ER Doc wanting to remove High Flow O2 from protocol

[tniuqs]

no , we manage quite well without a further dilution of patient care to yet another 'single function professional' , also don't forget the UK is very much anti ringfencing roles at present , and most descriptions i have seen of the RT role are tasks undertaken by nursing staff and/or physios in the uk context

Yes I see, we have tried the "generalist approach" to medicine here in the colonies as well but as modern medicine progresses and advancement in the area of pulmonary medicine there has been an identifiable need. Factually many others, such as as OT and combined lab/diagnostic imagery as well. It has become abundantly clear that these discipline (s) are quite essential, tis a pity that the UK has not followed this and dogmatically sticks to it's traditions for traditions sake alone or an anti ring fencing philosophy. I dare to say that job descriptions vary widely from in function to the application of degree level programs specializing in these areas. Physio and RNs here are not permitted in most cases to touch any thing other than the 100% key or silence key unless inadvertent alarms sound on "state of the art ventilators" in fact we as RRTs have generally gained the respect of the vast majority of RNs in the ICU and ER settings, unfortunately there are some old hold outs.

The idea of "cross training" individuals is rapidly gaining popularity here as given a chance it usually enriches both "lateral professions" Hence we do have regulations against the "standard RN" in the back of Ambulances as well as they must actively gain the EMT status, unless they are specialists in transport teams.

RRTs also do a very admiral job in the home care settings as well, quite independent of Nursing, why would an RN be in care of an individual dependant on a Home Ventilator? or the trached BPD patient or the COPD patient this simply baffles me.

Query:

Do nursing sisters still wear the traditional Cap and white smock over there?

[VentMedic]

Respiratory Therapists from Canada and U.S. are present in the UK but as educators and consultants to the physicians for getting new technology/therapy started. There have been a few hospitals in the U.S that have hosted groups of physicians from the UK that wanted to see observe Respiratory Therapy in action. Seems they are fans of the many articles published by RRTs in internationally recognized medical journals and the technological advancements in our ICUs. Improving pt care, decreasing ventilator days, preventing vent assoc. PNA and providing optimal breathing comfort both on and off the ventilators have provided RTs with a wide open universe of opportunity to show their worth. Entry education has now equaled or passed the RN. Other professions that have gotten a heightened professionalism through education include Physical Therapy; M.S. and now Ph.D., Occupational Therapist; B.S., M.S. at entry level.

Our physicians throw new articles at us almost on a daily basis wanting us to keep up with the evolving theories and technology in critical care medicine. Sometimes our budget does not keep up with all of the new technology. So, the RRTs write for research grants or petition a company for a trial to get resources for new equipment.

Sometimes it is necessary to delegate some of our duties on the floors to nurses to free us up for more duties in the ICUs. However, we are still there for training other professionals and can be called for consultation on any patient.

Endnote for the thread;

If Paramedics could kick up their educational standards, more credible opportunities for in research would open up. Debating something such as prehospital oxygen therapy would be in their court at the advantage.

[zippyRN]

Yes I see, we have tried the "generalist approach" to medicine here in the colonies as well but as modern medicine progresses and advancement in the area of pulmonary medicine there has been an identifiable need.

identifiable need for what? another person to bill for?

i really don't see how diluting the care given can ever benefit someone - the best number of people to be responsible and accountable for the care of any individual is the minimum that can safely and effectively be achieved.

Factually many others, such as as OT and combined lab/diagnostic imagery as well. It has become abundantly clear that these discipline (s) are quite essential, tis a pity that the UK has not followed this and dogmatically sticks to it's traditions for traditions sake alone or an anti ring fencing philosophy.

I'm not quite sure what you mean here , especially given that the UK has Occupational Therapists, Radiographers and various flavours of clinical scientist recognised as Health Professionals

I dare to say that job descriptions vary widely from in function to the application of degree level programs specializing in these areas. Physio and RNs here are not permitted in most cases to touch any thing other than the 100% key or silence key unless inadvertent alarms sound on "state of the art ventilators" in fact we as RRTs have generally gained the respect of the vast majority of RNs in the ICU and ER settings, unfortunately there are some old hold outs.

odd then that Uk critical care and emergency care Nurses and our medical colleagues manage to drive our own ventilators quite effectively working as part of a team that doesn't include 'respiratory therapists'

The idea of "cross training" individuals is rapidly gaining popularity here as given a chance it usually enriches both "lateral professions" Hence we do have regulations against the "standard RN" in the back of Ambulances as well as they must actively gain the EMT status, unless they are specialists in transport teams.

the competencies are more important than the collection of certificates and badges - the UK has a open scope of practice for all health Professional groups where expansion and extension of role in the most part is not reliant on gaining a further registerable qualification, and standardso f practice are profession and settign independent

RRTs also do a very admiral job in the home care settings as well, quite independent of Nursing, why would an RN be in care of an individual dependant on a Home Ventilator? or the trached BPD patient or the COPD patient this simply baffles me.

other than their other multiple health needs or is holistic care for the RRT just like holistic orthopaedics in that in might just include the other parts of the system...

Query:

Do nursing sisters still wear the traditional Cap and white smock over there?

not in the past 20-25 years

[VentMedic]

zippyRN,

I'm crushed! You didn't use anything from my post.

Give peace a chance.

There are many types of health care professionals now that have improved pt care tremendulously over the past few years.

We offer offer a multidisciplinary approach to pt care so that something is not overlooked. And actually, healthcare costs are decreased with the shortened vent and ICU days.

Relatively new professions such as EMT/Paramedic and Respiratory Therapy have made their impressive mark in the health care realm. They are still evolving and will continue to grow.

I too can start IVs, hang meds, and manage just about any technology in the ICU. But, I prefer a team approach and am willing to work with anyone who can help improve the outcome of the pt. That is what healthcare is supposed to be about. Egos need to be checked outside of the health care environment. Too much wasted energy on how to get one up on the other.

I have not worked with many nurses from UK in the ICU. I do not know your skills. By your comments, I would say you have not researched our education or skills. I only know the doctors from the UK who have visited and attended our seminars. They are very receptive to innovative ideas and technology.

Let's not put the healthcare profession back into the dark ages. There is still so much work to be done.

[zippyRN]

zippyRN,

I'm crushed! You didn't use anything from my post.

happy now? :twisted:

Give peace a chance.

There are many types of health care professionals now that have improved pt care tremendulously over the past few years.

We offer offer a multidisciplinary approach to pt care so that something is not overlooked. And actually, healthcare costs are decreased with the shortened vent and ICU days.

and this can't be achieved without creating another Health Profession?

contrary to the picture painted by some on tUS -centric boards the NHS is very much into optimising the use of it;sbeds, firstly to keep an eye on costs - and secondly to reduce the average stay to sensible minima ( i.e. having people in the lowest safe acuity of bed )

Relatively new professions such as EMT/Paramedic and Respiratory Therapy have made their impressive mark in the health care realm. They are still evolving and will continue to grow.

I too can start IVs, hang meds, and manage just about any technology in the ICU. But, I prefer a team approach and am willing to work with anyone who can help improve the outcome of the pt. That is what healthcare is supposed to be about. Egos need to be checked outside of the health care environment. Too much wasted energy on how to get one up on the other.

the question has to be asked - why create another professional role instead of addressing the preparation for practice of others ?

it quite often seems the US way is to create a new role rather than address the preparation for practice of other roles and each role likes to carve out it's niche of exclusivity and require others to be registered in that professional group as well if they dare to cross the line i nthe sand. UK health professional development is much more about common standards for skills regardless of who undertakes them and there is little exclusivity or ring fencing of roles

[tniuqs]

zippyRN:

and this can't be achieved without creating another Health Profession?

The creation of the RRT discipline stemmed from an identifiable need here in Canada as it did in the US, the bottom line was that there was a lack of the so called RN specialist in "inhalation therapy" attempting to teach pulmonary mechanics and applications, ad hoc at bedside this was neither not cost effective nor a productive means of delivering appropriate care at that time. Seriously RRTs are now entrenched have been around longer than the caps and gowns "lost" era in the UK and oddly enough the history of Inhalation Therapy originated from ex Korean British RNs. (I am under the impression that they wished to be an independent group as they were frustrated with the dogmatic dominance of the RN umbrella)

Contrary to the picture painted by some on US -centric boards the NHS is very much into optimising the use of it's beds, firstly to keep an eye on costs and secondly to reduce the average stay to sensible minima ( i.e. having people in the lowest safe acuity of bed )

I find this statement rather odd, the cost delivery and reduce the average stay portion? I don't believe you have actually researched the data (could this be why UK MDs are looking across the pond?) as in fact the cost effectiveness of the RRT in the ICU in regards to average stay on a Ventilated patient or any factual studies or sensible minima that you refer to is without real proof it is an based on what again? Conjecture?

Also in passing are the studies that Ventmedic so astutely refers these are beyong highly suggestive and do compare the senior RRT's to the Junior RRT's (we challenge all aspects) their experience in prioritizing and to continue with weaning of Chronic patients when the unit gets busy, a proven cost saving to boot, daily statistic are mandatory in my old department and prove conclusively the statistically value this "new field" of expertise as you would call it. On the other hand RNs have failed to apply this statistical proof of worth, I look into my crystal ball and suspect that this will bite them in the ass not far down the road.

Fortunately here in the colonies, patient care comes first and then a cost effective delivery is the philosophy, we RRT (s) are streamlined in administrative positions as well as RRTs act more independently, the ratio of Administrator to Bedside provider is vastly superior in that regard but then again my experience is only in the frozen northern part of america, I can't speak for my southern allies.

Ventmedic:

Relatively new professions such as EMT/Paramedic and Respiratory Therapy have made their impressive mark in the health care realm. They are still evolving and will continue to grow.

I would certianly hope so, by putting these cross trained members on the front lines of health care may be very refreshing and insightful for the mulitdisipline care perspective dare I say a holistic approach as well, besides the fact that one seat is used in that rig, or onboard that aircraft, a very cost effective to my way of thinking.

I too can start IVs, hang meds, and manage just about any technology in the ICU. But, I prefer a team approach and am willing to work with anyone who can help improve the outcome of the pt. That is what healthcare is supposed to be about. Egos need to be checked outside of the health care environment. Too much wasted energy on how to get one up on the other.

Yea yea, tis very unfortunate that "Paramedics" in a Hospital setting hired as an RT under a "different set of rules" separated only by a piece of glass in a window, we are not allowed in my "hood" to practice to full scope of Paramedicine inside the hospital property this is limited by what philosopy, frankly and I seriously doubt that any "medics" on this site would disagree, as my candid observations have been that RNs are somehow threatened by any other recognized well organized entity. My opinion would be that the dominate Nursing profession is very Territorial like a big dog in fact protecting its turf and growling at any passersby. Could it be that Old School Nursing Practices cannot progress with the times, gosh I hope not!

The question has to be asked - why create another professional role instead of addressing the preparation for practice of others ?

Perhaps administrators are very concerned with the grip that the RN profession has with Unions and Associations and the like that are in areas that seriously impact health care but are NOT cost effective nor best for the system at all. ps I don't know how your System is operated in the UK, but I suspect that just one dominate Union and one may find this is NOT a superior way to manage the System nor the best way to represent ALL the health care workers.

It quite often seems the US way is to create a new role rather than address the preparation for practice of other roles and each role likes to carve out it's niche of exclusivity and require others to be registered in that professional group as well if they dare to cross the line in the sand. UK health professional development is much more about common standards for skills regardless of who undertakes them and there is little exclusivity or ring fencing of roles

ring fencing

Could you please explain this term, I really do not understand this slang, while you are at it, please and thank you in advance explain the the term "POM" that the OZ use to identify the Brits is a bit of a mystery as well, if you would be so kind.

Further, please look at my flag I am so not an American no offence intended: So just how will one accomplish this "meaning acute care medicine" in the future, a 6 year degree level program for Nursing? This would impact negatively on the numbers of registered RNs and fail to provide adequate numbers of the much needed Generalist Health Care Providers for the public at large. Here in Canada and looking down the road the demographic breakdown in regards to the average age of the bedside RN is around 48 years old, so how will your system "with the aging population" be able to provide for this eventuality? Just my opinion again but frankly I would rather work beside a Diploma level RN (with experience) than a degree level RN, they seam to have portions of their anatomy like there "heads" in areas of Exit only.

Quoting Zippy:

Identifiable need for what? another person to bill for?

Well an excellent point in "fact" RRTs are paid just slightly less than their RN counterparts here, so bill for a few cents less and your argument becomes...... well just simply hopeless accomplishing the "required work" for a lowered cost with a specialist trained in that area.

Quoting Zippy:

I'm not quite sure what you mean here ,

Sorry that comment does not make sense to me now as well, I guess it boiled down this :

squint:Tis a pity that the UK has not followed this and dogmatically sticks to it's traditions for traditions sake alone.

Quoting Zippy:

The competencies are more important than the collection of certificates and badges - the UK has a open scope of practice for all health Professional groups where expansion and extension of role in the most part is not reliant on gaining a further registerable qualification, and standardso f practice are profession and settign independent

Have you looked at your offshore programs for the north sea or remote practice in the UK? Frankly and not intending to sound flippant but please look at all the badges, certs, and collections mandated by your boards your pointing the finger the wrong way.

In closing I was taught in school by a Proper British Eductor, so I hope you don't mind that I capitalized your comments, perhaps your having technical difficulty with the SHIFT key I suspect.

cheers and ps: I call myself a Paramedic FIRST, btw.

[tniuqs]

Would it be possible to get back on topic at this juncture?

Apologies all for my boring rant, but I do not think that this "hijacking" of this thread should be continued as professionals.

I was hoping that insight "on topic" would be provided by OZmedic this topic is dear to himself as in other Forums his research is stellar, damn it I just can't find it in my searches.

cheers

[Ridryder 911]

Unfortuantely, like EMS not all respiratory technicians are created equal as well here in U.S. There is not one R.T. in my moderate size hospital that has a college degree. Rather they were grandfathered in and completed a correspondence program. We do have a well developed associate degree program in nearby community and at one time had a cardiopulmonary B.S. program, but the last I heard was discontinued due to lack of interest and employers wanting to pay qualified graduates.

I do agree an well educated respiratory therapist is an adjunct to any unit and hospital. I do not agree that just by having dual education as a medic/therapist allows or qualifies one to be able to work in a unit. The same as in an EMS unit as a RN, the scope of practice, education methodology and objectives are not focused or designed to function in those areas as that type of provider.

R/r 911

[VentMedic]

Apologies to all, this should go under a professionalism thread...except for the last paragraph.

Ridryder 911,

Fortunately Respiratory Therapy in the US has finally gotten together to raise the bar starting last year 2006. 2 year min in education. Also anybody lagging behind as Certified, waiting too long to get their Registry will be left out in the cold. The days of diploma mills are long gone for the RT profession. We haven't "grandfathered" in over 20 years in most States. There were still a couple States lagging about 5 years ago. The 4 year programs are grueling but rewarding if you can make it through. Employers look for cheap ways until they pay for a couple lawsuits. With the heightened JCAHO requirements, no room to cut the standards now. www.nbrc.org

Now EMS needs to get its standards together and raise the bar a little. There are still way to many diploma/PDQ mills mass producing "stretcher techs". I am against other professions being able to challenge the EMT-P. I do believe in training. Another thread...another time...

The point I was attempting to make with ZippyRN, in this high tech society, the days of "jack of all trades...expertise at none are gone". I would prefer someone with much expertise overseeing my lung tissue. Who would I want pulling my loved one out of a wrecked car or rescuing from a hiking accident or being present at a cardiac arrest at the dock? I want a person with expertise in that area. Nurses are very vital to healthcare. However, like other professions, their training, education and scope varies region to region and hospital to hospital. They still have a mail order program in the States for entry level. Enough said...I have too much respect for the nurses that do excel in their education, training and skills to let someone who needs to feel above it all warp my view of their professionalism as a respected team member in the healthcare system...where ever that may be.

Our nurses generally welcome the team approach. Sharing educational/training ideas can show us that we still have a lot to learn. Embrace the changing times.

If we keep shooting each other in the foot as professionals....

Just like the O2 protocol, every different professional with a different level of education, with a different level of training, with different experiences and with a different professional journal subscription will have a different take on the subject. That is what makes medicine so challenging and stimulating that we can agree to disagree and still do what is best for the patient.

[Medicus]

[align=left]

WHAT?

This is crap. Your best treatment to reverse traumatic shock is high flow O2 and fluids. If your Doc is that worried about proper O2 therapy tell him to pitch in on some life pak 12's if you don't already have them and train everyone to use the capnogrphy feature. No big deal, Thats how we roll. MEDICUS