This year marks 20 years that RTs have been regulated health care professionals in Ontario, and some of you, like me, can trace your practice back even further than that. An awful lot has changed in that time – and I anticipate that there are more changes yet to come. Twenty years ago, being an RT was pretty straight forward…with ventilator/airway management, oxygen therapy, bronchodilator treatment and cardiac/respiratory arrests making up a good chunk of what we did. But now RTs do so much more. Some are being crossed-trained with nursing in emerg, ICU, and on rapid response and neonatal transport teams. We’re also receiving delegation for procedures that take us well “below the diaphragm” and to the outer limits of our scope of practice, which according to the Respiratory Therapy Act (RTA) is:
The practice of respiratory therapy is the providing of oxygen therapy, cardio-respiratory equipment monitoring and the assessment and treatment of cardio-respiratory and associated disorders to maintain or restore ventilation. (RTA, 1991, s.2)
To survive and sustain itself, our health care system needs to find new ways to provide optimal patient care by making the best possible use of our finite human and financial resources. Everyone in health care is being asked to do more with less and RTs are now taking on roles never conceived of when the RTA was drafted. All of this is being done to provide patients with access to the care they need, but it can make it difficult to determine if these tasks are still within the respiratory therapy scope of practice of. For example, administering Ventolin via inhalation in emerg is a core practice clearly within the RT scope of practice – you don’t even need to think about that one. Other tasks, such as giving IV Fentanyl for procedural sedation, sit at the outside edges of our scope. As an RT, you can potentially do these things but it first requires some careful consideration.
Our scope of practice is not just derived from the RTA or any other single element. The professional scope of Respiratory Therapy also comes from our education, our experience and from our practice settings. Therefore if we begin with the end in mind – the provision of safe, competent and ethical patient-centred care- then the overriding issue becomes not “can I do that?” but rather “should I do that?” The following are some factors to consider when asking yourself that question:
- Do I have the necessary training and knowledge-base not only to perform the task, but to also manage any potential complications that might arise? (Basically, “…do I know as much about Fentanyl as I do about Ventolin?”) . And how will I maintain my skills?
- If something was to go wrong, would I be able adequately explain why I was the best person to perform the task at this time?
- Is this task something that I, my department and my employer see as being as the best use of my knowledge and skills?
As we move forward into the next 20 years of our profession, we will need to continually strive to create and recreate a balance between the growing demands of the health care system and what is (defensibly) in our patient’s best interest.