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

[prmenrs, RN]

RTs DO spend a lot more time and education on things like gas laws and such. They know more about that one particular system than we do.

On the other hand, nurses are often able to better "conceptualize" the body AS A WHOLE than RTs. Both skills are needed.

THAT'S JUST MY OPINION. The level 3 NICU I retired from had it's own Neonatal RT department, physically located in the unit, and we worked together. We could change vent settings, but we'd better chart it on their form and let them (and the docs) know why we changed it. We drew blood gases, and either RN or RT ran them (we had our own machine, which simultaneously analyzed basic chemistries. They handled (cleaned, packaged, sterilized, etc.) their own equipment.

We couldn't have done w/o each other!

[RTreformed]

work in the NICU and our RRT's are amazing.

I can not make any vent changes because it would be equivalent to them going and changing the rates on my IV's......I let them handle what they trained for and I handle the rest. They collaborate witht the docs and often make changes and call the residents to tell them what is going on and what needs to be done. If I notice a problem I call them. They come in a reasonable amount of time...they see the patient as being "their patient" too.....they have a liscence to defend as well. Now, I can change FiO2 to wean and if the pt requires more O2, we notify RRT of the changes we make. There is no power struggle, just a mutual respect.

They teach residents and nurses and know a lot about the other diseases our patients have and are just great resources all around. I love having them.

*they are the primary people called when a pt extubates....residents called when there is time, not usually time, though...

please excuse the choppiness...sleeeepy!

thank you, and this is the experience at the 2 hospitals i have worked at as well... im not saying Rn's cant do what i do, but if i had chosen the profession, i could do what an rn does(poop, pee, and puke, ugh, i couldnt do it lol) also, just because anyone can turn a knob, or push a button, doesnt mean someone fully understands the concept and rationale behind it, i can make changes on iv pumps, ive been shown, but i dont... ive read back through my posts here, and man, im really coming across as an *edited*, sorry...

[nurseasia94]

In our hospital, RN's pretty much do everything. We suction, do ABG's, trach care, monitor the vent. The R.T would do a vent check 2x a shift, give a neb tx and extubate/assist with intubation. RN's need a good understanding of vents and pulmonary disease processes so they could better manage their pts needs and make suggestions as necessary.

[anonomous RT Guy]

I think it's different at each hospital. With the new JCAHO regulations, it would be even more difficult for RN's to pursue ALL the tasks that respiratory therapists do (careplans, documentation requirements, etc). I also think that at larger hospitals, most respiratory therapists are more well rounded and are involved in more things. To take away some of my anonymity, I work were jprakes works and we assume more of a roll in "plan of care" and ventilator management.

I think the great thing about the medical field is you are only as ignorant or as knowledegable as you want to be. The resources are there. The only thing is knowledge is great, but the clinical skills gained through experience and hands-on training is pinnacle

[RTreformed]

I think it's different at each hospital. With the new JCAHO regulations, it would be even more difficult for RN's to pursue ALL the tasks that respiratory therapists do (careplans, documentation requirements, etc). I also think that at larger hospitals, most respiratory therapists are more well rounded and are involved in more things. To take away some of my anonymity, I work were jprakes works and we assume more of a roll in "plan of care" and ventilator management.

I think the great thing about the medical field is you are only as ignorant or as knowledegable as you want to be. The resources are there. The only thing is knowledge is great, but the clinical skills gained through experience and hands-on training is pinnacle

im being stalked here... lol

[anonomous RT Guy]

nope...just stumbled across this forum...

[dfk, RN, CRNA]

alright, i just gotta say..

i know it's been a while, and i've read this thread just as much as you.. listen, RT's do what THEY do because they WANT to.. RN's do what THEY do because they WANT to..

you know what's funny?

we bit*h because they (RTs from here on in) aren't there when we (RNs) want or lazily need them; they may complain just the same because although it might be something that i, as an rn, would, or could, want to know but CAN'T because management or ego keeps getting in the way, COMPLEtElY fix (machine-wise of course, half-joking, umm, sure, b/c of whatever factor.

but i DO know that RTs can be overworked just the same.

we all do and want for whatever reason(s).. get off whatever high-horse, low-horse, whatever..

we're here for the same thing, i hope..

admittadly and proudly, in whatever size -

the pt ~ !

[bethem]

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...

I'm with you! I'm a student in ICU at the moment, and I am able to suction, suggest vent settings, help turn patients, do ABGs - all under supervision of course, but without an RT. If a patient who is heavy needs turning, we get a wardsperson. Actually, this ICU has a policy of having two to turn regardless of weight - even the bubs get two, one to hold the tube and one to turn. Some of the nurses in my ICU view even the physios as extraneous, because 'all' they can do is chest percussion and look at CXRs. It would bug me a great deal to have to wait for an RT to turn up to help reposition or suction my patient. And i agree, Steve, it does seem like a bit of a wast of money to hire another person to do jobs RNs are capable and happy to do.

[RTreformed]

I'm with you! I'm a student in ICU at the moment, and I am able to suction, suggest vent settings, help turn patients, do ABGs - all under supervision of course, but without an RT. If a patient who is heavy needs turning, we get a wardsperson. Actually, this ICU has a policy of having two to turn regardless of weight - even the bubs get two, one to hold the tube and one to turn. Some of the nurses in my ICU view even the physios as extraneous, because 'all' they can do is chest percussion and look at CXRs. It would bug me a great deal to have to wait for an RT to turn up to help reposition or suction my patient. And i agree, Steve, it does seem like a bit of a wast of money to hire another person to do jobs RNs are capable and happy to do.

stay in school before you start running off at the mouth... never, and i mean, NEVER in your life will you have the conceptual grasp a good RT has on mechanical ventilation, the pulmonary system, and how they affect every other system, period, accept it. just as i will never have the grasp RNs have on most other things, drugs, doses, etc. im not disputing RNs, or what they are capable of... and the job you would so happy and (in)capable to do, is not yours to do, because you are not educated enough or trained to do it... being able to turn a knob when a physician tells you to is one thing, knowing its wrong, why its wrong, and how it will affect the pt is different all together, and thats all you would be able to do, make changes as told to do so... when you graduate, i would bet you payday after payday that you couldnt do it, and win everytime... suctioning, drawing abgs, these are remedial tasks equivolent to passing meds and drawing labs, i am MORE than capable of doing it, but im not trained to, so i dont... yeah, RTs may not have as much work in an ICU as you do, maybe, but im paid for what i know, and my ability to think at the moment and do whats best for the pt, even when the RN or MD have run out of ideas... nothing is better than being in an ICU, with an extremely ill/injuried pt who is going down the tubes, having an RN that has total faith in my ability, as i do in theirs, and the resident is clueless as to what to do, and by morning, the pt has turned around, and you know, that between the RT and the RN, that the 2 of you, working as a team, but letting each other do their own thing, saved the pt... thats what its all about, i dont need an RN to make suggestions to me, because im sure, its already crossed my mind, and if its a good RN, then they dont need my assistance, because whatever my suggestions may be(lasix, vasopressors to bring up a poor pressure due to my necessary vent settings increasing intrathoracic pressure) the RN will be 2 steps ahead of me... and thats healthcare, RT and RN teamwork at its finest, you do what you have to do, i do what i have to do, and maybe, we save the pt individually but as a team...

[RTreformed]

alright, i just gotta say..

i know it's been a while, and i've read this thread just as much as you.. listen, RT's do what THEY do because they WANT to.. RN's do what THEY do because they WANT to..

you know what's funny?

we bit*h because they (RTs from here on in) aren't there when we (RNs) want or lazily need them; they may complain just the same because although it might be something that i, as an rn, would, or could, want to know but CAN'T because management or ego keeps getting in the way, COMPLEtElY fix (machine-wise of course, half-joking, umm, sure, b/c of whatever factor.

but i DO know that RTs can be overworked just the same.

we all do and want for whatever reason(s).. get off whatever high-horse, low-horse, whatever..

we're here for the same thing, i hope..

admittadly and proudly, in whatever size -

the pt ~ !

very well said...

[RN Randy]

There are many icu's where the RCP intubates, places arterial lines, places Swan Gans and does the monitoring of these devices.

RCP's can place a Swan?? Where do you work, if you don't mind me asking?

thanks!

[dfk, RN, CRNA]

RCP's can place a Swan?? Where do you work, if you don't mind me asking?

thanks!

no offense, but, no sh!t where is this? i'll be sure NOT to lay up there... hmpff!