Annual Compliance Training: From Safety to Theater

The first year I sat through annual compliance training, I actually thought it mattered. Fire safety? Sure, I’ll pay attention. HIPAA? Good to know. Hand hygiene, patient rights, infection control — all important things. I took notes, stayed awake, and felt like I was learning something.

The second year, déjà vu. Same slides. Same narrator. Same quiz. Okay, still worth a refresher.

By the fifth year, I realized it never changes. Same script, same questions, same “check the box” exercise. That’s when I figured it out — this isn’t about learning, it’s about paperwork.

By year ten, it had turned into a game with my coworkers. Who could finish the fastest? Who could pass the quiz without even glancing at the material? Gone were the days of taking it seriously — now it was bragging rights in the breakroom.

These days, it’s videos on mute, quizzes answered from memory (or with AI), and compliance complete in a fraction of the time. Fully compliant, fully absurd.

Believe it or not, this didn’t start as a joke. Over the past 30+ years, federal and state regulators started requiring proof that healthcare workers were trained in specific areas. OSHA’s Bloodborne Pathogens Standard (1991) requires annual training for anyone at risk of exposure to blood. HIPAA’s Privacy Rule (1996, enforced in 2003) requires training on patient privacy and data protection, though not specifically annual — hospitals made it yearly to cover themselves. The Joint Commission has long required education on infection control, patient safety, and workplace violence. CMS has Conditions of Participation that push hospitals to prove staff competency and education. Over time, hospitals added more and more modules — partly for safety, partly for liability. Then COVID hit, and it all doubled down.

In Michigan, Governor Whitmer in 2020 added mandatory implicit bias training for healthcare workers, followed by gender sensitivity modules. That’s when it became a running joke for many of us. The bias training basically assumed you were guilty until proven innocent. The gender module even locked me out unless I answered that there were “many genders.” It had nothing to do with safety. Nothing to do with patient care. Just more clicking boxes to make someone in an office happy.

On paper, the point is good: make sure workers know safety procedures, protect patients, and keep up standards. In reality, the repetition makes everyone tune out. The very rules meant to protect us are so overdone that people lie, rush, and game the system just to get it over with. And sometimes, it really does feel like this is just busywork — something created to justify someone’s job in an office. My boss says that’s not true. Maybe he’s right. But it sure feels like it.

Look, it’s not the admin’s fault. It’s not even the hospital’s fault we have to sit through this every year. The push comes from higher up. So no blame here goes to the hospital. Still, you’d think they could do a better job of lobbying for a smarter system. Right?

Here’s a thought: instead of every year, why not every two? Or better yet, every five? That way, when training rolled around, people might actually take it seriously. They’d pay attention. It wouldn’t just fade into background noise. The truth is, annual compliance doesn’t make us safer—it just makes us better at hitting mute. Or here’s another idea: pay us. Bring us in on a day off and pay time and a half. Money talks.

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Sources

• Occupational Safety and Health Administration (OSHA). Bloodborne Pathogens Standard, 29 CFR 1910.1030. (1991, requires annual training)

• U.S. Department of Health & Human Services. HIPAA Privacy Rule. (1996, training required but frequency left to institutions)

• The Joint Commission. Hospital Accreditation Standards. (requires ongoing training in safety and infection control)

• Centers for Medicare & Medicaid Services (CMS). Conditions of Participation for Hospitals.

• State of Michigan. Public Act 30 of 2021. (Governor Whitmer’s mandate for implicit bias training in healthcare)

The Evolution of Annual Fit Testing

Sweating like a turkey in a sauna box.
Just say you don’t smell a thing — perfect fit.

The first year I did a fit test, I took it serious. Hood goes on, they spray the sweet or bitter stuff, I’m focused, I want to make sure this mask seals. Okay, I get it.

Second year, same thing. Still paying attention, still trying to do it right.

By the fifth year I’m looking around thinking… this is the exact same test, the exact same video, the exact same instructions. And I’ve got decades of this ahead of me?

By year six and beyond, it’s a different game. Hood goes on, I’m sweating like crazy, and the only thing I want is to get it over with. Do I smell anything? Nope, not a thing. Let’s move on. Videos go on mute. Quizzes get answered out of habit. Compliance box checked. Done.

What’s funny is the rule for annual testing isn’t new. OSHA wrote that in back in the 1990s. But before COVID, most places just did it once in a while — at hire, or when you changed mask models. And honestly, that worked fine. People took it seriously enough to make sure they had a good seal.

Then COVID hit. Suddenly, N95s were everywhere. Supply chains were a mess. One week you had 3M, the next week you had some no-name brand. Regulators cracked down, hospitals panicked, and the “annual” rule went from something loosely followed to something enforced to the letter. And what happens when you push people too hard? They stop caring.

It’s the same as annual compliance training. The first time you pay attention. The tenth time, you’ve got it muted and you’re just clicking through. If there’s a quiz, you know the answers already. Some people even have AI do it now. Everyone knows it, nobody admits it, and nobody’s actually learning.

Same with masks. We went from making sure they sealed properly to faking our way through because the process is miserable. Too hot, too repetitive, too pointless. People lie. People rush. And half the time, staff just end up wearing surgical masks anyway because N95s are uncomfortable.

And then there’s the gowns and gloves. They throw those at us for viruses like flu and COVID, when those are airborne. It doesn’t even line up with the science. It’s theater. Looks good for the inspectors, makes the paperwork shine, but it doesn’t actually change the way things happen on the floor.

I’ll give it this: those first couple of years, we all wanted to do it right. We wanted that mask sealed, and we wanted to feel safe. But by year five, and definitely by year forty, the truth sinks in. It’s not about the mask. It’s about the paperwork. And that’s why nobody takes it seriously anymore.

Solution: Let's compromise and do it every five years. 

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Sources

• Occupational Safety and Health Administration (OSHA). Respiratory Protection Standard 1910.134 (requires annual fit testing). osha.gov

• Centers for Disease Control and Prevention (CDC). NIOSH: Fit Testing of Filtering Facepiece Respirators. cdc.gov

• Michigan Occupational Safety and Health Administration (MIOSHA). Respiratory Protection Program Guidelines. Michigan Department of Labor & Economic Opportunity.

• Brosseau, Lisa M. and Sietsema, Margaret. “Commentary: Should Healthcare Workers Use N95 Masks Year After Year?” CIDRAP (Center for Infectious Disease Research and Policy), University of Minnesota, 2020.

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Chapter 2

Brothers and Baseball

“Hey, Lance, you coming outside?” Bobby called from the front porch, tossing a baseball in the air.

Lance looked up from his notebook, where he’d been sketching strange shapes and symbols. The warm summer air drifted in through the cracked window, carrying the smell of fresh-cut grass and faint exhaust from the highway.

“Not now,” Lance muttered, adjusting his glasses.

“Come on! David’s waiting.” Bobby was older by a year and more confident — he had the easy smile and the strong hands that made him a natural leader.

David appeared behind Bobby, grinning wide. “We need you, man. You’re our secret weapon.”

Lance sighed but stood, slipping his white Alupent inhaler into his pocket before following them out. The warm air made his chest tighten, but he didn’t say anything.

Outside, the sun warmed the cracked driveway. Bobby tossed the ball to David, who caught it easily. Lance felt the inhaler press against his leg — it made him feel safer, like a tiny shield no one could see.

“So, you believe in that radio stuff?” David teased, nudging Lance’s shoulder.

“I do,” Lance said, eyes serious. “I think there’s something out there listening. I just have to figure out how to talk to it right.”

“Sounds crazy,” David laughed, but there was no real mockery in his voice.

Bobby threw the ball to Lance. “Crazy or not, you’ve got heart. Let’s see what you can do.”

Lance caught the ball clumsily but smiled. For a moment, he forgot about the chip behind his ear, the whispers at night, and the dreams he couldn’t quite explain.

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Trump’s Welfare Changes: Not Cuts — Just Getting Rid of Fraud and Abuse

A lot of fear-mongering

The other day, a patient’s mom asked me point blank: “How do you think Trump’s welfare cuts are going to affect hospitals?”

It’s a fair question — and there’s a lot of fear and spin about this right now. So let’s break it down.

First, it’s not really a cut in the way people think. The bill she’s talking about — officially called Trump’s Big Beautiful Bill (OBBB) — just passed Congress and is heading to Trump’s desk to be signed into law.

The goal of OBBB is simple: get rid of waste, fraud, and abuse in programs like Medicare and welfare. By law, people here illegally don’t qualify for Medicare or many welfare benefits — but loopholes and lax enforcement have let some slip through the cracks. That’s taxpayer money that shouldn’t have been spent in the first place.

So, how will this affect hospitals?

Not much — because hospitals can’t refuse emergency care, no matter who you are. If someone was on Medicare fraudulently and loses it, that care shouldn’t have been covered by Medicare anyway. So hospitals won’t lose legitimate funding — they’ll just stop getting checks for people who shouldn’t have been on the rolls.

Will some of these people still show up for care, uninsured? Yes — but hospitals already handle that. The impact is likely to be small compared to the savings for taxpayers.

What about people with real needs — like disabled kids?

The mom told me her son has cerebral palsy and needs a lot of care. She was afraid he’d lose coverage. The truth is: kids like her son do qualify. He’s not the problem. He’s not fraud. No one is pushing kids like him — or grandma — off the edge.

OBBB is about keeping the safety net strong for the people who truly need it, by plugging the leaks so money doesn’t get wasted on fraud and loopholes.

Bottom line:

✅ Hospitals won’t see a big hit.
✅ The trust fund stays protected.
✅ Real patients keep their care.
✅ Taxpayers save money.

There’s a lot of noise about “cuts” — but look closer. Waste and fraud help no one. Fixing them helps everyone who truly depends on these programs stay protected for years to come.

1983: Mom’s Voice and the Nice Respiratory Therapist

The highlight of any hospital stay was when my mom came to visit. She usually arrived early in the morning and stayed until the overhead announcement declared, “Visiting hours are over.”

During those visits, Mom would read to me. One time, when she ran out of my usual books, she read a story from Reader’s Digest. The story was too complex for me to follow—or maybe I was just too hyped up on all the medicines I was taking for my asthma—and I had trouble paying attention.

Still, I loved hearing Mom’s voice. It was almost as therapeutic as Sus-Phrine, that asthma medicine I relied on. There was something soothing about her reading that relaxed me in a way nothing else could. I treasured those moments and wished she had read to me more often.

But in our busy household, the only times I really remember her reading were in the doctor’s waiting room or when I was in the hospital bed. I’ll take those memories wherever I can get them.

One day, when I was eleven, Mom had just left, and a young respiratory therapist named Star came into my room. She was really nice, probably because she actually paid attention to me.

Star would sit on the edge of my bed and watch TV with me. I remember one time we landed on a program showing naked Aboriginal people. I started to change the channel, but Star told me to leave it on.

I wasn’t interested in learning about them—I was too busy laughing. She gently scolded me for laughing, but I didn’t mean to. I was just giddy, probably from all the meds.

The next day, Mom brought my brothers to visit, but she had to take them home soon after. Once Mom left, I went to look out the window. That’s when Star came back in. She gave me my treatment and said, “Let’s play some cards.”

Mom had left a deck of cards on my table, and although I don’t remember which game we played, Star stayed with me for quite a while. It was so nice to have someone pay attention like that. I was happy to have a therapist who helped pass the time.

But then an overhead page came, and Star had to rush out. Still, those moments meant a lot.

Sixteen years later, when I was hired at Memorial Medical Center in Ludington as a respiratory therapist, Star became my co-worker. She would later tell me I had been a very excitable kid.

When Fresh Turns to Frazzled: The Stack-Up That Burns Out an RT

You know that feeling when you come back from days off, rested and ready, only to have your first few shifts slowly grind you down?

Yeah, me too.

Right after my six-day break, I dove back into the chaos — running those critical, useful treatments that actually help patients breathe better. But then there’s the rest of it. The stuff that piles up and drains you.

Like spending two hours at a code in the ER where it’s painfully obvious the patient—maybe someone in their late 80s with end-stage COPD and stage 4 cancer—is already gone. But the family is at the bedside, and the team keeps working, because... well, family presence matters. I get that. But it’s emotionally exhausting.

Or getting called to place a Zio patch in the ER—something that’s not urgent but just “on the list.” Then, ding! — a new patient to see on the floor. But before that, I have to rush back to the ER for a treatment I know is ordered more for “mom satisfaction” than medical necessity.

The ER doc even told me, “In the past, I wouldn’t order treatments for a kid with a simple cold, but after one mom got mad and left a bad review, now I do it every time — just so moms think we’re doing something.”

Then, to add to the fun, your coworker is tied up with outpatients. So you’re on the inpatient side handling everything yourself. And when she’s stuck doing a PFT—which takes an hour—you get pinged for an outpatient EKG that just came in. Suddenly, you’re doing all the inpatient stuff and the outpatient stuff too.

You see, all of these little things—important or not—stack up.

We have patients who genuinely need us, and if that was all we did, maybe burnout would be just a faint worry.

But when the useless, the unnecessary, and the “just for show” get piled on top, it hits you hard — sometimes within hours, even fresh off days off.

So yeah, those upcoming ten days off? They look really, really good right now.

Note to self: This stacking of pointless tasks? It’s the fuel behind what I call respiratory therapy apathy syndrome. When you do too much useless stuff, you stop caring—not because you don’t want to, but because it’s a defense mechanism.

If you’re feeling this too, you’re not alone. And maybe it’s time we all started talking about the real stuff behind RT burnout.

When Vodka Was a Breathing Treatment for Heart Failure

Today, respiratory therapists treat pulmonary edema with CPAP, BiPAP, and diuretics like Lasix. But there was a time—especially in the early to mid-20th century—when another, more surprising remedy was used: alcohol. And not just ingested alcohol, but inhaled alcohol—sometimes even vodka—administered as a breathing treatment.

Why Alcohol?

In cases of acute heart failure, fluid backs up into the lungs, leading to pulmonary edema. This can cause the patient to froth at the mouth—literally—as fluid mixes with air in the alveoli and upper airways, creating a white, foamy sputum.

Alcohol, especially ethanol, is a known anti-foaming agent. When nebulized and inhaled, it reduces surface tension in the foam, essentially collapsing the bubbles. This makes breathing easier by improving gas exchange and reducing the pink frothy sputum that characterizes severe pulmonary edema.

How It Was Used

In the 1920s through the 1950s, nebulized ethanol (typically 30-50%) was commonly given via facemask or oxygen tent. When hospitals lacked pharmaceutical-grade alcohol, staff sometimes used vodka or gin as a substitute—whatever was on hand that contained a high enough proof to work. There are even anecdotes of vodka being poured directly into the endotracheal tube (ETT) in emergency situations.

Respiratory therapists (then often called inhalation therapists) or nurses would add alcohol to a nebulizer, often connected to humidified oxygen. The mist was inhaled by the patient, calming the froth within minutes. It was a low-tech but effective intervention at the time.

When Did It Fall Out of Favor?

The use of inhaled alcohol declined sharply in the 1960s and 70s as better pharmacologic treatments for heart failure became available. Furosemide (Lasix) was introduced in 1966, providing a fast and reliable diuretic effect that removed fluid at its source. Positive pressure ventilation also became more common, offering mechanical support to improve oxygenation.

Eventually, studies raised concerns about potential complications of inhaling alcohol—like mucosal irritation, systemic absorption, and delayed clearing of secretions. As more effective and safer treatments became standard, alcohol nebulization was abandoned.

Still in the Literature

Although rare, you may still see inhaled alcohol mentioned in older nursing or respiratory therapy textbooks and journals. It's one of those fascinating chapters in medical history—a time when we used what we had, and sometimes, what we had was vodka.

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Sources:

• Donnelly WH. "Nebulized Ethyl Alcohol in Pulmonary Edema." JAMA. 1946.

• Pinsky MR. "Historical Perspectives on Pulmonary Edema Management." Chest. 2004.

• Furosemide FDA approval: U.S. National Library of Medicine, 1966.

/John Bottrell's Facebook