What Respiratory Therapists Wish Nurses Would Understand

When I was a new nurse working in the hospital, I quickly learned who one of my best allies was – the respiratory therapist! As I moved into the ICU, they were invaluable as we weaned patients from the vent and rescued them from death. My second ICU job was at a large metropolitan teaching hospital in NYC. I was working nights in the NeuroSurgical ICU and almost fainted when during my orientation, I was informed that there really was no RT support at night. In fact, the nurses did the vent checks, blood gases, retaping ET tubes (this is where I learned NO pink tape!) and even the weaning and extubation! Say what!! I was grateful for the great RT’s that trained me – I would have been so lost without their valuable insight and knowledge that they instilled in me (and I am pretty sure the patients are thankful also… I still remember my first extubation – not pretty!) Lessons learned and I truly discovered the value of the RT on my team during my shift when I moved on to another hospital.

So, you could say, I had a new found respect for the masters of the lungs, wizards of the vents and providers of smoke pipes! But, one thing in my journey as a nurse I have discovered, they find us pretty annoying…. and rightly so! I often come across nurses who lack respect for their discipline and yet want them to rescue their patient they have let go down the tubes. So what do they wish we knew about them? What do respiratory therapists wish nurses would understand? Well, I asked one of them and here is what he said….

Respiratory Therapy

What Respiratory Therapists wish nurses would understand.

1. Please don’t ask us if we are respiratory. We have names and it probably isn’t “respiratory”. Instead ask us if we are FROM respiratory if you don’t know our names. We don’t ask you if you are “nurse”. Please don’t call us “techs” either. Chances are, unless you have your BSN, we have had more schooling than you.

2. A wheeze…that breath sound that is caused by bronchospasm…is always high pitched. If it’s a low pitched “wheeze” that you hear, it’s rhonchi and a treatment will do nothing to help. What you hear is the sound of secretions in the large airway. Have your patient cough. Call the doctor to order a mucoltyic.

3. Bronchodilators don’t do anything for mobilizing secretions UNLESS the patient has asthma and the mucous is being blocked by spasming airways. It does nothing for anything upper airway. See #2.

4. If the patient is “wheezing” because of being fluid overloaded due to pulmonary edema, bronchodilators won’t help. Unfortunately, science hasn’t found a way to put swimming arms on the bronchodilator to allow it to make it pass through all of the fluid to the smaller airways where the medication actually works. If the patient does have asthma, a bronchodilator may help a bit, but they will still need a diuretic or get dialyzed.

5. We aren’t the only ones that know how to NT suction. You were trained to do it as well. Don’t call us to do it unless you have at least tried to do it yourself. Certainly don’t tell us that you already tried and not have even bothered to make sure that there is a suction canister set up in the room for when we arrive. Most likely if we aren’t on your floor we are busy in a unit in another part of the hospital.

6. Please don’t call us to say that your patient needs a treatment. Ask us if we could come assess your patient. If they need one, we will be more than happy to administer it. Years ago, I arrived in a patient’s room by request of a nurse to give a treatment and he was in obvious distress. He had no pulmonary history per his chart (a big tip off). I listened to his lungs…right side was totally clear and left side was absent. I explained to the nurse that he didn’t need a treatment but instead need a stat CXR. I had to call the MD myself as the RN was too busy being upset with me for refusing to give the treatment. The CXR revealed a massive plural effusion. The patient was taken to the unit and the had almost 3 liters of fluid removed from his left pleural space via thoracentesis. I never gave the treatment.

7. Don’t touch any button or knob on the vent except the FiO2. Only touch it to go up if the patient is desaturating and call us to let us know what happened. Do not wean it for us. We are responsible for all settings in that machine. We don’t touch your pumps.

8. Chances are, we do not get another RT to cover our assignment when we take our lunch break. We always carry our phone or pager and are responsible for answering them even when we finally get a chance to eat.

9. If your patient has a trach and becomes acutely distressed, please check to make sure the inner cannula is patent. It can take us 10 minutes to get to bedside and that’s long enough for your patient to code. Checking the inner cannula takes 5 seconds.

So there you have it…. the inner working of a Respiratory Therapist! I have always wanted to know what irks them the most… now we know! So keep showing them some respect, they have a lot to teach as they are the masters of the lungs!! And ask them to show you a few things – I have learned more from them than any book could offer.

A special thanks & shout out to my favorite RT – Sam Durden, and make sure you call him by his name!!

Thanks for visiting! Take care, be safe & wash your hands!!

233 thoughts on “What Respiratory Therapists Wish Nurses Would Understand

  1. Wow! First time I’ve seen the other side in writing & it is long overdue. We shouldn’t need to be reminded we are a team, but we do and this is an excellent reminder, especially showing RESPECT for all members of the patient care team. Very good insights….thanks Sam

    • Hi first I would like to say most of the Respiratory Therapists that I have the honor of working with are very knowledgeable and work great with the floor nurses. However, just like in any profession you have your lazy worker so it defiantly goes both ways for that matter. As like you we also are so busy we take our phones everywhere we go, yes we carry phones too. I am a R.N. and work in the largest inner city hospital in Buffalo N.Y.. I feel like the comments made were very contradicting you want the nurses to make respiratory decisions before calling you then you say nurses are overstepping their boundaries when we make decisions of respiratory nature. As an R.N. I feel that if I am uncomfortable with a pt’s respiratory state I am calling you this is your job. I also think it is pretty petty that it bothers you how we ask if your from respiratory. I f you don’t like how your being addressed maybe introduce your self when you get to the floor this is clearly a two way street. I hope this helps you understand where the nurse is coming from. Nurses and Respiratory Therapist’s need to work as a team and the Resp. Therapists are invaluable to me and my patients just remember we are on the same team, so stop worrying about the little things, there may be reasons the nurse don’t want to make a decision without you it is your realm of expertise. This is a shout out to all the Respiratory Therapists at B.G.H. THANK YOU.

      • We don’t like being called Respiratory. I’ve worked with a nurse for 6 years, and she still calls me “Respiratory”. To my face.

        • i fully understand how you feel, if i were you, approach this nurse, and say, nicely, you know we have worked together for six years, my name has always been leslie! depending on my mood, if someone addresses me as respiratory, i will come back with nurse…..

        • Yes! That’s like when dietitians are called “dietary”! At least call us “nutrition”. It may be a little thing but it almost feels derogatory. I completely understand and respect the struggle. It’s different to be asked if you’re “from respiratory” vs if you “are respiratory”.

          • This post seems a bit bitter? And from the responses it seems it is a common feeling. I have worked as a sitter, pt care assistant, emergency med tech, and now RN. What is so wrong with being grouped in a group of medical technicians? It takes every single person in a hospital doing their job to make things happen – from the individual that sanitizes the rooms to the surgeons. I don’t understand the negativity towards nursing. Also, it seems contradictory– RT doesn’t want a call to do a neb but when they are there and it’s not done correctly we shouldn’t do that on our own? A nurse who cannot distinguish lung sounds or give a treatment correctly needs training. And yes, sometimes we are that busy that we call for help – that is in no way demeaning to RT. perhaps there’s some projection happening there because it increases the workload. I have NEVER heard any RT tell me the things in this article. And I never touch the vent. I guess I’m at a loss regarding the difference between respiratory and from respiratory- because it means the same in my head… I know my RT by name (normally) but if I don’t I say are you respiratory? (As in – “are you the person responsible for respiratory”) I don’t see anyone taking offense to that… Either I’m blind or it’s a tone issue?
            No one thinks any more or less about RTs than any other essential staff… Be it nurses, techs, or unit clerks.

      • Based on your comment you seem to be the kind of RN that may pose problems and are a bit full of yourself. Remember that a RN does not have more education but is learned in a specialty. RN’s are educated on respiratory very briefly to understand basics. RT’s are also trained in your position briefly to also understand the basics of RN duties. Once you are able to stop looking down on other fields will you get the respect from coworkers. Unfortunately RN’s are spoken highly mostly by other RN’s due to the disrespect others recieve by most RN’s. I would challenge those that feel superior to RT’s a test of knowledge in Cardiopulmonary. We don’t wish to be superior to an RN and are aware that you are more qualified to perform RN duties and that an most RN’s would fail the very basics in cardiopulmonary so they should accept the reality that we all serve the Pt with our specialty but according to most RN’s view to be equally qualified in Respiratory is like saying a Dentist is just as qualified to perform a simple surgical procedure like appendectomy since the dentist is a Doctor. You are a RN we are RT different and both with their own knowledge and experience. So may I ask for self evaluation as to if you might be part of a problem and if so get on board and start proving you belong in PT care and work as part of the team or get out as you are causing friction and are more in the way of actual PT care than you choose to admit.

        • I think youre an RT that’s the kind of RT that’s “FULL” of himself. I went to school for 4 yrs to get my degree, if you bother to look it up, It is the hardest undergrad degree in College period. My classmate went to work at a rural clinic and ER where they have one RT there during the day, none at night. In less than six weeks he was taught to perform all of the RTs duties at nights by the RT because they don’t have the staffing otherwise. And guess what, it’s in the RNs scope of practice to do so. We can get a certificate that qualifies us to intubate as well. Is an RT licensed to performs the duties of an RN? I’m not saying I’m better than any RT, although I would accept your challenge on Cardiopulmo function including medications for not just ACLS, but how about we throw in all cardiac meds and pulmo meds while were at it, not just breathing treatments or rescue inhalers. How about the fact that with one more pharmo class along with the 4 classes I have left for my FNP I’ll be qualified to practice medicine as an independent practitioner in 29 states and counting. In fields like ID, Cardiology, Pulmonology, Surgery, Dermatology, ETC. What’s that? you can’t? Pls don’t compare Apples to Oranges. I don’t think I’m better than an RT, I am however allowed to do much more in my scope of practice including, with some instruction, everything that an RT does in their scope of practice. The same cannot be said about the other shoe. For someone that says they don’t think they are above someone else, challenging them to a test of knowledge isn’t? And that comparison between a dentist and a surgeon is just asinine. The simple truth of the matter is, whether you like it or not. RNs can get certified in Vents, ABGs, trachs, and intubation. You as an RT would have to go back to school for at least 2yrs to earn an ADN

          • Yikes, we studied just the lungs and related topics for two years and we do it all day long. That’s got to count for something in your scoreboard. Frankly your superiority complex make me wish my early career correction to computer information systems, project management and systems analysis should have been to medical school. I guess I would be your worst nightmare then. Jeez, how trite this all is. In short try to understand a different viewpoint and show a modicum of professionalism instead of getting on your high horse, u look dumb up there.

      • “However, just like in any profession you have your lazy worker so it defiantly goes both ways for that matter.”


        I loved this blog, the lines of communication and understanding it opened up regarding how marginalized our profession of Respiratory feels at times. I am going to go out on a limb and suggest to you that when you say that you are “a nurse”, nobody questions your education, credentials, or professional abilities. Your post suggests you do NOT have a good working professional relationship with your RT’s, as there is an underlying bitter tone regarding a lack of understanding that should be fairly clear from your end in terms of professional abilities and responsibilities. On your UNIT, you likely have several RN’s working at a time. In your HOSPITAL, you likely have a handful of RT’s covering the entire building! Yes, if we are busy with urgent situations, I am going to be pissed off if you call me “just because you can” to administer a routine Q4H bronchodilator treatment or after hours ECG when you could do it yourself. No, I am not going to take the time to spare your feelings and introduce myself by name when I am rushing to your unit to resuscitate a coding patient that has been hooked up to a room air regulator instead of the oxygen regulator (glaring error) when returning from an X-Ray, to “deliver a breathing treatment” to a patient who upon my immediate arrival in the room clearly suffers from pulmonary edema or worse! We may not always be friendly or suit your personal bias of acceptable interaction, but Cindy, we are always there when you call for us, regardless of the validity of the call and the attitude received when we get there. I have arrived at MANY codes to see nurses not even practicing basic CPR, never mind what we should be providing in a hospital environment. Chest compressions don’t happen like we see on TV, and they always have to happen on a solid surface. My partner and I arrived at a code one day to find a nurse basically rubbing the chest instead of the universally trained, hard, fast, 1/3 chest volume compressions. We physically pushed her aside on arrival, mocked her, saved the patient’s life and I am not ashamed of that. Long term, quadriplegic, ventilated patients? Their ventilators don’t just alarm to “annoy everyone”! They are alerting to a situation occurring outside of the set measured parameters of the machine. Instead of standing outside the patient’s room (who is blue at this point) rolling eyes and tapping feet for Respiratory to come, how about this strategy? CHECK THE PATIENT! Attach the resuscitator to the trach, breathe for them, call Respiratory and let us fix it.

        If you want respect, then give it and earn it. The first would be punctuation, spelling and grammar in an adversarial post. The next would be to keep your own house clean before you suggest house cleaning for another. I find it UNBELIEVABLY petty that you attempt to justify how you request and address Respiratory, while complaining that we just don’t introduce ourselves correctly. It is because, more often that not, we are attending a situation that could have been easily prevented had you taken a thorough approach to your job instead of wondering what we may be doing. Because as the ER nurses learned one night in the hospital of my first job when my “code pager” went off and their pagers did not (same tone in our hospital), we are not just your in house 911, we are EVERYONE’S in house 911, and my code pager alerting to a “code pink” (baby) that didn’t effect them opened their eyes to the fact we wear many hats.

        It took many years for my coworkers and me, as a new grad, to earn respect at the first hospital I worked at as our role expanded greatly at that time. There was a lot of push back and ignorance similar to the tone that your post hints at. By the time I moved back home and left the hospital, we were all friends and acted as an interdepartmental team. I sure hope the same happens for you when you overcome your personal biases.

        Cheers Cindy!

        • Hear! Hear! I LOVE 90% of the RN’s I work with but the fact that the majority of the hospital has no freaking CLUE what we do is annoying. I’m sick of “defending” my career and position in the hospital. I have intervened and saved I can’t tell you how many lives because I caught something no one else was paying attention to due to our exceptional assessment skills or just gut feelings. I say this only because when other health care workers view your position as one to put on a nasal cannula or give a breathing treatment really pisses us off. What’s “funny” is this is ABSOLUTELY a universal complaint amongst RT’s. What doe that tell you?

          • Thanks for taking the time to comment! No doubt RT’s have a very unique skill set that is under appreciated and unrecognized!What do you think we could do to improve that? Thank you for keep up the good fight…maybe one day your voice will be heard! Take care & thanks for taking the time to leave a comment!

        • I have to say that your attitude SUCKS! I’m an RRT-ACCS with many years of experience and I’ve never once “saved the patient” all by myself. I have the help of a qualified team of Nurses, physicians, pharmacists, CNAs and other ancillary support people. We aren’t superior to nurses as they aren’t superior to us. We are team members and the BEST patient outcomes come from a multidisciplinary approach.
          Nurses truly don’t get much training in our specialty, but it’s our job to help educate them in a non-confrontational way so that they can learn from it and not turn around and call us an a-hole when we leave the unit.
          I don’t mind being called “Respiratory”, because if I’m sitting down and charting and someone comes up and asks if I am a nurse, I say, “No, I’m respiratory”. You can’t tell me you have never ever said that. I also have to say that I respect most of the nurses I work with and if they call me because they are worried about the patient, then I go and help them. If someone is desaturating, it doesn’t hurt to tell them to increase the O2 and that we will are on our way.
          If you want respect, you need to earn it. Yes, it is that basic.
          And, no, they don’t know what we do during our work day. They don’t know that we have 5 units to cover and 20 patients to assess. They don’t know that we are in a “rapid response” when they call us, so just tell them. Communicate. I know we all get irritated with calls that we think are ridiculous, but isn’t that what we are being paid to do. To assess a patient who is in respiratory distress despite what is causing it. If you assess and look at all the facts and feel that it truly is something that we cannot fix, then present the data assertively (not aggresively) and go from there.
          Learn to be a team player and maybe the nurses will learn your name instead of calling you “RT or respiratory”.

      • AMEN!!!!!!! Tired of hearing how nurses trample and disrespect RT’s. Nurses do double duty all the time and contrary to popular belief, some nurses do know what they are doing . I do respect all members of the healthcare team, do you all? If so act like it and quit gripping about the wrong things.

      • I honestly think that if you’re a nurse, you should have a little better grammar. Also, a better attitude. Just by reading this post it allows me to know just how high and mighty you make of yourself. RN’s like this is the reason why it makes RT’s act like your team. Clearly, you need to step down and understand that we both have our jobs to do and that it wouldn’t be that hard to tend to your own and let us tend to ours if you’re going to have an attitude like this.

      • Very well said Cindy. This article is great in showing the importance RT has in our field also. Some of the comments from RT make nurses look unappreciative, lazy or less educated. Like it was said it works both ways…There’s been plenty of times I’ve gotten “are you the nurse” from respiratory or PT. I don’t get offended, we’re all pretty busy in our fields. I’ve always said.. unless you’re in someone shoes , have done their jobs you have no clue.

      • Please review read the post without the negative attitude. People are trying to help you communicate better so that there can be teamwork. This is the sort of close minded approach that creates rifts among the disciplines instead of cohesiveness.

      • No hun asking are you from Respiratory is OK. You are asking but just calling us respiratory is the issue. I’m not respiratory. Maybe you should re read I think you have a couple things mixed up. Carefully re read without being on the defense already and you might get a clearer picture.

        • When I go into a facility, hospital or nursing home, I am always asked, “are you hospice?” It doesn’t bother me, it is all semantics. Don’t take it personally. We are all doing the best we can to care for people that need it.

      • No offense meant here but your response is probably one prime example of why RT’s are wishing RN’s would learn the things the author mentioned above. My name is not Respiratory and I can say, after 30 years of experience, that it does not matter how long I have worked with any RN or how long they have known my name, they still ask if Respiratory is around. They still say “hey, we need Respiratory” when wanting me. I have even had them say “hey Respiratory” to which my response is usually to ignore them or ask, “Yes, Nurse?” Now mind you, these are RN’s who have worked in a closed unit with the same staff of Respiratory Therapists for over 20 years. They are not asking if we are “from Respiratory” as you mention but calling us “Respiratory” as the RT mentioned in his list. If you re-read his list, you will find that he, and most of us, are fine with you saying are you “from Respiratory?” We are proud to be Respiratory Therapists! Just don’t call me “Respiratory.”
        Secondly, yes, we are all a part of the team and that is why we ask that you please include us in your decision making. I don’t think you will find many of us who mind being asked to assess a patient you think is not doing well. What we resent is your assessing a patient, calling the physician and getting an order for something that is inappropriate for that particular patient. You, personally, may not do this but that is not the case with the majority of people who think Albuterol is the saving grace for everything from a cough or rash to a stomach ache! We are trained to know the many side effects of the medications we administer and yes, they are drugs with side effects. By the way, so is oxygen and it too requires a physician’s order before it can be given. There is no way, that you as one person, can know the side effects of all the drugs you are asked to give on a daily basis without looking them up. Many of the drugs we administer must not be given to patients who have glaucoma, arrhythmias, allergies to certain foods or to some of the preservatives in a certain brand of drug. Did you know that Albuterol has gastric side effects or that it can cause changes in serum potassium levels? Do you know that Mucomyst is one antidote for a tylenol overdose? This is why we are the experts and every respiratory treatment can hurt someone….they are not benign.
        Third, I have worked in critical care agencies, non-critical care agencies, educational institutes and many other settings. I know what my skills are like and I am offended when someone calls me a “tech” or tells a nursing student who is failing out of their program that they should try Respiratory Therapy school! Just because you haven’t heard this or don’t do it personally, doesn’t mean it doesn’t happen. We typically hear things like this on a daily basis. If you are not one of the offenders, then ignore this post. However, I am willing to bet that most of you have either said this or heard it being said. If you didn’t stick up for your RT’s then you are just as bad as those saying it. It is amazing what RN’s learn when they shadow us for 4 hours….the response is typically “wow, I had no idea you covered that many areas or that you did that much.” Ignorance is no excuse for being mean or disrespectful!
        I don’t dislike any member of the healthcare team and I mean down to the folks who clean the floor after we have thrown things all over it during a code situation. We all have our jobs to do and one or two of us, without the other, does not make a successful patient outcome. Search the literature…..Physicians without RN’s, Physicians and RN’s without RT’s and all of us without someone to clean up after us do not even come close to the successful outcomes present with all of us working together.
        RT’s don’t want to take over anyone’s job, we typically have enough work for us and then some. We are not at your bedside because we are with another patient. We are the only ones who can prioritize our patient care. You do not know anything about the other 30 or so patients we are taking care of in addition to yours. We are not just sitting around waiting for someone to call…..We just want to be respected as necessary to the healthcare team for positive patient outcomes. They are not “your patient’s” or “our patients,” they are “OUR PATIENTS.” All we ask is that you remember that!

      • You aren’t asking us if we are FROM respiratory, you are asking us if we ARE respiratory. There is a difference. And I don’t mind when the nurse calls me concerned for a patient’s respiratory status… as you said, that is my job, but I do mind very much when you (or other nurses) tell the patient that I will be giving him or her a nebulizer treatment to fix their low spo2.

        • Excellent idea!! Would you like to collaborate?? I think it would certainly add to the conversation. Thanks for the visit!

          • RTs and medical tech. Putting in the” and other tech” does in fact include RTs as techs. Leave out the word other.

        • We are not technicians, we are Registered and Certified. BS will be required soon just like Nursing. Our profession has been plagued by a lack of support at the national and state level. Nursing has directly impacted Respiratory salaries and benefits. Nursing has empowered itself through participation in their national and state organizations. I am saddened when folks in Respiratory refuse to get active and have their voices heard.

          For the most part Nursing and Respiratory care are synergistic. It is not an I profession it is We, working together providing the best care to insure a great outcome for our patients.

          • Thank-you Red!! I was proud to be called “Respiratory.” I was proud to be part of a team… because it is only while working together that positive outcomes can happen. Respect is earned, you are absolutely right – but more importantly, it is the patient that comes first. We all bring a skill set to the table, and I hope I was able to teach patients and staff; because I always loved learning from them.

            And to all the RT’s out there, try to remember that we see many more codes than most nurses, because we are part of a Rapid Response Team or a Code Team. There is no room for judgement during an event, but plenty of time when the patient is stabilized, to go back and in a good spirit of teaching, pass on information “such as” — please double check your flow meters, or a quicker way to assemble a bag. I loved the nurses that I worked beside, and because I told them about my education and experience while doing my job, I felt respected by them. We are the said to be the first in the room and the last to leave… make it count, make a difference, and let the small stuff roll of your back. We hold the trust of our patients in our hands.

      • PRN means as needed not as wanted. Please don’t call and say that a patient wants his/her prn treatment. That’s pretty close to oxymoronic. Please at least listen to the patient’s lungs before calling.

        • ok we’re nitpicking at this point. There are patients with chronic respiratory disorders who request treatments for shortness of breath. They know what makes them feel better. Saying that they want their prn is ok.

      • I would only add one thing and it may be just me, but…please do not in any way wake or disturb the patient that I am doing a vent check on until I have finished documenting his resting parameters. Please, for the love of all that is Holy, stop.

  2. You rock! You just summed up what every RT wishes RNs knew. Of course, I wish the Drs ordering bronchodilators for low sats or pneumonia knew these facts also

  3. I do all these things. I have a tremendous respect for the respiratory therapists role in the healthcare team. If I take pride in what I do and strive for the best patient outcomes, I recognize the importance of establishing rapport with the interdisciplinary team members. This post gets under my skin a bit because it implies that nursing as a whole is incapable of a competent respiratory assessment. Thanks for the run down, but I am very much aware of the difference between a wheeze and rhonchi.

      • Just because you had 2 months of “respiratory training” doesnt make you an expert. I went to school for 2 years because what I do is a specialty. I can intubate under my license you cannot so don’t THINK we are useless because if I dont intubate you dont have a patient who is breathing. So think before you speak.

    • You may know the difference but the majority of the nurses where I work do not and I’m at a trauma center. You took it too personally when it’s meant in general, I think it was great 🙂

      • If your RNs don’t know the difference they between those lung sounds they need to take a course to help them learn. This seems to be a basic nursing skill. While working in critical care I definitely respected our respiratory therapists. But, this should go both ways. After all, we are there for the patient, and working together can only help our patient. If a respiratory therapists feels a patient order( aerosol tx. Or whatever ) isn’t appropriate, they should discuss this with the nurse , and explain why they feel the way they do. A little teamwork goes a long way

        • Most times it is discussed with the MD not the RN as the RN is not the Physician and if you question the RT ask the specialist such as a Pulmonologist who is trusted in Respiratory Therapy decisions the RN or the RT. Be prepared for the answer that the RT has a Degree in Respiratory and the RN is only trained in the basics of cardiopulmonary.

    • Nicole, it is great that you are aware of the difference in airway sounds, but it is also true that a majority of RNs do not. Not every wheeze can be fixed with a breathing treatment, and the respiratory patient who is pestering their nurse with endless bell calls. Albuterol will not help them either. How about the pedi patient with RSV that is bubbling with fluid in their lungs? Breathing treatment for them because the nurse is so sure a dose of Albuterol with get rid of all that fluid, huh? Or the ventilator patient who is fighting the vent because they cannot breathe, oh for sure, breathing treatment will fix that.
      The best request for a treatment ever came from two cardiologists in a ER who decided that giving a patient 15ml of Albuterol with NO saline or any other med added, would fix their patient who had a cardiac wheeze. I did refuse, that was definitely not in my scope of practice.
      So, some RN/MDs know the difference, some just don’t.

      • You say the majority of nurses do not know the difference between rhonchi and wheezing….how are you qualified to make this statement?? That is a terrible assumption to make!

        • I agree I ‘m sure you don’t know me. I don’t think any of the R.N.s that I work with can’t decipher the different respiratory sounds. And just for the record it is your job as a Respiratory Therapist to make the call what the patient needs when dealing with respiratory issue, then you could address your call with the R.N. so they may call the Dr. and get the proper treatment for the patient. The patient is what’s important here. I also am glad that I am not a patient where you work if the nurses can’t tell the difference between respiratory sounds , and if this is true it is your responsibility as a licensed professional to tell your manager so that teaching can be done. You as a professional are just as guilty if nothing is done, so stop complaining and fix it remember the patient !

    • I agree, I work in a Medical ICU home of the failing lung population, and most of the nursing staff dont act the way this RT is referring. One bad experience with some hospitals shouldn’t be reflected upon the nursing world. But yes the newby residents need some teaching.

      • Thanks for the visit my fellow MICU friend- where it’s all about the drugs and bugs! Sadly I wish these were isolated examples… but just today over 60,000 views…. it definitely struck a chord and hopefully we self-reflect for the benefit of our patients. No blame here…. just getting the conversation going! Thanks & take care!

    • Thanks Nicole! I completely concur with your response! As I read this article, my thoughts were that these are essential components of the Nursing Process! Thus, ‘nurses’ should have all these understandings as I most certainly do! I have been an RN for over 21 years.

      • You just made my day!!! Thanks for the comment and for confirming that some people just need a little reminder now and again! Thanks for taking the time to visit & leaving a comment! Good luck in your career & never hesitate if I can ever be of any assistance!!! Take care!

    • I really like your post, as it stresses the importance of team work and learning from one another. While you didn’t say it directly, your post does correctly imply that respect is a two way street and essential to the one common goal of any successful health care team: Excellence in the delivery of patient care. I was a little heated when responding to a different comment in this thread earlier today and, after reflecting later, I felt badly that I had left out a very important point regarding the professional value of every team member. Nurses are educated on so many topics I had a limited exposure to in school, yet by having respectful dialogue (and even friendships), we have so many things to learn from one another. A great example I would use is ECG interpretation. At least at my school, we learned to interpret only 2 different leads even though in many smaller hospitals we are the ones who perform them (and let’s face it, while the modern machines provide a “diagnosis” at the top of the page, machines are often not correct). I learned SO MUCH from my friendships with the ICU nurses on a quiet night when they would teach me about more in depth interpretation of all leads, and shared with me their deep wealth of knowledge on many topics that were only just touched on during our education for a couple of weeks. They also wanted to learn things from me that were only touched on during their education. We are all vital components to patient care, and that is the thing I left out of my heated response earlier and wish in retrospect that I had not only included, but emphasized. Without everyone holding respect for the knowledge and value of all professions, the entire team fails the patient in providing a “Gold Standard” of care. We generally all feel great pride in the work that we do and the impact it has on the people we care for, but no RN and no RT can do it alone without the participation of large intersecting team of different medical professionals all contributing their specialized knowledge and skills. I know the nurses I have worked with in ICU sure appreciated when you jumped in to help them position a patient for daily care, or offer your hands to hand them items during a dressing change, etc. I know I sure appreciated when they would suction an endotracheal tube that required it instead of calling me away from assessing another patient. I feel the initial intent of this blog was to foster knowledge and respect for other professions and (clearly) for me it was a great dialogue opener and thought provoker. I hope you know how valued nurses like you are to us, Nicole. I also know that if you and I worked together and you paged me, I would RUN, because it can be guaranteed the call is not petty or frivolous.

  4. I would love to say thank you but i also would love to say thank to my nurses too as there are many that have great patience for us n willing to learn as theres therapist that are willing to learn too your job is as hard as ours because you get to know these families and patients personally for 12 hours shifts and they tend to be difficult pts and families and you guys are amazing taking care of them so our jobs become even easier when we arrive to the room and understand that not always it’s possible to help every family member to understand and appreciate what we do but you guys do make sure they know who we are and what we do.

  5. To add, if I had a dollar for every time I was told by a nurse the pt. was having trouble breathing only to tell the nurse the pt. just needs some anxiety meds, I’d be rich. Also, nursing needs accurate training on a pulse ox, just to simply put one on and take the first number you get, isn,t always accurate. To get called to the bedside for a low saturation only to get a normal reading because the problem was, poor circulation, cold finger, didn’t leave on long enough, etc., assessment is a critical part of nursing, please take time to do it before calling us away from other duties. And yes, it is easier for the nurse to go ahead and suction the pt. instead of waiting for us to get their.

    • Agreed! Pulse oximetry is a trending tool that must be evaluated for application of the probe, waveform and patient condition (ie- cold hands or people who wave their hands as they talk or cannot stop tapping the probe repeatedly on a surface, yet have a pink face, no respiratory distress). It is the one thing I STRESS to all patients going home on oxygen who select to purchase an oximeter- follow the trend, look at the waveform, don’t panic over the flash of one low reading unless it also matches the colour and distress of the person. I imagine nurses went through this entire patient education fiasco when home BP measurements first became a “thing”.

      • Agreed! Pulse oximetry is a trending tool that must be evaluated for application of the probe, waveform and patient condition (ie- cold hands or people who wave their hands as they talk or cannot stop tapping the probe repeatedly on a surface, yet have a pink face, no respiratory distress). It is the one thing I STRESS to all patients going home on oxygen who select to purchase an oximeter- follow the trend, look at the waveform, don’t panic over the flash of one low reading unless it also matches the colour and distress of the person. I imagine nurses went through this entire patient education fiasco when home BP measurements first became a “thing”.

  6. Thanks to all who take the teamwork concept seriously, and consider all of us as serving the same mission. As a 20+ year therapist, I always thought nurses work the hardest of anyone, and I understand how quickly our stress levels can surge. I live two blocks away from the old workshop, and walk up the hill to visit when I’m homesick. At shift change, I remember why I took early retirement. My dear young friends who transitioned from respiratory to nursing have become burdened with student loan payments, so it seems necessary to find a way to encourage our public schools to help pay their way somehow. Maybe forgiving debts to new graduates? Nevermind, off the subject, back on track: How about coaching our ER docs not to order updrafts and ABGs on everyone who walks in the door? P.S. Bless you all, so very fond of you

    • Bobby Vance- YES! Also a huge issue at the first hospital I worked at. They struggled to recruit physicians to such a remote northern city, and therefore didn’t exactly attract the cream of the crop and often from countries that did not require them to speak to women at all. There were several outstanding physicians at our hospital. There were also some that if they were working, I would not even bring my beloved dogs to them for care, never mind a loved one. The ones who appeared to struggle with patient evaluation and differential diagnosis accessorized their bluster with blanket tests for everyone so they would not miss anything. I used to joke that even as a visitor to our hospital, you were at risk of having an ABG ordered by some of the physicians, lol! I was strongly rebuked by one of the physicians as a brand new grad (in school we were always told to respectfully question an order, especially an invasive one like an ABG, if we didn’t understand why we were doing it). I was fresh out of school, a week into the job, when I was asked to do an ABG on a 25-year-old man who was otherwise healthy, but had broken his ankle. He was in no distress, not asthmatic or diabetic. I asked why I was to do the ABG, and was promptly yelled at for all to hear in the ER that I had no right to disobey an ordered test and to never speak to him directly again.

  7. I appreciate the comments, I have done Respiratory for more than 40 yrs, the number one pet peeve through my career is for a nurse to say I can run the vent it is not that big of a deal, my comment back is so you would want a dermatologist to do your heart surgery, he’s a surgeon. A great team is made up of people whom are great at what they do, their is no person better than another, but together a team is made. If you don’t believe it try running a code by yourself.

    • Thanks for the comments! We definitely all play an important role and that starts with respect. Plus, know your resources! Thanks for the visit!

  8. I would also like RN’s to know an incentive spirometer or bubbler is not STAT. If you are calling for a treatment please make sure the patient knows we are coming. Many times I have gone into a room and the patient did not request or want a treatment, the RN decided they should have one. Patients know their own bodies- listen to them. Also let the patient know we are on our way and give them a time frame if you were given one, saves stress on their part if they know when to expect us. As an RT I always try to give a time frame, I may be in the middle of an emergency, starting another treatment or just around the corner. Communication on everyone’s part is the key to a good relationship and the building of trust.

  9. I definitely think this was an insightful article and I actually learned something myself. HOWEVER being that I am a nurse with my BSN I am slightly offended about some things that were said. I feel that this was almost a bashing of nurses. In reference to #1 last time I checked the amount of schooling you had had nothing to do with competency. There are LPNs who can run circles around me based off of EXPERIENCE.

    As far as 2-5 go these are things specific to your field so I would expect you to be an expert on it. I have worked med-surg and as of right now I work in postpartum. You think there’s a lot of mom’s getting treatment? No. Nursing school and being a nurse period encompasses a lot of information and body systems. It is impossible to know every pharmacological detail for every medication and be an expert at every body system. However I too know the didferrence between wheezes and rhonchi. Now if these are nurses who work around it every single shift for 12 hours straight like RT does then of course it is shocking that they are obviously incompetent on those topics.

    #7: you think only nurses press buttons on machines? How about patients or their random family members or the techs or doctors? But yes of course blame it on the easy targets. And thanks for not touching our pumps but we have enough hands on them as referred to above.

    #8. All I have to say about this is I can coins on one hand in my career where I have had time to sit and eat a complete lunch. Better yet even take a lunch during shift. Oh and how many times have I gotten called on my phone while I’m just trying to use the bathroom! You think we have coverage? Lmao. No. Even if you utilize a buddy system let’s be honest that buddy nurse could care less about your patients.

    • Thank you for your comments. The article was in no way intended to offend, just get us thinking and talking…. which apparently it has…our sarcasm is often mistaken, but all.was said with good and true intentions in the hopes of helping our patients better. Thanks again for taking time to be a part of the conversation! Take care!

  10. I really enjoyed your list and am bookmarking your site. I particularly like the comment about Not being a “tech.” I’d even rather that someone who didn’t know me, yell “hey Respiratory!” than hear “Oh Respiratory tech” caroling down the hall. When I teach some one about breath sounds, I usually describe rhonchi as blowing bubbles in milk. Most of all though, I like the sense of teamwork that you display. Our entire reason for being is the one laying in the bed. She or He benefits the most when we are all (including the patient) a team working against the illness or injury.

    • Please don’t assume that you have more, less, or the same education as an RT. I started as a Biology Major and them did two years of Respiratory training. Very few people that I worked with knew this. Also, the translation of book knowledge to clinical knowledge varies from one person to the next. So please Annette, don’t assume anything — and that is what I took to be the point of this article. We all bring something to the table and fill in the gaps where they are needed.

  11. Understanding each other can help alleviate a lot of frustrations. I have always appreciated respiratory therapists, they have helped me a ton. I think it’s important to understand that nurses are learning system after system, treatment after treatment, medication after medication very quickly and trying to retain something after the test (not that respiratory therapist aren’t), but when I graduated there was so much I needed to learn still! Sure, I NT suctioned a fake mannequin patient once, but the first time I had a real patient that needed it, I was glad the respiratory therapist working that day was patient and came to teach me! The first time I had a pt with a trach I was nervous, I was trying to remember everything I had learned, and once again I was grateful for the respiratory therapist who came and helped me! Years later, I am still learning! Everyone has different experiences, different areas they are strong with, and other areas where they aren’t so strong! I hope as healthcare workers that we try to help eachother learn, share our knowledge, judge eachother less, and respect eachother more!

    • You are so right!! And that was the intention of this post…. learn from each other…. but just presented in our jaded, old healthcare workers way! We definitely have to stick together! Thanks for your kind words and take care! Also, is there a topic you would be interested in learning more about, open to suggestions…. learning never ends!! Take care!!

  12. Thank you so much this article. It was right on the money!!! Thanks for taking your time and sharing some insight on how we feel as RT’s. We love our nurses as well. We all make a great team 🙂

  13. I am both RT and RN. I do both jobs and understand the viewpoints of both. My biggest complaint as an RT is that nurses very often look at the RT position as less than theirs. I am frequently asked why on earth I still work as an RT when I can work as a nurse, and do I have to take a huge pay cut when I work respiratory hours. Most nurses seem shocked and a little ticked off when I tell them I actually make more as a therapist. As if that role is not worthy of their pay scale. I went to same amount of schooling for each. And for the RT’s out there, most nursing schools teach NP suctioning, not NT, it’s rarely effective and sometimes just gets the airway all irritated. Good suctioning is a skill of technique, and the more a person does it, the better they are at it, just like ABG’s and starting IV’s. I would rather be called and have less trauma to the patient. I am always grateful when the nurses call me to suction. My biggest pet peeve, when the nurse keeps stressing the term “my patient” . It happens to be our patient as well, and we are equally responsible for their care.

  14. What a great article. As a Respiratory Therapist with over 35 years experience, I found much to agree with. I currently work at an LTACH with a great group of nurses and RTs. We are a team. I’ve often said, the day they figure out how we can nebulize lasix will be the day our ordered treatments will finally be really effective and needed by most of the patients they are ordered for when a Dr is doing the ordering. I do love working where we have therapist driven protocols and Drs who trust us.

  15. As a long time RRT >30yrs, I have always believed our jobs are much easier when we work as a team!! I learned most of my patient skills from an old time LPN who worked in ICU. Her instincts were amazing. I love what I do and respect the hard work of the nurses , nutritionists, transport, housekeepers,etc…….
    We all add something to the care and comfort of our primary focus…the patient. #9 is spot on…been there many times. Never criticized, always turned into teaching opportunity!

    • Everyone is definitely part of the team & they all have something to teach us if we are willing to learn. Heck, the housekeeper had to show me her trick to keep the bags that didn’t fit our cans from always slipping g down! Thanks for the comments & visiting!!

  16. I love the article hate how defensive people get. We are all there for the common good of patients. I didn’t take it as a slam towards RNs just a heads up. I give respect if I get respect to anyone. Housekeeping, RNs, RRTs, and everyone in between have a job to do. I do have to say I hate being called respiratory though lol!!

    • Thanks for your kind words…. we knew it might rub people the wrong way, but that is just how Sam & I are… if you can’t laugh, what’s the point. No sense in taking ourselves so seriously. Thanks for the visit!!

  17. As both an RN and an RT I find this article to be a little self serving for RTs and a little insulting to RNs. The article sounds like RTs think nurses don’t know how to assess breath sounds, are rude to RTs, and lack basic judgment. Of course this is true of some nurses as it is true of some RTs. Most nurses are working very hard for lengthy shifts doing there best to juggle multiple competing priorities, care deeply about the safety and well-being of their patients, manage complex technical equipment, accurately assess patients’ full physical, emotional, and spiritual status, and make difficult decisions under stress, just as RTs do. Nurse respect RTs and most want to learn if they make mistakes, yet this article felt very patronizing. I mean no disrespect to anyone with my comments, only wish to express we do better when we treat each member of the team as important, knowledgable, and necessary and do so with the same kindness we have for patients and families. I am disappointed with this article because it does a disservice to each profession and I feel it does not accurately reflect the beliefs of the majority of nurses or respiratory therapists.

    • Thank you for your honest and insightful comments! I truly appreciate them. We in no way intended to speak for everyone, but instead try to shed light on some common issues, misconceptions, etc – get a conversation going, which it certainly has! I fear that Sam and my sarcastic sense of humor may be misinterpreted, but I take responsibility for that. As I mentioned, I have learned more from RT than any other, especially Sam, and want nothing more than to care the best for our patients. Thanks for being a part of the conversation and your unique perspective!!

    • feel like some things accurate. some nurse-bashing. i am retired. i wish this “between staff” criticism would just stop. I finished up 40 yrs as an rn at an acute rehab unit. The Pts and Ots also dissed our assessments. it made for a difficult working environment. they have Master’s, I understand, and a different point of view. I had my rn and 40 yrs Icu and neuro ortho surgical nursing experience. the “downplaying” of our roles as nurse- advocates can hurt the patients. I love the Respiratory team, always helpful, but sometimes resented our call,as they are even more overworked than we were. so let’s drop the “I am better than you” stuff. Nursing is hard enough. i truly don’t miss the stress of trying to explain my nursing assessments to other disciplines. i did better with the mds’. sally vanderclock RN

  18. Great article!!! I love working as a team with everyone!!! Nursing is hard and I love being there for them when they need our special skills! And please don’t call me hey respiratory!!

    • Thanks for the visit!! I actually had no idea it was such a sore spot before writing this post! Who knew? Now I do!! Take care!!

  19. RNs would like to remind RTs that you need to know ONE body system, while RNs need to know them all. We all can’t be experts in everything.

    • That is not entirely true. The respiratory system might be our main focus of study, but what makes you think we don’t have to know about other 10 body systems and their effects on the respiratory system? Lets just forget about the other body systems because they have nothing to do with the respiratory system….only if it was that easy.

    • Which is why you should respect the opinion or suggestions of the RT if they happen to disagree with you or offer an alternative therapy. That is all this article was implying! No hate towards nursing, just understand that there needs to be better communication and understanding between providers.

    • Lisa, if only it were that simple. Any good therapist would agree. I would love to tell you we only have to know lungs or cardiac. Unfortunately that isn’t true. In order to perform our duties correctly we have to take every aspect of yours into consideration as well. Every med you give, every thing they’ve eaten how much out, how much in, it’s all relative. Example; OUR patients vomiting all day, their electrolytes are blown which means there is a possibility of a sodium potassium shift a cardiac issue which then turns into a breathing issue not because of the bronchials but because the whole body is out of whack then it effects the ST then can turn into flash pulm edema or more. Please don’t be so dismissive in what we have to know and not know. It’s all applicable in the best treatment of OUR patient. I’ve had to learn the whole body as well.
      To All RN’s: I hope that you can name a few RTs that you are releaved to see walk in. If not re-evaluate the relationship that you have with them. I have been lucky to work with some of the most amazing nurses and just like you I have worked with ones that I fear for my shared patients ALL night long. I’ve seen many posts on here saying you work long hours. We do as well we work 12’s side by side with you. You get 4-6 patients a night. Last night I saw over 80. (Gotta love this flu season). Your job is demanding but ours is too.
      Not everyone is perfect but I will tell you not a night goes by that I’m not called multiple times for a patient that is a pain and/or anxious. Being demanded to give an unneeded treatment. And being glared at when I say they are 100% room air clear in no distress and need a little vitamin A, Xanax, Haldol, something not a treatment.
      LOVE your RTs they will love you back. When I’m in the room I do everything I can for the patient water, blankets, adjust in bed, anything to make my nurses nights better. I guess that’s why they always are willing to help me when I need to hold someone down to prevent getting slugged by a hostile person.
      I will agree breath sounds are a learned thing and a lot of people don’t know them as stated before. It’s not an attack it’s a truth. But that being said RT’s if you see your nurses struggling with names of sounds help them!! It makes your life easier in the long run by having more accurate charts to look back on if there’s a sudden change in status.
      Be as good as you expect someone else to be.

      • Thank you for taking time to be a part of the conversation! I love your passion & your team is lucky to have you!!

        Plus, I think you just gave me my new favorite saying, “Be as good as you expect someone else to be!” LOVE IT!! Good truth!

        Thanks & take care!!

  20. As a respiratory therapist for 18 years before becoming a RN for 5, and attaining my CCRN, i loved this article. I have the knowledge and expertise, but you bet your butt I am calling my team mate the respiratory therapist for any and all things pertaining to respiratory with my patients. That is how I advocate for my patient. It is not about ego people. It is about collaborating and utilizing resources that provide the optimum outcome for our patients. Utilizing someone trained SPECIFICALLY in the science of respiratory care to treat and care for our patients with respiratory issues is smart nursing. Thanks for the article!

    • wow a perfect comment. I too think R.T.’s should be called I do know the difference in lungs sounds but as I have said earlier it is RT.’s specialty. I don’t call R.T. for abdominal issues. Don’t harass me for calling you for a resp. issue no matter how menial it is to you . You are trained as long a I am only you have more teaching in resp care so utilize your skill in deciding who needs to be seen first it is something we all have to do everyday. Also I am really sick to death about nurses asking if your respiratory. Do you know that I can’t count the number of times R.T. has come to my floor and said hey are you the nurse for XXX patient I am wearing a name tag just as you are so stop once again you could come to the floor and say I am xxx I need the nurse for xxx two way street.

  21. Listen, I agree with this person (Mr. Sam Durden)… I wish I could join in and help out some how.. Let me know if I can..

  22. This is awesome!!! I so much enjoyed so much excellent information in such a small space. Was getting ready to share!!!

  23. I do agree with this list. As an RT it does seem that a large percentage of nurses will call for treatments anytime a patient complains of respiratory distress, often times calling the doctor first to get orders instead of trying to figure out the cause of the distress. Very few medical conditions respond to bronchodialators, specifically asthma, bronchitis and COPD. They have to have an obstructive disease process going on. A study many years ago evaluated respiratory orders on all patients at a hospital. It found that over 50% of breathing treatments ordered were not clinically necessary but that many patients that needed them didn’t get them.
    I will never deny a nurse asking me to evaluate a patient. I understand a lot of nurses aren’t comfortable assessing respiratory distress. I am willing to make recommendations and Will even talk to the doctor if needed to give my suggestions. Unfortunately in this day and age, a lot of respiratory distress is caused by hypoventilation caused by obesity which often also leads to pulmonary HTN and pulmonary edema or pleural effusion.
    I remember when nurses used to orientated one shift with a respirstory therapist so they could see what we did and how much area we are asked to cover. I have no problem teaching my role or how to NT auctioning, but if I’m unavailable, you should not allow your patient to suffer waiting for me to get there if it’s something you can do.
    I agree we all need to work as a team, ever more important as reimbursement rates continue to decline and we all get more patients.

  24. Two thoughts come to mind with your article. For one, when called to ICU/CCU to intubate, one of the most
    irritating things the RNs do is constantly ask during the intubation “DO you need more light?” ect? Last time I intubated the Rn asked me 6 rapid fire questions as I am starting to intubate. I had to pause a second and said “Respiratory” (lol) is here, now let me do my job. She appreciated it. She felt then, she said as if it was under control. Second is when called to come evaluate a patient and they already start agruing with you. I step back and said ” I am here to evaluate the patient.” If I feel as if the patient doesnt need a treatment I will chart as such and you can call the house doctor. But I loveeee my job still after 39 years, 🙂

  25. Although this comes off as arrogant it has some valid points. However if I was trained as a respiratory therapist you wouldn’t be needed in the medical field. So this is definitely done in poor taste. There are nurses out there at all levels its your job to assist them in the care of the patient not to make fun of their assessment skills. I have been a nurse 25 years . I didn’t get out of nursing school knowing what I do today.

  26. I have been a RT for 23 yrs and I am married to a man who is a RRT with a BSN, currently working as a RN. He also taught Respiratory for years. We can both say that this article sums it up pretty well. It’s not just an isolated experience because we both can say it’s happened to us at numerous places of employment however there are some hospitals where the nurses respect Respiratory a lot more than the hospital I am currently employed at. It all comes down to respect. If I am asked to suction a patient by a nurse, and she or he is polite and respectful, whether they know how to suction or not or they are just busy, I never have a problem doing that or anything for them. It is all about the patient. I am always willing to show a nurse, who doesn’t know how to suction, the right technique. Respect is something that is earned and in order to get it you have to give it. That goes for Respiratory, nurses, doctors, and any other health care worker. It does work both ways. I have to admit sometimes it does feel like they think of us as peons, and a lot like they know more than us about our own field. I also have worked with some awesome and wonderful nurses, I’m married to one. I think next time I am called “hey respiratory” I will just respond with “what doctor or what nurse”. I know one thing, you got to laugh, life is too short.

  27. Spot on. As. Former respiratory therapist turned nurse. I could not agree more. When I became a nurse the first thing I taught the new nurses was to respect your respiratory every single point is so true!

  28. Thank you do much for this! As an RT student, I am shocked at the way some RNs treat RTs. Remember, we are licensed Healthcare providers, just as RNs are, we need to complete CEUs just like you do, etc. Let’s work as a team!

  29. That’s not what she was saying at all but here we go again..i think your adding to the point she was trying to make.

  30. Wow! As an RN with 20 years critical care experience I certainly feel this is written for no other reason than to bash Nurses. I do believe if an article about what nurses want Respiratory Techs and therapists to know may sound something like this:
    1. Nurses have a duty to call Rapid Responses on their PTs if they are concerned, their pt is having a change in status, or of the family wants one called. No one including yourself knows everything so do not come to the rapid complaining, stating it is a bogus one, or making any other comments disparaging the feelings of the nurses. You want to be part of a team, you are so stop complaining when your knowledge is needed.
    2. Many nurses do not perform abg’s because their hospital administrators want it that way. It would be much easier for nurses to do it themselves (we can shock people back to life) but when our PTs need one and the doctor or Mid-levels agree, we are told we must page YOU to do it. Stop taking 30 minutes to get to the pt at and then complain when you get there that the pt does not need a gas. Stop saying it over the pt while you’re at it. Stop telling us “the Sat is 100% he is fine.” It’s not about you. Guess what? Metabolic issues can be just as serious as respiratory ones depending on the scenario.
    3. Many nurses in the field are brand new. If you think you know something they don’t, stop belittling them and teach them for 5 minutes if you are so smart. You can be part of the problem or part of the solution.
    4. Nurses do not order medications. If you don’t like the treatment the DOCTOR ordered you are perfectly welcome to pick up the phone and suggest a better course of treatment. We are hearing what you are saying. Don’t take it out on us.
    5. We don’t take breaks either and you know what? We don’t complain about it or bring it up in an online article bashing RTs. We choose not to leave our patients for 30minutes to an hour because we care. We are the ones attached to them for those 12 hours and either don’t trust anyone else but ourselves to care for them when they are so sick or we don’t want to overburden the other nurse who would have to watch the pt. You know what else? That’s what we do. Nursing is a calling to is. It’s not a job.
    6. Sometimes the nurse actually knows what they he/she is talking about because we have been at the bedside caring for this pt 12 hours. We talk to their families, we have seen them “crap out” before and what worked last time.
    7. We are supposed to be a TEAM! We should be teaching other. No one knows everything.
    8. If you are “short-staffed” we will help you. We only care about the pt. If you can’t give the treatment right away, we will do it. If you are tied up in a code and ask us to make a vent change for you. We will do it. We are a team!

    • Thanking for taking the time to leave your comments… they are appreciated & glad you joined the conversation – goal accomplished! Will probably be doing another blog post on what we wish other departments would understand about nursing – you have a lot to contribute, happy to give you the forum to express your thoughts?? Let me know! Thanks again & take care!

    • I just want to add to this comment you don’t know how many times I have found my pt with a mask on and the tx was done 30 min. to an hour ago’ or the pt takes mask off and it’s laying in their bed. The pt also had no o2 on. Nurses don’t always call R.T. for txs maybe we want your opinion and want to act prior to a pt crashing it is called collaboration and I know time is tight but it takes a lot less time to nip it in the bud rather than a full out code. Better for pt too, a smart nurse with a live pt is better than a nurse afraid of what some one is going to say and have pt in trouble. All this because they don’t want to do their job. I value and respect the medical opinion of my R,T,’s and I call when I feel I need more help.

  31. Call it what you want. This is nurse bashing and insulting our intelligence. Believe me many of us would rather draw our own gases or make vent changes so we don’t have to hear the RTs complaining.

  32. see above comment. re; nurse bashing; other disciplines playing ” i am better than you” forgive our ignorance, but being an rn involves ALL body systems, not just lungs. and hearts. so forgive us. we have been taught to Call for Help whenever there is a change in a patient’s condition.. to save a life. not sayin we shouldn’t know the difference between wheeze and rales, rhonchi. 40 years of practice has taught me that. i just don’t like the inter disciplinary criticism. do the Respiratory Therapists know how to diagnose a bowel obstruction? or impending gangrene? or multisystem failure? or stroke, mi, dehydration, or worse, the seizing patient. or the ones with serious cardiac complications. two can play at this game. remember. i am retired, do not miss that interplay. sally vande clock RN/

  33. Been an RT almost 30 years and don’t mind getting calls from nurses to suction a patient. I may get a little stressed if I’m super busy so I may sound a little short when called, but I’m probably just prioritizing my tasks, rearranging how I’ll get to everything. I’m also happy to show a nurse how to do it if they have time. As long as the nurse isn’t rude to me, I’ll do whatever I can to make both of our days go well. 🙂

  34. This article does nothing but perpetuate a culture of hatred and misunderstanding between nurses and RT’s. How about we not write these articles and instead attempt to understand where we are each coming from based on the patients needs. This isn’t mentioned in this article because that is not what an RT is taught to do. RT’s cover one system whereas a typical RN has a caseload of individual and unique patients with a multitude of diagnoses on any given day. Holistic care is up to the nurse and if an RT isn’t willing to work with the nurse rather than bad mouth RN’s on social media, they should find a different job. Most RN’s have way more education than RT’s because most RN’s are RN’s as the result of a second degree (look up the statistics). And, who has more education is not important! What is important is to stop this type of debauchery to each other. I work in a facility of RN’s, LPN’s, and many RT’s. But you want to know something interesting….? Most of our RT’s are licensed nurses. Want to know why?? Because an RN can do anything an RT can but not vice versa. I very seldom speak out on the internet but your article really bit my buttons. How dare someone draw a line in the sand when holistic care is hard enough to accomplish as it is.

    • For someone who claims education isn’t the important factor, you sure do mention it an awful lot. Btw, just like RNs, many RTs have bachelor degrees and even master degrees. (I’m not one of them.) Like you said, that isn’t all that important as far as patient care goes–I’ve known RTs with master degrees who were crappy therapists.

      I’m not sure why you think all of RT patients have the same diagnosis, but you would be wrong. We get all kinds too, and on any given day, we might have patients with COPD, pneumonia, trauma, neonates on cpap, asthmatic, post-op vents, and the list could go on. I work in a community hospital and we cover a level 2 nursery as well as the rest of the floor. We have to have our NRP, PALS and many have their ACLS as well.

    • I would hate to be your patient or your coworker judging by the tone of your comment. Many RTs have multiple degrees and believe it or not also chose RT as a second degree. I work with RNs and RTs that have degrees ranging from LPN-MSN and RT techs-MSRT. Some are better clinicians than others, regardless of education. The fact that you state RNs can do everything a RT can truly makes me question your clinical experience. I would venture to guess that you don’t work in a high level trauma facility because if you did you’d realize the fallacy of your statement. What RTs do in LTACs vs Trauma 1 facilities can be very different. And for the record, many facilities have had the thought that RNs can do RT services. You know what happens? Care declines, readmits increase and RTs are eventually brought back. EVERYONE plays a vital role in caring for patients from EVS to Surgeon. The patient should be our primary focus.

      • And before anyone gets their wig twisted, care often declines because they are trying to add additional duties to an already overworked RN who doesn’t know the respiratory system to the extent that a qualified RT does. My statement isn’t bashing nursing. It goes both ways. My facility had the bright idea to cross train RTs to do total care on vent patients. That was eventually scraped. RTs were too busy and didn’t do none RT stuff as well as nursing because it wasn’t done often enough to be second nature. Every discipline exists for a reason.

      • Again, well said!! EVERY role is so important. I always tell my students – be thankful for EVS – if they weren’t here, that would be one more job the nurses would have to do!! And, as you said, takes away from the patient – who we are trained to care for. Thanks again!!

  35. I enjoyed the article. I have been an RN for 16 years now. It is true that working in Oncology means that I have some solid skill sets, but I do not strictly deal with abnormal lung conditions all the time. I like having an expert to call. I got to sit in a classroom listening to a video of abnormal breath sounds during training and I work, but I don’t hear every possibility routinely.

    In all professions, I come across people who are condescending and act resentful. I do find the worst happens when people are territorial or when the number one priority at the bedside of a sick patient is “how much do I feel people are respecting me, did you ask me nicely enough to do my job?”

    When the results of my assessment is uncertain, I am not calling for a debate. I like that I can send a text to a senior RT, describe the situation and ask for their help and they come. I find some less experienced people will phone back, pull me away from the patient, and start to grill me and feel disrespected by my tone – when the patient doesn’t breathe well, there can be other things like IVs, phlebotomy, paging MDs, medications that I am also trying to get done in a short period of time for the patient. I called to ask for help, teach me after the situation is controlled.

    I use your name if I know it – I may not. At a desk of a dozen strangers, I will request you by the role the patient needs. I refer to MDs by service, same with PT and OT. Yes, you are a whole person in your own right but you have a role to play, just as a choir director will refer to Soprano or Alto, or a sports commentator will refer to Running back. More than you being you, at the moment you are the function you represent in the team. As am I. If you really want me to use your name, introduce yourself and probably to everyone and more than once. Should I appear scared or stressed, that might be the wrong time to shake hands and abetter time for us to get down to work.

    I have spent years working with some cancer patients. I’ve been part of their family, and I may be emotionally invested.

  36. I have been a nurse for over 26 years. I respect the Respiratory team very much, for without them our job would be very difficult to care for so many of our patients. At the same time, even though we may know what is going on with the patient and explain to the on call PA, or MD a lot of the time we are just following orders because they do not want to come see the patient. We do not have as much control as people think we do. When they tell us to use our judgement, we do and then we get in trouble for it. So, as much as we respect and need you, remember it is not always us making the call.

  37. I would like to say that I have been an RT for 23 years and this article is spot on. I would also like to ask those of you who feel that this is RN bashing to take a moment and realize that while you may not feel this is justified, that doesn’t make it not true. Please, instead of getting your feathers ruffled, be mindful about how you may have contributed to this overwhelming feeling. If you have always been respectful, thank you. Are you coworkers being respectful? This is an opportunity for you all to know how we sometimes feel. Let’s change this feeling by acknowledging the parts we play and try to improve moving forward.
    Thank you in advance for being mindful of others feelings and contributions

  38. For an article that is supposed to foster respect between nursing and respiratory, I feel it has had the completely opposite effect!! I am a BSN and my hubby is an RT and if he said any of these things to me, I would be angry! Health care should be a collaborative effort, not a “I know more than you” competition!!

    My RTs are grateful when I can wean Fio2 or make a rate change on a vent when they are too busy to get to me! And to indicate RNs don’t know how to take a SPo2 reading, really?? Wow!!

    Oh and just so you know, I suction my pediatric patients better than 50% of the RTs I work with….the ones who suction well are like gold to me!!

    Maybe your article should have focused on the things we can appreciate about each other instead of slamming RNs.

  39. I’m an RT who just left a job at a very large hospital in Pittsburgh. I’m not sure how the size compares to others in the country but there were 13 icu floors. And many step downs and general floors. Big I think by any cities standards. I’ve experienced all these issues mentioned. Does someone calling me respiratory bother me? Only if I’ve talked to them a bunch of times and I always answer my phone hi this is terry with respiratory and they still don’t remember. Otherwise I realized they just needed an RT and were just trying to get my attention as the navy blue scrubs were the indicator that I was probably the RT. As far as the difference between bronchspasm and rhonchi wheeze sound. I find most nurses can’t identify the difference but let’s remember they learn about a broad spectrum of things. Briefly touching on this I’m sure. Experience and an explanation from an RT probably help this issue best. NT suction I’d say call me. I kinda feel that’s more my area than yours. No offense meant here but I’m probably better at it than you. I’ve simply just done it a lot more than you have. If you wanna try by all means have at it but I’m happy to help. If definitely say please please please don’t touch the ventilator settings. If desating yes crank up the fiO2. but if the resident says go up on the rate by 4 CALL ME. Cause if this patient has severe COPD or anything that can cause various other issues often more than just the respiratory rate need adjusted so that the patient ventilates properly and doesn’t do something like say air trap for example. The trach one I’d say def pull that inner cannula if they’re in distress and you don’t think they just need suctioned. Try suctioning if you think that’s it but def call me if your not sure. Biggest thing here is don’t let them get to the point of coding by waiting for me as in a large hospital like the one I just left I may not be there as quick as we’d all like. If day usually with the trachs try to suction. If that didn’t fix it or you can’t pass the cath pull the inner cannula. Make sure your not just caught n the tip of the inner cannula though. Give the cath a good twist back and forth. You wouldn’t beleive how many people think the tube is occluded when they’re really just hitting the edge of the very tip of the inner cannula.

  40. As a senior RN student going into my final quarter of nursing school, I found this article a little condescending. I will be that new nurse struggling with breath sounds. The last thing I need when I feel my pt. needs an RT consult is for an over worked, angry, RT to come tell me I don’t know **** and wreck my confidence without taking the time out to teach me. The same goes for MD’s, mid levels, PT’s, and OT’s. One thing most nurses do well, especially new nurses, is learn. In order for there to be a positive learning atmosphere, egos have to go out the window. And honestly, if the the pt. is going to receive the best possible care, there is no room for anyone’s ego. I didn’t go BACK to school to become a nurse so I could brag about my 160 something college credits or turn my nose up at specialities because I’ve studied more body systems than they have. I went back because it was a calling. Some day very soon I’ll say goodbye to lunch breaks and probably have to start on a PPI because I’ll have to eat my lunch like I’m in basic training, but you’ll never hear me complain about it. I’ll face older nurses dead set on eating their young, MD’s with God complexes, and a pt. population full of drug seekers and people that expect their healthcare to be delivered as quickly as their Super Sized #1 from McDonald’s. So be kind to your new nurses. Take the time to pull us aside and teach us a few things. If you invest in us early, I’m willing to bet we’ll be great to work with down the road.

    • Kyle – thank you for your insightful comments. Our dry humor is often taken as condescending, but it comes from a place of frustration! You will have a long and wonderful career with your awesome attitude and this article is no way directed to you and your open mindedness. It is when we shut down and become more concerned about our pride that problems arise – and patients suffer. Thanks for visiting and being a part of the conversation!! Good luck and the future looks bright with you in it! Hope we can chat again…. take care!

  41. For me the list would be a little more basic.

    1. First, I’m happy to teach and educate. It’s one of my responsibilities as a registered therapist. I love doing it. I will teach you trach care, suctioning technique, how a CAM works, discuss breath sounds, or discuss the pathophysiology of any respiratory disease if you just ask. I want you to call me if you’re concerned about your patient. I won’t laugh at you or ridicule you for your concern.

    2. Please don’t tell a patient that I will be there at a specific time or that I will give them a PRN medication unless I have told you that. If I can’t get to your area quickly because I am needed elsewhere it creates friction with the patient and impairs the patient’s trust in me as a provider. Also, if a patient asks for a scheduled treatment, please don’t call me unless the medication is flagged as overdue on the MAR or the patient is a new admit or has new orders. It slows me down to have to answer the phone every 5 minutes. The best thing you can do is to tell the patient I’ll be there as soon as I’m able.

    3. I have to triage. I need your help to do that. “My patient needs a breathing treatment” will get your call moved to the back of the list, unless I am absolutely not busy. It might also be a violation of the practice act, unless the patient asked you for a PRN. I really do need you to tell me your name and role, your patient’s name and room number, and your impression of the patient so that I can prioritize correctly.

    4. This may apply to my hospital and state, but RT works under protocol. Much like a physical therapist, occupational therapist, or speech therapist, I can receive an order which simply says “RT to evaluate and treat.” I have reasonable discretion as to when or if a patient receives a bronchodilator, even if it’s ordered on the MAR.

    5. I can refuse to give a PRN treatment if it’s not clinically indicated. Neither you nor the patient thinking that a treatment is needed counts as a clinical indication. That said, I will usually give your PITA lunger a PRN to get them out of your hair and mine.

    6. If you have a patient develop respiratory distress and they don’t have a diagnosis of asthma or COPD, please call me to assess the patient before you call the MD for orders. I can’t count the number of times a nurse has asked for STAT albuterol on a patient in severe heart failure.

  42. Wow, reading this posting and the subsequent comments from RTs has just confirmed my opinion that most RTs are incredibly arrogant. No, you don’t have more education than me. I know a lot more than you, whether you can accept that or not. I’d love to compile a list of annoying things that RTs do that piss off nurses. Believe me, there’s a lot more than nine items on that list. If you want RNs to treat you better, maybe you need to look at your own behaviour.

    • Sarah,

      The arrogance appears to be coming from comments like yours. To broadly say that you “know a lot more than [me], whether you accept it or not” is supremely arrogant. Nurses are trained to be generalists. This is the case whether the nurse is trained in an ASN or BSN program. You’re given only the most basic education in organ systems, pharmacology, and pathophysiology in nursing school. There’s no time for anything else. Nursing education in the organ systems, diseases, and modalities traditionally covered by a respiratory therapist is, by necessity brief and basic.

      Respiratory therapists receive far more education in cardiopulmonary A&P, pathophysiology, and patient management than is true for nurses. We’re expected to be able to evaluate and treat anything from an asthmatic child or end-stage COPD patient to patients requiring an artificial airway and mechanical ventilation for any number of underlying issues.

      Our education is very heavy on the basic scientific principles behind the therapies that we use, and there is almost no fluff similar to “nursing theory” or “nursing diagnosis” taught in nursing programs. We’re expected to be able to manage a patient’s airway, breathing, and often assist in maintaining circulation. By necessity, our education in caring for a patient’s psychosocial or spiritual needs or how to re-position a patient is limited. We’re not going to be able to give you much advice on how to manage your patient’s poorly healing leg fracture, but we can tell you what we can do for the patient if they have shortness of breath related to orthopedic pain.

  43. Great article – I am one of the “other RT’s” – a Registered Radiologic Technologist, RT(R)(MR) and have similar experiences in the nurse interaction world. Maybe next article could be from a Medical Imaging perspective? (the magnet is ALWAYS on; a fever doesn’t equal STAT, everything is digital so get the order in the computer FIRST if you have an urgent need, I know it is hard to travel to the basement with the 450 lbs patient but a portable abdomen x-ray isn’t going to work out the way you want it to)

    Also, my hospital refers to the respiratory therapists as “respiratory care practitioners” (RCP) which seems both more professional and less confusing.

    It seems that budget-slashing administrators often try to cut respiratory care staff and IV nurses – both of which are in the “when you need them you REALLY need them” category. It is called a TEAM for a reason, we need each player!

    • Thank you for your perspective!! Great idea for a future article – I may take you up on that!! Thanks for visiting and taking the time to be a part of the conversation!

  44. I have been a Respiratory Therapist for almost 14 years and worked in many different clinical settings. I really enjoyed the original article and agree with it’s message. I would like to add the following:
    1. Please understand the we are aware that you may have a heavy workload but it has been my experience that nurses are assigned to one unit of the hospital and their patients are ALL located within that unit, we rarely have that luxury! I have seen as many as 40-50 different patients in a single 12 hour shift, located on multiple floors and care units. We are often required to mentally triage which calls should be answered first in addition to our scheduled therapy and we rely upon the nurses who call to provide us with enough information to make those decisions. You wouldn’t dare call a doctor to come see a patient you hadn’t assessed yourself, so why would you do that to RT?
    2. My only concern is for my patients, I am not there to fill in for your lack of skill. It is your responsibility as an RN to speak up when you are handed an assignment that includes a patient that you aren’t comfortable taking care of. Suctioning is categorized under first come, first served. It is inappropriate to leave a patient that is having difficulty to call RT to come from another area to suction.
    3. I am not a substitute for smoking!!!!!!! I have had countless patients call for PRN treatments just so they can have something to puff on. PRN stands for PER REQUESTED NEED, not PER REQUESTED WANT. If I show to assess someone that doesn’t clinically need a treatment, they don’t get it, I don’t care what kind of tantrum the RN has.
    I have a great working relationship with the nurses at my hospital, I have been recognized many times for the great job I do. Every now and then, a newly hired nurse decides to challenge the balance of respect but quickly learns that RT makes a better friend than enemy.

  45. I think that this article has brought forth a lot of debate over this subject….As a student in the last semester of school as well as the clinical rotation, I would like to have an article done asking for RN’S and some RT to have more respect for students and not see us as a nuisance just in the way. We should always remember we all started out from the same point….a student….I have been treated good by some and bad by some which makes wanting to go in the field for some students a hard decision. I appreciate the job of RN and RRT…but I have seen the sometimes arrogant attitude of some RN’S towards RRTs….Let’s remember to not get on the defensive but use this as a chance to rethink how we act in the field. The article is not stating that all RN’S are this way, but the majority are. Me personally, I can’t wait to get done with school and pass my boards and work with great RNs, DRs, RRTS and all of the other professionals whose ultimate goal is the patient!!! I’m sure I will learn even more from everyone!!!

    • Thank you so much for your great perspective!! And you are right, we were not speaking for “everyone” – just wanted to get people thinking and start a conversation – not a war!! Like you said, maybe the real first step is to not get so defensive. Thanks again for visiting and good luck with school – hang in there, you are almost done!!

  46. In my 26 years as a therapist I have found that things go much smoother when we realize that Rt’s work WITH nurses not FOR nurses.

  47. I agree. I felt the same way. And then I went to nursing school and felt pretty bad about my feelings towards a lot nurses, I had no idea how lacking their cardiopulmonary education was! ! Best thing RRT’s can do is educate RN’s. After all, it’s really about the patients. Let’s all expand our knowledge and skills, it could be our butts in the bed next!

    • That used to piss me off big time until the nurses learned to call me and ask for pt. assessment to see if a breathing tx is needed.
      I am now retired and “on the other side” of the fence. Have PPMS with aspiration issues and a history of airway stridor, related to swallowing issues and not from asthma. Every time I need to be at a ER for choking/airway issues, it is a automatic breathing treatment for me with albuterol/atrovent. The RN is the one who makes this decision, they see the patient first. The MD may not see the patient for up to 1/2 hr. after pt. arrival, so the RN is directing the treatment. Even if it is the wrong treatment.

  48. I would have to say that one of the most annoying things that happens to me as a RT is when I ask if a pt is in distress… If I am working the floors at my hospital (level one trauma center) I have half of the whole hospital to see… I am asking if they are in distress to simply put them in priority not to insult you or blow you off… I get calls all night and I don’t have a problem seeing every single patient but if I am running the floors please don’t lie and say yes they are in distress… There is nothing more annoying when I go into a room and the lights are off the patient is sleeping (comfortably) and the RN in nowhere to be found… If our patient is in distress then stay with them for comfort until I arrive… My mother is a RN and I have such respect for the profession… So lets work together…

    • Yes, it is difficult working in a 100+bed community hospital. With 2 RRT to cover for a 12 hr. shift. 50 patients each, difficult to see every single patient that may need attention. Throw in a emergency/code etc. and there is no way you will get to see all your patients. We rely on nursing to assess a pt. to see if they need a treatment or further intervention.
      While at work one night, a RN called for a stat tx on the telemetry floor, a priority due to the unit. I was there within 5 min. of the call. The patient was sleeping upright in bed with his wife next to him in a GeriChair. She asked me not to wake him for the breathing treatment but to please give it to her husband via a mask. I did assess and he had a tiny wheeze, so I gave the tx, turned the lights off, and left the room. Came back in 10 min. to remove tx, and oops, the pt. no longer breathing! big oops! Quickly got the nurse who initiated a code blue. The wife called off the code, advance directive said DNR.

  49. Hi all!

    Came across this post when I was googling for RT’s. I recently learned this was an actual specialisation in the USA and some other countries.

    I myself work as an ICU nurse (RN) at a level 1 traumacentre in the Netherlands. Our job description states that we are responsible for the entire nursing care of any patient with possible life-threatening problems when admitted to an ICU. So my daily work has a great deal of respiratory care, this is including the “vent settings” and all airway treatment/care.

    So my big question is: why are ICU nurses in the states not qualified, didn’t you get the training. I’d like to know more about the reasons for having an RT, are there studies that show better quality of care by a specialist opposed to ICU nursing care?
    Also what kind of MD’s are present at your ICU’s? We have specialised MD’s like cardiologist-intensivists, anesthesiologists-intensivists etc. We work very closely with them.

    If anyone reads this and would like to respons, I hope for a positive discussion without any mud-throwing (hope this expression makes sense..)
    Oh, btw. Out training is a lot longer then 2 months, its just a period I read somewhere in the reactions above.


  50. RT’s started as oxygen jockeys, i.e. the ones who lug those O2 tanks all over their facility and for home care patients. They evolved into first line clinicians who are responsible for maintaining a patent airway. Respiratory therapists study airways primarily and all things associated with airway. We learn how to take apart and repair all airway modalities from a nasal cannula to infant oscillators.
    RN’s course of study is the whole human body, and it is possible to obtain a RN certification with a 2 yr. AAS degree from a community college. Further education = higher pay in the US. The key word of this is “whole” . It is near impossible for one RN to treat a emergency/critical care patient by themselves. A team is needed. MD, RN, RRT are essential; each has their own tasks to ensure proper care is given and maintained throughout the course of hospital visit.
    Yes, nursing can and do many airway tasks, but they do not receive “in depth” education or training for ventilation management; intubation; ABGs; and so on.
    Nurses in acute care settings, simply do not have enough hands to do everything for a patient, and often have more than one CC/ER patient.
    Perhaps the most compelling argument is that it is cheaper to hire 2 RRTs for the price of one RN.

  51. great article!!

    I have to say I was taken aback by the defensive posturing of some of the nurses that replied. Did the article touch a soft spot? Exposed your inability to properly assess a patient?? As an RRT, you who complained about the article are exactly the nurses I despise working with. You are too bitter to be working with the sick; either retire or go flip burgers .

    With that said, I sensed a twinge of humor in the article, and ooh yes! You nailed it! I have a large amount of respect for the amount of responsibility RNs carry.

    If you are paging me cause you are too busy with your iphone to do at least do a 10 second assessment of the patient, you will incur my lecture and inquiry of pt appearance, ABC’s pulse oximetry, resp rate and depth, color, breath sounds, blood glucose, IVF rate, admission diagnosis and PMH. If you are genuinely concerned about your patient, I got your back. I am more concerned for the patient in the former scenario because the patient has a potentially incompetent nurse. BUT… in either case .. i will not neglect nor harm the patient regardless whether you agree or disagree with what I do or don’t do for the patient. It’s not about you or your iphone or how bad or busy of a night either of us may be having.. its about the patient.

    I am Brian, your respiratory therapist.. nothing’s gonna happen to my patients on my watch because of you or in spite of you!

  52. I am a RRT and I work for a 22 bed LTAC unit. Since we are not always full we are told to help with some of the CNA duties. Such as answering call lights, get water for patients, turn patients, assist X-ray with moving patient, and the list goes on and on. What do you RT think about this. We are also responsible for our vent patients and respiratory patients.

  53. Nurses have way more tasks than RTs, therefore we not have time to abide by YOUR ridiculous rules. We are busy administering tons of meds, dressing serious wounds, rounding with doctors, etc. (oh and by the way, we always have our phones on us too, including during our so called lunch breaks). Just come up and give the patient the breathing treatment when asked. Thanks

    • And we have way more patients on way more floors. I’m sorry I can’t give your fluid overloaded patient a breathing treatment right now, too busy doing CPR on my ICU patient. It goes both ways. Try taking care of patients on multiple floors sometimes to see how frustrating it can be to just leave a floor only to be called after you leave. My favorite is when they ask the clerk or PCA to call and tell me to just come up. I refuse to do this now. If you need to talk to me, you call me. I will ask to be transferred to the nurse so I can triage what I need to do first.
      Oh, and we carry our phones on our lunch breaks too, just like everyone else in the hospital.

  54. I appreciate your writing, but base on this article, the RTs get annoyed to nurses because of being lazy and lacking knowledge in assessing and doing independent nursing skills.

  55. Thankyou, I face these for since 1984, it’s been interesting. I was singled out one time for saving the life of a young child, hospital setting. I quickly took charge of situation with patient and there nurse, intubation the child. She later had a cleft Palit repair, then went home. The job is stressfull, made worse by stressed out managers. Doing the job best to your ability, screw the managers who don’t see just how well you’re doing your job, picking on little things that mean squat.

  56. 1). As part of the disciplinary team it’s common to be referred to as your title. I’m called “nurse” a million times a shift. As are the “aides” and “docs”. Why would “respiratory” be any different??? As far as education, sure RT receives extensive training on 1 body system, as a result they should be more knowlegable in that area. As nurses we have 11 body systems to concentrate on. Your comparing apples to oranges.
    2, 3, 4) Some less experienced nurses may feel more comfortable asking the more experienced therapists for their assessment. It’s your job and your getting paid, right?
    5,6) So as nurses RT want us to be competent enough to decifer
    lung sounds and suction the respiratory trach (so they don’t have to) but not competent enough to assess whether our patient needs a treatment??? Double standard- I think so.
    7). Nope, RT never touches our pumps.
    8). I missed the point of this one. We’re ALL busy and as nurses I almost never get a lunch break. Again, the point?
    9). Now let’s highlight all the things as nurses we wish RT knew…
    Nonetheless, it’s our job to do what we do. We can all sit around and complain about eachother or we can work together for the good of the people we care for. GET OVER IT!!!

  57. I stopped reading once I got to ” unless you have a BSN we probably have more education than you.” I was intrigued until I realized that this was less about teaching and more about “venting” ( punn intended). If you truly want to educate then you’ve missed the mark with your ignorant and incorrect comment.

  58. I recently got my RN license, it is going to take me quite a while to getting used to lung sounds, i do listen to my patient’s lung sounds and if in doubt i consult more experienced nurse, but i wish we have RTs in my facility as a new nurse, there were times i doubted myself as to what i was hearing, sure, for me its all about practice. but for the respiratory therapist out there, i am ready to learn, and be an expert on this issue even with a small fee.To make matters worse, i started working at a nursing home, and we don’t have respiratory therapist, so every SOB or decreased oxygen saturation gets a breathing treatment, so i would like some help if any one of you RTs can help, i want to be the best i can in what i do.

  59. RT’s… they complain about giving treatments, complain about being called, and when they are done complaining they return to the RT department to bash Nursing while they knit and watch TV. If i call for a neb treatment I’m told they don’t need one, if i call for them to assess my pt they take 20minutes telling me that all the pt needs is a neb treatment, then they as if I’m going to call the doctor for an order… If asked to do something like NT suctioning, all of the sudden there line of ” I only deal with the lungs” doesn’t work and they switch to, ya know thats a shared responsibility. Trach care, ohh boy another shared responsibility that RT’s won’t ever take the initiative to do.. and when the RN’s ask… ohh boy look out. How dare we ask RT’s who go on and on about how they know so much about airways and lungs to suction a patient, or to maintain an airway, like a trach….. Must be nice to only be responsible for one system, and to be able to pawn it off on other departments so easily

    • Sounds like you work with some bummer RT’s for sure! Recognizing that there are lazy RT’s and lazy RN’s is 1/2 the battle. Good thing the majority of the RN’s I work with are top notch. Our patients are lucky to be cared for my such an A++ team!

  60. It appears to me that the Respiratory Therapists you are dealing with need a wake-up call. There is nothing more frightening than being short of breath. It would be nice to see the Nursing Department and the Respiratory Department come together to define roles. there are two sides to a story…. and nothing but frustration and anger in between. I hope that your issues can be resolved so that everyone comes out ahead. It is a team effort to create good patient care.

  61. Wow! I just read all the comments and forgot what was mentioned in the article. All I can say is I have been in the respiratory field for 15 years. Currently I work in a medical ICU as a RRT-ACCS. I never have problems with RN’S, because we work as a team. They help me out when I am busy, and I help them. They teach me new things, and I teach them. We all collaborate in rounds daily, this includes the MD, RN , Pharm-D, dietician, and case coordinator.
    I really don’t understand the battle between some RRT and RN’s. Remember this is not about who is smarter, or who does more. It is only about giving the patient the best possible care that we as a team can provide.

  62. Good info, but imparted with the same snarky attitude as à lot of the therapists give where I work.. Most of this I did not learn in school, but with experience. You don’t know what you don’t know. RT should maybe present this info to new grads and new hires (in a kinder way) as part of orientation. Oh, and they don’t know my name any more than I know their names, their schedules, or assignments. I am “that nurse for bed 5” and I really don’t have time to be offended by that. We are all struggling to care for pts, and while RT is suctioning, I can be medicating, repositioning, cleaning, prepping to transport, calling for X-ray, and updating family members. We have to be kind and teach each other.

    • You seem to imply that while nurses have many tasks they might be performing, RTs have only the task of suctioning. While nurses are suctioning, I could be medicating, repositioning, cleaning, prepping for transport, calling for xray, and updating family members. The biggest difference is, I don’t have the luxury of working on one floor with a few patients. RTs are assigned to every unit of the hospital on every floor, and while suctioning a patient might be your highest priority at the moment, mine might be the CPR in progress coming into the ER or the pediatric patient suffering an asthma attack. It might even be as simple as the COPD pt whose airway is in spasm and needs her tx stat. I’m sure we could both add to that list, but what’s the point. It’s all about prioritizing. It’s also worth mentioning though, that as a new grad there were many things I did not know, but rather than sit back and wait to be oriented to that task, or ask someone else to do it for me, I asked to be taught how.

  63. I love being called a nurse. Currently a BSN in pursuit of family focused DNP. My education filled with intense science courses from a university makes me proud to be a nurse. I love it please call me a nurse I’m very proud of my education and accomplishments. Not sure why RT doesn’t like being called their title but I’m a nurse and I love bring called the nurse.

  64. I’m an RN and I totally agree with this insight. RTs are more than “great resources” for nurses; they should be viewed as great clinicians with value to bring to the team. My only trouble with RTs where I work is that some are hours late giving their meds. I can understand if you are giving 2100s at say 2230, but at midnight? When I used to work ortho sometimes they would not even come to give the patient their Rx Albuterol, Ipotropium, etc. That puts me in an uncomfortable spot as the RN, because I’m attatched to that patient at the hip for 12 hours. Then, if the patient starts to get distressed, wheezing, etc, I gotta call RT. Sometimes they are rude about it, and it’s sad because it delays treatment, and the patient suffers. The above article is useful to me because it helps me understand why they want to argue sometimes, come late, or get defensive (sometimes). Let’s face it, they have tough jobs too, and are under appreciated, disrespected, and put up with that 10% of us nurses who have superiority complexes, and also the inexperienced ones who may need some education and further training. My frustration with RT-what I wish they’d understand- is I don’t have time to negotiate a breathing tx for my patients, and the pts should not have to wait because of unnecessary arrogance on the part of the respiratory therapist. Most RNs are well educated, understand cardiopulminary pathologies very well, anticipate respiratory needs appropriately, and have lots of experience taking care of patients with respiratory problems. We understand the proper indications for prn aerosolized txs very well. Most of us have given breathing treatments before; either in school, or at a previous facility, and recognize adventitious lung sounds just as well as you do! (And many of you understand how to perform and interpret an ecg just as well as me) so let’s both work on our egos. If we have a COPD pt who is wheezing and uncomfortable, and sob, the doc’s got albuterol ordered, please, don’t be lazy, or argue with us. Don’t scrutinize me and interogate me about what I have or haven’t done. Bronchodilating thier airways is usually a temporary fix, I get it, and I’d be happy to brainstorm over some of the things we should maybe be doing in addition to initial sx control, but in the meantime let’s give that treatment, make them feel even a little better, and not argue or complain about it, and then we can talk, brainstorm, and plan. And I’ll listen, because I respect you as an equally important and necessary clinician.

  65. I am about two months into my RT program here in California and I must say WOW.. maybe we all need to grow up and really, REALLY focus on patient care? I come from a background of pharmacy and Laboratory from a very busy hospital ‘Kaiser’, former manager and supervisor just an FYI, and I am quite worry about the future if all were worry about is name calling, who is superior, and who has more education and list goes on. Get your mentality straight and work as a team my friends cause we all need each other and in the end the least thing I want to worry about is my team member stressing me out, as if we have nothing else to worry about.. KUDOS to those that know that respect is something earned not given…

  66. I never understood the anger toward being called Respiratory or Tech. People seem to be a bit touchy on that subject. Never bothered me at all. Just don’t call me for dumb reasons. Never cared if you touched the knobs either.

    In saying that, most RNs and Dr.(s) for that matter…..don’t know their a#* from a hole in the ground when it comes to breath sounds. Albuterol doesn’t fix PNA, pleural fluid, mucus, viruses….It only fixes forms of bronchospasms. CPT/flutter does nothing if patient cannot perform an effective cough. In 60-90% of cases, respiratory therapies ordered are not indicated.

    Quick education on wheezes. If you hear them, ask patient to cough. If BS changes, it’s not a WH. It’s secretion based.

    In closing, don’t call us and tell us your patient is in distress…..we come up…..the patient is either eating, “pooping”, sleeping, showering etc. If they’re truly in distress, none of those things would be happening. Well maybe making dookie butter in the bed.

  67. Thank you Joan, where were you 42 years ago, when I was a brand new Respiratory Therapist, we were so poorly received, unaccepted and disrespected, and hospital administrators only regarded us as great cash cows for revenue. I remember in 1976, decorating IPPB machines with Red, White and Blue streamers, to celebrate the day our profession became autonomous and no longer was governed by nursing administrators, who viewed the RT as the field slave, which generated revenue, and ultimately more nurses.

    From RT, I ent onto Biomedical Engineering, but in the early 80’s a hospital based BMEs wer just glorified mechanics, I once had to tell a nurse to call miantence to replace a wing nut on a bedside commode, that that was not a BME task, finally, I became a Physiologist, and was a very early Research RT, transitioned into the Medical Device Industry, the Pharmaceutical Industry and finally the department of defense, where I work as a Respiratory Research Physiologist, suffice it to say, most of what I needed to build my long multiphased career, I learned from my days as a RT, I continue to dabble, and have all the sub specialty creditials, including: NPS, ACCS, RPFT, AE-C, CTTS, SDS, but I also have a MS & an MSE, which provides a salary comparable to whaat a RT is really worth, because a good RT is essentially an applied physiologist, with skilled use of high tech instumentation. Also, it takes an artist to interphase a human with a machine and simulate an organ system. The RRT exam is the second hardest allied health exam, second only to Nucular Me with specialty training in targeted chemo and Immuno therapies.

    The world needs more nurse like Joan, kudos to you Joan and your colleagues who have similar regard fro all the allied health professions. Nursing is so highly respected because you produced a Florence Nightingale and Clara Barton. Though not as famous, many NICU nurses mentored be in Neonatalogy & Peds.

    Remember Vivian Thomas, was the true father of CT surgery, though he was an Afro American lab tech, and above all an artist, who trained most of the great early CT surgeons in his dog lab. . Jimmy Albert Young, was the Vivian Thomas of RT, a brilliant, gifted Afro American Oxygen Supply person, who gave us our profession, I think it’s time for an RT version of the movie Something the Lord Made to pay tribute to Jimmy A. Young, the first RT. When Jimmy founded our profession in the early 1940’s, I hope there was a a nurse like Joan, who expressed some gratitude and respect.

    Thanks Joan, you’re a prize to your profession.

  68. Wow. Sorry but I cut out after Respiratory #1. “Please don’t call us…” What a total jerk. That is something that matters? WE HAVE NAMES. And sniff, sniff, we’re not techs either; we’re BETTER THAN YOU because we have more education. I’ve got an idea; why don’t y’all stop being snowflakes, stop whining and your jobs. What a bunch of rubbish. One good slap and they’d stop this nonsense and get back to being real people who cared more about their jobs than how other’s perceive them.

  69. As an RN I absolutely appreciate our RTs. I have been involved is codes and every single person in that room is an asset and plays a vital role. It is important to me to learn whatever I can from a RT because it is adding to my skills and confidence. My Pts depend on me to take care of them the best I can and that means learning all I can. Who better to learn from? Every role in the hospital is vital and each profession should be respected. I can put a Pt back on the bi-pap (inform RT of course), put someone on a bed pan, answer a phone or a call light, give shots, do wound care or whatever. It’s not a bad thing to learn each other’s names and it doesn’t take that much energy to learn it. Many times I have been called nurse and I am proud of that title because of how hard I had to work to earn it. Do I get offended if someone calls me nurse? The answer to that question is no but that’s just me. Now say I am “just a nurse” and that does get under my skin so I can respect the fact that being called respiratory gets under someone’s skin. We all get busy and need to respect that about each other. Many times the bipap would beep and I call RT and try to trouble shoot over the phone because they may have just left our floor and walked clear across the hospital. Health care is a team who depends on each other’s skills and knowledge. I’m sure there is lazy people in every field and they are well known. Our RTs and great people who I enjoy talking to when things finally slow down. Because in front of all our titles is a name of a pretty awesome person.

  70. Love the RTs that I work with in the unit.

    Just a couple things:
    Patients and families scream “nurse” all day everyday. Let the name calling go. We are literally stuck with the 1-3 patients in the icu for the whole shift while most RTs can leave to go on to their next patient. Often our treatments, care, and medication admin will involve more time consuming tasks. The patient throws up, has an incontinent episode, needs a foley, ng, bms placement etc. we are stuck with doing it.

    In addition to the “cleaning” of a patient we also:
    Titrate vasoactive drips, sedation, and paralytics.
    Every 5, 10, 15, and 30 minutes. With immediate and potentially critical results.
    We manage rotoprone (an RT/RN collar must!) CRRT, balloon pump, and echmo therapy.
    Run codes, draw up the meds and administer those meds.
    We call the medical examiner, the state donor services, the hospitalist, and all the other MDs when a patient passes away. We can call a time of death with a physician.
    We can continue on to advanced practice NURSING.
    Nursing is a profession that is founded and based on theory and evidenced based practice, much like physicians, but NOT physicians.
    Nurses can practice independently of physicians in certain fields and states.
    Nurses can provide primary care services, acute services, have prescriptive authority, etc.

    Yes, I love and depend on my RTs working in the icu… in the hospital. We make a great team. However, writing a “sarcastic” article that is a few years old, but still relevant, is not helping either role. Especially if it makes the other defensive (guilty). At the end of the day, everyone has different acute clinical skills, but the nursing profession is based on a theroritical framework that does not just live in the hospital or facility setting but the outside world.

    • Thanks for your input and feedback. And just FYI…it was written by an RT and was not to be taken so seriously. But what I have learned over the years as it gets recycled – sure has struck a nerve and shows we have a lot more conversations to engage in. Thanks again!

  71. This article has good information. However, as revealed in the comments, had cause quite the disconnection between RT and RNs. Perhaps writing in a constructive style, and friendlier tone would help, in the future, not upset so many people.

  72. if i had a dollar for every patient that RESPIRATORY said something to the effect of…

    “I’ve been doing this for 30 years. Pulse ox is fine! they don’t need an ABG”

    to then have the patient crash within the shift (or next) with a sh*t ABG…

    i’d be a millionaire.

    but hey! they don’t need an ABG!… what they need is a STAT CXR blah blah blah…
    by the time that happens and results get back… an ABG could of been done giving us a clue as to how they are fairing so we can expedite the damn process!!…. DERP!

    so i seriously doubt, at this point, that respiratory can see “the bigger picture.” it leads me to believe that all respiratory knows is how to maintain the airway, keep it clean, and keep the pulse ox above 90.

    -RN for 5.5 years and i can honestly say… every patient that has ever gone south on me was related to RESPIRATORY’S reluctance to do an ABG. it could have given us a CLUE… A LONG TIME AGO on the patient’s status. INSTEAD!! all i hear is “They’re fine… just give’em xanax.” then watch them burn out 6 hours later, to be put back on the vent, and VUALA they’re stabilized, diagnosed, etc. My job is to catch stuff early. not kick the can down the road. i can’t do it alone. much love to the REAL respiratory therapists that listen.

    and for all you RT’s theory crafting scenarios as to why an ABG wouldn’t have helped and that i was wrong…

    guess what…

    i’ve cross referenced my thoughts with the Pulmonologist and Primary on board- consisting of gentleman and gentle ladies who are LEAGUES above all you RT’s and they 1000% AGREE WITH MY CLINICAL DECISION MAKING!!

    In closing:
    i don’t care if an ABG turns out to be normal or not. it’s about ruling in and ruling out, and PATIENT SAFETY.

    • “so i seriously doubt, at this point, that respiratory can see “the bigger picture.” it leads me to believe that all respiratory knows is how to maintain the airway, keep it clean, and keep the pulse ox above 90.”
      “i’ve cross referenced my thoughts with the Pulmonologist and Primary on board- consisting of gentleman and gentle ladies who are LEAGUES above all you RT’s and they 1000% AGREE WITH MY CLINICAL DECISION MAKING!!”

      Yeah, you’re a pleasant one. Definitely not part of the problem at all.
      Get over yourself.
      If your stories of rampantly inept RRT’s are true then you work in a facility with a shithole for a Respiratory Department. And if your RN management team embraces your attitude, then you may very well work in a shithole facility. I call embellishment on your part. If I wished to be “dramatic” I could say the same for “all RN’s” and cite how many times an RN calls in an absolute panic over something they diagnosed incorrectly or incompletely. Typically if said RN is receptive, I would address the situation and then provide education.
      Simple. Share the knowledge none of was born with and I have attained expertise in. I would hope you would do the same. But based on your response, I don’t think that would be the case.
      Go work at a facility where an RRT would run circles around whatever it is you think you know about ABG’s, vent theory, cardiopulmonary physics and physiology, etc!
      I doubt you’d survive long in such a facility!

  73. I have always respect RT, because quite frankly, my experience and training in this area was limited and not quite adequate without a lot of daily experience on the floor. As a Rehab Nurse, I never had many patients who required a lot of respiratory management and when I did, I found RT invaluable. This article has opened my eyes and will try to remember the names. It is better when we all try to work together respectfully.

  74. Wow, these comments got heated really quick! I admit the list given doesn’t sound like the RT has a lot of respect for RN’s, but I also would not take it so personally. If you do a great job as an RT or RN, then why would you feel so offended by something written to begin with. If someone showed you no respect or spoke to you in an unprofessional manner than absolutely you should speak up for yourself and your profession. This list has a few things I can relate to on it but it would never be addressed in this way for me. First, while it doesn’t make this RT my first choice for teammates, it doesn’t mean that some of what they are saying isn’t real frustrations for RT, I think it is how it is being relayed that is the issue. Who wouldn’t get offended by that? I am beginning to think that the writer has some hidden agenda to destroy the RT profession. LOL kidding!!! Truthfully, it probably wasn’t the best list to publish when you have thousands of RT’s and RN’s all reading it. After a long night in our ED, someone speaking to me in that manner would not go very well. Then again, I would never let anyone disrespect me or my profession in that way. Just as I would not disrespect my fellow RN’s that way either. Even after reading some of the comments, I still would not disrespect those I work alongside that way. However, in all fairness, I honestly am not sure if the RT who wrote that list has ever really worked in a facility where they are short staffed, overworked, or underpaid to begin with. How many places have you worked where the RT or RN get lunch breaks on a regular basis? I am lucky to get a bathroom break let alone lunch, and that is while I am trying to beat the RN’s to the bathroom for their one bathroom break in the 12 hour shift as well. If the nurses are getting lunch then I would bet they are not working in a hospital to start with. The only nurses I know that get a lunch on a regular basis here are those in administration and those that work in the clinic. They close the whole office for an hour so naturally they get their lunch but even then, they usually are late getting out for lunch. That all being said, what has happened to being respectful and showing professionalism. Regardless of what the RT said, why respond to one another’s comments with the same lack of professionalism and utter disrespect that you felt the RT showed in his list? What makes your comments any better than his? In reading them, I felt some of the comments posted in response to one another were much worse than the guy in the list to start with. Talk about having respect for those on your team. If that is how professionals talk about each other, than I can see why it would be difficult to work on that team. I seen very people on either side, actually say something positive about those they work with. Only a few brag about those they work with or even said positive things about anyone in the opposite profession. That is why I wasn’t surprised when it got spun out of control and next thing you know it, we are comparing resumes and degrees. When you have to pull out your resume and college degrees to prove your value as a professional, then I would say you need a new career. If your good at what you do and you show people respect, then most, not all, but most will return that respect and show you respect as a professional for the job you do. You don’t need to pull out your resume if you do a good job and are respectful towards your team. In the last 15 years practicing as an RT, I have worked with both RT’s and RN’s that are exactly like that though. They think they have to boast about being more educated, more knowledgeable than anyone else, critiquing their work, etc. Some facilities seem to be filled with attitudes just like that, but then there are places and people who truly define what teamwork and respect is all about. It can be hard to find sometimes, which is truly a shame, when you consider it is the patient and the care they receive that are ultimately affected in the end. Patient care is impacted, whether negatively or positively, by how well a team or group of professionals work together. How many times have we watched the videos in ACLS, or even see it in real life, where team dynamics play a huge part in patient outcome. Team work will not even be possible if a team doesn’t exist. If you can’t work together, or if you don’t respect one another, than it will never work as a team. I must just be old school, because I was always taught to treat others with respect. I do not see a difference in the RT who made the list and the people who commented back and forth arguing with one another over who is more educated than the other and so on. How could you expect someone to work as a team if you are told you are not valuable? What makes you any different than the dreadful list maker of an RT that you are so determined to prove your value or worth over? WOW! They just get worse and worse. I would never say anyone on my team was invaluable. I guess it is easy to say things though over a post and comments when in reality I am sure the attitude toward the other profession is completely different in real life. I would hope so or I feel sorry for the patients involved. And here I said I wasn’t taking it personally. LOL!
    If I was the writer, I would probably consider another source for my topics or avoid respiratory all together in the future. 🙂 🙂

  75. I’ve worked with RTs in the ICU and tele for years. Most will not listen to lung sounds, do not bother checking the vent/oxygen. In short they rely on the RNs to handle the vent and assess the patient. They mostly just administer neb treatments and do blood gases…which rns can already do. That is why some hospitals do not hire them or hire many of them. That being said they know the vent better than most rns and the article is absolutely right about neb txts and rhonchi.

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