A Nurses Guide to Respiratory Therapists June 25, 2008
Posted by keepbreathing in Career Advice, nurses, respiratory therapists, respiratory therapy.trackback
As part of this weeks Change of Shift I have been asked to assemble an article about RTs: what we do, how we think, and how we can improve our interactions with nursing. First: what RTs do!
Respiratory Therapists are usually responsible for all aspects of breathing-related care. In many different areas, we assess the respiration of patients with a variety of diagnostics and treat their disorders with a plethora of therapies. Among our arsenal of skills for assessment: auscultation of the lungs, examination of chest x-rays, sampling and interpretation of arterial blood gases, minor pulmonary function tests like vital capacities and peak flows, and full-blown pulmonary function tests in the laboratory. We also do homecare and work in sleep labs, two closely related aspects of our field.
In addition to applying our crazy assessment skills, RTs are responsible for all kinds of therapies to assist respiration. We give patients bronchodilators, perform chest physiotherapy, and work with patients to train them with various breathing exercises. We run BiPAP machines, both as critical-care machines and as sleep-apnea management systems. We manage mechanical ventilators, the machines that breathe for people when they are incapable of breathing. We intubate patients to manage their airways. We perform CPR. We assist physicians with placement of tracheostomy tubes. If there is something we can do to make a patient breathe better, we will do it.
Moving to thought. To understand how us RTs think, it is important to remember that our job focuses on what we perceive to be the most important bodily function: respiration. It has been said that if you are not breathing then you are not going to be doing anything else, and this is very true. Breathing is one of the few body functions whose immediate cessation will lead to death.
Seeing things through this lens helps us to arrange our priorities. At the top of the list are people who honestly, genuinely can not breathe. A 55-year-old patient having a severe COPD exacerbation will require our immediate attention, while a 22-year-old in for a bunionectomy who “needs incentive spirometry” will be at the very bottom of our lists. In short: the greater the likelihood of a severe derangement in respiration, the higher the priority on our lists. RTs typically take much higher patient loads than nurses, anywhere from eight or ten ICU patients to twenty or thirty medical patients on the floor. Balancing the demands of caring for so many people appropriately keeps us busy.
Now: how can RTs and nurses better relate?
I think that the first part of this is understanding one another. Too often, nurses will become irate with RTs for various reasons: the RT was “slow,” they were argumentative, or perhaps they were just blunt. RTs become irritated with nurses for similar reasons: the nurse won’t leave me alone, the nurse wants something pointless, the nurse is just demanding and rude. If not resolved this kind of acrimony leads to bad teamwork and affects patient care.
The key to getting around this is to consider the viewpoint from the other side. RTs, remember that when a nurse calls you, nine times out of ten they are calling because they feel you can do something good for their patients. Sure, there are nuisance calls (stat incentive spirometry or albuterol treatments on a fluid-overloaded patient, for instance) but most of the time when you are being called there is a reason or a way you can be of assistance. Take a deep breath, smile, and focus on assessing the patient.
And nurses, consider the RT. When you call the RT and they’re blunt, perhaps they are simply harried and being pulled in a hundred directions at once. When the RT is arguing with you, listen: we will not withhold care we feel is neccesary, but we also do not want to perform unindicated therapy because it usually means that the therapy the patient really needs will be delayed. If the RT is slow, remember: you feel busy with five patients and we often carry twenty or more on the medical floor. The bottom line is communication: speak clearly, politely, and concisely and actually listen to the other party. It is amazing how much better things run when people communicate.
So that concludes the Nurses Guide to RTs. We RTs provide valuable care to patients through our superior knowledge of cardiopulmonary function and our ability to treat pulmonary dysfunction. We aim to be a “breath of fresh air” and I think we do an excellent job. The bottom line is that nurses need RTs just as much as RTs need nurses, and if we all make an effort to cooperate and communicate we can improve lives and help people breathe. And really, that’s what it’s all about.
Well written. This pretty much sums it up.
Nicely explained–great post!
Strong work. I love our RTs, they’re top notch and willing to help when they can. In fact, I would have been in a couple of really sticky situations without them.
Say, this raises a question I’ve been forgetting to ask for the past month. I understand the basic concept of and rationale behind incentive spirometry. But must *every single patient* in a hospital overnight have an order for it? I recently had a 24-hour stay for leg surgery and the overnight nurse really had her undies in a bundle over the fact that I wasn’t playing with that damn incentive spirometer all night. She handed it to me, I did it in front of her (perfectly, I might add) and then I put it aside. She told me to do it every hour while I was awake and I (politely) told her that was the dumbest thing I’d ever heard. Every time she came in she asked about it. What the hey?
Would love to see something like this written about RNs, nurse practitioners, the other types of nurses (LPN or RPN depending on where you are), OTs, PTs, dieticians, chiropractors, naturopaths, and many other professions.
I would also be interested in reading about the training that each of these disciplines receives, more specifically the length, degree type, curriculum topics, and extent of practical training.
I’m disappointed my medical training doesn’t offer it already.
As a medical student who has volunteered with RTs for years and is related to and good friends with a number of RNs, I already am very much aware of those disciplines… most of my colleagues, however, don’t have that privilege (and few would be likely to seek it out on their own).
Understanding another person’s background, approach, capabilities and limitations is important to working together on a team and goes a long way towards treating each other with respect.
This article/post is really great. It hits alot of the issues I will be dealing with. Recently I was volunteered by my department to oversee a process improvement project regarding the RN vs RT issue. At the hospital which I work at as an RT, there has been a growing dissatisfaction and unrest, and resentment from both sides. Unfortunately, the ICU is the area which has in the recent passed voiced their dissatisfaction with our RT department. So, lucky me, I get to create and distribute a questionnaire that will survey both the pulmonary department and our ICU counterparts regarding performance. The purpose is to improve relations and communications overall so that we can peacefully and respectfully go on about our day, and concentrate on the priority of patient care. Arrrrgh!