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….
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!!