Scope of practice in respiratory care breaks down on legality vs. hospital policy.
Legally? I can administer any drug, by any method, as long as it related to cardiopulmonary function. I could run IV lasix, titrate vasopressors, or consciously sedate a patient. It is covered under my license, and I received the appropriate pharmacological/physiological education in school to it. That was a while ago though, I'm sure I would kill someone if I tried to do it these days. And not that I ever would anyway, 99.5% of hospitals don't allow and don't need RCP's to do this type of stuff. They have plenty of RN's around to handle it who I'm sure would do a better job of it than me. There are some transport teams out there still where the RCP and RN are essentially interchangeable and you will see RCP's managing drips and whatnot, but they are a very rare breed.
Inside the hospital an RCP's scope is typically: vent management, aerosol medication delivery, chest physiotherapy, airway management, ABG draws, lab sampling via sputum inductions or MiniBAL's, and medical gas administration (typically O2, Heliox, nitric oxide, and rarely CO2). Other specialized duties can be doing ECMO and IABP. Inserting A-line's, PICC's, or other CVC's. And lastly intubation. These are all much more facility dependent though (and I've found also very dependent on your geographical region as well).
I have to know plenty of things outside the respiratory system yes. Cardio-Renal-Respiratory especially are all tied very closely together, any RCP who doesn't have a strong physiological understanding of all three systems, how they work, and how they work together isn't doing their job very well. Where I work we typically round with the ICU NP or resident at night. We obviously discuss the ventilator, but also any labs (CBC/Chemistry/Coagulation/Micro/etc) or relevant studies/imaging that were performed (Echo, CXR, MRI, CT). In essence it's not about knowing the lungs, it about knowing how they're doing as a part of the bigger picture of the patient's global disease process. Considering I typically work MICU most of these patients "problem list" goes on for pages and pages, so you have to have a pretty broad view. The RCP's folks who work Rapid Response have to be able to rapidly assess their patients to determine why the patient in distressed, how to intervene, and who to call - so naturally they have to understand the whole patient too. The CT-surgery people have to know a ton more cardiac physiology as they work with a lot of heart and lung transplant patients, ECMO's, LVAD's, and whatever else nonsense they do down there. The neurosurgical people have to remember their neurophysiology of respiration so they know how to properly react/intervene when those patients start doing their different types of unsettling "neuro-breathing".
As far as injections/IV's, again we can legally but don't. About the only injection we do is the yearly PPD test. I can also flush a line if I use it to draw a lab or something, but injecting saline into a port doesn't really count as an "injection" haha. There is talk of allowing the Rapid Response RCP's to start PIV's to take a bit of the load off of the Rapid RN, but again this is just a unique facility circumstance, not the norm.
Pretty much sums everything up. I'll attempt to address some other things about the profession for the OP.
Hello everyone, I am really interested and looking into getting into a respiratory therapy program. I have a previous degree in education and after realizing that that teaching was not for me and having a passion for medical/ healthcare, I ddecided to look into respiratory because I like the idea of specializing in one area.
I have some concerns though. I have read that the market is terrible for resp. therapists and I also read that they might soon be replaced by nurses because nurses can do their jobs. Is this true?
What can a respiratory therapist do that a nurse can't? Also, as far as advancement, can they advance to be a pulmonary PA?
The downsides to being an RT are:
Some job markets are tight, so you might have to be willing to move around if you want a decent job.
At many places, lazy RTs just skate by. A good RT is worth their weight in gold, but there's a great number of RTs that do the minimum and will skirt work at every given opportunity since much of what we do is not exactly life-saving (CPT, needless albuterol treatments, etc). This means you might have to pull some dead weight if your coworkers are in this category, and that you might be working alongside some people that have let their understanding of basic science concepts stagnate as they simply do what is ordered like automatons rather than clinicians. You also will have to deal with the stigma these RTs create for your department whenever you enter a new unit or are working on a new floor and people don't know you.
Disrespect from the nurses and some physicians, as the nurses will often basically try to give you orders or push you around into doing what they believe is best for the patient. I can't even count the number of times I had a nurse without a stethoscope tell me to give albuterol to her "wheezing" patient and get furious at me when I refused because, on auscultation, it turned out they were crackly up to their nipples and were horribly fluid overloaded. Respiratory departments are typically lower on the power end of things than nursing, so if a dispute arises, generally they will win. Physicians generally will respect you if you do good work, but occasionally a new resident will view you as some untrained monkey of a technician that should only be doing as they say, regardless of whether their treatment plan is incorrect. All this having been said, most nurses and physicians will respect you if you both respect them and do well at your job.
Lack of understanding for what you do is a bit of a nebulous thing, but you're going to be fielding questions about what you do for a living for the rest of your life, and it gets tedious. I wish people knew and understood what RTs are and their importance in healthcare just so I wouldn't have to keep explaining it. Not a big downside, obviously, but it's just kind of annoying. Like saying you're a "consultant," the majority of people outside of your field just get confused at the mention of your title.
Limited upward mobility, as most hospital management positions require a nursing degree or medical degree.
Upsides of being an RT are:
Critical care, getting to deal with legit emergencies like codes and patients in the ED, and basically getting to be a part of all the awesome teams in the hospital if you so choose.
Getting to hop from unit to unit in most hospitals, which keeps things fresh- you can be doing neonatal ICU one day, MICU the next, and CT the following if you want. Nurses, physicians, and basically everyone else in the hospital is trapped in one unit or practice environment for the majority of a career, but not so as an RT. This, combined with the constant emergencies and the intense nature of critical care makes the job perfect for a person that gets bored easily.
You don't have to deal with the more intensely emotional aspects of care if you choose not to. Nurses do all the juggling of often irate or unstable family, friends, and relatives, the angry phone calls, etc, while you get to just deal with the patient themselves and leave when your treatment is done.
You'll never have to change a bedpan, insert a urethral catheter, administer a suppository, or do an enema. You trade all of that for having to deal with phlegm all day. I heard it joked once that god put all of the potential nurses and RTs in a room that was waist deep in feces, then made it rain phlegm. The ones who dove became nurses, the ones who stayed standing became the RTs.
You've got an area where you're a specialist. You will actually know more about mechanical ventilation than the vast majority of the physicians and basically every nurse that isn't a former RT in the hospital. Pulmonologists will have you beat hands down, and a lot of anesthesiologists will know the physics and how to ventilate patients in surgery better than you ever will, but that's about it. This specialization and knowledge makes you a critical member of the decision making process in a lot of situations.
I honestly don't think we work as hard as nurses overall. A floor nurse has no such thing as a slow day, an ICU nurse is always at a patient's bedside in case SHTF. As an RT, once your rounds are done, you kind of just wait until your next rounds begin, and just sort of are on standby in case of emergencies. Some days you'll have zero downtime because of things that come up, some days you'll have a few hours of downtime. It's kind of unpredictable, but I'll take it over the endless mundane tasks a floor nurse has to perform day in and day out any day of the week.
Great experience if you want to become a PA someday or go to medical school.
The pay is pretty good for the work you do, generally only a couple bucks less than the nurses are making per hour. I'll take the two dollar pay cut to not have to deal with diarrhea or irate family.
As to the future, RTs aren't going anywhere. Nurses are not capable of troubleshooting and operating a vent, plain and simple. It's a very technical thing, and requires a couple years of training to do successfully. That's our biggest saving grace, really- a nurse may be able to administer all of our meds, but the technical side of respiratory therapy and the fine art that is mechanical ventilation are far beyond their capability. HMOs tried to wipe out RT departments in the early 90s and mortality rates and VAP shot up as a result, so I really doubt the same thing will happen again. As to the job market, that depends on how willing you are to move. It's good in some areas, horrible in others. Do some research on your area if you want to find out.
Does anyone have any "motivational" stories for me? FYI, I am based in the Bay Area, if that helps anyone with their feedback or advice.
