One of my favorite PT assignments involved learning how other healthcare disciplines interact.
In this post series, I’ll be asking similar questions to clinicians in various settings, and/or of different disciplines, in an effort to learn more about other professions/settings, understand what a normal day is like for them, and determine how we, as physical therapists, can communicate and work together more effectively to improve the quality of patient care.
This first post is from Musi Nde( MOO-see UN-duh), a Respiratory Therapist (RT), who is also working on his Masters of Medical Science in Anesthesiology.
We went to Cusco, Peru on a medical mission trip, with a large group of Allied Health Students, back in 2013.
What is the educational background, licensure/certification, test to become an RT?
There are currently two paths to becoming a Respiratory Therapist (RT). The first being through a two-year degree Associate of Science in Respiratory Care from an accredited school which allows a person to apply for the Certified Respiratory Therapist (CRT) Licensure exam. The second option being a Bachelor’s of Science in Respiratory Therapy which requires an initial two years spent in an undergraduate program completing prerequisites for a bachelor’s degree. A RT can only take the Registered Respiratory Therapist (RRT) Licensure exam after graduating from an accredited bachelor’s program or after holding a CRT license for two years.
What kind of setting do you work in? Are there other settings RT’s commonly work in?
I currently work in a hospital setting doing primarily acute care work. I round on post-op surgical units, medical intensive care units, neonatal intensive care units, and step down units. Hospital settings for respiratory therapists can vary widely from hospital to hospital. RT’s can also work in home healthcare visiting patients that are ventilator dependent and tracheostomy dependent, they can work in Long-term acute care facilities (LTAC), Nursing homes, and can also go on to do sales representation for pharmaceutical companies as well as companies that sell medical equipment.
What does your typical day look like? What are some of your job duties?
Daily activities can vary depending on my particular assignment and depending on the time that I go into work. I work mostly night shifts so my experience will be different from an RT working during the day. The average day (night) in an Intensive Care Unit (ICU) primarily involves rounding on patients that are on mechanical ventilator support. I make note of a patient’s status and whether any changes need to be made to ensure that patient is a close to their own ventilatory baseline as possible without doing damage. This sometimes involves me obtaining arterial blood samples from patients in order to analyze their Arterial Blood Gas (ABG) values so that I can accurately make changes accordingly in cooperation with the critical care team. I also provide patients with any sort of nebulized or inhaled treatments as well as provide education on proper use. I am responsible for taking care of patients with secondary airways such as tracheostomies and laryngectomies. I am also present during Codes to provide assistance. During the day RTs are more likely to transport patients for CT scans, MRI’s, and surgeries.
What kind of interaction do you have with PT’s?
Most interaction with PT’s happens during the day, with good reason. During the day we want to help get patients up and moving ambulating, stretching, and exercising however they can because it helps hasten recover and shortens their hospital stay. My interaction with PT’s comes from when they work with patient’s that are using supplemental oxygen or when the patient is being mechanically ventilated. In the case of patients on supplemental oxygen, we work with PT’s to determine how much a patient needs and to ensure that the patient gets what they need during any form of exercise. We also can provide inhaled treatments to make exercise easier for patients. PT’s at our hospital perform all manual percussive therapy so it’s important for me to be nearby so that I can be there to assist in case of any sudden distress that the patient may exhibit.
In what ways could PT’s help to make your job easier? Or how could PT’s and RT’s work together more effectively to improve patient care?
Please be patient with your RT’s. They see a lot of patients all over the hospital for various reasons. We do our best to be in 3 places at once, but it’s just not feasible sometimes. For instance, imagine I get a call about a patient that is having difficulty breathing on the 3rd floor, just before that I got a call that there is a patient on the second floor with a tracheostomy that needs to be suctioned. All of this while I was on the 7th floor in the ICU I was covering checking on a patient that was being mechanically ventilated. There are cases where PT’s and RT’s are supposed to be working together to do something such as ambulating a ventilated patient. Often times it is difficult for an RT to drop what they are doing to help because there are several other patients that still need to be seen. This situation is mostly alleviated through proper communication. Talk to each other early on about the plans for the day so that each person can schedule accordingly. The slogan at our hospital is “We’re all in this together” and it’s in everyone’s best interest to keep an open line of communication and ensure that everyone understands each other and we are able to cooperate efficiently. I can call for help from other RT’s, but on a particularly busy day or night I may be all you got so if you are a PT and notice that a patient’s SpO2 is dropping or they are short of breath, turn their oxygen up give me a call and let me know what’s going on and if it becomes emergent I will be on my way.
Was there ever a time where a PT did something to tick you off or interfere with your treatment session?
Our PT’s are wonderful and in general I haven’t had any major issues with them, but one thing I notice happens often is that sometimes they are not paying attention to how a patient is getting their oxygen and so a patient’s nasal cannula becomes unattached mistakenly and their oxygen saturation (SpO2) begins to drop. I’ve seen more than a few PT’s who begin to panic not understanding what is happening then I get a call about the situation and walk in and immediately notice that their oxygen is not working and they have turned a flow meter up very high but didn’t notice that there was nothing connected to it. It is a little annoying to be called away while caring for another patient to go fix a problem that would have taken a second if you had just paid attention.
Are there any stories when a PT was especially helpful?
There are plenty of stories where PT’s help us. Our PT’s are skilled enough to usually not need us when they are working with a patient receiving supplemental oxygen unless the patient is critically ill. Often times our PT’s will just notify us of what’s going on and tell us they will call if needed. This frees up the RT’s to ensure that they are able to spend ample time with the more critical patients. PT’s have also assisted in code situations where RT’s are doing most of the CPR, PT’s can come in and assist to ensure that there we have a proper rotation and no one is getting fatigued.
Finally, if there was some sort of information that you wish the general public and PT’s knew more about in terms of RT care that you would like to share?
There are plenty of good things to do so you never have to have a run in with a RT. A good one is to stop smoking or to never start. A lot of the patient’s I see are those with smoking induced COPD and this is an absolutely preventable thing that can lead to serious complications. Another is taking care of your asthma. If you find yourself using your rescue inhale more than 3 times a week and especially if more than once per day, then you need to speak with your physician about being prescribed a medication to maintain your asthma. Asthma should not be something to be hospitalized for except for a very small minority of patients who have a particularly severe case.
I really appreciate Musi taking the time to write this up. Hopefully we can use information from this post series to improve our ability to interact effectively with other clinicians and learn more about what they do on a daily basis.