I have been a respiratory therapist for 16years. I have never had trouble finding a job til now. After training nursing staff for 7 years and taking care of patients in 5 nursing facilities, i was told by the Senior Regional Vice President I was no longer needed. Nurses can do what respiratory therapists can do. Hospitals in Greenville, SC want associated degree RRT only. What happened to experience counting for something. I am leaving the respiratory field and moving on the coding and billing. I am very said to say CRT's are no longer appreciated. I feel we only give the AARC money for RRT's.

Hello, I also would like to comment that I feel it is important for nurses to know basic mechanical ventilation, just as we as RT's should know the basics on medication delivery and how an infusion pump works. We work as a team, and need to have a good grasp of each others roles, equipment, procedures, etc. so that we can assist and learn from each other to promote excellence in patient care. We are all professionals, and each one of us has something to add to the care of the patient. It is the common respect that we share with nurses that secures our places at the bedside as Respiratory Therapists. As someone who has been in the field for 25 years now, I feel that the future of Respiratory Therapy is bright, if not vital ,as we move forward in this constantly changing and technologically advanced field of healthcare.

I stopped reading the article when it stated that Inspiration is terminated when a preset pressure is reached in Pressure Support and Pressure Control Ventilation. These types of statements is what happens when nurses try to write mechanical ventilation papers. I agree with other responders in that this article is not promoting nurses to take over mechanical ventilation from RT's. I also believe that they should have a basic understanding of ventilators so that the nurse and the RT can communicate about the ICU patient on a ventilator. I have always traded information with nurses (you teach me this, I will teach you that). This doesn't mean that they can take my job or I can take theirs. I actually earn respect from them because of my knowledge of ventilators and they earn mine with their knowledege in their field. On another note, nurses are in a bigger shortage right now and in the future than RT's. How are they going to fill the gaps that they have right now and fill ours?
I also don't feel that the one article takes the place of RT school when it comes to mechanical ventilation knowledge. I teach our vent class and that article goes nowhere near what I cover in my class. However, anyone could go out and purchase Pillbeams vent book, Hess/Kacmarek's vent book...... and read them to learn about ventilators. Still doesn't mean that they are going to take my job.

Good Morning;
I have to respectfully disagree with the idea that articles such as this will spell some sort of doom to our profession. In reading the article, I see no indication that the authors intent is to teach nursing to do our job. In fact, within the first few paragraphs, the following is written: "The purpose of this article is to
present an overview of mechanical ventilation modes and the assessment and management of dyspnea
and patient-ventilator dyssynchrony." and "Only a brief review of commonly used ventilation modes
and basic operation is provided; interested readers are referred elsewhere for more in-depth information". The rest of the article does go into some detail, but nothing that is secret or new or more in depth than just scratching the surface. Just look at the references. Everything is out there for people to learn. I am approaching 20 years in this profession, and have seen respiratory therapists grow and become recognized as cutting edge clinicians and professionals. We remain the experts, the "go to guys" (and gals) for ventilation in critical care. What possible good would arise from NOT sharing that knowledge and expertise? I have been in countless critical situations where a well educated and competent ICU TEAM has made a life saving difference with a vented patient. Not just one person, but a team. That includes the bedside nurses. I don't advocate shifting duties per se, but knowledge of each other's professions, knowledge of the patient as a whole, by the entire team, is what makes for good outcomes. Think of this, most of us take ACLS, right? But how many of us actually run the codes or push the meds? Would we consider ourselves competent without that type of knowledge?
We, as a profession, have to "fight the good fight" every day. But staying in a cocoon, keeping all of our knowledge to ourselves, isn't the way to do it.
Thank you for listening, now, back to our regular program, already in progress...

Hi Chris~
I just read the article that you mentioned in your blog, and I have to say that I agree with you. I also read the comments to your blog, and everyone had some great ideas. I am just glad that this topic has generated enough energy to have returned comments. I have been a therapist for 3 years now, and I have obtained additonal credentials in other specialties, and soon will be acquiring my bachelors, but I do feel that if we keep training nurses in our specialty, then we will start to eliminate ourselves as a profession.Granted the nurse is the first one at the bedside when a patient's clinical symptoms start to change. But if a nurse is trained on the basic modalities like alarms and settings, then there will be no need for respiratory to even exist in the healtcare team. here in Illinois, some institutions allow only RNs to draw ABGs. and respiratory is then scolded for even performing an ABG. so again, how do we fight the good fight and take charge of our profession???? I think that as respiratory therapist we need to acquire the highest level of credentials that we are entitled to rather than just stopping at the bare minimum. and just simply being knowledgeable in our profession. WE did the 3+ years to have this right and we should definitely take it. And if we dont, then it will only be our fault if our profession becomes extinct. And if the nurses are trained in critical care skills to be able to manage ventilators, respiratory departments around the world will diminish, and there wil be less patient incidents...... definitely something to think about.

This issue arises periodically, and sometimes we are our own worst enemies. You say that at the places you worked, RTs had to signoff on RNs to handle ventilators. Why would we do that? Knowing the limited level of instruction nursing school, upon what basis would an RT sign off on an RN as "competent" to handle ventilators. Maybe a limited signoff on responding to alarms, knowing when to bag, or such. But signing off on them as competent based on a little clinical observation ENDORSES the idea that with a quick inservice and a little review, RNs can do and know all that we learned in 1 to 4 years.
RTs get tired of responding to the unit and start letting nurses do minor manipulation of the ventilators. Over time this grows, and then suddenly one day, the Administrator or a bean counter walks through the Unit and sees nurses "managing" ventilators. "Gosh, I guess we can do without RT and their salaries and their Director." And the die is cast.
Administrators do not understand the depth of our knowledge and unfortunately, the things they see us do most of the time APPEAR fairly simple, so why can't nurses learn it in 10 minutes? The very first hospital on record (published in ACHE journal) trying to eliminate RT to save bucks (something-Newhall in California in the 1980s) suffered several major patient events and very negative outcomes immediately following the change, faced a large wrongful death suit which was settled, was hit with a physician boycott to admit pulmonary patients there, and in a very short period of time recreated the RT department with more people and higher credentials. But that part of the project was never publicized. A literature search will still find a glowing article about what they were going to do and what they were going to save. There is NO article delineating the disaster it became, what it cost them, and the fact that it was reversed.
In practically every place RTs are eliminated, it fails and the department is restored - usually in 12-18 months. But it is disruptive as all get out during that time-frame. RT will not go away unless WE fail to learn from our past mistakes and don't cause our own elimination.

I just edited Sam Giordano's monthly "Observations" column for the August issue of AARC Times, which should be online around July 20, and in the mail. In it he addresses your concerns and provides advice on how to make yourself valuable to your hospital during this era of cost-cutting and advancing technologies. Be sure to read this.
Here are just a few quotes: "Health care provider employers are going to be looking for multi-skilled professionals. Our future health care system will have no place for persons who provide care — and only provide care. Just think about all the education that we can impart to our patients with chronic lung diseases while they are hospitalized....exacerbation rates would decline, as would physician office visits, emergency department visits, and hospital admissions and readmissions. Do you think the health care system of the future would value you as a health care professional who caused these elements of success to be realized? Of course they would."
(I am the assistant editor for AARC Times.)

I think RN's should have a working knowledge of ventilators - we're a team and we should all contribute what we can. At the same time, a single article is NOT enough to manage a patient on a ventilator. It's not about putting in numbers and hitting the accept button. There are waveforms that tell clinicians in REAL TIME what OUR settings are doing to the patients. There are Cst checks, setting the proper tidal volumes, keeping alarms tight, selecting the best mode of ventilation for the patient, SBT's, Weaning parameters (acceptable values and unacceptable values), changing circuits, etc etc etc. I would not base your assumptions on this article. RN's spend a lot of time at the patients bedside while RT's float from department to department. It's assuring to have RN's who know how to work ventilators but I do not see this as an opportunity to replace the RT role in ventilator management.