RT bosses, admins think on different level as RTs

I can kind of understand why the administration here at Shoreline has been having conniption fits lately, and why they have been clamping down on on us lately, as I come to work today to learn there is an entire patient floor closed due to lack of patients.

As I wrote in a previous post, the size of this hospital is too small to be considered a large hospital, and too large to be considered a small hospital. As we are too small, we don't make enough money to be able to have extra staff on hand, which should explain to you why I have to work alone on nights regardless of whether I have eight patients on my board, or 22.

We are too large to receive government grants. Which is funny, because when I used to work at Death Line Medical Center, which is about 40 miles from Shorline Medical, I never could figure out how they could afford to have two therapists during the day. The RTs there never got called off, even if there was no work. When I worked there I was told, "If you are scheduled, why would the place call you off?"

Well, here at Shoreline, when it's slow, people get called off work. So how could these two hospitals so close together have such a different view on when to call workers off? I'll tell you the answer, Shoreline is located in such the perfect (or imperfect) location where we have just enough more patients than Death Line that we are over the line that would classify us as a small hospital. And, since we are over that line, we do not qualify for government grants.

So I suppose when the patient load is down, like it is today, workers get called off. The surgical floor and the step-down unit have both been closed, and, of course, all the staff that usually works over there are getting called off. While over at Death Line, even though their census is down too, well, they continue to make their paychecks.

That's just the way the medical field is. In September and October, if you remember from my posts, we were so slow for so long I wondered if it would ever pick up. Then from November through May we were so busy all the staff here was getting burned out. Now the cycle has come full circle, and we are excessively slow again.

So, I can see why the administration would make a big deal about a few miss charted treatments. If we were busy all the time like some big city hospitals, then I don't think the administration would have the time to worry about the minor things. If we were small, and the hospital received extra money from the government to cover its debt as is the case with Death Line, I don't think it would matter either.

But, since Shoreline is not small and not big, the administration spends that extra time looking at all the statistics. They get bored and instead of taking care of more important matters, they sit around double checking all our charting to make sure we dotted all the i's and crossed all the t's. The get nit-picky. And sometimes they make decisions that they see as for the better of the institution, yet they forget to involve us in the process.

And that, my friends, is why some RT departments might develop a low morale from time to time. The admins don't intend for morale to dip, but it just does. It does because the staff feels like the admins are making a big deal out of spilled milk. And, quite frankly, they are making a big deal out of spilled milk. But, as more and more smaller hospitals are merging, or closing their doors, Shoreline has managed to stay afloat -- alone. So, perhaps, this little nit-pickiness is a necessry component of independence.

Now, whether this battle to maintain as an independent hospital works to the advantage to us RTs or not I have no clue. Part of me thinks it would be bad. But, the other part of me thinks that if we merged with Aero Medical Center, that we would all get nice hefty raises so our staff would be paid as well as their staff. As, being a smaller hospital (not small enough, not big enough), the administration here will not even consider the idea of giving us all hefty raises.

But why would they give us raises? All the RTs in this department have been here so long we are all complacent. We have worked here so long, have so many friends here, love it here so much, are comfortable here, that we wouldn't go anywhere else to work. In a way, that's true. I am comfortable here. I love it here. I have many friends here. I'm complacent. And, while I could go somewhere else, I don't. It's far easier to stay here. Besides, if I decided to take another job, at Death Line for example, I'd have to drive. That's wear and tear on my car, and, hell, with gas prices at near $4.00 a gallon, I'm better off staying here, where my drive is only five minutes.

And, with 10 RTs here, and all of us in relatively the same boat as me, the administration can afford to push us a little bit. And this, what I write today, is some of the mentality behind the administration forcing our RT bosses to crack down on our charting, making a big deal of little errors, and make an attempt, as my fellow RTs and I like to put it, to make us perfect.

While I do have a bachelor's degree in business, and an associates in respiratory therapy, I still don't know as much about hospital administration as some of you guys. If I am ever to move up the ladder and become one of them, there is a lot I have to learn. However, I would imagine that my analysis here is not too far from reality.

Usually here at Shoreline the morale is high. Usually, all we little RTs and RT bosses and administrators get along. Some of us get along in close little friendship type relationships, and some of us in good little business relationships. Some of us, like me, have a combo of the two. But on occasion the administration pushes our buttons just because they can. And slowly but surely the morale will decline. The morale will decline until someone gets tired of it all and mossies on into the RT bosses headquarters for a little chit chat.

Then, once the RT bosses realize that they pushed us a little too far, they back off. Then morale starts to climb. Then things get back to normal for a year or so until someone in the administration gets another idea, and the RT bosses, or the administration itself, pushes us over that line again. They will wait just long enough so they think we forgot the last time they tried to cross the line. But we are smarter that: we don't forget.

I've worked here long enough now to know this is how it goes at a hospital that's too big to be small and too small to be big. That's just how it goes.

Tonight I came to work with a self diagnosed acute exacerbation of chronic laziness. I feel this way not just because I had too many days off, but because the patient census is so low again. Now, I'm not making a big deal about this, because I love it when its slow because I get paid to blog, as I'm doing now. And perhaps I blog too much, but you guys can be the judge of that. But the downside of a low census, as I've already explained, is that the admins get all stressed out. And when the admins get all stressed out, so too will the RT bosses. That's just how it goes.

This time around, it was my turn to let the RT bosses know they went too far. I had my little chit chat with the head RT boss. I had to tell him that morale was down. That it was so bad that even people in ER were asking me about the "tension" in the RT Cave.

"What?" he said. "I didn't know tension was that bad?"

Well, guess what? There ain't no tension anymore. While the RT bosses still want to improve our charting, improve the little things, they have backed off. It's like clockwork. I know these guys like the back of my hand.

Sometimes, as I sit here thinking about it, I think I could do that job and better than those guys. I think if I were the RT boss, there would be no lack of communication, particularly because I've worked here on nights for 10 years and I know what it's like to be on this end and I'd have empathy.

Then again, both RT bosses were RTs once upon a time. They are both dragons now.

Then again, I think that once I cross over and become an RT boss, I will slowly but surely turn into one of them. I will slowly turn into a dragon. I will slowly forget about simple RT mindset, and start thinking in terms of money. For RT bosses, money is the bottom line. And money can do a lot of damage to ones mind. Hell, just look at Hollywood for some good examples of that. RT bosses aren't' far removed from that crowd. They get a little wacky sometimes. They don't think rationally. I'd like to think I'd be different if I were an RT boss, but would I?? Who knows.

Now, getting back to the size of this hospital. Death Line has remodeled all its rooms so that all patients now get a private room. They have remodeled all the OB rooms so there is a hot tub in all the rooms -- and they are all private too. And they have a brand new ER. I've decided they get to do all that because of the government grants, which they get because they are just a little less busy than us and are qualified by the Fed as a small hospital.

Here at Shoreline, well, we are stuck with an ER that is just too small, especially in the summer when all the visitors flush into the region, and an OB that is way too old for modern times, and patient rooms that are too small for all the modern equipment and two patients per room.

Yet, even while we have this old facility, the admins have managed to keep it looking pretty sharp. While we have an old ER, we have a damn good staff. While we have an old, rickety OB, we pride ourselves in knowing we have a far better staff than Death Line. We take care of our patients as good as the best big hospital, the best small hospital, and the best hospital that is too large to be small and too small to be large.

And, for the most part, except for a few bumps in the road, the morale is high here. We are all one big happy family. All the units work well together, and I know it's not like that at all hospitals, as I've worked for some where there was no click between departments. And since we all know oneanother on a personal basis, because this IS still a small town no matter how the Fed wants to define Shoreline.

So, while the admins at this too big to be small and too small to be big hospital can sometimes get a little anal about little things, things that would be totally ignored in other hospitals, they still do a pretty damn good at keeping this place together.

Hell, all they would have to do is go down into the basement and look at the main computer to see that I've been blogging here all night, and they could make a big deal about it -- but they won't. They won't because I hold this RT Cave up while they are away. I make this place look good (except for my little piddly mistakes).

And besides, because I'm complacent here, because I have kids in the local schools I'm trapped in a way in this small town of Shoreline. I come to work every day not just because I want to, not just because I'm a great RT, but because I have to. I have to because the alternative would mean moving my kids to a new school again, and I don't want to do that.

The admins know this. They know this because this is how it is for about 80% of the people who work here. Because of this, and because they know I love the aura here at Shoreline, an aura the admins helped to create in those many periods of high morale, they know they can get me for a cheap wage. The funny thing is I know this, and yet I'm still here. I know their game. I'm just smart enough to know their game.

So they won't say a word to me any more about this little game they have been playing about being perfect. Because, as I told the head RT boss the other day when I approached him in a civil manner, "I do not have to stay here. None of us have to work here. We work here because we love it here, but we do not have to stay here. So let's move on."

And we will. For the next two or three years the admins will not try to push us over that line. And they better not, because I could just as easily go over to Death Line and work for a better looking yet inferior institution.

Then again, they might call my bluff.

The RT Cave is living 20 years in the past

You know what I also think is cool is free music downloads off the Internet. I've always been sort of frivolous my whole life, and have found better things to spend my money on than music. Not that I don't like music.

When I was in college, nearly 20 years ago, my friends all had CD and stereo players, while all I had was a few tapes of my favorite artists. It was during those few years that, probably while having a few drinks, I discovered music.

All my friends were from Big City, and their tastes in music seemed to be different from us small town folk. In fact, even what they wore seemed to be, well, twenty years ahead of us. They always joked with me that I was 20 years behind the times, which was probably true. I told them I preferred it that way.

But they were still cool. And we still had lots of cool times, especially when we pulled out their CDs to listen to cool tunes. And usually after we had been drinking, and were drunk, we'd pull out Pink Floyd. That was so cool listening to with a good buzz. Probably the only thing better would be Bob Dylin, of which neither of them had.

Those good years of college lasted only 2 years before we parted ways. I never saw those chaps again. I lost complete contact until the advent of the Internet. And I lost complete contact with Pink Floyd and all that great music until the advent of free downloads on the Internet.

So I listened to Floyd, and did a search on the net for my old pals. I found them. That was so cool after 20 years. We were all journalists back then. I almost didn't click on the link to the law firm. None of my friends were lawyers, I thought. Fritz was. How cool.

Ray didn't change at all. He was working for his parent's factory. That's what Fritz and I figured he'd turn out as, despite four years of college -- er, partying. I don't think he ever changed. Cool. Now he lives a few blocks from the Major League baseball team. Cool. Probably still partying, but listening to 2007 tunes -- tunes we'll discover in 2027.

Ray sent me an email: "After all these years you're still listening to Floyd."

"No," I wrote back. "We live in a small town here, remember. We are 20 years behind you guys in the Big City. We are just discovering Pink Floyd here. What you guys showed me back in the 80s was a glimpse of future music. And it's pretty cool."

And now, while I listen to Dylan classics I heard about but never listened to before (it's so cool discovering old classics), I'm thinking how true it is that we are 20 years behind here in small towns.

It's a lot less stressful, living in the past that is. I suppose it's easier for us if we let you guys experiment with the new stuff. You'll reap the rewards of what works, but you'll have to suffer with what doesn't. I think we small city folk like it that way. We tend to be more conservative. We like to avoid all that stress

And, to relate this to respiratory therapy, it's true in our hospitals too.

Think about it. In the Big City hospital that old BiPap machine has been in the back of the closet collecting dust for about 20 years now. We have only recently stopped using it. The same is true with those bulky mist tents. And, while the Big City hospital has been enjoying protocols for a while now, we are still being controlled by doctors.

However they are just starting to show signs of giving up some of that autonomy. It's so cool. And we RTs appreciate it. Well, most of us do anyway.

I wonder when it was that protocols first became the thing at Big City hospitals. Whenever that time was, just calculate 20 years later, and that's when we'll catch up with you guys. Until then, we'll enjoy the past.

Perhaps these free music downloads will allow me to listen to the same music of the Big City folk. I doubt it though. So, whatever you guys listen to in the big city, about 20 years later we'll catch up.

Wham! We got hit hard today.

It was a nice Christmas break. I had just clicked the songs I wanted to listen to and slouched back in my computer chair with the intent of relaxing the half hour before I had to pack the kids and leave for work, when the phone rang.

"Hello," I said. I knew it was my wife by the number on the caller ID. She split a shift with one of her co-workers because there were no patients in OB. I figured she was bored.

"Well," she said in her usual cheerful manner, "Are you ready for work?"

Okay, now why's she asking that? "Yes."

"I guess ER is going to ship someone by ambulance and they need you. And also have a bad kid. Can you come in?"

Shit! That doesn't sound good. "Can you leave work early."

"Well, I guess."

"Then I'm good as there."

"Okay kids," I said, hanging up the phone. They both looked at me. Now, how the hell do I get KK to cooperate here. I know "There's a really sick boy at the hospital and I need to go help him out." That ought to get them rushing along

My quick whit worked like a charm. My 9 YO quit his game and was standing by the door with his coat on before I even had a chance to grab his sister's coat. My 4 YO, KK, gave me no trouble either, unless you consider 1,000 question to quench her curiosity about the little boy trouble.

"What's wrong with the little boy?" She stood still while I slid the coat over her arm.

"I don't know." The other arm was a little tricky. "There you go."

"Is he sick?" The zipper was stuck.

"Yes."

"Is his mommy sad?"

"I bet she is." This damn zipper. Ah, there it goes.

"Mommy doesn't like that zipper."

"I bet she don't. Here, slip your boots on."
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You know when you get a call an hour before you're supposed to be to work things aren't going well.

"What do you want me to do?" I asked Jane, who was huffing and puffing down the hall when the elevator door swung open.

"Oh, man, I'm glad you're here."

"I absolutely refuse to go for an ambulance ride," I said. I was joking.

"Well, then I'll go. If we need to go." She didn't catch my joke. It must have been one of THOSE days. She's turned into a no nonsense Jane.

I get the hint. "Oh, so we don't have to go with the ambulance."

"No, Air-Flight is here to take the guy." Awesome

"Cool."

"Here's the treatments we didn't get to yet." She circled six patients on her board. "If you could just do these, I'll handle the unit and ER."

"Why don't you just give me the beeper." You look exhausted. If I had a clue what was going on I'd probably send you home.

"I'll keep the beeper for now," she said, "I think we're going to have to intubate the kid."

Shit. The kid's not intubated? "Oh, so you have two bad patient in ER?"

"Hell, yeah. Not only that, we have a vent and a a Bipap in the unit."

"Are you alone?" I hope you didn't do this alone.

"No. That's just it; Nell is putting together four airway boxes. We've both been too busy intubating patients to do anything on the floor."

"Why don't you give me the ER beeper and you can do these easy treatments. You look exhausted." She did.

"No I'll take care of the vent and then I'll go to ER. If we intubate the kid I'll find you."

Within the next 20 minutes I knocked off all six treatments. Two had gone home, and one was sleeping, which made my quest easy. When I got done I wandered back to the unit where Jane said she'd be. She wasn't there.

The CCU nurse corned me, "Rick, we need inline suction hooked up to the vent."

"Now?" My question received no answer, as the nurses were busy rushing from here to there, answering call lights and responding to beeping IVs. Jeeze, you'd think this were a busy hospital like on TV or something, but this type of rush has turned into a rare occurrence of late. It used to be like this all the time. What happened?

Anyway, I connected the suction, and then the vent started to alarm. Shit! Where are you. You gotta be around here somewhere. It had been so long since I had a vent here that I couldn't' find the silence button. Ah, there you are
--------------

Jane must have been looking for me while I was looking for her, and when I finally found her she was bagging a 1-year-old boy while the Big City Hospital Air-flight doctor was holding the tiny tube in the little boy's mouth. The doctor was standing at the head of the bed.

Holy cow, I didn't even know Air-Flight was coming for the kid. This is good for us. Which turned out to be not so true. While Air-Flight usually took complete control over bad kids when they got here, they made us work this time.

I looked back at the Air-Flight patient bed and it was indeed a small one. So, I decided that this was not the same crew that was supposed to take the intubated adult who was hiding someplace else in the ER, if they hadn't left already. This was indeed THE pediactric crew. How the hell did they get here so quick?

When I looked back the boy was trying to thrash his head back and forth, and Nell was holding the kid's head steady.

The Air-Flight nurse gave orders (I thought she was the doctor at first the way she was giving orders) for something to calm the child down. I don't remember what the med was, but within a minute the child stopped fighting.

I walked over to Jane and stood by her. I thought about asking her what happened, but didn't want her to have to explain again, as the mom and dad were both leaning against the couner watching on with concerned eyes. The mom wiped tears from her face. Instead, I said, "Why don't you give me your beeper."

She reached into her pocket and handed it to me without hesitation, a sure sign that she was ready to get the hell our of Dodge. "Here," she said, "Why don't you take over this." She motioned for me to take over bagging.

Shit! I should have kept my mouth shut. Not what I wanted, but okay.

I took the tiny bag and continued bagging the same rate and depth Jane was, with about half a push on the bag with one hand. At first I was afraid if I used two hands I might give too much air and cause a pneumo or something to those tiny lungs. I most certainly didn't want to be responsible for that. It was a job that took deep concentration. All the while I had to keep an eye on that tube and the sat, which dropped every time the tube jerked. I learned to bag with a steady hand.

Then, however, the Air-Flight nurse took the bag from me and gave a full-force breath, squeezing the bag so one side touched the other.

Shit! That's a lot of air for those tiny lungs. But, you're the experts on kids. Right? You know what you are doing.

She handed the bag back to me and I continued bagging, the way I thought it should be done.

And now I watched as the Air-Flight nurse attempted to secure the ETT with a trach tie. It wasn't going to happen, as the tape kept sliding off the boy's head. I thought about volunteering to do it, but I decided that she was more of an expert on pediatric airways than I am. She deals with these little stressful aireways all the time.

I watched the ETT carefully as Red-frothy secretions poured from the tube, and I didn't say anything right away because the airway wasn't secure yet. The flight nurse continued to struggle.

"You need tape."

"Oh, no, I have it." She did not have it. I didn't care, really, as I know it could
just as easily be me on the spot. Then I smiled as she reached for the tape. Give up, hey?

"We need a breathing treatment," she said as soon as she finished tying the knot over the boy's cheek. "We need to get a treatment in here."

A breathing treatment is the last thing this patient needs, I thought. What this patient needs more is to be suctioned. I looked around and saw the doctor was just standing there at the head of the bed now that the tube was secure. "Would you suction, please."

"Oh, yeah, sure," he said. His equanimitous nature was impressive given the choleric co-hort he had for a nurse.

"Are you sure we need one?" I heard Jane Sage declair from the other side of the room. I thought you left. I guess I was wrong.

"He's in pulmonary edema," Jane said. "You sure he needs a treatment."

The doctor stood watching over the patient, and Nurse Ratched continued to work her magic with needles and bottles of medicine and, of course, giving orders. She was busy, and she did an excellent job for the most part. I couldn't imagine doing all this without her expertise. I know I'd be a lot more stressed, let alone our poor nurses.

Jane must have decided to give up her protest, as I no longer saw her in the room. I believe she took her time, as twenty minutes later the flight nurse was asking, "Where is my treatment?" Shit, Jane, where are you?

"Ah," Nell said, "She will be right down." You have no clue where Jane is, do you Nell? Cool.

"If I knew you were going to take this long I'd have sent my pilot to get our adapter in the helicopter," Nurse Ratched said while inserting a foley catheter.

Then why didn't she just do this to begin with? It would have saved us a lot of stress, and we wouldn't look so stupid running around looking for gadgets. She was probably enjoying it.. "I think it would be a good idea if you did that," I said.

Jane was REALLY taking a long time. I wondered if this flight crew was thinking we were a bunch of jack-asses. How often do you have to give a treatment while bagging? And, usually when we have the adaptors available, we never use them. It's only when we don't have them available that we need them. Is that in Murphy's law?

As soon as Jane came back with the jury rigged treatment adapter she plucked it between the bag and the tube. Then, like clockwork, the ETCO2 shot up and the PO2 shot down.

"Stop the treatment!" Ratched ordered.

Jane popped the treatment out of the circuit..
-------------------------

"Why the hell did they want a breathing treatment?" I asked Jane as soon as we were back to the RT Cave.

"Beats me," she said, "The patient was wet. That's why I wanted to get the hell out of there, because I about had it with this crew. Usually I'm really impressed with Air-Flight, but not today."

"I was thinking he didn't need a treatment, but I didn't want to say anything because I was just kind of thrown in the middle of this and didn't know what was going on really." Through the window I could hear the noise of the helecopter.

"Well, you didn't miss much. Nurse Ratched was bagging so hard I feared for the kid." She looked out the window and watched as the copter lifted off, turn, and
shoot into the distance. A moment later I could hear the humming of the heater.

"Oh, you saw that too. I figured she knew what she was doing of all people." The helecopter was now a mere blur in the distance.

"I have the utmost respect for most Air-Flight nurses, but they are human, and prone to mistakes in judgement, as you saw from the demand for breathing treatments."

"I saw it all right." I slouched back in my chair. "What was wrong with that kid anyway? I never really got the scoop."

"He drank Kerosene."

"Kerosene?"

"Yeah. You know, like from a Kerosene lamp."

"How the heck did he get access to that."

"I guess it was set out for decoration, and he... well, you know kids."

"Yeah. That's why I put all that kind of stuff up."

"Anyway, we got your shift off to a good start."

"That you did."
-----------------------

Jane left and I trudged back in the unit already feeling burned out. I learned my Bipap patient was changed to comfort measures only, and he was moved out to the floor without Bipap and not on treatments.

Then, as I was doing my vent check, my vent patient started seizing. The nurse was standing at my side, and she informed me the patient was JUST changed to a DNR. My luck is turning out to be better than the day shift's.

No more therapies due until morning, unless more bad happens. But, these bad things usually come in threes, and that kid was #3. I should be set. Right? Or did I just jinx myself.

This is why I am proud of my job as an RT

Where I work there are only two of us who work nights on a regular basis, so about 8 years ago we got together and tinkered with our schedule. We created the ideal work schedule for the both of us.

My schedule works perfect for a family man, because every other week I have six days off in a row -- it works out like a mini vacation.

I do have to work a four day weekend every other week, but it comes right after my six off, so I'm usually well rested. Basically, I'm four on, two off, two on, and then six off. It's the kind of schedule most people only dream of.

If I want to take a longer vacation, usually all I need to do is take off the two day stretch in the middle of the week and I have ten days off. I usually do this three times in the summer. Last summer I added the days up, and I had over 50 days off in June, July and August. How's that for cool

One of my coworkers likes to say, "I work so I can get days off." I love that line because it rings so true where I work.

Yesterday Carrie and I both had off, and we went to the Big City where my family were to meet for our annual Christmas party. I come from a family of six, so getting us all together is very hard these days, especially considering we are spread out all over the state. But, despite the weather forecast of freezing rain and strong winds, we all made it but one of us.

We all had a blast, despite the fact we only had 2 hours to spend there before we had to get going . We wanted more than anything to beat the weather. On the way back the roads started out nice, and continued to get whiter and whiter and narrower and narrower and darker and darker, and I kept driving slower and slower.

By the time I got to Shoreline county I was driving 40 mph, and snow was falling fast. At times it was a complete whiteout, but I kept moving forward hoping to get some view of the road. It was rough, especially with daughter getting impatient in the back seat. It's not easy keeping a tied in 4-year-old entertained in the car.

And, it never fails, that even when you can't see the road and you're driving slow, some trucker passes you going what seems like 100 mph spewing snow and slush into your windshield making it nearly impossible to see. I'm amazed I've never seen one of those guys wipe out in front of me.

Today KK wanted to go outside and make a snowman, and I wanted to take her out, but it rained for most of the day. So instead of going outside I played Super Mario Baseball with JJ, and later played an amalgamate of games with KK. I don't know if my kids will ever appreciate all the time I'm able to spend with them.

When I was a kid (I hated when my mom always said that), my dad worked 10 hour days at his business, and then he came home to eat dinner, and then he left to work on his apartment houses. When he managed to get a day off to spend with us we really appreciated it. My job allows me to spend lots of time with my kids.

I hope they still appreciate it.

Well, I still have three days to go. Carrie is working right now, and she'll work again tomorrow. So pretty much it's just me and the kids until Tuesday. That will be my night to go to dinner or a movie with Carrie. I'm really looking forward to that.

You can't beat this. This is one of the greatest of all the benefits of working as an RT at a small town hospital.

Grumpiness stays in the RT Cave

For whatever reason business really picked up last weekend. That, coupled with the chronic lack of sleep and family life, brought me to work on Thursday night on the edge of insanity.

While I'm normally pretty equanimitous no matter what I'm doing, I grumped to my co-workers as soon as I saw the increased number of patients on the worksheet. I clicked on the worksheet I-con on the computer and deleted all the diagnosis's and put in my own.

Here's what the new worksheet looked like. I've always been a proponent of writing reason for treatment instead of diagnosis, and that's what I did here:

• Post-op Bowel: Just because


• Post-op Bowel: Just because


• COPD: needs


• Liver CA/ sepsis: needs


• Hip Fx: Jealous of room mates treatment


• Asthma: exaggeration of


• Pancreatitis: Had a cough once


• Failure to thrive: Nosocomial COPD


• Pneum/COPD: needs


• Hip FX: Bored, needs attention


• Failure to thrive: had ronchi at admission

"Rick you're grumpy," my co-worker wailed. She was a complacent.

"I'm sorry," I grumbled, "but I'm sick of running around doing these useless breathing treatments when I got patients who need my services. All this crap does is wear me out."

She looked at me stunned. She was surprised at my sudden anger, I could tell. She was knew I enjoyed RT humor, but to complain like this was not normal for me. And, if that's what she was thinking, she was right.

I took a deep breath. "Well, now that I got that off my chest, how about report." That was the end of the outward grumpiness for the most part the rest of the night.

However, when a nurse called me to do a treatment on a CHF patient I had just recently did a treatment on, I was blunt on the phone: "She doesn't need a treatment."

"But," the RN said, "She's short-of-breath and wheezing."

"Did you get her up to the bathroom?" That's the only way she'd get SOB that fast, I knew the type. I know my patients that well.

"Yeah, we got her up to the..."

"Well, that's why she's short-of-breath. All you need to do is let her rest." She's a cardiac patient. She has a weak heart.

"But she's really..."

Right here the professional Rick turned on. I know from experience that all the explaining in the world isn't going to work with this RN. "Hey, I will be right there." I should have just said that in the first place.

Being the consummate professional, I knew that I couldn't let my exhaustion effect my work, and whether the patient was recovered in 2 minutes or not I was going to check on her just to be on the safe side. I think all responsible RTs would do the same.

However, I took my time getting there. I was almost certain she'd be fine with rest, and that she really didn't need a treatment for anything other than an oxygen boost.

When I looked in on the patient she was sleeping comfortably. Even though I believe that if someone is sleeping she's comfortable -- most of the time. I woke her anyway. "Hi Mrs. Dee. I'm sorry to wake you."

"No problem, Rick. How's it going today."

"Wonderful," I lied, and then smiled.

RT Cave Rule #8: A true RT professional never carries a mood into the patient room. It's best to keep it in the RT cave.

"I heard you were winded. Are you feeling better?"

She confirmed she was fine. Then I left the room and hunted down the nurse. I probably could have left it at that, but the political me wanted to make sure things were square with the nurse. After a brief hunt, I found her.

"You called for Mrs. Dee, right?" I said.

"Yeah. She's sleeping now, though," the RN said. This was a very nice nurse, but in the past I've had trouble explaining to her RT facts.

"Uhuh. I woke her up anyway. She's a nice lady."

"Yeah. She was really short-of breath. And she was really wheezy."

"I know," I said. "It was a cardiac wheeze."

She gave me a look I interpreted as the, "you are a prick" look. She was thinking I was just another lazy RT. I know when you're exhausted you see problems that aren't really there, so I considered this and decided I would be best to walk away.

The rest of the night I went from one procedure to the next. You know those nights: every time you sit down the pager goes off. By 4:00 in the morning my eyes are burning and my body felt
like it would melt at any moment. My feet were killing me. All of you guys have been here at some point, or will be. Heck, you city dwellers probably go here every day.

My boss called me. I have no clue why she comes in so early, but she does. I trudged to the RT Cave. "Hey, Boss."

She was blunt: "I saw what you wrote on the treatment sheet, and I changed them for you. If Julie saw those she'd write you up." I could tell she was in a good mood. Hell, why wouldn't she: it was her Friday. She didn't have to work weekends like the rest of us.

"Yeah, I meant to take those off by now, but I just didn't get a chance yet." It was the truth.

"You shouldn't put those on there."

"Who's gonna look at my board? And if they do, they'll learn the truth." I tried to feign a smile, but my face was stayed limp. That's how tired I was.

"You know it's not very professional." She was never shy of saying what was on her mind.

"I don't care," I said. I normally would have said something more professional, but when you're really exhausted your true feelings slip out at times. It was one of those nights. "I'm sick and tired of running around ragged when I shouldn't have to."

"I know," she said calmly, "but you really need to stay professional."

"You're right," I said, and set down at the computer to make my changes. Then I thought what I really wanted to say:

I'll be professional all right. When she writes me up, I'll be real professional in front of the admins and explain to them the truth about what the doctors are making us do. I will. Then they'll really be able to cut back on unecessary costs. It's time one of us spoke up. That's the reason things have gotten so bad is because nobody has the nerve to speak up.

"Was it really so bad," the reasonable part of my mind said, "You love your job."

As all of you RTs know, professionalism is more important than releasing frustration. And that is why we participate in RT humor amongst ourselves. That is our release.

This was a very rare occurrence for me to feel grumpy like this. However, and my point in writing this, is while I felt one way, not one of my patients had a clue I was grumpy. And, hopefully, not one of the nurses did either.

The only people I vented to were fellow RTs. Then, to the best of my ability, I left my grumpiness in the RT Cave. A true consumate professional becomes very good at doing this even in the worst of nights.

Good night at Shoreline

I have to admit that despite getting called STAT to ER a few hours ago to do a sputum induction, I'm having a pretty decent night tonight.

The patient load yesterday morning was down to only five patients, so Dee worked solo days. And, which usually happens when one of the day shifters is called off, all hell broke lose.

"Why didn't you call Tom in?" I asked her in report.

"I wish I would have," she said, and sighed.

"Other than this one, none of these patients need these treatments," I said, "And besides, you knew I was coming in, so you could have just left stuff for me to do, no point in being overwhelmed."

"I know, I should have, but you know how it is."

When you have a shitty day like I know Dee had, it pays to know you have a good RT relieving you. We good RTs aren't nit-picky when the day shift leaves us things to do, especially if there is a good reason.

I grabbed the stack of 20 EKGs Dee did during the day and filed them despite her objections that I was doing her job, and told her to go home.

I had a little rush in ER right off the bat, and (get this) I was called STAT to ER to do a sputum induction. Not only that, but the doctor wanted me to NT suction the patient to get it.

"You really want me to traumatically suction this patient," I asked the doctor. How about if we do this to you to see how you like it, I wanted to tell him, but held my thought to myself.

The doctor looked at me like I was an idiot, and said, "Yes I do. We need to bla bla bla bla."

Okay, so I did it.

Afterwords, the RN, who happened to be a rental RN, cornered me and explained why he ordered the STAT sputum induction: "We have a pneumonia protocol and we have to have the antibiotic given within four hours or I get written up."

"Okay," I said. "That's fine." Well, I wasn't really fine by it, but I wasn't going to debate with a rental nurse who's done working here in a few weeks.

However, after asking many questions, I leanred the pneumonia protocol does require a sputum induction prior to antibiotic, but it says nothing about having to be done in a certain amount of time. He must have been thinking of someother hospital protocol.

This RN, I am certain, pressured the doctor into getting this induction. What a moron. I'd like to suction him.

Despite that episode, I'm having a decent night tonight. While not all my treatments are indicated, I have no gomers, and no sundowners and no outrageously crazy patients. They are all nice individuals who appreciate my time.

I have two real COPD patients who really need the treatments, and both want to be awakened, so I don't have to worry about being snapped at (one of the things us night shifters worry about).

I have one patient who has septic shock secondary to pneumonia secondary to COPD who is probably on the verge of STD (Swirling the drain). But her Q4 breathing treatments are supposed to cure all these ailments (see Holy Water or Scrubbin-bubbles on right side of blog.)

I believe she is a full code, as there is no "plunger" at the bedside (a little inside humor there).

The best part is that I've been called on three occasions tonight by nurses for me to assess their patients and give my opinion. One patient appeared to be fine, but the RN wanted me to listen and give my opinion "just to be on the safe side."

Cool.

I love it when I work with nurses who respect my opinion this way. I love it, and I make sure they know I appreciate it.

Good patients + great nurses + a decent doctor in ER + an ideal equilibrium of the planet = good night for the night shift RT.

HAPPY HALLOWEEN

I just called work, and I'm going in late, which means I get to go trick-or-treating with my kids tonight. This is another great advantage of working for a small town hospital, and of it being very slow.

Last year my kids only had a little bit of candy in their bags, and they were content. I wasn't. I wanted to have more candy so I could steal it from them. I ended up putting my 3 YO on my shoulders and knocking on doors myself.

My son is nine this year, so hopefully he is self driven. We'll see. My daughter is already whining about wearing her Winni-the-Poo costume. She says it makes her look too fat. So I told her to wear her chicken costume. "That makes me look too fat too, da da."

Hmmm, I wonder where she got that idea from.

No dieting tonight.
---------------------

Well, KK finally decided on the chicken costume, but it took her mom to persuade her that she didn't look fat. My son was actually into moving fast house to house, which is the way I like to do it, but the wife and daughter were content to lallygag along. I looked back once and observed my wife and daughter doing the chicken dance.

"Come on, mom!" my son yelled. It was of no use. There was no sense of urgency back there.

That's how it went for the first hour, until my son wanted to go to his school. Here the kids had to wait in line to play various games in order to get candy. How boring for dad. But, being the good dad I am, I waited patiently the 10 minutes it took for my kids to get to the front of the line. They bot got their prizes and we were out of there.

When we were back outside my wife said, "How about if we go home now."

"Yeah, I'm ready to go home," my son agreed.

I looked at the clock as I hop into the car. It was only 7:15. "You guys have another 45 minutes, don't you--"

"Sush!" the wife looked at me bug-eyed. "They already said no."

"Fine by me," I said. "You might as well drop me off at work."

"Besides," she said, "I'm tired and want to go to bed."

I suppose by the time my kids are really into Trick-or-Treating I'll be too old too care. I'll turn into my dad and just drop them off wherever they want and follow them around inside the toasty car with a beer between my legs.

The funny thing is, my kids ended up with a huge hoard of candy in that hour, enough to last us until Easter when I'll end up throwing half of it away.

Speaking of Easter Candy, it's time to toss it.

The reality of small town hospitals

Shoreline Hospital is a relatively small hospital on the shore of a Great Lake in Michigan. I noticed the first time I walked into this place I was going to like it here. As one of the senior RTs described it to me at the time, "this place has a nice down homey feel to it."

There are the obvious goods and bads of working for a small place as this.

The good: We RTs have time to sit and get to know some of our patients. That's one of my favorite things about this job is learning about an elderly persons entire life in just a few short hours. Sometimes it reminds me of the movie Fried Green Tomatoes. If you haven't seen that movie you should.

When it's slow we talk, play cards or simply hang out. Sometimes, when a good ballgame is on, we turn on a TV and enjoy it, only to leave every ten minutes or so to check on our patients, or, in my case, to run down to ER occasionally. And, on nights like tonight, we have pot-lucks.

When it's really, really, really slow I sit here and do this. Earlier in the summer we wrote protocols for everything imaginable, we did research, we looked for new innovations to improve our hospital. That's what we do here. Or, that's what I do here when it's slow. I can't just sit around twiddling my thumbs or gossiping. I hate gossipping.

If I were busy I highly doubt I'd be making entries here every day. How many jobs can someone get paid to blog all night long? When it's like this, coming to work is like going on a vacation. I tell my kids this is what you get to do at work when you go to college.

The bad: When I first started working here Dave came up to me and said, "Rick, you should go to work in Grand Rapids. If you go there you will be able to use your skills all the time, instead of once in a while. If you stay here, you might lose your skills."

He told me he's been working here so long doing frivolous breathing treatments that he didn't have any real respiratory skills left, and that there was no hope for him ever getting them back.

Needless to say Dave is our complainer. He's a great therapist, but a complainer. You know what they say about complainers, that they say more about themselves than the people they are complaining about. Every hospital has them. I hate complainers. I avoid them to the best of my ability.

I also hate doing breathing treatments on people who don't need them. I hate going into a room at 5:00 in the morning to wake up a patient just because the doctor said. If the patient is not having bronchospasms, if he's sleeping, he doesn't need it. I hate waking these patients up. I feel stupid. I feel like any person out of college could do this part of my job. This is why I'm such an ardent supporter of protocols, to get rid of this junk.

We will get busy again soon, and more than likely it will happen all of a sudden, and involve 20 Q-forever breathing treatments for no reason, and ER will be swamped.

My ideal workload: I want to be busy doing real RT work. I want to be busy with critical patients, COPD patients, asthma patients, real chest pain patients, and the only breathing treatments I do are for bronchospasm.

Reality: We will have a mixture of all the above. I will not move to Grand Rapids or Ann Arbor and definitely not Detroit where I'd actually get to use my skills on a daily basis. I can't because I'm not switching my kids to a new school, and I hate moving as much as I hate complainers and gossipers.

So we make the best of it here at Shoreline Hospital. The complainers will continue complaining, the button pushers will continue pushing buttons, and us hard workers will continue researching, writing protocols, and thinking of new ways to make this the best small hospital respiratory therapy cave, even if it's just to appease ourselves.

But there's only so much of this we can do. So when we're slow as long as we've been it's easy to drift off into la la land. When you don't do work for a long time you get lazy.

And I guess that goes full circle to what Dale said. And, ironically, that was one of my biggest fears when I graduated with my RRT: do I go to the small Shoreline in my hometown and risk getting lazy, or challenging my skills in GR?

Anyway, my point is: Despite the bad, despite my newly formed laziness, despite the high school work, we still have a pretty good team here when it comes to solving real patient problems. I think this is a well respected, well experienced, well educated group of RRTs; and this is a pretty nice place to work. I suppose what it comes down to is: it is what you make of it.