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

susi_q · Jul 1, 2004

I like having RT around. True in the "old" days RNs did it all ... but there wasn't as much machinery to deal with - the pace of change was a lot slower. We need to recognize that we can't be experts in everything. RTs actually have a similar amount of education as an ADN (just don't have to take boards, yet). They can focus on respiratory interventions - and stay up to date in that specific area, while nurses focus in their areas of expertise.

By the way ... in our facility RT is there 24/7. They intubate during a code, do breathing treatments & EKGs, vent management ... but work with RNs to evaluate patients. They're usually pretty responsive and receptive to requests. What is so "dangerous" about having someone else to bounce ideas/observations/concerns off? Two heads are better than one ... especially when each has some specialized information that they can share with the other (IMHO)

**canoehead, BSN, RN** · Jul 1, 2004

An RT is not a bad thing to have around, but two professionals that have whole-body knowledge would be even better.

Pediatric Critical Care Columnist · Jul 1, 2004

Our RTs are so territorial it's not even funny. We have to call them to the bedside if the kid desats so that they can titrate the O2, we have to call them to the bedside to help with suctioning (even though we ONLY use inline suction catheters) because they have to increase the O2 for preoxygenation, we have to call them to the bedside to give the nebs/MDIs because although they know about them they don't bother to keep track, we have to call them to the bedside to do trach care because it's their responsibility but they don't keep track, we have to call them to the bedside before we turn a patient so that they can "manage" the tube, but I've never seen one do chest physio other than vibrations... There are usually three or four of them sitting around the RT station surfing the Web, having a snack (nurses and family members are not allowed to eat in the unit... I guess they're special), reading a magazine, chatting or napping. God forbid you should run a gas within the last half hour of their shift!! Some of them are very helpful and willing, others are not. I had a run-in with one over a tiny post-op Glenn who had orders to "keep sats between 75 and 85%" whose sats gradually crept up into the low 90s and hung there. The risk of significant vasoconstriction of the PAs was a very real possibility, and I told her three separate times over about 90 minutes that this baby needed her O2 decreased. She had a million reasons why she couldn't come do it, so I asked if I could do it myself... and got my head handed to me in a sack! I finally drew a gas and when the charge RT saw that the co-ox sats were 93%, the O2 was adjusted STAT. I documented all of this of course.

Yes, they do understand the physiology of ventilation better than I do, but like Dinith88 said, the ICU can run without RTs but not without RNs. :nurse:

IamRN · Jul 1, 2004

Yikes janfrn! RT present to hold the tubing while you turn the patient :confused: and to pre-oxygenate????

Is this your hospital's policy or just the way it has always been done?

IamRN · Jul 1, 2004

Yikes janfrn! RT present to hold the tubing while you turn the patient :confused: and to pre-oxygenate????

Is this your hospital's policy or just the way it has always been done?

Pediatric Critical Care Columnist · Jul 2, 2004

I don't think it's a policy, more like a unit-specific practice. Where I worked in Winnipeg, we shared our RT with the wards and sometimes the neonatal resus team, so we fast became proficient in hand-ventilating with one hand and suctioning with the other while holding the patient's head still without contaminating our catheter. No inline suction there except in specific situations (PEEP >/= +8, oscillator, jet or highly infectious secretions). And our VAP rates were only a fraction of what we see here. We turned our patients with another nurse's help, if they were big enough to warrant help, or alone if not. And we titrated our O2 as needed. So it was a huge culture shock for me to come here and unlearn all that. To say nothing of all the bloody knuckles from having them rapped for giving O2 breaths or making adjustments to it. Only RTs can touch the ventilator, Jan!! :angryfire I never could quite grasp the point of inline suction when the RT would come to the bedside, take the patient off the vent and bag them while I suctioned. (This practice has been gradually phased out due to our extremely high VAP stats!!) AND the suction set-up is a shared one for both ETT and oral/nasal suctioning... meaning we disconnect the inline and drop the end on the bed, hook up the tonsil suction to the tubing, suction the mouth/nose and whatever else, give the tubing a quick rinse (at least I do) and then reconnect the inline. Hmmm...

Pediatric Critical Care Columnist · Jul 2, 2004

I don't think it's a policy, more like a unit-specific practice. Where I worked in Winnipeg, we shared our RT with the wards and sometimes the neonatal resus team, so we fast became proficient in hand-ventilating with one hand and suctioning with the other while holding the patient's head still without contaminating our catheter. No inline suction there except in specific situations (PEEP >/= +8, oscillator, jet or highly infectious secretions). And our VAP rates were only a fraction of what we see here. We turned our patients with another nurse's help, if they were big enough to warrant help, or alone if not. And we titrated our O2 as needed. So it was a huge culture shock for me to come here and unlearn all that. To say nothing of all the bloody knuckles from having them rapped for giving O2 breaths or making adjustments to it. Only RTs can touch the ventilator, Jan!! :angryfire I never could quite grasp the point of inline suction when the RT would come to the bedside, take the patient off the vent and bag them while I suctioned. (This practice has been gradually phased out due to our extremely high VAP stats!!) AND the suction set-up is a shared one for both ETT and oral/nasal suctioning... meaning we disconnect the inline and drop the end on the bed, hook up the tonsil suction to the tubing, suction the mouth/nose and whatever else, give the tubing a quick rinse (at least I do) and then reconnect the inline. Hmmm...

steve0123 · Jul 2, 2004

Too many cooks... RT's in a consultancy or therapeutic role seems quite appropriate to me (and lets face it, thats all that really matters ). But mini demarcation disputes over who is and isn't allowed to do this/that/"the other" would drive me insane. As far as I'm concerned, the patient is *my* patient (my own... my very own...) and I'll be a monkeys uncle the day someone slaps me on the wrist for suctioning without permission. Jan, you must have a strong faith in the the principles of karma or ethanol-anxiolysis, cos I'd have blown every fuse in the proverbial switch box...

steve0123 · Jul 2, 2004

Too many cooks... RT's in a consultancy or therapeutic role seems quite appropriate to me (and lets face it, thats all that really matters ). But mini demarcation disputes over who is and isn't allowed to do this/that/"the other" would drive me insane. As far as I'm concerned, the patient is *my* patient (my own... my very own...) and I'll be a monkeys uncle the day someone slaps me on the wrist for suctioning without permission. Jan, you must have a strong faith in the the principles of karma or ethanol-anxiolysis, cos I'd have blown every fuse in the proverbial switch box...

kids · Jul 2, 2004

I was working pediatrics and a kid with asthma was tightening up about 2h into a Q3H neb schedule, so I called the RT (as required) to get another neb given. Took him 15 min and two phone calls to show up, then he says "just give him more O2." Stupid me, I asked if perhaps he would like to listen to the patient first. So he slams into the room spends 30 sec, and comes out saying how he didn't have time to trapise all over the hospital giving nebs (!) on a prn basis.
So by now it was 2 1/2 hours...lucky the kid didn't have his airway compromised.
Coming from Canada we gave nebs on the floor as often as Q1/2 hour according to the nursing assessment. I couldn't adjust to having a child with asthma and not being able to DO something about his main issue. Why couldn't nursing do ongoing assessments and titrate the frequency of nebs so the kids got out sooner?

I love to have an experienced RT to bounce things off of and to deal with the more mundane (but important) time consuming tasks.

But just like nurses I have encountered more than a few "bad" RTs. Ones who had just a tad too much ego, were territorial or forgot there are body systems other than respiratory.

I have never had to get permission from an RT to do a PRN neb never mind have them "over ride my assessment". Turn up the O2? Good intervention but not a solution. I would have ridden that RT like a pony all the way to the unit managers office.

Was this situation hospital policy or a "bad" RT?

kids · Jul 2, 2004

I was working pediatrics and a kid with asthma was tightening up about 2h into a Q3H neb schedule, so I called the RT (as required) to get another neb given. Took him 15 min and two phone calls to show up, then he says "just give him more O2." Stupid me, I asked if perhaps he would like to listen to the patient first. So he slams into the room spends 30 sec, and comes out saying how he didn't have time to trapise all over the hospital giving nebs (!) on a prn basis.
So by now it was 2 1/2 hours...lucky the kid didn't have his airway compromised.
Coming from Canada we gave nebs on the floor as often as Q1/2 hour according to the nursing assessment. I couldn't adjust to having a child with asthma and not being able to DO something about his main issue. Why couldn't nursing do ongoing assessments and titrate the frequency of nebs so the kids got out sooner?

I love to have an experienced RT to bounce things off of and to deal with the more mundane (but important) time consuming tasks.

But just like nurses I have encountered more than a few "bad" RTs. Ones who had just a tad too much ego, were territorial or forgot there are body systems other than respiratory.

I have never had to get permission from an RT to do a PRN neb never mind have them "over ride my assessment". Turn up the O2? Good intervention but not a solution. I would have ridden that RT like a pony all the way to the unit managers office.

Was this situation hospital policy or a "bad" RT?

**canoehead, BSN, RN** · Jul 2, 2004

I was hospital policy, as the same issue came up with almost every asthmatic patient overnight, and the same solution by the RT's. The manager was well aware of what was going on but she had been trained in that hospital, so thought that was the correct way to deal with it- after all, that's what the RT's told her, and they were the experts. Anyway, the kids at that hospital had their neb frequency reviewed twice a day by the residents unless something went really bad, where I was used to reviewing response with every neb- check lungs before and after, and sometimes at 15min intervals when I was trying to stretch the timing. In credibly poor care IMO.

Another time I was involved in preparing a newborn for transport and the RT's got so involved in getting blood gases that they pulled the IV line out. I nearly killed them! That's why I think two professionals with a more holistic view of what is going on would be more appropriate. We don't call them to difficult deliveries any more because the nurses are trained and capable to do all the resp interventions, and then some. The doc does intubation if needed; we are a low risk hospital so no neonatologists, etc.

AND...one more thing...it burns my butt when the RT dept decides they don't have enough money or staff to cover nights and passes it all over to nursing. If we can do it at night butt the heck out and let us take credit for being able to do it all the time. And, by the way, give us half your budget if you are only going to be working half the time.