It's 8:30 p.m. and an RN is checking the I.V. for an intubated patient receiving mechanical ventilation. Suddenly the ventilator alarm starts to make that loud, annoying noise warning everyone within panic distance that something is wrong. Quickly assessing the patient, the nurse can't identify the source of the alarm, so he calls out, "Where's respiratory?"

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To a respiratory therapist, this simple question sounds like fingernails on a chalkboard. Just joking!! Well, kind of. It seems to me that a more positive approach would foster a better patient-care environment.

I believe that outstanding nursing units across the country have at least one thing in common: a constructive and dynamic relationship between nurses and respiratory therapists working as a team. The first requirement for team building is to know the names of the people you work with. Addressing a colleague as "respiratory" does nothing to enhance teamwork.

I tell my respiratory therapy students to start each shift by introducing themselves to the nurse assigned to the patient on the ventilator. Building a trusting relationship is the first step toward ensuring that the patient will receive the best possible care.

One of the fundamental elements of true team building is to acknowledge the expertise and skills that each member brings to the team. It's important for nurses to recognize the expertise and skills that respiratory therapists bring to the bedside. Likewise, respiratory therapists need to understand the complexities and stress that nurses face when they're responsible for the overall care of a patient who's on a ventilator.

Nurses and respiratory therapists who are part of a vibrant patient-care team know what it takes to perform at a highly specialized level each day. They have a sincere appreciation for their unique roles and don't let "turf wars" develop. What an amazing sight to behold!!

In many units, a major shortcoming in the care of patients on ventilators is that nurses and respiratory therapists have independent shift reports. This immediately creates a potential conflict in goal setting. The better option would be for nurses and respiratory therapists to have shift report together so they can create an appropriate plan of care for each patient. I confess that this model is mostly wishful thinking right now, but why couldn't we make it a reality? Communication, shared knowledge, and mutual respect go a long way toward building collegial relationships and first-rate patient care.

Chris Kallus, RRT, MEd

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Professor and respiratory care program director, Victoria College, Victoria, Tex.