Where is the Respiratory Therapist?

[BostonTerrierLover]

I have the utmost respect for Respiratory Therapy, even at my current "contracted" facility. Most of them are right on target- and IF they have trouble making it on time for a treatment, or show up a little late on an emergency, I know they are really busy and doing something with another patient on another floor or area. This is different.

Let me set up the Scenario.

Small 40 bed Acute Care 3 Unit Area, 5 Room ER, 8 bed ICU, 12 bed Post-Surgical. 5 Birthing Suites/10 Post Partum/Women's Care Rooms. 20 Swing Bed Rooms, 100 bed Nursing Home/20 of those bed Mental Health Senior Care. There are ALWAYS 2 RRT's (Registered Respiratory Therapists) on staff at ALL times!

One is ALWAYs stationed ONLY for ED and ICU beds. The other covers the 3 story, 3 unit acute care, and swing bed facility. During the day, the RRT Supervisors does the Treatments in the Nursing Home.

Of the 6 RRT's on staff here, (plus the practicing Supervisor=7), all but one are STELLAR! The one I have a problem with is RENOWNED for intubations, and is great "skill" wise. Dependability is NIL!

He is dating one of the Acute Care RRT's, so needless to say, it is starting to affect her as well- but NO WHERE NEAR as bad as him. It's nothing for him to never show up for routine ordered Treatments, I have seen him see a sleeping patient, and walk away. We don't know if he's charging or not- but if I am sure he didn't give one- I initial and circle on MAR for hold.

FRIDAY NIGHT.

Clocked in, started shift. It's Me, an ER Tech (CNA trained for ER), and the Doc. I see the RRT clock in, and leave the unit. 4 patients in rooms, 1 awaiting EMS transfer, 1 waiting for ICU bed (massive CVA)*, all stable but awaiting some orders *besides my transfer.

Admitted Asthma/COPD patient, Anxious/Trembling all over. Spo2 84%, BP 166/106. They wouldn't deny CP, and stated 4/10, pressure- but "better now." 3 lead EKG showed Sinus Tachycardia, no ectopy, 153 BPM, resps labored, wheezing, non-productive coughs/congested-31 RPM. Accessory Muscle Use. Pupils pinpoint, diaphoretic, cyanosis Obvious. Paged 3 times while working with patient. Told ER Tech to page over head.

RRT does EKG, Resp Tx's, Oxygen Set-Up, and blood gases (all of which were ordered stat)! No response from overhead, sent ER tech to RRT Sleep Room (3am), No Response!

Of Course, at this time I have started IV plus meds, O2, the first treatment, but am running crazy to get my EMS transfer ready (MVA), and I hear the alarm- CODE/MVA.

Call Code Blue- I get 2 Acute Care RNs (regular ER back-Up Nurses), and the floor RRT who saves the day. 11 minutes after the stat page, he shows up. We work code successfully, get EMS transfer, He did tx's on Asthma Pt, Spo2 95% on 2L NC, Sinus at 89 BPM now, I tell him what else I need, (needed), but it is handled now- "but don't run off." Fell on deaf ears! Found out 1 hour late, he never drew my second set of ABGs, I wrote it up! My first ever time to write up another department!

4 minutes later EMS report enroute Premie 1 1/2 months early, respiratory distress. Stat page over head (didn't even bother paging him- I told him NOT to run off), and by the time he get's there, Doc and I have baby intubated, IV, and in Incubator awaiting further orders, no distress. Mother's doing fine, but is anxious.

I can NEVER get him when I need him, he just "vanishes" for HOURS at the time. He smokes outside, and I have seen him sit in his car outside and just talk on cell.

I have dealt with the same issue at other hospitals where it looked more like understaffing, but feel this issue is just plain NEGLIGENCE! I have begged for the ones I know will not do the treatments to give me the medication so I can!

I know there are sometimes other things going on, but I am the kind of person who, when I finally ask for help, I NEED HELP NOW! I don't pull a nurse, or make a page unless it's out of my hands. I can go for weeks without pulling a nurse from the floor, or overhead paging any of the OTHER RRTs, it's just this guy!

I know working the floor it is common to get blessed out on the phone by an RRT because a patient is requesting a "PRN" treatment, and they are "Too Busy!" Yet I see them all on my next break smoking, and sitting in the courtyard!

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

How can I address this issue without making it worse?

Do you ever do their Respiratory Treatments for them?

ANY ADVISE ON DEALING WITH NO SHOW RESPIRATORY THERAPISTs PLEASE

[wanderlust99]

I think it's just that particular person, because in my 7 years as a nurse in 8 facilities (typically ICU) the RTs are always really good. I really depend on my RT's opinion regarding vent settings, always trust them and find them to be very helpful. I think they deal with some staffing stuff and being overworked and overassigned just like nurses do, so I really don't care if they are 2 hours late for a treatment. If I ever needed a stat treatment they are always there. Love the RTs!! It's a shame you don't have good ones at your facility.

[Vespertinas]

I've worked in hospitals where I do almost all the RT work so it doesn't ruffle my feathers too much when I find myself doing it in a hospital where it IS their responsibility.

I HAVE reported a RT once when during a code, he waltzed in after 11 minutes in a great mood. My educator informed me that there is a protocol for how quickly the code responders should arrive and he not only missed the mark by a long shot but he also showed no remorse. I think you should start keeping track of numbers of times you have to page and how long you're waiting and what interventions you are doing instead so you can bring hard numbers to a supervisor.

[BostonTerrierLover, BSN, RN]

Thats the CRAZY thing about this facility, you are helpless supply wise, and if your RRT doesn't bring you the equipment, . . ..

So, all I am saying is, leave ME access to the nasal cannulas, tubing, Xmas trees, face masks, BAGS, and intubation kits! They even have the ONLY key to the RESP drawers in a code (although I have a key now after this last code). But, before this happened, I plead for one!

I will be PERFECTLY happy to do their jobs, (Its ALL about the Patient), but don't leave me helplessly DEPENDENT on someone that will not show up for an emergency. AIRWAY??! Which reminds me they have ALL the oral and nasal airways!!!!

Routine- I agree with above poster

(This is a Monopoly situation).

[Vespertinas]

That's crazy

[anotherone, BSN, RN]

Thats the CRAZY thing about this facility, you are helpless supply wise, and if your RRT doesn't bring you the equipment, . . ..

So, all I am saying is, leave ME access to the nasal cannulas, tubing, Xmas trees, face masks, BAGS, and intubation kits! They even have the ONLY key to the RESP drawers in a code (although I have a key now after this last code). But, before this happened, I plead for one!

I will be PERFECTLY happy to do their jobs, (Its ALL about the Patient), but don't leave me helplessly DEPENDENT on someone that will not show up for an emergency. AIRWAY??! Which reminds me they have ALL the oral and nasal airways!!!!

Routine- I agree with above poster

(This is a Monopoly situation).

You work in an ER and nursing does not have access to the face masks, xmas trees, nc and tubing, intubation kit? this seems insane, a mockery of nursing even.

[WongRN-4lyf]

We are run the exact same way. It's usually because of the charging system. EVERYTHING resp r/t must be brought to us too from RRT, and it SUCKS! So does our Resp Dept. Vespertinas, your completely right- It's Insane!

I agree Boston, just give us the stuff, fire the dept, and give us a raise.

[wooh, BSN, RN]

just give us the stuff, fire the dept, and give us a raise.

That will never happen. Although I could definitely see giving you the stuff and firing the department. The raise though, that would NEVER happen. I mean, do we get paid more for doing anyone else's job?

[BostonTerrierLover, BSN, RN]

Lol, I went for the mop and mop bucket yesterday an hour before housekeeping came in, and then I went back for a wet floor sign. By this time, Housekeeping was easing in . He asked me what I was doing with the Wet floor sign- left himself wide open for this mind you!

I said, "Well since I don't have any clue how to do maintenance's job, and fix the AC, I am going to fan my nursing staff with this sign." He looked confused and said, "I got a fan in here that would work better." I took the fan too, and pointed it at my mopped floor. (Don't think I was taking advantage of my Housekeeping guy, he caught the joke later on that AM, and I said, "What do MOST people do with Wet Floor signs?"

When the ER called to complain about the Heat, I started off to find a maintenance guy, and walking by the closet, He promptly said, "Do you want me to take them the sign?"

Promise it was funnier there!

:redbeatheBoston

[BostonTerrierLover, BSN, RN]

Oh, and don't worry, when I smoke myself into emphysema- I am going to call RRT just so I can draw a deep enough breath through my trach to smoke a cigerette. They LOVE that. Revenge is soooooo sweet.*

*I did manage to quit smoking 2 years ago, but if I ever find out I have 6 months to live. . . .

[CompleteUnknown]

Boston, I can fix your issues with the RT. Move to Australia where there is no such thing as a respiratory therapist, and items that are needed for the patient are taken out of the cupboard as required with no need to keep any records as people do not get charged for items used. Your hospital bill will be higher if you need an oxygen mask? That sounds like such a waste of everyone's time!

Well done on the quitting smoking by the way!

[BostonTerrierLover, BSN, RN]

Find me a place by the beach, I'm packing. Lol!

[rrtDude]

I love my nurses because they are smarter than me and can do 90% of the work that I do. But with all this venting about them stupid and lazy RTs, does this all mean that I can no longer come onto your floor for free coffee and donuts? Just trying to clarify some things here before I start making my rounds