A Day in the Life of a Respiratory Therapist - Behind the Scenes Stories
Today, we're shadowing respiratory therapists to see what really happens behind those hospital doors. Spoiler alert: it involves a lot more than just delivering nebulizers!
5:45 AM: Rise and Shine
Our respiratory therapist Maria "Mighty Lungs" Martinez awakens to her alarm. She needs to be at the hospital by 6:45 AM for the 7:00 AM shift change. Her morning routine includes a quick breakfast and a lot of coffee – she'll need the energy today.
"People always ask how I can function at this hour. The truth is, you never really get used to it. You just get better at functioning while half-asleep." - Maria, RRT
7:00 AM: The Sacred Handoff
Morning report: The night shift respiratory therapists pass the torch with updates on patients:
"Bed 4 is still on 60% oxygen after the pneumonia diagnosis"
"The COPD exacerbation in ICU Room 8 had to be intubated at 2 AM"
"Watch out for the patient in 12B – he likes to remove his oxygen when no one's looking"
Assignment distribution: Maria is assigned to the Medical ICU and part of the general floor today. She'll have about 15-18 patients under her care.
7:30 AM: First Rounds
Maria meticulously checks each ventilator in the ICU, verifying settings, emptying condensation from tubing (affectionately known as "vent rain"), and performing quick patient assessments.
For each ventilated patient, she checks:
Breath sounds
Ventilator settings vs. physician orders
Patient-ventilator synchrony
Tube position
Cuff pressure
Airway pressures and volumes
Oxygen saturation
End-tidal CO2 (when monitored)
Reality check: What looks like a simple ventilator check to an outsider is actually a complex assessment with dozens of data points being simultaneously evaluated.
8:15 AM: The Code
Her pager sounds: "Code Blue, 5th floor, Room 522."
Maria grabs a crash cart and sprints to the elevator. Upon arrival, she finds a patient in respiratory distress. The team is already performing CPR. Maria's role? Manage the airway.
She prepares intubation equipment while the physician performs the procedure. Once the tube is placed, Maria connects the manual resuscitator bag, confirms proper placement through chest rise and auscultation, and then transitions the patient to a transport ventilator.
"In codes, everything happens at once, but somehow, time also seems to slow down. Every team member has a role, and respiratory is the airway expert. No pressure, right?" - Maria, RRT
9:30 AM: Back to Regular Patients
With the code patient stabilized and transferred to ICU, Maria returns to her scheduled treatments. She administers nebulizer treatments, performs chest physiotherapy, and draws arterial blood gases on patients who need them.
Patient interactions highlight the day:
She teaches a newly diagnosed asthma patient how to use an inhaler correctly
She performs percussion and postural drainage on a cystic fibrosis patient
She coaches a post-surgical patient through incentive spirometry
Behind the scenes: Between patients, she's cleaning equipment, charting treatments, and talking with physicians about changing patient status.
11:45 AM: The Lunch That Almost Was
Maria grabs her lunch bag and finds a quiet corner in the break room. Just as she's about to take the first bite of her sandwich, her pager goes off again: "Rapid Response, 4th floor."
The sandwich goes back in the bag for later. Respiratory distress waits for no one's lunch break.
12:00 PM: Rapid Response Team
Maria arrives to find a patient with increasing oxygen requirements and labored breathing. The rapid response team – a critical care nurse, a respiratory therapist, and a physician – work to assess the situation.
Maria suggests switching from a nasal cannula to a high-flow oxygen system and helps position the patient to maximize lung expansion. The intervention works, preventing a full code situation.
Did You Know? Rapid Response Teams were developed to identify and treat deteriorating patients before they progress to cardiac or respiratory arrest. Studies show they significantly reduce in-hospital mortality!
1:30 PM: The Difficult Weaning
Back in the ICU, Maria works with a long-term ventilator patient who's been difficult to wean. Today they're trying a spontaneous breathing trial.
She carefully adjusts settings, monitors the patient's work of breathing, oxygen levels, and comfort. It's a delicate balance – challenge the patient enough to build strength, but not so much that they become exhausted.
"Weaning is as much art as science. You learn to read subtle signs – a slight increase in heart rate, minimal recruitment of neck muscles, changes in breathing pattern – that tell you whether a patient is ready or not." - Maria, RRT
Today's trial shows progress, but the patient isn't quite ready yet. Maria documents the findings and schedules another attempt for tomorrow.
3:00 PM: The Intubation That Wasn't
Maria is called to the Emergency Department for a possible intubation. Upon arrival, she finds a COPD patient in distress. Rather than proceeding directly to intubation, she suggests trying non-invasive ventilation (BiPAP) first.
Working with the ED physician, they fit the patient with a BiPAP mask, adjust settings for optimal support, and closely monitor response. Within 30 minutes, the patient's work of breathing decreases, oxygen levels improve, and they avoid intubation altogether.
"One of the most satisfying parts of our job is preventing intubations when possible. Each avoided tube is a win for the patient." - Maria, RRT
4:15 PM: Education Time
Maria takes time to train a new graduate respiratory therapist on ventilator management. They discuss strategies for reducing ventilator-associated pneumonia, troubleshooting patient-ventilator asynchrony, and the art of weaning.
Sample wisdom shared:
"Always check the simple things first: disconnected tubing, condensation in the lines, secretions in the airway"
"When a patient fights the ventilator, try to match the machine to the patient before sedating the patient to match the machine"
"The art of respiratory care is knowing when to intervene and when to let the patient work a little"
5:30 PM: The Emotional Moment
Maria visits a patient she's been working with for weeks – a 34-year-old COVID survivor who spent nearly a month on a ventilator. Today, he's walking the halls with minimal oxygen support.
He thanks her for all the breathing treatments, the coaching through panic attacks, and for never giving up on him. These moments make all the difficult days worthwhile.
6:45 PM: Handoff to Night Shift
As her 12-hour shift draws to a close, Maria provides a detailed report to the night respiratory therapist:
Patient status changes
Equipment issues
Anticipated procedures
Special observations about each patient's preferences and needs
7:30 PM: The Unofficial Debrief
Before heading home, Maria meets briefly with a colleague in the parking lot. They process the code from this morning, discussing what went well and what could be improved. This informal peer support is not in any job description but is vital for emotional wellbeing in healthcare.
The Invisible Work
Beyond the hands-on patient care, respiratory therapists handle countless behind-the-scenes responsibilities:
Equipment maintenance and troubleshooting
Supply management
Protocol development
Quality improvement initiatives
Interdisciplinary coordination
Student training
Family education and support
The Respiratory Therapist's Toolbox
Beyond technical skills, successful RTs rely on:
Calm under pressure - When everyone else is panicking, the RT needs to remain focused
Adaptability - No two patients respond exactly the same way
Communication skills - Explaining complex concepts in understandable terms
Physical stamina - 12+ hour shifts on your feet
Emotional resilience - Handling both remarkable saves and devastating losses
Problem-solving abilities - Ventilators don't read textbooks
Advocacy - Being the voice for patients who literally cannot speak (when intubated)
Wrap-Up Challenge
Next time you encounter a respiratory therapist in a healthcare setting, consider the depth of knowledge and range of responsibilities behind their work. A simple "thank you for keeping us breathing" can make their day!
Coming up tomorrow in our respiratory series: "Breath Sound Bingo" - where we'll decipher the mysterious whistles, crackles, and rumbles that reveal what's happening in your lungs!
*Disclaimer: This blog post represents a composite day based on typical respiratory therapist experiences and does not reflect any specific individual or institution. Patient names and identifiers have been changed for privacy reasons.