Staff at the Heart Hospital of New Mexico “have to know everything” to treat patients.

 Beth Tate, RRT, says a lot is expected of RTs at HHNM

While RTs in various health care environments are kept busy by their traditional duties, the expanded roles of the RTs at the Heart Hospital of New Mexico (HHNM) in Albuquerque keep them arguably busier than a lot of their counterparts elsewhere.

Among the duties of the eight RTs on staff at the heart hospital are ventilator management per protocol for uncomplicated cases and post-open heart surgery; noninvasive ventilation; arterial line insertions, of which they perform approximately 1,100 per year; intubations, of which most at HHNM are performed by the RTs; working in the operating room (OR), including assisting the anesthesiologists with all cases, inserting lines, and setting up the room by calibrating monitors; placing IVs for patients in the OR and pulmonary care unit (PCU); bronchodilator administration, including intermittent positive pressure breathing, and nebulizers; assessing and treating patients per physician order and per protocol; assisting with Swan-Ganz catheter insertion in the PCU and OR; pulmonary function testing, including simple spirometry and complete pulmonary function tests; assisting with diagnostic and therapeutic bronchoscopies; teaching for second-year RT students at Albuquerque Technical Vocational Institute; in-house teaching for nursing and techs/patient care partners staff, including airway management, ventilator, and advanced cardiac life support classes; airway care for tracheotomy and intubated patients; and suctioning patients.

The RTs also participate in performance improvement projects, with each therapist choosing an area of interest and collecting data. Because radiology is only at the heart hospital on a limited basis, the RTs must also have familiarity with x-rays in order to assist the physician team with alerts for potential pulmonary problems.

Two of the RTs on staff are also trained in and are integral members of the peripherally inserted central catheter (PICC) team.

“Basically, they all have to know everything,” says Libby Trowbridge, RRT, team leader of respiratory therapy at HHNM. “I can’t even call them an ancillary unit; they’re a team with the nursing staff. They are called a lot to evaluate the patients.”

The RTs have an expanded practice license through the state that allows them to do other techniques and procedures beyond their traditional duties as they receive training and show competence in these areas.

“There’s a lot expected of us as RTs and as the advanced practitioners that we are,” says Beth Tate, RRT. “We’re really depended upon here. They have a high expectation of us.”

Tate calls the RTs at HHNM “jacks of all trades.”

“I’ve been [an RT] for almost 23 years, and it’s just such an advanced practice here,” she says. “I like a challenge, and I get challenged here a lot.”

A Dream Becomes Reality
Stemming from the shared vision of the New Mexico Heart Institute (NMHI) and Southwest Cardiology Associates (SWCA) for a hospital dedicated to heart care, HHNM opened in October 1999, becoming the state’s first hospital dedicated to the prevention and treatment of heart disease.

In 2002, NMHI and SWCA merged under the New Mexico Heart Institute name. The heart hospital is now owned by MedCath and NMHI.

The Heart Hospital of New Mexico is located on an eight-acre tract of land neighboring the St. Joseph Medical Center campus, and offers a comprehensive range of heart care services. The two-story facility includes three operating rooms with complete facilities for heart and vascular surgery, four cardiac catheterization laboratories, seven emergency and trauma rooms, 55 inpatient beds for acute and critical care, and 10 beds for day patients.

The RTs mainly see patients with respiratory distress, pneumonia, myocardial infarctions, and congestive heart failure. “We get the sickest of the sick,” Tate says.

Besides New Mexico, the hospital receives patients from bordering Arizona, Colorado, and Texas.

Working at the specialty hospital has provided the RTs with experiences, responsibilities, and respect on a larger level than they say RTs often get in general hospitals.

“My staff loves it because they have a level of responsibility that they would never have anyplace else,” Trowbridge says. “Their opinion is valued, and I think that’s the most important thing to them.

“They also like it because they get a level of education they don’t get in other places,” Trowbridge says. “This has been very much on-the-job [learning].”

The RTs work mainly with the hospital’s anesthesiologists, and continually learn from the physicians. Tate credits the anesthesiologists for the RTs’ training. “A lot of it we learned about in respiratory education, but we never had the opportunity to use, such as arterial lines,” Tate says. “It was definitely being in this environment that [enabled me to learn] all of these other things.”

Trowbridge says that while the workload for the RTs at HHNM may seem overwhelming, the all-encompassing model should be copied at other facilities, especially in the critical care areas.

“More RTs need to do this,” Trowbridge says. “We [in the field, in general] have shot ourselves in the foot in a lot of ways because we’ve given up so many of our responsibilities to nursing.

“[At HHNM], we’re recognized as a resource. We work with the nurses, and we are the resource for respiratory,” Trowbridge says. “This, to me, is the way respiratory should be.”

Danielle Cohen is a staff writer for RT.