Trach dislodgement

MunoRN, RN · Dec 1, 2014

Sometimes you might also forget what it is like to cover 200 patients and have everything paged to you as STAT.
I wish I had time to thoroughly teach everyone.
The RT in this situation did respond to the bedside. He did not blow off the call. He may have been short with the OP but we don't know what his workload was like. He might have been in the ER trying to keep a child from being intubated or prepping for a meconiun baby in L&D. He might have come back later to teach when things calmed down. But if the OP stated or projected that he thought this RT was lazy and didn't care, I probably would not have come back to that either.
It is difficult to always be perky when stressed for time and trying to prioritize many patients and tasks. There are many, many discussions on this forum about this topic by nurses. Had this RT spent a few minutes with the OP, someone else (doctor or nurse) would probably be yelling at him for not responding fast enough to them. Some shifts you can't win.

Yes, if only nurses knew what it's like to have an excessive workload.

GrannyRRT · Dec 1, 2014

Yes, if only nurses knew what it's like to have an excessive workload.

MUNO, you quoted me but failed to read what I wrote.

Sometimes you might also forget what it is like to cover 200 patients and have everything paged to you as STAT.
I wish I had time to thoroughly teach everyone.
The RT in this situation did respond to the bedside. He did not blow off the call. He may have been short with the OP but we don't know what his workload was like. He might have been in the ER trying to keep a child from being intubated or prepping for a meconiun baby in L&D. He might have come back later to teach when things calmed down. But if the OP stated or projected that he thought this RT was lazy and didn't care, I probably would not have come back to that either.
It is difficult to always be perky when stressed for time and trying to prioritize many patients and tasks. There are many, many discussions on this forum about this topic by nurses.Had this RT spent a few minutes with the OP, someone else (doctor or nurse) would probably be yelling at him for not responding fast enough to them. Some shifts you can't win.

Not everyone is superman and perfect nor can they drop everything to teach what probably should have been taught by a preceptor before placing a nurse in the position of caring for a patient with a trach. This is the CRITICAL CARE section. It is a failing of the system, that includes nursing and RT, to place someone in a critical care area who must rely solely on an (meaning one) RT for airway care such as was the statement in reference to the "RT's job".

I speak more about the reality of any busy shift and really don't feel the need to fluff fluff every situation or post. I know many times when working the floors or the units where the RNs have been too busy to answer my questions or even the patients' questions. Look at some of the discussions on this forum when many RNs have vented or asked for advice about busy loads. Given the nature of both of our work loads, I do my best not to take it personally or try to start ******* matches. Muno you can say sweet things on this forum about the ideal world to win approval points but there are hopefully those who know it is what it is when it comes to being busy and spread too thin whether it is a nurse or an RT.

As far the original post, the RT arrived at the patient's bedside as requested and checked the patient. The OP has the option of calling RT for all respiratory situations or formally request more education about trachs if it is expected of him to care for these patients. It sounds like the OP needs more foundation and it is bad to be placed in a situation you are not fully prepared for.

Asking for help is one thing but if you cop this attitude

God forbid I ask him to actually do his job.

don't expect someone to drop everything for you. An RT on shift can answer a few questions but they are not allotted time to teach everything. I have gotten very long winded on my trach posts and still only scraped the surface of what should be taught. Maybe if the OP had not copped the attitude about RT I would have gone into one of my indepth explanations. But, I feel that learning about trachs was not the intent of his post.

sallyrnrrt, ADN, RN · Dec 1, 2014

i have done both work loads, and since I have a choice, today I do more nursing as a RN, THAN RRT, the work load and # of patients at some hospitals was

unbelievable, sometimes the whole house.........but the way I reduced calls on that horid of a schedule was to teach as I did..........The majority of young in tenure nurses today were not afforded the clinical experiences I was, I have been at it so long that when I was in nursing school there WERE NO RESPIRATORY THERAPIST,........so most nurses I worked with were eager to learn, ie: you can avoid this, by securing the trach harness a little tighter.,.....or in different senerio, can you start the albuterol neb, i will be right up, but i have to get a gas done on an er patient......i will be right up, as soon as I can, I did not just educate techniques, and interventions, but also what my work load was and when they could expect me, unless they may need to do something else.....most were grateful and understanding....... but as a RN of almost 43 years, nurses really have no idea of the number of patients a resp.therapist has at times......being brisk or responding in a frustrating manner, really made it worst for me and the nurses......so i may of fluffed a little, but it reduced my calls, and nurses were able to handle more..heck, my mannerism might have been just to keep me together, :)....the real fault is placing nurses in critical care positions wothout adequate academic and clinical preparation.......But i am getting off topic.

GrannyRRT · Dec 1, 2014

Sally I am not saying I don't teach or that RTs shouldn't teach. I think by most of my posts on this forum I do show an interest in teaching. The RT department does take part in teaching nurses at many hospitals. We do empower nurses to be self sufficient doing respiratory things which is why many RT departments are half the size of what they once were. CMS also knows this and the reimbursement has dried up for RT for many procedures. Thus, less staff. But, that is a different discussion.

What I am saying is it is unfair to label an RT as lazy and not doing his job by one interaction and only hearing one side of the story from a new nurse who may not know how many patients one RT covers.

My comments are directed solely at the OP and this situation.

If the nurse has the attitude that something is solely my "job" when it is a shared responsibility then I am going to be taking a different approach.

So Sally, don't be so quick to judge me or other RTs as lazy or who don't want to teach. There are just times you can't do everything no matter how good you are. If the person in need of more teaching also has an inflammatory attitude towards me or RTs, then I am going to choose a different time and place. RT and nursing management will also need to be involved. Not all personality clashes can nor should be resolved at a patient's bedside. Had this been an RT calling a nurse lazy because he or she did not have time to teach during a busy shift you would probably be defending that nurse's actions. Remember there is usually only 1 RT per 100 - 150 nurses in many hospitals today. It is hard to please everyone every time.

sallyrnrrt, ADN, RN · Dec 2, 2014

Granny , I am not so quick to judge orther RT, Just responding to Op response, yes it is a shame at load RT carries, an example of some of the rediculousness is in Texas there are very few RT in LTC, but in order for the L t c, to get paid for reimbursement for neb.treatments etc, they must be taught by us in an inservice, and demobstrate they took adequate time assessment etc for the treatment..........sorta crazy............yes i agree with you re nurses attirudes re "my job"........i just try to make each intervention, that is a "shared responsibility"......... a teaching oportunity..cheerfully when possible, sometimes that may be helping my frustration, as much as an insecure nurse....I also was responding to the one interaction the OP described......since I am both a RN and RRT, I am very aware of the , insane staffing ratios between nursing and respiratory.

MatthewBSNRN · Dec 17, 2014

Nope the RT's on our floor are strictly for our floor so he wasn't overloaded. I'd understand his frustration if he were the RT for multiple floors. When this occurred he was on the computer screwing around on Facebook which is why the situation was so frustrating and unprofessional. It was like he couldn't be bothered to do his job.

You have an RT who is probably covering all departments including the ER and ICU.
Since RTs can not be at every patient's bedside with an artificial airway all the time, the RN or LPN should have enough basic trach training so they can care for these patients safely. Caring for a trach patient is also part of your job. If you came across with the attitude this trach patient is solely his responsibility, I can easily see his response towards you.
One of the first things which should be taught is trach positioning to center and secure. This can ensure correct position to prevent dislodged trachs and damage to the wall of the trachea.
This RT might just be expressing frustration with a system which has set you up for failure. It would probably be in your interest to work with the RT to help the nursing department provide more education rather than fueling the fires of hatred between disciplines.

MatthewBSNRN · Dec 17, 2014

I think I was justified in "copping an attitude". I was standing, there my patient was in distress and I reached out to the person who is the expert, the RT and he was on Facebook and the copped an attitude with me. I will do whatever I need to do to protect my patient. I'm sorry that disturbing a medical professional's Facebook time is apparently an issue.

GrannyRRT · Dec 17, 2014

I think I was justified in "copping an attitude". I was standing, there my patient was in distress and I reached out to the person who is the expert, the RT and he was on Facebook and the copped an attitude with me. I will do whatever I need to do to protect my patient. I'm sorry that disturbing a medical professional's Facebook time is apparently an issue.

Now you present a very different scenario from your first post.

Can a tracheostomy tube look like it's coming out but not be simply because of the patient's head position? I had an RT get mad that I called him to the room because of the above scenario. God forbid I ask him to actually do his job. Thanks in advance.

If your patient is in RESPIRATORY DISTRESS, don't just call a Respiratory Therapist, call a Rapid Response Team or even a code. This way you will get people immediately who can help the patient. Do this from the bedside if at all possible and don't leave the patient's bedside to get the RT off of the computer. That would be a better choice to protect your patient than get into a ******* match with the RT.

You didn't give us a follow up as to what happened to the patient or what your or the RT did to alleviate the respiratory distress. Did you do a follow up for more education? Did you learn more by having this experience about what to do for a trach patient in distress? Do you have a BVM, spare trachs, extra inner cannulas and suction catheters at every bedside? What happens if that RT is in the middle of a trach change on a patient? Can you do some basics to keep the patient alive until the RT or a team gets there?

You can waste time ******** about someone else to justify an attitude or you can make it a chance to learn more skills and knowledge to share in the patient's care. Go through your hierarchy but stick with facts and keep the attitude in check if you want the complaint to be heard by both managers.