Background: Emergency departments and other acute-care environments depend on tight coordination 
between nurses, respiratory therapists (RTs), and physicians while simultaneously managing high cognitive 
load, staff stress, and continuous physiologic monitoring. These domains interact teamwork affects protocol 
execution, monitoring alarms contribute to workload and stress, and stress can undermine communication 
and response reliability. We aimed to synthesize PMC full-text evidence on nurse RT emergency medicine 
interactions around acute respiratory, psychological stress in these teams, and ECG monitoring relevant to 
nursing care. Methods: We conduct a PRISMA guided systematic review. We searched the PubMed 
Central full-text archive using structured keywords for emergency, respiratory therapy, inter-professional 
collaboration, stress, ECG monitoring, and alarm fatigue. We included original studies reporting outcomes 
relevant to nursing care in acute settings. We narratively synthesized results because outcomes and 
designs were heterogeneous. Results: Ten original studies met inclusion criteria across three clusters 
inter-professional emergency and acute respiratory and critical-care processes, psychological stress, 
burnout in nurses, RTs, and ECG competence and alarm management. Inter-professional on-floor 
education in ED settings was feasible and perceived as beneficial. A nurse, RT-driven asthma pathway 
reduced PICU length of stay, while an ED asthma decision-support approach did not improve time to 
disposition in a trial. Rapid response team implementation was associated with reduced hospital mortality 
and cardiopulmonary arrest rates in a large pre. RT-driven lung-protective ventilation protocol 
implementation increased guideline adherence and was associated with reduced ARDS incidence, but also 
raised concerns about communication for a subset of RTs. ECG education increased nurses’ confidence 
but did not reduce psychological stress about ECG monitoring; ED work experience was associated with 
higher ECG-related stress. Alarm-management training improved behaviors and reduced alarm fatigue.
Conclusion: PMC evidence supports that protocolized, team-based interventions can improve process 
and some patient outcomes, but social dynamics and workload must be addressed. Monitoring competence 
and alarm behaviors are modifiable, yet stress may persist even when confidence increases. 
Implementation strategies should explicitly target communication, staffing, and alarm ecology alongside 
clinical protocols.