RT refused to give NEB!

At our facility, RT administers all nebs. We have a patient who is in with aspiration pneumonia. His O2 sat was in low 80s and was in distress. He asked for a treatment, which was amazing because he has been literally too sick to speak for about a week. He had scheduled nebs plus PRN nebs q2h. RT was already on the floor and I asked her if she would give him a neb. Her response was "well, you know nebs are not a cure-all". I kindly said "I never said they were, but he is needing one and its time for one. If you dont want to, or dont have time to, I can do it myself." She said "uh, no, you cant because only RT can administer nebs". lol. I casually asked the coordinator later about it and of course we are aloud to give nebs. I dont know why, but RT gets infuriated when we ask them to administer any PRN neb. I know they are busy, but that is their job and nebs are ordered for a reason.
My personal favorite story along these lines was when I called RT because my patient was in great distress, he was ordered to have treatments PRN Q1hour if needed, he was a real train wreck. Anyway, got told "I'm very busy, I'll get there when I can" and got hung up on. Mind you, this patient was a known quantity and I was trying to NOT have him die on my shift! After half an hour, called again, got same rank RT who said "I TOLD you I was BUSY" and before she could hang up I said "if you don't get here soon, you're going to be busy explaining to the MD why he's DEAD". :angryfire She managed to get there. I'm STILL mad about it!

Did she actually refuse to give the neb? You didn't state that in the thread, just in the title. If she refused, then it's time for a write-up.

wow! I'm glad our RTs aren't like that -sure, I know they get overloaded just like the rest of us, and there are times I've had to wait and worry but I never doubt that they will get there as quick as possible.

That's not good, RT's are busy yes, but if that's what is ordered, they have to give it just as if it is a medication.

I'd get in touch w/their shift co-ordinator, nursing supervisor or write an Incidient/Occurance/whatever report.Recently, we had a 26 weeker on a ventilator waiting for the tertiary care to get there, they were on another transport. We are a level 2 nursery, we don't keep babies on vents. I called RT to take blood gas, when he came, I told him I needed him to stay after he brought the results back. He asked if he could make rounds 1st. "how long will that take" "2 hours" "No, a baby on a vent needs your att'n til it's transferred out, you need to stay down here." Next time I saw the RT dep't head, I verified w/her that that is what the prioritizing was. I felt a little bad that he would probably be behind all, shift, but, if the RT can't prioritize correctly, I'll do it for him.You're in the same position if you have a pt in distress. If the RT can't break free to do the treatment, ask them if another therapist is available. I think you can do it yourself, too.Good Luck!

nah, i doubt it........something must be going on here, because a neb is an MD's order. The RT HAS to give the neb unless it is standard practice in your unit to give the neb.

Wow I'm going to start Rt school in june and I hope I never become like that Rt you described. I've read on this board before that nurses express themselves very good about their Rt's but i guess there are people like that in all professions.

Our RT department is awesome. I depend heavily on their opinions and assessments of our patients.I have run into the situation where when I called RT, I said something like "My pt is coughing pretty hard, could you come down and give him a treatment please?" and have gotten the response, "A treatment isn't going to help a cough." What? You mean that aerosolized saline isn't going to help break up the mucus he's trying to hack up? The coughing won't improve if his narrowed airways open up in response to a bronchodilator?Of course, I haven't actually said anything like this; instead I say, "Well, I'd like you to come down and assess him then, because everything I have tried isn't working, and if I call the doc the first thing he's going to say is, Have you contacted RT, so I'll wait to call until I get your assessment and recommendation." I've noticed that almost always they end up giving a treatment.It seems like I'm hearing this "A treatment won't help a cough" more in the last couple of months. I wonder if there is any new trends in RT that recommend holding off on aerosolized treatments and instead giving oral meds? Or if it is just a couple of otherwise great RTs being lazy or overworked or just grumpy?

We do not have RTs. The RN gives all nebs during her/his med round. If a patient needs 2 hrly or prn nebs we give them. Why can't you give nebs?

I'm an RT and I'm very sorry that that happened to you, last noc I was called in to my PRN job and there was a patient there that is a "No code" comfort measures only. I gave him a TX at the scheduled time and he had no PRN orders for nebs, but a nurse, not his nurse, called me and asked if he could have a tx, I looked on my sheets and explained to her that I just gave him a tx 2 hrs prior to the current time in which she called, I also explained to her that he had no prn tx's ordered, but if she could get me an order, I would come and give a tx. Mind you, I was in my office on another floor. She hung up the phone and apparently tried to call the physician. In the meantime, I decided to go up (on my own) and reassess the patient, I was worried about him. I went up there and I could hear him just gurgling on his own secretions..I went to the nurse and explained to her that I could give him a tx, with a prn order however, I truly felt that the patient needed to be suctioned more than anything. Since suctioning is invasive and traumatic for a patient without an artificial airway, I explained to her that I could do that as well for the patient, but I would need an order from the physician. She explained to me, in a very frustrated tone that "nurses could nasally suction patients at their discretion without a physicians order.." I said, "fine, if you can do it that would be great, but for an RT to do this, we have to have an order written in the chart". She proceeded to find the patient's Nurse and have him suction. We were still waiting at this point for the physician to return a call. Anyways, to make a long story short...hehe, the physician called back, gave an order for prn nasal suctioning and for a stat neb tx. The patient however was completely unwilling to be suctioned but he did take the neb tx. I like being an RT, I love my patients and I'm concerned about all of them. I would love to spend every bit of my 12 hrs assessing and treating my patients in a timely manner, however, some of the RT's out there only focus on their current patient workload. I would gladly dump all of that to fix a patient in distress. But sometimes, when your treatments have to be written off because of priority, the RT dept manager likes to write up therapists that write off treatments...(legal issues and all). I feel like saying that they all need to staff enough RT's to perform therapies and staff 1 RT for emergencies, even if that Emergent RT sits at work all noc and does nothing...The safety of the patients in need of emergent care take precidence over the "clear lung sounding" scheduled q4hr tx's...(IN MY OPINION)SORRY FOR THE SOAP BOXand i'm very sorry that an RT treated you in that manner....Katie

Quote from kate1969I'm an RT and I'm very sorry that that happened to you, last noc I was called in to my PRN job and there was a patient there that is a "No code" comfort measures only. I gave him a TX at the scheduled time and he had no PRN orders for nebs, but a nurse, not his nurse, called me and asked if he could have a tx, I looked on my sheets and explained to her that I just gave him a tx 2 hrs prior to the current time in which she called, I also explained to her that he had no prn tx's ordered, but if she could get me an order, I would come and give a tx. Mind you, I was in my office on another floor. She hung up the phone and apparently tried to call the physician. In the meantime, I decided to go up (on my own) and reassess the patient, I was worried about him. I went up there and I could hear him just gurgling on his own secretions..I went to the nurse and explained to her that I could give him a tx, with a prn order however, I truly felt that the patient needed to be suctioned more than anything. Since suctioning is invasive and traumatic for a patient without an artificial airway, I explained to her that I could do that as well for the patient, but I would need an order from the physician. She explained to me, in a very frustrated tone that "nurses could nasally suction patients at their discretion without a physicians order.." I said, "fine, if you can do it that would be great, but for an RT to do this, we have to have an order written in the chart". She proceeded to find the patient's Nurse and have him suction. We were still waiting at this point for the physician to return a call. Anyways, to make a long story short...hehe, the physician called back, gave an order for prn nasal suctioning and for a stat neb tx. The patient however was completely unwilling to be suctioned but he did take the neb tx. I like being an RT, I love my patients and I'm concerned about all of them. I would love to spend every bit of my 12 hrs assessing and treating my patients in a timely manner, however, some of the RT's out there only focus on their current patient workload. I would gladly dump all of that to fix a patient in distress. But sometimes, when your treatments have to be written off because of priority, the RT dept manager likes to write up therapists that write off treatments...(legal issues and all). I feel like saying that they all need to staff enough RT's to perform therapies and staff 1 RT for emergencies, even if that Emergent RT sits at work all noc and does nothing...The safety of the patients in need of emergent care take precidence over the "clear lung sounding" scheduled q4hr tx's...(IN MY OPINION)SORRY FOR THE SOAP BOXand i'm very sorry that an RT treated you in that manner....Katie

We have many great RTs and a few ...less than desireable... ones. Anyway, the hospital I work at is very large (1000+ beds), and there are pts in 4 different buildings...of course they are all connected, but its quite a way to walk. The way they have our therapists broken up, they have upper floors on 2 buildings that are right next to each other, then they have to travel half way across the hospital to do ONE floor in another building. They get REALLY upset when we call for PRNs, and it's because they are frustrated because they spend so much time running around between the new building and the older ones. I think the enw building just needs to have it's own RT...it's just too far to be able to get anything else done. Anyway, but they end up picking stupid fights with the nurses ("how dare you take the O2 off of that pt???" "He's a DNR-CC and he took it off himself because he doesn't want to wear it." "Well he needs to have it on." "No, he doesn't". "We need to keep his sats up." "No, we don't. He's a DNR-CC, I don't care if his sats are in the 40s, he can leave the O2 off if he wants to". "I know how to take care of a DNR pt. <storm away and ask RN obn other side of unit if it is okay to take O2 off a DNR-CC pt>"). Dumb stuff like that. ]And we had a new admit once (with a ...tricky...family, frequent flyer and such), and he asked for a tx right away. I called the RT, tol him, he yelled at me on the phone for 5 minutes about how he is far away right now and cant just drop everything he is doing to come to my unit stat - I said, I never said stat, I asked you to come when you get time - then made his way over. Then he yelled at me some more. Then he dragged the computer over to show me that it was too early...it was 3 minutes before it was due, and he said, "now i have to explain to my boss why i gave a tx early". I was like, well, you could have waited 3 minutes and been fine. Like I said, they are frustrated with the way they are split and sometimes they take it out on us. But overall, they are good.