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

[RN Randy]

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...

i am MORE than capable of doing it, [nursing] but im not trained to, so i dont...

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.

[aDDctd2sBUX]

its nice to have RT's to clean the trachs

[jesa]

I'm a nursing student but my husband is an RRT and he wanted to respond to this post:

I over heard my wife reading this thread and wanted to share my thoughts. I graduated '99 with a BS in Cardio-pulmonary Sciences, (impressive title for a RRT i wish I had read the fine print). 50,000 in debt and pay equal to an OJT RT i wanted a refund or exchange my major. I've worked as a traveler from east to west, i've worked at the finest teaching institutions (Harvard, BU, Stanford), i've been a sup., clinical specialist, researcher. (I've seen it all). I burned out quickly. I'm frustrated with the proessional organization (AARC), credentialing organization (NBRC), legislature law (politicians), hospitals, in other words the decision makers, not the RT's, not the RN's, (not the front line). What's the major difference between an RRT and an RN? The nursing decision makers rubbed the right shoulders, respiratory has taken a different route,-mainly research. Why? The highly technological aspect of the profession makes it low hanging fruit and most importantly offers more to the pt. Enough politics!!! Instead of asking what does an RRT do that an RN can't? Instead, what does an RRT do that an RN may? 1. deliver meds, (I don't mean neb. jockeys), Nitric oxide, Flolan (via IV pumps)-all selective pulm. artery dilators. 2. draw blood (ABG's, A-lines) 3. assess pts. & decide on best. protocol. 4. provide essential info. in rounds. 5.save lives. 6.respond to codes. 7. intubate. is that in an RN's scope??(not an easy thing to do with all those eyes on you). 8. ECMO ( again...not an easy thing to do on those kids) (we were also on the flight team). 9.oh yea those bloody traumas at 2am. In closing, RN's remember those sophisticated ventilators aren't IV pumps and they have a lot more buttons.

[RN Randy]

I'm a nursing student but my husband is an RRT and he wanted to respond to this post:

I over heard my wife reading this thread and wanted to share my thoughts. I graduated '99 with a BS in Cardio-pulmonary Sciences, (impressive title for a RRT i wish I had read the fine print). 50,000 in debt and pay equal to an OJT RT i wanted a refund or exchange my major. I've worked as a traveler from east to west, i've worked at the finest teaching institutions (Harvard, BU, Stanford), i've been a sup., clinical specialist, researcher. (I've seen it all). I burned out quickly. I'm frustrated with the proessional organization (AARC), credentialing organization (NBRC), legislature law (politicians), hospitals, in other words the decision makers, not the RT's, not the RN's, (not the front line). What's the major difference between an RRT and an RN? The nursing decision makers rubbed the right shoulders, respiratory has taken a different route,-mainly research. Why? The highly technological aspect of the profession makes it low hanging fruit and most importantly offers more to the pt. Enough politics!!! Instead of asking what does an RRT do that an RN can't? Instead, what does an RRT do that an RN may? 1. deliver meds, (I don't mean neb. jockeys), Nitric oxide, Flolan (via IV pumps)-all selective pulm. artery dilators. 2. draw blood (ABG's, A-lines) 3. assess pts. & decide on best. protocol. 4. provide essential info. in rounds. 5.save lives. 6.respond to codes. 7. intubate. is that in an RN's scope??(not an easy thing to do with all those eyes on you). 8. ECMO ( again...not an easy thing to do on those kids) (we were also on the flight team). 9.oh yea those bloody traumas at 2am. In closing, RN's remember those sophisticated ventilators aren't IV pumps and they have a lot more buttons.

Hi Jesa,

Well... once again it seems that it comes down to personal opinions and semantics. Everyone seems to be confused on the simple facts.

You husband has good points but the underlying statement has a real turf war feel to it.

People seem to be totally ignorant of the first [and biggest] problem with the whole mess, as thus:

Trying to compare nursing and RT is like comparing apples and oranges!

Nursing relates to the field of patient care.

Respiratory relates to a specialized field of cardiopulmonary care.

Why is it always nursing and RT banging heads? Why not say, Radiology or Dialysis?

It's probably related to the whole patient contact thing. Radiology is generally a specialized task, where RT has to integrate into the patient care and outcome plan. [A specialized *field*] That makes RT a vital part of the program, but since the civilian world doesn't draw bold/clear lines around things, we get left with that stupid gray area where jobs overlap. Then it becomes a pissing contest about who is better, or who knows more or whatever. The truth lies in task vs. procedure vs. scope.

People, understand that a simple task [turning a knob, pushing a button] and a scope of practice, are two different subjects.

It seems to me the arguments usually occur over simple tasks, like upping a vent rate or O2 change. ie: "I don't touch your IV's and you touched my vent!"

That's just thick.

Facts:

Vent management is within the scope of nursing practice.

IV Medication administration and maint. is not within the RT scope.

Most RT *tasks* are within the scope of nursing.

Most Nursing *tasks* are not within the RT scope.

Nursing is charged with a patient's total care in the loose organizational chart. Period.

Allied Health as a whole, is SUPPORTIVE to the patient's plan of care.

[ie, nurses 'help' the docs, allied health 'helps' the nurses help the docs, ancillary services helps us ALL help the docs, which untimately helps the PATIENT. And in the end, it's about the patient, not who did what.]

Finally, these facts in no way relate to the intelligence level, education level or capability of the individual license holder caring for said patient.

How hard is that?

It isn't.

The hard part is understanding that there is an order to things, [as casual and loose as it may be] and one specific branch of allied health cannot claim superiority over any other, and definately not over nursing. Just as nursing can't claim equality or rank over the practice of medicine.

We are all necessary to make the system go, guys. And in a system, everyone isn't equal. There must be rank and file, and arguing over rank is just silly.

Jesa, to answer your hubby,

1. Yes, RT gives meds, as does nursing, and radiology, and nuc med, and so on. But different routes/reasons. Better yet, if your Flolan patient is also an employee in housekeeping, once he goes home with his pump, technically HOUSEKEEPING will be giving Flolan. Does that bother you? Not me.

2. Yes, RT's draw blood, insert art-lines and assess said results. So does nursing, the docs and lab in some cases.

3. Negative. RT does not assess the patient and decide on best protocol. RT does a focused cardiopulmonary assessment and suggests a plan of cardiopulmonary care/vent management to the health care team, specifically the physician. The PHYSICIAN decides the best protocol.

4. Rounds info? Absolutely, as does every member of the TEAM.....

5. Negative. RT's [or RN's] do not save lives. Paramedics save lives. Then it's up to the Docs/Nurses/Allied Health to KEEP them alive. Sorry folks, a code in a hospital is not an emergency situaton, it's simply an immediate action situation.

6. Respond? Absolutely, as does every member of the code TEAM....

7. Intubation is indeed within the scope of an RN or anyone else that's ACLS certified, for that matter.

8. ECMO? Now you're out in left-field. NICU RT and nursing have zero comparison to any other unit. Working in NICU is usually two steps deep into the sub-specialties.

9. Yes, we all suffer from the 2am bloody trauma.

In closing, RT's please remember that a ventilator is no more sophisticated than an IV pump. One shoves gas, the other shoves liquid, and last I looked at a plumset next to an I or 840, the IV pump wins the button count by far! :-) But seriously,

Neither machine is capable of doing anything without a trained OPERATOR at the helm, and ANYONE can be an operator. [Yes, we're just operators, BioMed techs being the experts.] EQUIPMENT OPERATION in no way reflects the knowledge or education of the operator, So can we please stop arguing over a silly rate change or O2 increase? When someone says RT serves no purpose or isn't educated, please feel free to throw a fit, but this equipment ops and task completion battle is just daft.

I can upkeep my vent after RT leaves, just as I can upkeep my CRRT machine after Dialysis leaves. [manage, not maintain] It does not mean that I am an RT expert or Dialysis Technician. It simply means I'm responsible [i don't get to leave] for total patient care, and that includes supervision of ALL aspects of said care, to the best of my ability.

I'm not the big boss, and I'm not trying to take over anyone's job. I'm just doing what needs done when it needs doing. If it's outta my league, I call those in the know.

-copyright 2006 by rmbelcher - all rights reserved -

LOL.. sorry..

[jesa]

You missed my point and I promise to shut-up after this. It wasn't an attack or "turf war (I'm lazy and prefer extra time with my 2yr old)." I saw a question and provided an answer. Perhaps the question needs rephrasing??

Here's the big picture: Medicine is a business and like any business the goal is profit, (sorry folks for now that's the way it is). How do you best achieve profit?? Reduce over-head and restructure, (look around).

The organizational structure as follows: 1. Sales dept-PPO's/HMO's 2. Operations-docs, PT's, OT's, xray, LVn's, rn's. rt's, blah..blah, Allied Health- just a name for reimbursement and billing. 3. Product-life and death 4. Customer-all of us one day. 5. CEO's-elected officials. That's rank and file. Silly to argue it. Doc and RN row harder, our boats sinking!

How do you increase revenue?? Restructure, cut-jobs, create jobs. Your right, RT is a specialist. So aren't anesthesiologist, pulmonologist, gynecologist, proctologist, dentists, pt, ot, xray...... Nursing is finally catching on. Unless of course you enjoy the ratios, national shortage (the pay isn't as good-I was hoping to be a stay at home dad.)

I heard someone mention naive. If you work at a teaching hospital you should have realized those deer in the head-lights residents can't absorb all that info. Whose supporting who???

Ventilation isn't about achieving a acceptable acid-base balance or fixing hypoxemia. all of which can be accomplished by turning the knob to the left and back to the right. What to do with pt. dyssyn. rn/md induced fluid over-load, recruitment, how do you recognize over-distention, how exactly does PCV/PCV+, APRV, VV+ (for you 840 buffs), Bilevel, PSV, that useless and dangerous SIMV (I bet that's your default mode), a chimp can be taught when to turn knobs and push buttons (with the right snack.) By the way fluids follow laws of gravity, vent's follow the law of motion,-try to fully grasp that theory with a pt. going sour. My peers and i save lives everyday we show-up. I feel sorry for you if you minimize your role.

If your on this site posing questions like these you probabaly need to work at a better hospital or retire.

-But then ignorance is bliss.

-sorry....well educated RT

[RN Randy]

Jesa's spouse... First, let me say that's a much more believable reply and I have to agree with your well-informed assessment of the big picture. Sad but true.

And if you're addressing me directly, No, I'm not minimalizing my role, I'm something of a license-collector actually. The life-saving poke was another big turf issue that you must not be familiar with and was said half in jest. However; I have to stick to my assessment of a "hospital code" being a stat thing, not an emergency.

Next, you don't need to try and prove your point or prowess with in-depth questions and scenarios. I don't question yours or anyone else's education and expertise. You and I have apparantly missed each other's points I think. Your first post reads out like "RN's have silly little IV pumps, and have no clue about the complexities of a vent." NOW.... I see that may not have been your intention, but that's how it reads, and that's how I replied. Apologies if we're crossing wires. I also need to say that in my postings I notice that I haven't fully explained myself either, and I apologize for that as well. My background is similar to yours, travel RT, etc, and my license list includes Paramedic, CRT, RPSGT and RN. I can remember changing Vt with a 6" crank wheel, and changing PEEP by making a trip to the sink for a cup of water.

So trust me, I have seen it from all angles, and ye preacheth to the choir.

I guess I've had several run-ins with angry RCP's lately and this thread caught my steam purge.

Lastly, the question is not mine, it was asked quite a while back by the OP, and it is indeed the fastest way to tick off an RCP, so I understand the soreness of the replies. Any advice on fixing the problem???

tnx,

rb

[dfk, RN, CRNA]

Ventilation isn't about achieving a acceptable acid-base balance or fixing hypoxemia. all of which can be accomplished by turning the knob to the left and back to the right. What to do with pt. dyssyn. rn/md induced fluid over-load, recruitment, how do you recognize over-distention, how exactly does PCV/PCV+, APRV, VV+ (for you 840 buffs), Bilevel, PSV, that useless and dangerous SIMV (I bet that's your default mode), a chimp can be taught when to turn knobs and push buttons (with the right snack.) By the way fluids follow laws of gravity, vent's follow the law of motion

correct me if i'm wrong, but isn't this what the underlying issue was in the original post, or some responses thereafter? it's not about whether an RN can turn knobs and change some settings. it's the physiology of it all, and RTs have had that education, RNs haven't. plain and simple, unless extruded from some other source. so in closing, RTs have the physiologic training and experience that they bring to the table. if RNs want to push knobs and change settings, then get the proper education, otherwise, stop assuming one knows it all. apologize if this sounds cold and abrupt, but come on, this thread has been going on long enough about the same drivel. enjoy~

fellow RN, SRNA

[she_devil128]

LOL, good one DFK.

Truly Yours,

RRT, RN

[mandymcnurse]

Wow, this is getting quite heated!!:sofahider

All I wanted to say is, I have been nursing for 21 years, 19 of which has been critical care, both surgical, medical and cardiovascular. I currently work in a tiny 6 bed ICU in a small town. We do not have RT coverage when I work my weekend worker position. I was trained in large teaching hospitals in Toronto for most of my career. I am now expected to start pts on Bipap, start up the vent, make vent changes, run my own gases, alot of times with only a family physician to back me up. Scary, this I know! Fortunately, I have alot of confidence in my knowledge base, and my critical thinking abilities. That is not to say I don't call in the RT who is on call to check my set up, make changes, basically make sure everything was done right. I have a new appreciation of RT's now that I have lost that luxury at work. I realize there is so much I DON'T know about ventilating pts. The turning of the knobs, that we have all referred to in this post, is so much more that. Remember, nuclear bombs have been set off with such small gestures. There really is a great wealth of knowledge behind it. I recently became certified with Canadian Nurses Association in critical care. I know my knowledge base is strong in cardiopulmonary nursing. But, I can still afford to learn more. RT's have taught me alot. And I hope they would say the same about me. We compliment each other when we work together.

I think that is key, working together in mutual respect of each others abilities. And to not be afraid to learn from one another.

Mandy:caduceus:

[JoanieRT2b]

i thought it goes like this excuse me if im wrong okay RT see his pt ,RT reports to the doc about the pt, doc writes order for patient, RN follow the order

[RN Randy]

LOL, good one DFK.

Truly Yours,

RRT, RN

Negative, not a good one at all. It's the same drivel....

If an order is written by a physician, and a knob needs turned 3 degrees, anyone with knowledge of where that knob should be able to turn it. Your RN is generally qualified enough to see the possible negative effects if any. See, you're forgetting the physician should, and usually does, know better than you. Plus, HE/SHE is the responsible party and the only one ALLOWED to make the change. The phys says turn it, not RT; unless there is a protocol, [originating from physicians] and again, then anyone can do it, per FACILITY not licensure guidelines.

DFK's argument appears based on the premise that an RN took it upon his/her self to decide to knob-turn for whatever reason. Why would one do that? They wouldn't, I hope.

Despite your arguments, the fact remains that RT is not allowed to practice medicine as much as they seem to want to.

In short, you guys are still arguing apples and oranges.

All the RT people here are arguing that RN's don't have the in-depth respiratory knowledge as the RT. No argument there... never was one... read the thread.

RN's argue that when a simple change is needed, and the RT says "Well, I have higher priorites right now." and doesn't show up, then the experienced RN [under orders for the Physician; as we ALL are.] can make the change.

Yes, there are some losers out there in all fields, but that isn't the discussion here.

Take a pill peeps, it's ok! :-)

rb

[RN Randy]

Wow, this is getting quite heated!!

I think that is key, working together in mutual respect of each others abilities. And to not be afraid to learn from one another.

Mandy:caduceus:

Jacqx21,

Now THIS is an example of a good one. :-)

Kudos Mandy!

rb