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Wednesday, April 16, 2008

Anal RTs in the RT Cave

Usually after 9 p.m. I am by myself, and usually, it seems of late, that all the treatments are due right around 10:p.m. when I'm all alone. Since I'm alone, I usually start at 9:30 and chug along, and expect that by 10:30 I'll be done with all my treatments.

However, it usually doesn't work that way. Being in the field of RT, and having that dam beeper, you can never plan ahead as to when it might go off. And just as I start chugging away at my evening treatments is when ER calls. It's to the point now that I can almost bet on it.

Ideally, on nights when we have seven or more treatments due at 10:00, I think we should have 2 RTs working. However, this trend of being busy will end some day (hopefully soon as far as I'm concerned, however the RT bosses are happy by it), and I'll be so slow around 10 p.m. that I'll be looking for things to do.

So, this gets back then to the inability to plan ahead in this job. Unlike my application for overtime two posts ago, you cannot plan for overtime; you cannot plan when you are going to be busy. It can come at any time of the day or night. It can last up to one hour or three months. You never know.

Last Sunday, when I had that Cerebral Palsy patient come in and I had to spend the majority of my time with him that night, I pretty much didn't do any other treatments. I had to rely on the nurses to call me when a patient needed a treatment, and in a few cases they did the treatment for me. It was that kind of night.

Now, in my defense, by Sunday night, the night in question, I had already had the same patients all weekend, and knew who needed treatments and who didn't. So, when I got busy with this one patient, calling in help to do treatments that aren't indicated in the first place didn't seem to me like a good idea. So, instead of worrying about the un-indicated treatments, I focused on the patients who needed my services and was happy to care for them.

Actually, it got so bad at one point that I walked upstairs with a pack of Albuterol amps and handed them out to the nurses in case their patients called for a treatment, or actually got short of breath. As it turned out only one patient called for a treatment, and he was one of the patients who liked his treatments, but did not need them.

So mooring comes. The ventilator that was supposed to be cleaned during the night was still in shambles in the back room. Stock was dwindling in number as I did not do my job of stocking during the night. And not one of the four QID treatments were started.

Now, none of this would have been a concern of the RTs who work with me on my weekend, but since Monday the other weekend core of RTs work, the A-Team we call them (Anal), the little things matter. And, when I gave report, and it came to light the QIDs were not started, my relief said, "So, why didn't you call someone in to do the QIDs? Now they are all due and I have this vent to take care of."

Keep in mind here that she works solo until the 9-9 RT comes in. "Oh, I'm sorry," I said, being political, "It never even occurred to me. None of these people need treatments anyway, so I wouldn't worry about it."

"But these treatments need to get started," she said anxiously. "What am I supposed to do."

"Just take care of the vent. I'm telling you, none of these people need these treatments. They will be perfectly fine to wait until the Jake comes in at 9. Don't worry about them; trust me."

What I said went right over her head. These are the kind of RTs that have to have every treatment done at exactly the time the doctor ordered them. The Q4s have to be done exactly every four hours, and the Q6 treatments exactly every six hours. That's fine with me that's how they run their ship, but it makes for very little flexibility and high stress if ER calls or something else comes up. These people run around ragged and stressed all day.

Me, and the rest of the people who work on my weekend, are more laid back. We assess our patients so we know who needs them, and we give Q4 hour treatments a half hour leeway, and Q6 hour treatments an hour leeway. That is, unless they really need them. Then we don't dink around.

The Anal RTs are well aware that the treatment might not be indicated, but that doesn't matter: if the doctor ordered it Q4, then it must be done Q4. If the departmental policy says that QIDs have to be started by the noc shift, then that is how it must be. Anything else is grounds for anger and anxiety.

My point is, you can't plan ahead in this profession. You can't be so stuck on the idea of doing Mr. Robinson's treatment at exactly 10:10 because the person who worked before you did Mr. Robinson's last treatment at 6:10. It's only the Anal RTs who work this way, and they tend to be stressed to the max when things don't go as planned.

I suppose, though, that we all have our own way of working, and in the end, we all get the job done because we are all elite RTs. It's just that some of us are flexible and prepared for the interruptions, and don't let them bother us, and other RTs, the Anal RTs, have that anxious edge to them unless things go exactly as planned.

They are great people and fun to work with, and when you follow them you know that all treatments are going to be done, and all equipment stocked, and after hours they might be just as fun to hang out with as any other RT. But the anxious edge to them will be apparent, as they say things like:

"Man, you are going to be busy tonight," or "It was swamped today," "You better have brought your running shoes," or, "I think you better call in for help tonight."

I know, based on experience working with these guys, that I have to get a good report and organize my own worksheet and make my own judgement as to whether I can handle it by myself or not. Chances are, their anxious statements will be way overblown. Not always, but most of the time it is not as busy as they make it appear.

That, my fellow RTs, is the thought of the day.


JSage said...

Flexablity is right. We have to be able to make decisions on our feet as we beat them down the hallways. If in a time pinch I will always go to the guy who needs the treatment first and the "just because" guy last. We have to have the ability to treat patients on a need basis not on a task basis when the unexpected happens. All treatment orders are not equal.

keepbreathing said...

The Anal RT is a common character where I work. It seems that we have a lot of people who are protocol drones and obsessive policy readers, and while I do respect policy and protocol, reality calls for flexibility. Well said good sir!