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Discussion

RT working as the new nurse?

This is just not sitting right with me and I feel like I need some insight from other nurses.

In the facility where I work(surgical sub-specialty clinic with on-site ambulatory care operating room), an RT (who was working as the receptionist) was recently promoted to "clinician."

The new position requires:

  • administration of medications (oral, IM, IV)
  • assessment (NOT directly related to respiratory status, including orthopedic/complex wound assessment)
  • teaching (preop, conservative management, medication...all not related to respiratory status)
  • nursing procedures (dressing changes, suture removal, starting/ dc'ing IVs)
  • triage (urgent patients in house/taking patient phone calls)
  • evaluating/discharging post op patients

I can't find anything that states that any of this is strictly limited to nursing. I've read the state statutes regarding RT scope of practice (with a fine-tooth comb). Basically, it includes everything that nursing does (assessment, treatment, med administration) but is specific to respiratory care. But the first line is , "The 'practice of respiratory care' includes, but is not limited to:..."

So my employer is using "is not limited to" to equate RT with nursing.

Don't get me wrong, I don't think RTs are beneath RNs at all, but I think there is a scope of practice issue here, and I'm worried about patient care. I would not expect an RT to do sterile dressing changes or first-assist in the OR (in my state, now all scrubs must be certified or RN/LPN), let alone administer medications (obviously, respiratory meds aside).

I've scoured the internet for anything more specific that would apply to this situation, and I'm pretty much empty-handed.

Am I completely off base?

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    Highly depends upon the state and how they regulate medical practice.

    If your state is like Arizona then technically the clinic can hire a lay person to perform all those functions you listed. Now since the employee in question is a licensed individual by the state they are subject to the scope of practice set forth by the state, regardless of employment.

    My state, Arizona has an interesting SOP. Basically an individual can perform a duty as long as they are trained and educated to perform the task in question. From what you described, I do not think that the RT will be performing out of her SOP.

    What the employer is doing is rather unprofessional but I do not think it is necessarily illegal. I would highly recommend that you contact the State Board of Respiratory Care to ask them what they think. The Department of Health and Human Services may also have some insight into this.

    Edit: How your employer bills his patients may have a significant impact upon this practice. Medicare/Medicaid regulate many aspects of patient care and I believe require an RN to participate in certain aspects of patient care such as discharge. Being a surgical center I am not sure what the rules may be for your facility. I would research this.

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    You say they were promoted to "Clinician". It was always my understanding that to don that title, one must complete higher level education. Like a nurse clinician, for example. Maybe the RT was actually going to school for this- or maybe they were also an LPN or CMA as well as an RT. I know CMA's can't dink around with IV's or do assessments, so maybe they aren't a CMA, but possibly an LPN, and maybe, if they are really officially carrying the title of clinician, they've completed an additional program.

    I wouldn't get too worked up about it. It's not on your head if the RT is practicing out of their SOP.

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