Respiratory Therapists Inserting PICC Lines

Even the least amount of registered nurse education, the ADN, makes any RT program seem like remedial education. There is no comparison. Yet? Even an ADN (and in many places a BSN) registered nurse cannot insert central lines in most states, without further, specific IV training and certification. This is just another of the ongoing and successful attempts to reduce the status of licensed nurses while allowing lesser educated persons to take their places. Out of control, even as more nurses continue to believe that to obtain employment, they need to obtain advanced nursing degrees. Sad.

Even practical nurses can do most of what an RT does (trach care, suction, vents, inhalation TXs, etc.). In fact, when the PPS system started in the late 1990's, tens of thousands of RTs were laid off from nursing homes because they became classified as 'unskilled care' (unbillable) , that could be performed by the nursing staff. BUT- in most places an RT can't even give a patient an ASPIRIN. For that poster to claim that RTs are mini physicians, scares me. And as far as CPR? Anyone on the street is allowed to do that, so what makes a person a "CPR expert"? Please elaborate, thanks.

I have said it before, and I will say it again. Until nursing gets it act together, we will continue to have our professional practice given away to others.

RRTs have a two year Associates Degree, so do most nurses. But nurses make more money. Do the math.

If you were a hospital administrator, who would you give practices away to? Probably the one who will cost you less.

Nurses need to insist that a BSN be the entry into practice, mostly to DIFFERENTIATE US from other health care professional who have our same educational preparation. I am not saying that an RRT degree is any where as intense, or equal to, an Associates Degree in Nursing.

What I am saying is that, to a hospital administrator, it looks like an even switch, and the RRT costs less.

Nursing also need to insist on BILLING FOR OUR PROFESSIONAL SERVICES!! As long as a nurses' professional practice is rolled into the room rate, housekeeping, and the complementary roll of toilet paper, nursings' contribution to positive patient outcomes will forever be stuck on the negative side of the balance sheet. It is simple economics.

And hospital administrators and insurance companies want to keep it that way.

Grandfather in all nurses who have Associate degrees and Diplomas, so no on get left behind. I don't believe that they should be made to earn BSNs, unless they want to. It is just not doable.

As usual, JMHO and my NY $0.02.

Sorry that I have been gone so long from ALLNURSES. Too many issues to deal with.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW

I have said it before, and I will say it again. Until nursing gets it act together, we will continue to have our professional practice given away to others.

RRTs have a two year Associates Degree, so do most nurses. But nurses make more money. Do the math.

If you were a hospital administrator, who would you give practices away to? Probably the one who will cost you less.

Nurses need to insist that a BSN be the entry into practice, mostly to DIFFERENTIATE US from other health care professional who have our same educational preparation. I am not saying that an RRT degree is any where as intense, or equal to, an Associates Degree in Nursing.

What I am saying is that, to a hospital administrator, it looks like an even switch, and the RRT costs less.

Nursing also need to insist on BILLING FOR OUR PROFESSIONAL SERVICES!! As long as a nurses' professional practice is rolled into the room rate, housekeeping, and the complementary roll of toilet paper, nursings' contribution to positive patient outcomes will forever be stuck on the negative side of the balance sheet. It is simple economics.

And hospital administrators and insurance companies want to keep it that way.

Grandfather in all nurses who have Associate degrees and Diplomas, so no on get left behind. I don't believe that they should be made to earn BSNs, unless they want to. It is just not doable.

As usual, JMHO and my NY $0.02.

Sorry that I have been gone so long from ALLNURSES. Too many issues to deal with.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW

OMG. THIS!!!!!! A MILLION TIMES THIS!!!! You, my friend, are a HERO just for this post alone.

You can teach a monkey as long as they're cheaper!

I'm always amazed at the disdain some nurses show for respiratory therapists. Thankfully, it's the kind of disdain I've only ever encountered on the Internet, and it's usually about therapists who want to expand their scope of practice. How dare a lowly respiratory therapist express a desire to expand the scope of practice for his or her profession? Only nurses get to do that!

And, I'm sorry, but anyone who says that RT education is like remedial education compared to ADN education either went to a poorly managed for-profit RT program or didn't pay attention very well in school. The sheer amount of detail we go into regarding cardiopulmonary A&P, renal physiology, gas and fluid dynamics, respiratory pharmacology, and ventilation makes most nursing students cringe.

We're trained to specialize in cardiopulmonary diseases, disorders, and modalities of treatment. Yes, inserting central lines requires additional training, but to say that a respiratory therapist isn't qualified to the task after that training is risible at best. I can place an indwelling arterial catheter but somehow learning how to place central lines is beyond my ken?

I understand you don't like loosing tasks and procedures that, as a profession, impacts your value to your hospital; I don't either, and I fought just as hard when nursing tried to take balloon pump management, asthma and COPD education, and the ability to initiate lung expansion therapies (like IS) from respiratory care at my hospital.

However, I managed to do that without denigrating nursing as a profession or disparaging nursing education just because nurses wanted to expand their scope of practice at this particular facility.

It's a shame that some nurses see the need to take the low ground and run around banging pots about how nurses are going to be replaced and yell about the sky falling just because another allied health profession is making reasonable expansion to its scope of practice at hospitals in some states.

Omg. It's not totally a surprise but seriously. I am a Rn in the PICU and can speak from both sides since I still work as a RRT part time. So I know how ignorant some nurses can be the fact that a RT is a professional too. You will be surprise how many nurses can't bag mask a patient properly. And how many nurses think that albuterol is the miracle drug for every thing. And I don't fault them because clearly it's not their specialty. I'm a RT in adult acute care but working as a RN in PICU I am not familiar with some of the peds/nicu concepts. I respect my RTs. RT in some hospitals are the ones who intubate. Its a skill and clearly these RT's are capable of doing so. So placing a PICC line could be easily taught.. My sis is a PA with a 2 year degree and she was trained to placed CV lines in. And she came out of school knowing nothing. There are doctors that respect our opinion. There are also RTs that are ECMO specialists. Guess you feel they aren't qualified to do that either.

And a RN new grad at my adult hospital starts off at $22 and a recent RT new grad in my dept started $20. Hmmm

Respiratory therapists, at least in NC, can have a fairly extensive scope of practice depending upon their practice environment. Those of you that think that all a respiratory therapist does is twist knobs on a ventilator and suction trachs might want to read through some of the Declaratory Rulings on the North Carolina Respiratory Care Board website.

To counter the above comment, I would like to point out, that, in the military, ALL RRTs come in as enlisted. RNs, on the other hand, even when the Army and Air Force, were still commissioning RNs with RN Diplomas, and Associates Degrees, were STILL BROUGHT IN AS COMMISSIONED OFFICERS! All RNs now must have BSNs to commission, even in the Reserves, but RTs are still enlisted.

The reason for that, is the military felt, even though both had two year Associates Degrees, Nurses have a much more stringent, higher education content than RRTs. That is why RRTs are enlisted and ALL RNs are officers.

I have never known of RRTs to manage the IAPB. They also do not manage the Heart Lung Machines, Pump Techs do. Pump techs go to school to become Pump Techs, and they may have an RT background, but it is a specialty practice that entails attending a special school. So, no RTs do not manage the Heart Lung Machines. NURSES manage the IAPB, as well.

I have never know of an RRT to have it in their scope of practice to place indwelling arterial lines. Anesthesia, either MDs or CRNAs, do. That is their practice, not RRTs.

When I still worked in ICU, whenever the doctor would order a vent change, the RRT would have a COW, if I made a change to the vent, (and I would always chart it on the flow sheet).

I was told by an RT that they wanted to make all the changes because if a nurse made the changes all the time, what they were afraid that adminstration would take away THEIR PRACTICES AND GIVE THEM TO THE NURSES BECAUSE IT IS CERTAINLY WITHIN OUR SCOPE OF PRACTICE TO MAKE MD ORDERED VENT CHANGES, BUT RRTS, CANNOT TOUCH MY CENTRAL LINES SWAN GANZ CATHETERS, IV LINES, ETC.

Who is really afraid of another specialty encrouching on their professional practice??

So you are trained ,"to specialize in cardiopulmonary diseases, disorders, and modalities of treatment". And lets not forget, " The sheer amount of detail we go into regarding cardiopulmonary A&P, renal physiology, gas and fluid dynamics, respiratory pharmacology, and ventilation makes most nursing students cringe.". Really??

I have 160 college credits in nursing, which include, 8 unites in A&P, 16 units college level chemistry, 9 in Pathophysiology and Pathobiolgy, 3 in Anatomy and Kinisiology, Pharmacology, concerning the medications we are adminstering to patients and the reason why that particular drug is given.

We certainly covered all aspects of all the major organ systems in the body, and I recall, during my A&P classes, dissecting fetal pigs. At the college where I earned my BSN, the A&P classes had human cadevers to dissect for lab.

Inserting central lines has NEVER been in the scope of practice of RRTs. It is being MADE TO BE by Respiratory Administration. They muse feel that their profession will be taken over by RNs, in a cost saving measure, by hospitals and nursing homes because a nurses' scope of practice allows nurses to do respiratory treatments, O2 therapy, breathing treatments, etc. Nurses who work in nursing homes now do scheduled breathing treatments because nursing homes want to pay as few people as possible. RTs are expanding their scope of practice, so they will not be left out in the cold.

I have NEVER know of a nurse, whether RN or LPN, to think that Albuterol is a special "miracle drug", and that they know nothing about. Or cannot handle other practice like bagging patients, etc. It may have been a new grad or nurse, who had little experience, but experienced nurses are well aware, of Respiratory Practices.

It is respiratory who is afraid of losing their professional practice to RNs, and not the other way around. In years past, there were NO "INHALATION THERAPISTS" (as RTs were called back in the 60s and 70s, and NURSES did all of the breathing treatments)!

It is a shame that RTS feel the need to validate their self worth and self importance by making emballished, inflated claims of their professional prowess, expertise, and education.

Nurses can work independantly, start their own practices in the community, and many of them have done. RTs, cannot. It is NOT in their scope of practice. That says it all.

JMHO and my NY $0.02.

Lindarn,RN, BSN, CCRN (ret)

Someplace in the PACNW

'

Linda,

Scope of practice can vary considerably by state and facility. I placed arterial lines while still a student. It is also very common for RRT's to manage IABP and ECMO once trained for the modalities, and placing indwelling arterial line is certainly within our scope of practice. At most facilities I have interned at and worked at Nurses are not allowed to place arterial lines, perform arterial puncture, or interpret blood gasses.

We've been hearing that RN's will take over respiratory care for decades. My father heard the rumor when he was an RT starting in the late 70's, and again when he was one of the first RRTs in the country. It has never happened, and it will never happen. Nursing and Respiratory Care are two distinct fields of practice with distinct education and scope. Nursing still hasn't managed to take over respiratory care.

You have a very interesting perspective on RRT competency and education, and it seems to be exceptionally flawed. You took nursing courses, which prepared you to be a nurse. That's excellent. You did not take courses designed for respiratory therapists which had the depth required to understand cardiopulmonary A&P or pathophysiology or ventilation like an RT did.

The A&P course required for nursing students at the college I attended was specially designed for them, because nursing pass rates on the standard courses were too poor; it was widely regarded as having less rigor than the standard two semester A&P sequence that everyone else (including dental hygiene students) had to take. The same with nursing pharm. We had to take a general pharmacology course and a course specifically for respiratory pharmacology. More depth more rigor. I tutored many nursing students through their pharmacology with my supposedly less rigorous education.

I've met plenty of experienced RNs who want me to give more albuterol to their fluid-overloaded CHF patients with no evidence of bronchospasm. I've met plenty of experienced RNs who push far too much fluid and cause fluid overload. I've met plenty of RNs that overbag patients with pulmonary emboli because they don't know to look for spontaneous breathing and can't assess a patient quickly to figure out whether or not they're becoming fatigued. I've met plenty of RNs who cant use an inline suction catheter correctly, much less an open suction system. I've met plenty of RNs who don't know the first thing about properly managing a chest tube.

For every story you have about the mythical "lazy RT" I have one about the mythical "clueless nurse" that I've had to spend time with physicians cleaning up after. There are people in both professions who are not actually very good at what they do at the worst or are simply lazy at best.

I work with nurses every day who learn new things fro me and I from them. I work with experienced nurses who are happy when I come to assess their patient and troubleshoot their chest tube or ventilator or evaluate their ability to clear secretions. Why are these nurses happy to see me instead of bodily shoving my poorly-educated incompetent self out of their patient's room? Because I'm a highly skilled professional who has been educated, trained, credentialed, and licensed to manage the airways of their patient who very much needs my services.

I am eminently grateful that I work with nurses who are capable of recognizing that they are part of the team. I am grateful that they recognize there are limits to their education, scope, and experience. I'm grateful that they're willing to let me show them how to bag a patient appropriately and that they'll kindly "let" me manage the airway I'm licensed to manage when things go south. These nurses care about their patients and not professional siloing and breastbeating.

Thanks for that awesome post respstudent. :)