I am currently in my first job in respiratory care, at a large medical center. I'm interested in finding out what is expected from RT's at other large hospitals.
We recently hired a new RT from another large teaching hospital. In talking to him, I found his job at the last hospital was completely different than what we do at ours. In our hospital, we have one therapist per ICU. We frequently have 12-16 vents to manage. We have very little input into vent management, and do not have time to do rounds with the MD's. When giving report to the next shift, we stick to the basics, as we really have not had time to learn anything else about our patients. There are many days when we truly feel like "knob turners".
This new hire describes an entirely different situation at his last job. RT's there have a maximum of 8 patients apiece. They are involved in all aspects of care, do rounds, and do almost all vent management. They decide when ABG's will be drawn. Report to the oncoming shift is extensive, covering everything about the pt. Of course with 8 patients there is time for that. He also said that RT's at his last job recieved a lot of respect, and obviously earned that respect.
They also worked in one unit only for months at a time. At my current job, I rarely get the same assignment two days in a row! Frequently, we change assignments during a 12 hour shift.
So my questions are these. What is expected of you at your job? How much input do you have regarding vent management? Are you respected by nurses and MD's? And lastly, how is the work load divided at your hospital? Do you remain in one unit for weeks or months, or do you rotate on a daily basis?
Lots of questions, I know. Very curious to get input on this.

Im working outside of US (here in the middle east) and your situation is similar than ours that is ur current situation. Since I have been to a department that does proper RT jobs I come to the conclusion that ur responsibilities depends on the hospital setup and ur department head. Unless ur on the administrative level u cannot just change things. The setup of ur new RT is the proper one that is to give each patient its due treatment and proper care. But if ur understaff (undertime) u cannot do this. There are plus and minus for this and I hope at the end of the day ur satisfied that u have given somebody Resp. CAre

ric mandanas jr

My favorite memory as a practicing, respiratory therapist was in the medical ICU at San Bernardino County Medical Center in San Bernardino, California.

In that ICU, I made a difference.

The core therapists managed intubations, managed patient blood gases, managed patient ventilation, managed nebulized drug delivery and managed extubations.

We earned those privileges each and every day by making supportable ventilation decisions and then by holding our own on physician rounds each evening with information gained from personal experience as well as from information gained from reputable medical journals.

The pressure to justify decisions on rounds with physicians was enormous – the core RT's in that ICU gladly paid that price for the benefit of autonomy.

If you want the authority to make patient care decisions, you need to read medical journals on a regular basis so that you can gain the information necessary to support your decisions in a way that is respected by your medical co-workers. Then, when the time comes, you need to be ready to support your decisions with data from your own anecdotal experience as well as from data gained from reading.

Cyndy-
Sounds like you had a good job there. It sounds more like what I was expecting. I don't think it's possible for us, with so many vents to manage. In addition, the constant changing of assignments makes it hard for us to ever get to know our patients.

If you are a more valuable resource, you will be more valuable to your co-workers.

Probably, the reason you are now only a vent knob turner is that your predecessors have not proven their worth to be anything more.

You can change that if you have the guts.

Read, learn and take a stand on vent decisions you can support with knowledge based on concrete information.

Until you read and can support your suggestions with journal evidence, you will have no voice with physicians.

Don't give up!

Cyndy

Dear 21%

Your topic is one that is near to my heart. I have had the experience of working in several departments with a wide range of roles and responsibilities. From inserting arterial and central lines, complete control of mechanical ventilation, intubation, etc.... to the highly paid knob-turner status you speak of. Your role as a bedside therapist is a reflection of the attitudes in your management team and medical directors. If you are unhappy in your role and want to be able to use your brain at work then I suggest you research the various departments in your area and go for the role that best appeals to you. The department you are looking for could be across the street! If you feel like a project then make it happen at your hospital however this may take years and your clinical skills will only suffer in the meantime. Good luck!

I am so sorry that your first job experience is what you describe. I have been in the field pushing 20 years now and have had many responsibilities as the others had described. I currently work in a teaching hospital too and the department is respected by the residents and interns as well as the attending docs. I would not enjoy working in your situation at all. With the great demand that there is for RT's, there are jobs out there where you can be who you trained to be. Your work load is too heavy to be an RT. Is it because there is a need for more staffing at your institution? Hang in there. Maybe things can change where you are working, maybe not and you might have to find somewhere to work where you can grow as a practitioner and not as a technician!

I work in a large teaching facility affiliated with Brown University. I'm glad to say that our responsibilities are many (intubations, assisting with percutaneous traches...). We are encouraged to round to the point that if the therapist is not there they will look for him/her. We utilize respiratory protocols to the fullest extent. I love my job!!!

Well there certainly is a BIG difference between how things are done by RT's at differnt places.

The question you gotta ask yourself kid is "do I feel lucky?". Seriously, as a new grad it's going to take a bunch of perserverance and LUCK to make it through that type of work situation and continue to thrive as an RT. As a new grad I would recommend you find some way to "hook up" with other RT's and stay grounded in good professional practice. Join the AARC, sign on to RC World newsgroup, monitor and participate on Ventworld. Read Critical Care Medine, Chest, etc (at least scan the articles and make a note of the abstracts that are most relevant.).

Then maybe you could tough it out and slowly chip away at the situation, make allies, win slow and steady victories. But at the end of the day that situation will also affect your perspective and performance. Professionalism isn't natural and human nature is what it is. It's not evil, but the chronic effects of certain types of work environments produce predicable survival adaptations.

And if you try to push the role of the RT in such a workplace situation I CAN ASSURE you that some will feel threatened (which you are really) and respond in little, maybe big, ways. You make a mistake and you'll never hear the end of it.

If you can find another place to work where you can become better grounded in good practice then go back and kick butt at that place!

I have worked for many such places. But on one (about 20 years ago but the memory is fresh) of the first days at one I made a suggestion to the medical team about a patient. The MD later called me over and pointedly thanked me for the suggestion, complaining that the other RT's didn't seem to know much or give a damn about anything. Then I'd do a breathing treatment and, after using some mini autogenic drainage to help get up TONS more secretions, the patient was loudly saying "why didn't anyone else do this before?!!". But you can imagine how popular I was with some of my coworkders.

Good luck,

Hi 21. I am relatively new to all this as well compared to some of the other respondents to your question. I have been an RRT in Canada now for 5 years, and have worked on both coasts. It amazes me that despite a nationally recognized certification and nationally devised set of standards how much variabity exists from coast to coast and all stops in between. It has become apparent to me that the key to success lies within the individuals desire to put forth the effort. It is a sticky situation, and a disheartening situation, to have lots of zeal, fresh new ideas, and a vigor for patient care sapped by a seemingly uninspired group of collegues. It does not matter where you work you will encounter physicians, nurses, physio therapists, and respiratory therapists who do not want to hear what you have to say. However, I refuse to believe that with persistance you can not invoked a change. Learn from people with good habits. Read Lots. Get involved in education(ie teaching RN students, help with inservices, show residents how the vents work). I met an RT once who I have since held in great esteem. He once told me that the best part of the job for him was that anywhere you go in a hospital an RT can be of some help. As such he made a point to make himself useful. I have tried with every ounce of me, and that is a lot of ounces, to make myself useful to my collegues, my department, the physicians, and the nurses especially. If you keep up on the smarts, help turn the odd patient or more, and keep a smile on your face you'll be surprised how the tables can turn in your favor. It is our responsiblity at the end of the day to be sure we were an advocate for patient care. When an opportunity presents itself to throw in another skill that we're not yet doing, or try a mode we're not yet trying jump on it if it will help. To me that is the key to autonomy.

I am very fortunate to have found the situation I am in. I think the RTs I work with have strived over the years to earn the autonomy they have. The RTs they hire all bare similar qualities and as such a team of pretty progressive thinkers has been formed. I find that when I get called to the ward I am wanted to be there. The trachs, the spirometries, the blood gases, sat checks, and o2 starts of all kinds are non-stop. Often we are a bridge to a patient getting started on CPAP, BiPAP, or finding a new home in ICU. We are now carrying AEDs to all codes because the sites are so large it improves time to first shock being give. I find in ICU that if I make a suggestion the docs are pretty receptive. I have friends who work in the OR that say their role has got to stop growing or the Anesthetist might as well not come in. They are assisting with everything from line insertions, intubation, TEE, rapid infusers, cell savers, and so on. Some aneasthetists pout if the RT isnt handy. I also find we have lots of room for growth in NICU we are changing but slowly, in CVU the work seems mundane but we pretty much run manage wean and extubate with out question. ER needs a full time RT because it is the ward RTs responsibility. There is so much that we could be doing there and our manager sees it but money well she aint cheep. There is so much the ERPs like to have us do from conscious sedation, to trauma, to teaching, spiros, and so on that it compounds the ward RTs role to the point that you run all day and night long. ICU is my favorite place to work. We have a 6 month core in ICU. We see 6 patients at one site and 8 at the other. We intubate, put in art lines, working getting femoral central line starts, have on site ABG/lyte analysers, have an active role in managing vents and weaning, have an active role in patient rounds, and practice and encourage a whole system understanding to each patient keeping each of us well informed. The ICUs see a diverse range of patients from neuro, burns, post op, sepsis of everykind, ARDS, and on and on.

Im sure this isnt different than a gazillion other hospitals, but I really enjoy the autonomy we have and the role we offer.
I whole heartedly agree that reading, getting involved in education(ie helping with inservices or teaching RN students, ect..), practicing ongoing education and proffessional development, and presenting ideas during rounds to be the spice you'll need to survive that situation. Things can change. Anyway I talk to much so ciao thanks for the question