a tx, with a prn order however, I truly felt that the patient needed to be suctioned more than anything. Since suctioning is invasive and traumatic for a patient without an artificial airway, I explained to her that I could do that as well for the patient, but I would need an order from the physician. She explained to me, in a very frustrated tone that "nurses could nasally suction patients at their discretion without a physicians order.." I said, "fine, if you can do it that would be great, but for an RT to do this, we have to have an order written in the chart". She proceeded to find the patient's Nurse and have him suction. We were still waiting at this point for the physician to return a call. Anyways, to make a long story short...hehe, the physician called back, gave an order for prn nasal suctioning and for a stat neb tx. The patient however was completely unwilling to be suctioned but he did take the neb tx. I like being an RT, I love my patients and I'm concerned about all of them. I would love to spend every bit of my 12 hrs assessing and treating my patients in a timely manner, however, some of the RT's out there only focus on their current patient workload. I would gladly dump all of that to fix a patient in distress. But sometimes, when your treatments have to be written off because of priority, the RT dept manager likes to write up therapists that write off treatments...(legal issues and all). I feel like saying that they all need to staff enough RT's to perform therapies and staff 1 RT for emergencies, even if that Emergent RT sits at work all noc and does nothing...The safety of the patients in need of emergent care take precidence over the "clear lung sounding" scheduled q4hr tx's...(IN MY OPINION)

SORRY FOR THE SOAP BOX

and i'm very sorry that an RT treated you in that manner....

Katie

RTstudent · Mar 28, 2007

I'm an RT and I'm very sorry that that happened to you, last noc I was called in to my PRN job and there was a patient there that is a "No code" comfort measures only. I gave him a TX at the scheduled time and he had no PRN orders for nebs, but a nurse, not his nurse, called me and asked if he could have a tx, I looked on my sheets and explained to her that I just gave him a tx 2 hrs prior to the current time in which she called, I also explained to her that he had no prn tx's ordered, but if she could get me an order, I would come and give a tx. Mind you, I was in my office on another floor. She hung up the phone and apparently tried to call the physician. In the meantime, I decided to go up (on my own) and reassess the patient, I was worried about him. I went up there and I could hear him just gurgling on his own secretions..I went to the nurse and explained to her that I could give him a tx, with a prn order however, I truly felt that the patient needed to be suctioned more than anything. Since suctioning is invasive and traumatic for a patient without an artificial airway, I explained to her that I could do that as well for the patient, but I would need an order from the physician. She explained to me, in a very frustrated tone that "nurses could nasally suction patients at their discretion without a physicians order.." I said, "fine, if you can do it that would be great, but for an RT to do this, we have to have an order written in the chart". She proceeded to find the patient's Nurse and have him suction. We were still waiting at this point for the physician to return a call. Anyways, to make a long story short...hehe, the physician called back, gave an order for prn nasal suctioning and for a stat neb tx. The patient however was completely unwilling to be suctioned but he did take the neb tx. I like being an RT, I love my patients and I'm concerned about all of them. I would love to spend every bit of my 12 hrs assessing and treating my patients in a timely manner, however, some of the RT's out there only focus on their current patient workload. I would gladly dump all of that to fix a patient in distress. But sometimes, when your treatments have to be written off because of priority, the RT dept manager likes to write up therapists that write off treatments...(legal issues and all). I feel like saying that they all need to staff enough RT's to perform therapies and staff 1 RT for emergencies, even if that Emergent RT sits at work all noc and does nothing...The safety of the patients in need of emergent care take precidence over the "clear lung sounding" scheduled q4hr tx's...(IN MY OPINION)
SORRY FOR THE SOAP BOX
and i'm very sorry that an RT treated you in that manner....
Katie

you're the type of RT i want to become , thanks alot for your soap, i enjoyed reading it!!!