What does a Respiratory Therapist Do That An RN Can't?

[steve0123]

Hi All-

I was just wondering what education/etc one needs to become a Respiratory Therapist, and what their role is in the ICU? In Australia, Registered Nurses manage almost all aspects of day to day to care in the ICU, including ventilators (obviously in collaboration with physiotherapists and intensivists). Are RT's common in US ICU's, and if so how is their contribution to the patient more beneficial/cost effective/whatever than that provided by an RN? I'm not having a go at RT's, was just curious as I'm reading about all these diverse roles being undertaken by non-nursing staff in the US that are usually carried out by RN's in other countries (staff such as RT's, Anaesthesia Assistants, Surgical Technicians, etc etc etc).

Thanks,

Steve

[PollyPutTheKettleOn]

Oh how I laughed at this post!

I have worked in New Zealand, the UK, Canada and The USA, so as a voice of experience from both sides- the only thing an RT can do that an RN can't is sit in the RT room for hours at a time chatting to other RTs.

Patient outcomes are no better in units with RTs than those without, otherwise the UK, Australia, South Africa and New Zealand would have them too.

[augigi, CNS]

But I do wonder how the Aussies get by without RT...

Quite easily actually. Physiotherapists assist with postural drainage, incentive spirometry and chest physio. Nurses suction, adjust ventilator settings, run blood gases, run/adjust ECMO when necessary etc.

You don't miss what you never had!

[RTreformed]

wow, how this took on such a life... yeah, i was very defensive earlier, and will try to keep it tamed down a bit... as someone said(not sure who) it is a question of training and experience, and not intelligence... in an earlier post i said an rn could work for 20 yrs as an rn and not know as much about mechanical ventilation as i do after 6 yrs of practicing as an RT, and i mean it... just as i learn about various other aspects of nursing care, i could never grasp the full concept of nursing unless i did it day in and day out...

but to address the "an rn can turn a knob", i still dont agree... in the end, I am responsible for that ventilator and any changes made on it, and its my license and my a** on the line... perfect example, i worked in a facility that used the Siemens Servo 300, which is a minute volume constant ventilator... RN got a an ABG, didnt call me(although i was 4 rooms away) and decided to make a change herself... she decreased the rate... 20 minutes later, when i walked in the room, she said "hey, i got an abg and turned the rate down"... i walked to the vent and looked, and by her decreasing the rate, the kids tidal volume went from 80cc to 150cc... so, i got her from the nurses station and showed her, and she was amazed, had no idea... because she did not have the EXPERIENCE with the machine, and she was a well seasoned rn...

and to say an iv pump and a ventilator are the same, is simply moronic, and shows your ignorance of ventilators in general "one pushes air, one pushes liquids" or something like that, for gods sake PLEASE, if thats the grasp you have of ventilators, i pray that everytime you touch one someone slaps you in the mouth....

both facilities i have worked at, i work nights... people on here keep throwing the "well, an order has to come from a physician"... you know how i get orders for vent changes from a physician at both places i have worked?? i go to the md, and say "hey, i got this abg earlier and made these changes" no matter how significant they are... and the response is usually "oh, okay, thanx"... had an adult pt the other night on an oscillator, and neither resident had ever seen it, so guess how i got my orders... residents saying "just fix it then tell us what you did and why"...

[RTreformed]

This is why we have these goofus little turf wars, re: your rather self-absorbed statement on a nurse's total inability to grasp the concept of mechanical ventilation and comprehend RT. Then you turn around and say however; you're MORE than capable of doing an RN's job; you've simply not had the training to be licensed.

You equate RT with the pulmonary system and its relationship to the entire body, then equate nursing to passing meds...?

What boorish statements.

You've got quite the ego and attitude there, bro.

Here's some advice: Anger and ego won't help any situation, so it's best left home. Also, debating an issue as a professional will get you much farther than arguing over your opinion like an angry kid.

Yeah, someone far away says they're happy taking care of their own vent.

So what? No one attacked your intelligence/training/expertise, but your response was [more than once] a direct attack on the education and intelligence of others.

Not cool.

Had you read before replying, you'd see [and correct me if I'm wrong] that the post was made from another country where a vent patient is a 1:1 assignment. Listen bubba, the day I get a vented patient as a 1:1 is the day I'll do my own vent changes, CXR's, U/S and V/Q scans with all the free time.

I submit to you that I'm perfectly capable of doing your job, and you're perfectly capable of doing mine. No "job" is difficult at all.

The issue here is not one of skills, but of respect.

You must earn respect, not demand it.

Try to study up on the pecking order, [and there is indeed a pecking order.] It starts with the physician, who is held *accountable* for the care of the patient, and goes down from there.

Nursing is charged with the *responsibility* of *total* patient care, under direction of the physician.

RT [a member of the Allied Health team.] [Allied, as in an ally. Team as in not "I".], is charged with the *responsibility* of cardiopulmonary care, under direction of the physician and supervision of nursing.

Yes, I know that stings, but last I checked, if an RN gives a med that kills a patient, RT's phone isn't going to be ringing.

Nursing again, has the responsibility of overseeing total patient care, and that includes everything from Radiology to Lab to Resp. Care.

Jobs and scopes overlap. It has nothing to do with your expertise or level or training. It's nothing personal. It's not a power trip. It's simply a fact.

[it's sorta the same reason we have *attending* physicians and consults.]

No one is saying nursing is in 'charge of' RCP's, but that's the way RCP's seem to take it. Yes, I can twist knobs without an RCP. It's just a simple task, and it's only done by order of the physician, no matter who twists the knob.

No, I am not trying to dissolve Respiratory Care. However; I have a schedule just as you do, but mine is a total care schedule and it takes priority. If you can't be there, you can't be there. The change gets made, and in such a case, your job [read: responsibility as the expert] is not to dispense arrogance, but to check behind me, and correct me if I'm wrong. You know, like a *team*.

Nobody is taking your job bro, and attitudes only make folks even more hesitant to call for you.

lighten up a bit and don't take everything so personally.

rb

PS: let me note that the title of this thread is the exact wording one would use when seeking an argument with an RCP. I'm sure it was unintentional, but it does rake a bit rough.

Let me also note RN-itis and the nasty/power-tripping RN's out there that disrespect everyone around them. I apologize for them if no one else will.

if an RT gives a pt a pneumo, i pretty sure its not the RN's phone who rings, pretty sure it would be the RT's...

and i only give attitude to those i feel deserving, and every bit of attitude ive given on this board that were belittling were am at people who belittle my profession, just as if i had attacked nurses IN GENERAL... im pretty sure my attacks were aimed at specific people... and as for people being hesitant to call on me, i have NEVER had that as a problem, i have always had a great reporte with most(and you cant please everyone) RN's i have ever worked with, in many instances i was called to the patients bedside who were spiraling to code before the MD was paged....

i have NEVER made the statement i was more intelligent, simply that i am more knowledgable and experienced with ventilators and the pulm. system in general... i said it before, i have been shown by RN's many times how to run iv pumps and such, but if i see the pt is aggitated, i dont go up on they're sedation, even though i know how, why? cause im not the one accountable for it, and that is not a designated practice for me to do, even if the RN is busy in they're other pts room...

even with a simple abg with increased CO2, the RN way of thinking is "just go up on the pts rate"... yeah, turning that knob to increase it is easy, little bit more to it though... was the pt aggitated when you drew the abg, what was their minute volume? is the pt spontaneously breathing? could the pt use more tidal volume, do they need more ps, and thats if they are on a simple straightforward mode!!! what does the pt need to support there demand? yeah know, there is a calculation for determining how to correct a pts CO2 precisely, instead of "just increase the rate by 2 and check another abg"... again, trying not to seem attacking, just because it seems simple and straightforward, it rarely is...

and im sure, as i sit here on my 28th hour of being awake, that this is coming across once again as "attitude"... but hey, what can ya do....

[MAnders1405]

Here in Southeast Missouri, RT is very important to the health care team. Upon graduation from the local RT school, the new RTs have ACLS and PALS. How many nursing schools require that before graduation?

RTs at the hospital I work at are the leaders in a code blue situation. All RTs are required to go when one is called. If you were to walk into a room, and a code was underway, You would most likely see the RTs doing the work. Intubating, bagging, chest compressions, ABGs etc. The only thing we don't do is establish a IV and push meds IV. And yes, we do the labs off the ABG stick.

Each unit (2 ICUs, NICU, PICU and ED/ER) has one RT assigned 24/7. Some times we have more if workload is up.

Sure RNs can do RTs job but they don't. I can't count how many times I have been called to a room to suction a trach for an RN who says she/he doesn't know how. About half the time they do, they just don't like it. I thought RNs were trained on how to do that. Why are they calling RT?

RTs are trained for caring for and work with the cardiopulmonary systems. RNs are trained in total body care. I would think that RNs would apericate RTs help. After reading some of these posts, I guess not.

[lajean]

All I'm reading here is alot of jabbing at RT's. It seems that many RT's have made bad names for themselves, therefore ALL RT's are grouped in with those bad ones. RT's are..well...important. They spend the majority of their two-years education (not including pre-req's) completely focused on the cardiopulmonary system and how it is effected and how it effects other systems...period. They are VERY specialized. RN's on the otherhand spend their two-years education (not including pre-req's) covering ALL of the bodies systems. They should be knowledgeable of the RN's job, just as the RN should be knowledgeable of the RT's, but neither should be doing the others job. Instead, they should work together, share information, help the other, etc... The whole thing is about patient care, and patient outcome...not about whether or not the RT took a break, or whether or not the nurse can make a change on the vent. If the nurse is qualified to make a vent change, then do it - big deal. The RT shouldn't have a problem with that. What if that RT is busy in a code, unavailable to make a simple vent change? It should be ok and acceptable for a knowledgeable and qualified nurse to do what needs to be done. This does not give the therapist freedom to take a two hour lunch, however. The nurse should let the RT do his/her job. Sounds like a big territorial contest when it is divided into who does what, who can and cannot do this or that, who took a break, and who called the doctor. Get over it folks! If things are so hard to determine who does what, and it is such a huge issue - look up the job descriptions, and perhaps the licensing board outlined scope of practice. How about this, we focus where focus is needed, on the patient. If a co-worker happens to be a slacker - so what! Don't let it ruin your shift - or cause detriment to your patient. Do what needs to be done.

By the way, I am a Respiratory Therapist with 15 years of experience. I am also a nursing student. I will be an RN in the near future, as well as an experienced Respiratory Therapist. I hope to encourage and influence team work, dispense with territorialism, and increase collaboration between the two departments.

[Pkkostura]

i read numerous threads on this website about this topic--

what does a respiratory therapist do that an rn can't?

almost every state in the us has a board that governs the practice of respiratory care. a respiratory therapist holds a license to practice.

the following 2 statements are qouted from the arizona board of

respiratory care examiners website.

"32-3556. unlawful acts

from and after august 31, 1991, it is unlawful for a person to:

1. engage in the practice of respiratory care unless he is licensed or excepted from licensure pursuant to this chapter."

"the legislature finds and declares that the practice of respiratory care in this state affects the public health, safety and welfare and should be subject to regulation and control by the board of respiratory care examiners in the public interest to protect the public from unauthorized and unqualified practice of respiratory care and from unprofessional conduct by persons licensed to practice respiratory care."

www.rb.state.az.us

i'm an rn related to an rt.:balloons:.

moderator note:

threads merged for continuity

[OkieICU_RN]

Maybe I didn't read enought posts to know what you are talking about so maybe you want to expound on what exactly you mean.

I can do lots of things that an RT can do as I have been trained as a critical care nurse to perform some of those functions. I can change the FiO2 on the vent or BiPAP, I can ET/NT suction, I can bag a patient with the best of 'em, I can even flip somebody back to AC or IMV from flow-by if somebody's in trouble and the RT isn't around after I have paged twice.

I would like RT's to give RN's some credit and some allowances. There are times when RT's will get really ticked when you touch "their vent." I wouldn't do anything outside of what I have been taught in the ICU setting.

I don't make vent setting changes, I don't intubate people in a code, I don't manage somebody on BiLevel or Nitric oxide. Those are things that an RT has special training and experience in and I don't.

Can't we all just get along?

[meandragonbrett]

There are times when RT's will get really ticked when you touch "their vent."

?

Yeah, they might be managing the vent, but the nurse is the one managing the patient. A "prudent" should be ensuring the vent settings are appropriate and match the physician's order.

[RN Randy]

WHY OH WHY.... would anyone want to stir that topic back up again????

An RT practices within his/her scope as outlined in the governing state and national guidelines. If you aren't an RT, it doesn't apply to you. If you are an RT, there are plenty of RT boards out there to drop this on.

If you are an RN and want to know what an RT can/can't do...

CALL YOUR LOCAL BOARD FOR RESPIRATORY CARE.

So, let's put this one to bed before it goes south, please.

:-)

peace out,

rb

[interleukin]

Too many people(and this society perpetuates it) seek to define themselves by what they do, rather than who they are.

For this reason, people are terrified that they will not be seen as, "Commander in Charge" of their respective professions.

RN's are comprehensive in their responsibilities...RT's are specific.

Do your job well, then go home and develop into the human being you'd like to be. It ain't gonna happen on the job.

When thoughtful people find you to be an engaging, contributing, respectful, clear-minded individual who is not behaving like you're the center of all living energy, you're doing well.

When you're the only one who thinks he has achieved all of the above, it's time to drop your delusions.

[RN Randy]

Very well said.

Kudos.

rb