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Saturday, January 17, 2009

Contemplating large versus small hospital

It's been an arduous task to find inspiration for blog writing recently with a new baby and other children who need the attention of this father and RT. And yet, as I finally get back to work after three weeks off, I find that the patient load is still nearly non-existent. And, thus, the vacation -- in a way -- continues at work.

Yet it's still work of course. (When you are some place you don't want to be at 1:34 in the morning just so you can make money it's work).

It's ironic the way a hospital like this, that has seen it's busy days, can be so slow, yet I read the writings of other Rt bloggers, like the anonymous RT over at Respiratory Therapy 101, writing about how busy it is where he works to the point that he has no time to teach his student.

In an email to me about a year ago he pretty much summed up the difference between a large hospital and a small one like where I work: "There are definitely advantages to both paces though: a fast-paced place makes the day go by and lets you see a lot of intriguing things, but a slower-paced place has a friendlier atmosphere and you can often get to know your patients and co-workers better."

True. Another advantage to working for a smaller hospital is there is less staff. That means that you do not specialize in any one particular area. You are it. That means that you have to be the Ventilator expert in the critical care, the Intubation expert in the emergency room, the breathing treatment pawn who has to make sure all treatments are done on time, the Incentive spirometry expert, the ABG expert and anything else that might come up. You will never set your feet in one department.

You have to walk (well, all RTs do this). You have to climb stairs. You might even find yourself in the ambulance setting up an adult vent, and five minutes later in OB setting up a vent on a newborn infant, and then doing a breathing treatment on a patient in MRSA isolation, and then rushing to a code way downstairs in CT (arent' those the worst?).

Oh, and along with taking care of adults and adult vents, you also have to be able to swiftly and seamlessly shift your mindset over to pediatric care and neonatal care in a heartbeat. One moment you might be setting up a ventilator on an adult head bleed, and the next you might be setting up a newborn on a ventilator with a tital volume of 4 in pressure control.

The concept of taking care of neos and peds and adults is the same, but the way they are each set of on ventilators is different. The worse part about taking care of sick neonates and pediatrics at a small hospital is not setting them up on a ventilator, it's the fact that you hardly ever set them up. Therefore you have to practice and be ready. And, if needed, you need to have your cheat sheet available.

Still, 90% of the time, when you have a bad baby -- as I did last night -- you will not have your cheat sheet available. For some reason you will have set your clipboard down and not have it with you. The nurse -- if she wasn't so panicked -- would hear you curse, or do the Homer Simpson, "Doh!" You will then have to go by the wisdom you have wrapped up in the back of your mind.

The anonymous is RT right, though, that working for a small town hospital allows more time for the small things like spending quality time with our patients. However I'm sure there are times that the best RTs can find time to do this in larger hospitals too. This is where prioritizing and protocols come in handy (of course some doctors can hamper those things too I bet).

Keep in mind, however, that if we RTs have more time for small things, the RT Bosses also have more time to make a big deal when the small things are not charted properly. After all, in a small town hospital patients are harder to come by, and that means money is often on shorter supply (hence the difference in wages). And that can be the most frustrating part of the job -- along with the dreaded hospital politics (of course there's politics with every job don't forget.)

Sometimes I think I would like the change of pace of working for a large hospital. It's not that I would like feet that burned in the morning, but knowing that I will only have to work one area of the hospital one night instead of everything and everywhere. It would be nice knowing that I didn't have to work ER EVERY night. It would be nice to JUST do ABGs, or JUST intubate, or JUST work the critical care. Just once that would be nice.

It would be also nice, as the anonymous RT wrote, to see more things. Instead wrapping and stabilizing the head trauma and the head bleed or massive MI, it would be nice to keep those patients and see how things turn out.

But keep in mind --all you RTs who receive the patients we smaller hospitals ship, it's equally hard to stabilize and ship. The hardest part is HIPPA, and never getting an update on how the patient is doing, or at least how well we did at packaging the patient up. (However I've never heard a complaint either).

Most larger hospitals -- as far as I know -- tend to be more up to date when it comes to the latest equipment and technology and wisdom. We small town hospitals -- I honestly think -- tend to be 10 years behind. We still use the Bird IPPB for example (thankfully not as often anymore) while the larger hospitals sent those things to Ethiopia 12 years ago. Plus you guys get paid better (unless you own us).

There are many times I look forward to going to work just so I can relax. Can you imagine that? I bet no RT from a large hospital would ever be caught dead saying that. Yes. As I said, it's pretty hectic around my house right now with that new baby. And coming to work with only four patients and a (fingers crossed) slow ER of late is something to look forward to (why the heck is it so slow lately? That's a discussion for tomorrow night perhaps).

So, here I sit listening to Aerosmith on the radio, looking out at the patient and staff parking lots nearly empty of cars as most of the beds are NOT filled with respiratory patients. I'm leaning back in my chair with my feat up on the top of the computer typing away on my frivolous and for the most part senseless RT blog -- and getting paid for it. That's something you'd never hear a large hospital RT saying either.

But I work alone. You can't do this on day shift at a small hospital either. You have to hide out. But only until the bosses leave. Ah, the advantages of working for a small town hospital are tremendous. If you can find something to do; if you like to gossip (which I don't); if you like to socialize (which I'm not so good at); if you like to blog (ah, there you have me), if you like to read (you got me there too).

This is one of the nice things about capitalism is you get to choose between so many different environments -- big or small, busy or slow, friendly or not so friendly. And, at times, all hospitals share all four environments, as we sometimes get as busy as a large city hospital. But not lately. Lately it's been slow as a frozen snail. Yet I'm not complaining.

That, my friends, is the thought of the day.


Intubate Em!!! said...

I have worked at both a large teaching hospital & currently at a small community hospital. There was no way I could ever spend mindless hours 'working' at the big hospital, although I did see some really cool stuff there. I do miss the 12 hour rush. Now I come to work so I can catch up on everyones blog.

Breathinstephen said...

I too have worked in both and definitely prefer the smaller.

10-12 hours PM shifts( swing shifts)were my favorite in either setting.