Where is the Respiratory Therapist?

LostCauseCCRN · Apr 22, 2012

I agree! This is a unique department if you think about it because we can do 90 percent of what they do and they KNOW AND TAKE ADVANTAGE OF THAT!!!

Write-em-up, and keep Writing-them-up, before someone dies of negligence. It's already stealing because I can just about guarantee they are charging for every missed treatment!

Incompetence!

VICEDRN, BSN, RN · Apr 22, 2012

I am not a big fan of RT for the reasons LostCauseCCRN mentioned. They know their scope is encompassed in ours and they abuse that fact, especially in the ER where they seem to just *love* to avoid doing anything other than bringing a ventilator.

I have already tried to bring this up to the manager but to no avail as he is sympathetic to the RTs. In the future, I plan to document all of it to the nurse manager and if necessary file an incident report form for "Delay in patient care."

SICK of doing EVERYBODY ELSE'S job for them! (sorry...vented)

CoffeeRTC, BSN, RN · Apr 22, 2012

Sounds like you need to bring this up with you manager or maybe you have?

I haven't worked with an RT in years since I do LTC, but that sounds like a lot of patients for 2 RRTs to cover? Do they really go over to the nursing home section? Unless they have vents, why?

hrodgers · Apr 23, 2012

Oh my goodness it is so bizarre that this is the first thread I am reading tonight, because I am actually right in the middle of dealing with poor RT behavior. Working in the SICU and both of my patient's had abdominal surgeries, have huge round distended bellies, on 3-5 L O2 NC with 88-92% sats...not impressive and they are both struggling to take those big deep breaths we all keep asking them to. Breath sounds rhonchi/coorifice, very weak coughs, and poor incentive spirometry skills. They are basically identical with tenuous respiratory statuses. So the MD orders chest PT every 4 hours. Sounds great to me! Now at my last hospital we never needed an order for this, we just used our nursing judgment, clapped on those backs, and did what we had to do for our patient's! But here is different apparently. After paging the RT and bringing these new orders to his attention, he strolls in to the unit about 30 min later. He says that he thinks chest PT is contraindicated for one of the patient's because it makes his HR, which is already 100, increase to 110. And he gets dyspneic. Hmmm....I explain why I think he still needs it, and he suggests I call the MD to have him order neb treatments. So I do (I needed to ask the MD something else anyways), and he says that he doesn't think the neb treatments will hurt the patient but he still wants him to get chest PT. So I just told him that I'll do it with or without the RT's help, and he said thanks. Then the other patient is sleeping in the chair at the time, so he tells me he can't do chest PT on him now and walks away! He said to page him once he's back in bed. Arhhhhh! I feel like any excuse will do to get out of doing a little extra work to benefit the patient's. So frustrating! So I asked another nurse to give me a hand, we performed chest PT on both of my patient's, and now they are resting comfortably with better O2 sats and I'm weaning their O2. Thanks for nothing RT!

KelRN215, BSN, RN · Apr 23, 2012

Have you noticed a problem getting Respiratory Therapy when you need them?

When I worked in the hospital, we didn't have Respiratory Therapists on the floor and whenever we needed them, we had to page them. They could either respond right away or take hours. If we had a patient who needed q 4 hr pulmonary mechanics (NIFs/VC), the respiratory therapists wouldn't just communicate with each other that this patient needed to be seen q 4hr. No, it was up to the nurse to page them each and every time that it was time for them to see the patient. Aggravating to say the least.

How can I address this issue without making it worse?

I don't have any advice for you here, sorry.

Do you ever do their Respiratory Treatments for them?

At my hospital, nurses did the respiratory treatments. We did all nebs as well as the majority of the suctioning and chest PT. Respiratory, in fact, didn't do any of the chest PT and if anyone other than nursing did it, it was PT. But they would only come once a day. Respiratory, I guess, preferred to spend their time in the ICU.

BostonTerrierLover, BSN, RN · Apr 23, 2012

Wow, I knew from working several different facilities, that this problem is very trancending across the board.

To answer my previous poster's questions, Yes it would be a heavy load- if those bed's were to FULL Census (which I should have covered in my OP I admit). We are at the yearly slum in admits right now, and the Hospital wide census is 14.

We have 1 ICU patient (who the RN does most everything for anyway!) and only 4 Respiratory Patients on the floor now or "Respiratory Orders" patients.

I have the whole ER up to 5 beds, and 5 wall patients (curtains), with ONE tech (who is AWESOME)!

So, Basically, I had 6 patients this night, one code, two EMS transfers over a 3 hour period. I did EVERYTHING RRT DOES, except ONE ABG- he neglected the other! Plus, all my other Nursing Duties on the rest of the 5 patients after my EMS Transfer Out. It was in the middle of a 4 hour period for his due Nebs on the Floor. He had NOTHING Due for 2 more hours when I called him. I have since learned, 2 nurses circled their initials on MAR Nebs for the one's he was supposedly doing during the Overhead Page. (Also the floor is ALWAYS adequately staffed for the ability pull a nurse to ER for back-up.) Also, there is ALWAYs an on-call RRT, however, only the one on duty can make "that" call.

As for the 100 bed LTC area of the Hospital, the Supervisor ONLY does day NEBs, and at night this is contracted out to a third party (when necessary), or they are USUALLY admitted if it's an acute respiratory problem.

After finding out he neglected his floor duties TOO, this changes the whole picture. That means he basically has made a habit of lying to staff, not showing up in a timely manner, and his only Alibi is BS!!!

I just wish administration would give me the due Nebs, so I could handle it without chasing down an RTT!!!!

Thanks all posters for taking the time and consideration to Post.

wooh, BSN, RN · Apr 23, 2012

Most of our respiratory therapists are really great. But when it's shift change, don't expect help unless the patient is near coding. "Can't the nurse do it, we're giving report." Well what do you think we'd like to be doing????

techtoRRT · Apr 23, 2012

That sounds familiar. Thats what i used to hear when I got a bad blood pressure, bad blood sugar, or someone just wanting pain meds.

BostonTerrierLover, BSN, RN · Apr 23, 2012

TOTALLY behind you Wooh!

This is one of those 1% things, as most of the RRTs are awesome! One helps me in the ER with tech duties often! I feel she should have an award for terribly difficult intubations as well. I would wash her car every week, and rub her feet to keep her at the Hospital I work at half the year! She responds to emergencies w/o use of overhead, and on first "Pager" page.

I hate to page (on pager), "NEED YOU NOW!" and get a phone call 5 minutes later explaining why they couldn't come, "Do you still need me?":madface:

I would like to say "H%LL NO! The patient did! But don't worry about it, I just wish I could get your paycheck Friday- because I have done your job all week!"

BostonTerrierLover, BSN, RN · Apr 23, 2012

Lol, that's so funny and maybe it's God's sense of humor because our Lab Department is AWESOME!

Sacred eagle · Apr 23, 2012

At our hospital the police called and said they found anICU patient waking down the streeta mile from the hospital,dragging his iv lines and foley bag. First thing out of everyone'smouth was "where was the nurse".