My concerns about getting a respiratory therapy bachelor's degree

The AARC wants every respiratory therapist to get a bachelor's degree. I actually looked into this because I would love to further my education. However, when I brought this up to my wife, she said:

"If you are going to go back to school, you should get a degree in something so you can earn $75,0000 a year. If you get this, you won't make any more money. It may qualify you to be an RT supervisor, but it doesn't guarantee you will get that job, nor that you will want that job."

My wife is smart in this way. And she is right. If I were to go back to school, I would be better off going to be a nurse. They make way more money than we do, plus their profession is far better respected.

I'm not saying I'm going to be a nurse. I'm also not implying I hate my job. But, there is some degree of apathy present. It would be nice to do something different. But, to earn a bachelor's in respiratory therapy would not make me a better therapist nor would it make me more money. It won't even earn me more respect.

I would love to go back to school. However, I would rather do something other than respiratory therapy if I were going to do this. But what?

Thoughts?

Further reading:

• RT Magazine: AARC wants therapists to earn a bachelor's degree

Why get a Bachelor's Degree in respiratory?

I like the idea of respiratory therapists being better educated. I like the idea of having us obtain a Bachelor's Degree. However, the way it is set up right now, there is not really an incentive to do this. Here, allow me to explain. 

Right now, I'm a respiratory therapist. I have an associates' degree. Every other RT I know has the same qualifications that I do, including a license. Most of us are great at what we do, and further education will not make us better. However, further education "might" garnish more respect for us. 

However, that said, I actually thought about getting a BA. Two colleges near where I live now offer the program. I discussed this with a good friend of mine who said this:

"Why would you get a BA in respiratory therapy when you are not going to get paid more. If you are going to get a BA in something, you might as well choose a program that, when you graduate, you can get a job that pays you $75,000 a year."

That point stuck. I mean, really, there is only one reason to get a bachelor's degree, and that is if you are planning to head your department some day. And that's taking a great risk, considering there are many great therapists to choose from to run any department. And, quite frankly, I'm not sure I'd want that job.

Now, if I decided to get a BA in respiratory the institution I work for would probably pay for it. Still, to participate will involve the sacrifice of a lot of time, and probably some of my own money, as I'm sure there would be many related expenses along the way. Plus there will be a rise in my stress level, and less time with my wife and kids. All this for, what, respect? Pride?

So, that said, what is the current incentive to take the time, and spend the money, to get a BA? I do not see any. It will not make me a better therapist. It will probably give me a better overall understanding of how hospitals work (maybe), but it will not make me better at doing my job, and it will not earn me more money (unless I joint the small number of therapists who move into administration or some other similar job).

Thoughts?

Education does not determine how smart you are

I don't know if you knew this or not, but education does not determine how smart you are.  There are some very well educated people in this world who haven't an ounce of smarts.  Just think of all the people in Washington who think they understand how the economy works, and they just keep making it worse and worse.  These are people with Harvard degrees. 

So this is the false conception we get about degrees.  You have people who got C's and D's in high school, people who were never comfortable for whatever reason in the school setting, who educate themselves and do very will in life. 

Rush Limbaugh is a good example.  Like him or hate him, he has to be smart in order to get millions of people to tune him in every day.  Sean Hannity is another one.  Harry S. Truman never went to college, and neither did most of our founders.  Henry Knox was the first Secretary of war, and he educated himself through books.  These are people who basically educated themselves, and they are (or were) very smart.

I had a patient a few years ago who told me that he was staring out the window his Junior year of high school.  His teacher walked by his desk, smacked the ruler on his desk making a horrendous sound, and said, "If you want to make it anywhere in this life you need to stop looking out that window and pay attention in class."

He said to his teacher, "There's some fishy looking guys walking around out there, and those are my trucks. I have a business, and if my trucks get stolen I won't be able to make money."

This guy already had a successful business, and he was horrible in school.  He did pretty well for himself during the coarse of his life, and he never graduated. 

My grandpa kept skipping school. He was called to the Principal's office.  The principal said, "If you miss one more day of school you might as well not bother coming back."  Grandpa said, "Okay."  He never went back. 

My grandpa created the family business that my dad sold about ten years ago and is now living a pretty darn good retirement.  Yes, I might even have an inheritance so long as my mom doesn't die before my dad does.  My mom, with no college education either, is rather smart and frugal with money.  I think dad would be the opposite.  However, both are quite uneducated and smart. 

So there!  Any questions, comments or concerns let me know in the comments below.  But if you aren't nice, you still might be smart. 

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How much homework is too much?

My daughter is in the fourth grade.  She brings home homework that requires me to sit down with her for two hours, either to help her understand it, or to motivate her to do it.  Many nights she's up until 10 p.m. doing homework, when her bedtime is 8:30.  I'm wondering: is she getting too much homework?

I try to discuss this topic with my teacher friends, and I start out with this: if I'm going to be spending two hours a day helping my child with homework, I might as well home school her.  

On every occasion I get the e-e-e-e-e-evil stare!!!!  Then my wife says, "she's a teacher, you better not go there.

Well I want to go there with someone.  The teacher of my student won't go there either.  She is relentless, and so too was the fourth grade teacher of my older son.  It's like discussing "homework" is not allowed; that if they mention the words "reducing homework" Zeus will strike down upon them with a bolt of lightning.

It's really not that big of a deal.  I just want to have a friendly discussion as to why I think fourth graders get so much homework.  I believe it's because NoChildLeftBehind Act requires a test in the fourth grade, and the results of that test determine the schools rating, and how much money they will get.  So, they punish fourth graders with too much homework.

Well, there really not just punishing the kids, but the parents too.  My kids are lucky they have a loving, caring and patient mother

Note: I do believe responsible parents will spend time helping their kids with homework, and that doing so when the child is younger will result in good study habits later in life.  However, how much homework is too much?  Thoughts?

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Respiratory Therapy School: What you need to know about complainers inside the RT Cave

I'm going to expound here on RT complainers, however, it's hard to talk about complainers without sounding like one myself. Likewise, it's hard to discern between constructive complaining and non-constructive complaining.
I've had to rewrite this a few times with that in mind.

Before you read the following, I want you to know that I really do like my job as a respiratory therapist. And, I think this is an excellent job for people to go into, especially if you want to take care and treat patients with respiratory illnesses.

It's a really great job. At times it can be challenging. At times your adrenaline will be rushing especially when you have a critical patient, and what you do or don't do could determine whether or not that person lives or moves on to meet his maker.

Many times you will be able to work with doctors determining what route to take in caring for a patient. And, of course, sometimes doctors might not want your help. Okay, so it's that way with any job.

I think the job of RT is a great job for anyone who wants a job and needs to start working right away. That's why I chose this field. You get to start working as soon as you start school. Then, as you become certified and registered, you get your pay raises.

This is an ideal job for people who want to use RT as a stepping stone to moving onto other medical related fields, such as PA or DR. To be honest, I think all doctors should be RTs first. This is an ideal job for former stay at home mom's, construction workers or others who want an easier life, and asthmatics who want to work in a clean environment.

Basically, this is a great job for anyone who wants to start a career later in life and wants a guaranteed return on his investment. This is a great job for anyone who wants a career you can take with you no matter where in the world you live.

When you start working you may meet the complainers. I was lucky and didn't meet them until my third student rotation. I later found out that they often go into hiding when RT students are around.

You know them, because they are abounding in every profession. Don't let them get you down. Because you know that your job is what you make it.

You also should know that if they really hated their jobs they could easily get another one. You might tell them that at some point, but then they'd complain about you too. The truth is, they don't want to change careers. They are content with what they are doing, they simply find release in complaining.

They do not want to change jobs for reasons I stated earlier, that this is probably their third chosen career, they are getting up in age and don't want the stress of changing careers again, or they have families and don't have the resources or time to go back to school. Those are the most common reasons.

Herewith, I am going to make an attempt at explaining the RT complainer to you, because they are different from complainers of other career paths. Your teachers in RT school will not tell you any of this, so I am.

I've read a few posts this past week about RTs complaining too much about their jobs. In the post I linked to above I stated that about 60% of RTs are complainers, and someone corrected me by stating that she thinks it's more like 80%. Either way, they are abounding.

One of the biggest complaints I hear is: "What's the point of increasing my RT knowledge when doctors don't let me use it?" This is what I will focus mostly on in this post. I will not delve into "the hospital admins make decisions regarding us without consulting us," or "you'd think at a hospital they'd at least have good health insurance." I won't go there.

We'll focus on RT knowledge. As I stated above, greatest complaint regarding RTs is the result of them being over educated for the job.

Of course, you know why you should always try to increase your knowledge, because if the opportunity presents itself you want to be prepared. If a doctor is looking for ideas about what to do for a patient, you can say, "Hey, I read somewhere that..." He will be impressed with you.

The biggest advantage to improving your education is that if the career opportunity presents itself, and you are prepared and ready for it, you can apply. Now I've never had such opportunity, but if it ever comes up I will be ready.

But what's the deal with this "what's the point of learning" complaining?

The bottom line here is this: Most of us RTs feel that we are overqualified for our jobs. We have 2-plus years of education plus whatever experience we've accumulated on the job plus knowledge we obtain through continued education, all of this making us specialists in the respiratory diseases and how to fix them.

And yet, in many hospitals, we are not allowed to use this knowledge because many doctors do not want to give away any of their autonomy.

I will give you a few examples from my own personal experience.

1. Non-constructive complaining:

I feel absolutely stupid going into a room of a post-op patient with no signs of respiratory distress and telling that person I have to give a breathing treatment. There is no reason for it, and it's frustrating.

Many RTs bicker about this. It's best to keep your mouth shut.

2. Non-constructive complaining:

When I have a ton of therapies, and 70% of them are not indicated, and I still have to do every one of the non-indicated treatments while making sure my treatments on my SOB patients are never late, while still taking care of ER and STAT therapies, this can be taxing on me. It can cause unnecessary burnout.

I describe this in a recent post, "R. By the time I got to work I was already burned out, and I took it out on my co-worker. Not a good idea.

We all have our opinions, and the chronic complainers will let us know about them on a regular basis. But when I complain, it's usually when I'm burned out.

3. Constructive complaining and non-constructive complaining combined:

What if we have one patient who is SOB, and I know I have the cure for his ailments right in my pocket, but I have to wait a half hour for the doctor to respond. I have to stand idly by while my patient suffers. As a fellow asthmatic, I can't stand this part of the job.

I think I am justified in not being happy about this.

I find myself grumbling and griping, "Why hasn't the doctor called back yet?"

My solution to this problem is what I call my "Act now and apologize later protocol." I have never been written up for doing this. Never. So that solves that complaint. However, isn't this something that should be complained about.

This example could possible by non-constructive, if I grumble and gripe too much.

4. Constructive complaint:

In "Grumpiness stays in the RT cave" I detail another complaint that's really not a bad thing to complain about. I write about a nurse who called for a treatment on a patient when the treatment really wasn't indicated.

While most times I keep my mouth shut and just do the treatment, sometimes I like to take the time to educate the nurses. While most times they want to learn, sometimes they take it as a complaint. And, if I'm burned out, I probably come across as I'm complaining. So, I've learned it's best just to keep my mouth shut even in these situation.

5. Non-constructive complaint:

Using the above example, we know that educating is not complaining. However, when you have to do this on a daily basis, particularly over and over to the same nurse, it can become frustrating and can lead to non-constructive complaining. Most nurses, however, want to learn and will listen.

If the nurse is really busy, she might not want to hear it. This can get frustrating in itself. More than likely in this case, she just want you to make sure you take care of the patient, regardless of whether the treatment is needed or not. And, many times, RNs and doctors determine that giving a treatment is better than doing nothing, even when it's not needed.

In cases like this, I've learned to keep my mouth shut as, I'd presume, most RTs have.

6. Non-constructive complaining:

I will use all the above examples here. While RT complainers excel at this, all other RTs will complain about just about anything from time to time. It can't be helped and it's a fact of life. (If a content does this, you know you're in trouble.)

7. Constructive complaining:

I always tell my friends that I'm not complaining, I'm simply stating a fact. And, when I show people my list of 'olins (listed at bottom of blog), or I tell them some of my RT humor (plastered all over my blog), I think this is the best way to complain. Just by thinking of all this stuff we have to be learning something. So long as we don't go overboard, I think this is the best way to let off steam.

Well, at least I think so.

I can probably think of more types of complaining, but my mind is strapped at this time.

Overall, the greatest complain is regarding non-indicated breathing treatments. If you are a true professional, you would understand explaining them away like this:

When doctors and nurses call me for therapies I feel are not indicated, I like to think they simply want an RT to be assessing the patient QID or Q4 just to be on the safe side. That's not such a bad thing, is it? (It is if it leads to burnout.)

If you're still not content with non-indicated therapies, I suppose Taylor on Kid Nation says it best: "Deal with it."

The best way of dealing with the grumbling and griping is to continue to work toward impressing doctors and nurses by generating respect with them by always staying on the cutting edge of knowledge.

Likewise, if we do not have protocols already, we must study the protocols of other hospitals, continue the education process (as we do on these blogs), and work, slowly and patiently if needed, to get them implemented. Will this get rid of all non-indicated therapies, probably not.

By continuously working to better ourselves, we strain away our desire to complain. Most important, we know that by our complaining we only cause other professionals (Drs, nurses) to stray further away from us. They hate complainers. This is the best way to not make progress, as you can read about at Snotjockey's Revisited.

And you will be reminded many times that "the grass is not always greener on the other side of the fence."

You will find complainers everywhere you work. I was a journalist once, and they were there; 80% of them. I was a hotel desk clerk once, and they were there; 80% of them. I worked in the fast food business once, and they were there; 80% of them. It never ends.

Still, if you've set foot in any RT Cave, you know that RT complainers are not interested in making the RT Cave a better place, because deep down they are simply content to keep things the way they are. For reasons I listed above, they know they will be trapped in the RT Cave for the rest of their working lives.

To make themselves feel better, they gripe and groan. The rest of us are forced to take the brunt of it.

However, if you can stand to listen to a complainer, they are very intelligent people. As you know, they complain mostly because they are overqualified for the job. I really think that's true. I've obtained tons of material for this site by listening to complainers. They are up on their knowledge.

It's just too bad they don't use all that energy and focus it in on progress.

Here's a thought before I end for the day: "If it weren't for complainers, nothing would ever get accomplished in this world." I'm sure you've heard the old saying, "The squeaky wheel always gets the grease."

Bad news: Working nights linked with cancer; Good news: research may lead to cure for aging

Now we night shift hospital workers have yet another incentive to get off nights.

According to theAssociated Press, and research that shows an increase in cancer among night shift workers compared to people who work normal shifts, the World Health Organization is now including working night shift among its list of carcinogens. The American Cancer society states it will soon follow.

Some scientists say this is not necessarily true. However, based on my own research regarding melatonin, I'm leaning towards believing it.

Research on this is very new and quite vague, as researchers and scientists don't even know at what point working nights increases the risk of getting diseases, nor whether if one stops working nights his disease risk factors diminish or simply go away, nor if it's even linked to the disease process at all.

I wrote recently that I might try melatonin for my self diagnosed circadium rhythm sleep disorder, but instead of simply listening to my co-workers (and some of you bloggers) who told me it worked well, I decided to research it first. As it turns out, scientists have stated they know so little about melatonin that they really don't recommend that people take it more often than they really need it -- if at all.

The reason is because that while it may help you fall asleep, and while it may help you stay asleep, it's naturally produced by the body, and by you putting artificial melatonin in your body now who knows what effect that might have on your melatonin production in the future.

Not only that, but many studies have shown that people with neuro diseases, cardiac diseases and cancer have proven to have lower levels of melatonin. What they do not know is whether it is the disease process that causes the melatonin to decrease, or if it's low levels of melatonin that causes the disease states.

Older theories believed that melatonin decreased with age, and some scientists theorized that this might be what ultimately causes aging (and diseases). While melatonin is still considered to be linked with aging, it is no longer believed to decrease with age.

Thus, if someone has a low melatonin, something else must be going on other than that someone is just getting older, and lack of sleep might be one such causes of this.

Much research suggests that melatonin might be linked with aging and disease, and as further studies are completed, the study of melatonin might even lead to a cure to aging.

The reason they think this is because melatonin is an antioxident, which prevents the breakdown of cells. And, if we can prevent this from occurring, we can prevent cells from aging and diseases from forming.

If this leads in the direction we hope, this could result in major scientific breakthroughs that will benefit millions of people. Who knows, maybe it will put some of us medical workers out of jobs.

One expert suggested that you get your melatonin tested, because if it's normal you shouldn't take synthetic melatonin pills, because if your body thinks it is making too much melatonin, it will shut down production of natural melatonin. And when you stop taking synthetic melatonin, your body won't know enough to continue making its own.

Another expert wrote that melatonin can't be tested, because levels vary at different times of the day. So, as you can see, the experts vary in opinion regarding how to prescribe melatonin.

My thinking is, if you work a swing shift and are rarely getting enough sleep, you might as well assume your melatonin is low and take a small dose of melatonin to help you sleep. If nothing else, perhaps it will keep your melatonin levels closer to a normal level so you (hopefully) decrease your chances of getting lack of sleep related diseases.

Still, while scientists note that melatonin does not have the side effects of other sleep aids for most people, they still do not know the long term implications of using it.

One site I found had complicated recommendations for using melatonin, and recommend using it every day at different times of day. I'm not a fan of taking it that often.

Another site I found seemed more realistic, and stated that it's best to take melatonin the first day you are trying to adjust to sleeping days. This should allow your body to adjust back to sleeping days, and no further melatonin should be needed to help you sleep.

You should therefore not use it again until you want to adjust back to nights, and then you should (ideally) not need it again until you need to adjust back to a normal schedule.

My thinking is if your miserable due to lack of sleep, you might as well try it. Because having a little synthetic melatonin in your system a few days a week and risking whatever long term implications might result from this is far better than all the negative side effects that come from not sleeping at all.

In a way, it's kind of like giving small doses of steroids to asthma and COPD patients. While the small dose increases the quality of their life, studies have shown that having a small dose of synthetic steroid in your body is relatively safe.

That's my take on it. Let me know if you think otherwise.

RT to RN, BA in RRT: is it worth it?

I had a discussion with my coworker, Tom, who is working here while still attending school. Tom said he wanted to go on to get an RN and then proceed to getting a BA in nursing and perhaps move up even higher.

You have to realize that Tom is my age, and he has a wife and kids and bills and debt just like all of us hard working RTs.

"I told my teacher that I thought this would make me more marketable," Tom said.

Tom said his RT teacher tried to explain to him his options from a different angle.

He said, "He told me that an RN is basically on the same level, or same playing field, as an RT. And going on to get a BA in nursing isn't any different from going on to get a BA in respiratory. "

His teacher told him he'd be better off getting his RRT and moving on to getting his bachelors, rather than spending the extra time getting an RN. He'd save two years of his life and lots of extra money.

And from there he'd still have the benefits of increased pay, and an increased opportunity of moving up the ladder.

I agreed with Tom's teacher on everything here except the idea of an RT going on to getting a BA. There is no increased pay for BA's in this part of the state. It might work to help him move up the ladder, but there are a very limited number of RT department head jobs available. Would it be worth the investment?

"Besides," I added, "our boss doesn't have a bachelors degree."

"Good point."

"And do you think that piece of paper is going to make our boss a better leader? Do you think it would make him smarter?"

"No," Tom said.

"Well, it would make him smarter, but it wouldn't make him necessarily a better boss. Yeah it might help him get hired, but if he doesn't have what it takes to head this department, he certainly isn't going to be hired, regardless of what papers he has."

"True."

"So, technically speaking, is it worth sacrificing the two years to get a RT bachelors? I'm not convinced. I'm not trying to talk you out of doing this either. I'm just saying: is it worth it? "

"They do pay extra for BA's at some hospitals," he said.

"You'd have to move. Is that what you want to do?"

"I'm thinking about it."

We spent some time on Google trying to find advantages to an RT BA, but failed to find anything before we gave up.

Now, for an RN to get a BA is another story. There are a ton more opportunities on that side of the isle.

Another reason Tom said he wanted to go on to be an RN from RT is he could use his RT skills and he could be hired as a nurse and could fill in as an RT on occasion.

His teacher told him there really is no added benefit to having both an RT and an RN degree because you can only concentrate on one or the other, and whichever one you are doing you will forget what you know about the other.

That sounds veritable to me.

I can think of some really good reasons for someone going from an RT to an RN, and I think the experiences gained while being an RT will very much so make that person a much better nurse, especially when it comes to respiratory patients. For one thing, they certainly won't be calling for treatments on people who don't need them, unless their mindset changes that much.

Not only that, but there would be a pay raise, considering RNs make better money; and there are more jobs available.

However, I can think of no reason why someone who is an RN would want to become an RT, unless they work at a small hospital and they want to watch more TV. But trust me, while you may see me watching TV from time to time, I do my fair share of running. In fact, I think most RNs will agree that when I'm busy, I may be busier than a busy nurse.

Why would an RN want to take a pay cut? Why would an RN want to go from a job with many opportunities even within the hospital, to one where there are only a few RTs in the entire county?

That is, unless you are miserable as an RN and you think you'd enjoy sucking snot far better than wiping butts.

He also talked about being a physician's assistant. His teacher told him he'd be far better off taking the RN route if he were going to do that. But that's a lot of schooling, especially considering he still has to go through the RN program to do that.

Whew, he's gonna be real tired of school if he gets through all that, and very much in debt. But considering he has a wife and kids to support, he's probably better off just working as an RT.

That's my opinion. I think he should stick with what he has already committed himself to. Then, later on, if he's financially stable and still wants to be an RN, he can study instead of watching TV at night while getting paid as an RT.

But that's just my opinion, and I've been prone to be wrong from time to time.

A case against NT suctioning (agree or disagree)

RT Cave Rule #1: NT suctioning is a very traumatic procedure to be done only when excessive secretions are disrupting a >patients breathing and all other options have been exhausted.

"How would you like it if I took this suction catheter here, stuffed it down your nose and made you gag with it?" That's what I wanted to tell a nurse last night, but I held my tongue.

I like working nights, but there are some nights, like last night, where it would be nice to have someone here to back me up. In fact, if I had someone to tell me that I was right, or that I was being ridiculous, then I could have avoided the whole confrontation.

I was initially called at 8 p.m. to NT suction a patient who was in obvious respiratory distress. She had recently been moved from a recliner back to bed and her heart rate skyrocketed up to 177. Two days ago she had an abdominal surgery and now she was refusing to cough, and had some audible crud in her throat.

"I can't suction this patient," I said to the nurse. The nurse's name was Cindy.

"Well, we need to."

"I think I can fix her without NT suctioning," I said, and with a size 10 catheter I tickled the back of her throat and the patient spontaneously coughed producing a lot of phlegm, which I proceeded to suck up with the yankaur. Her sats increased, her work-of-breathing improved over the next 10 minutes, and, by the time I left the room, the patient was resting comfortably with a normal heart rate.

An hour later I was paged back to the room. "The patient won't swallow," Cindy said, "I have to give her oral medication for her thrush and she won't swallow. We need to NT suction her."

I said, "Look, I would be more than happy to suction her if I thought it was indicated, but suctioning isn't going to help the patient swallow. "

"Well, I put water in her mouth and she gurgles and spits it out. We need to NT suction her. She has a bunch of secretions in the back of her throat that she can't bring up."

"Not only that, but she has a sensitive heart. You have to remember NT suctioning is very invasive and traumatic."

"But we have that under control right now. Can we just try it once?"

I explained the procedure to the patient and she exclaimed, "No way!"

I looked at Cindy, "She's in no distress, has no audible upper airway secretions, and has no loud rhonchi. Let's just leave her alone."

"Well, we need to do something," Cindy said kindly. "We have to get this medicine down her throat, there's thrush all the way down there."

I encouraged the nurse to assist the patient with a drink of water which caused the patient to produce phlegm and gurgle. I simply sucked the junk up.

"There," I said, "Now you can give her her medicine." Cindy did and the patient took it just fine -- and we did not NT suction.

By this time I thought I had made headway with Cindy, but Cindy continued to call me back to the room several times during the night, and each time the patient denied any distress, denied she had secretions in her lungs, and I explained cordially to the RN that suctioning was not indicated. I even went out of my way to check on the patient every hour on the hour to assess her. Suctioning was never indicated, not even oral suctioning.

This whole thing really didn't bother too much, as I really enjoy working with nurses and educating them as appropriate. But, in this case, I felt I wasn't getting anywhere. I felt like I was trying to communicate with a brick wall.

"Look," I finally said, "You have a right to over rule me. If you want to suction this patient, I will be more than happy to assist you."

"No," she said, "I won't do that." Great, I finally got to her.

Wrong.

I was called back at 4:00 in the morning. By this time I'm exhausted and have a headache. I approach the nurse as professionally as I did each of the other times during the night and explain for the umpteenth time why NT suction is not indicated.

"I'm concerned about this patient," Cindy said. I think the patient deserves close watching, but I think she is fine right now.

"Look," I said. "The patient is watching a good movie right now. I'll sit in here and watch it so I can keep an eye on her." And I did. The movie was good too. This was one of my regular patients, and she really enjoyed me keeping her company.

Anyway, after the movie was over, I left the room and saw my boss thumping down the hall. "What's going on with this patient," she said.

Shit! I thought, as a rush of adrenaline flowed through my veins. Up to this point I didn't think there was a problem whatsoever, nothing worth getting my supervisor involved anyway. "How did you know about this patient?" I had a good idea, just wanted to hear it.

"Alex came to me." Alex is the nursing supervisor. "The RN complained the you were refusing to suction a patient. She thought that you were being lazy."

"Is checking on a patient every hour all night being lazy." I pointed at the patient. "Look at that patient. Does she look like she needs to be suctioned? If they'd just leave her alone she's be just fine, but they've been in there bugging her all night."

"I agree with you," my boss said. "I told Alex that you are a professional with a lot of experience, and if you thought suctioning was indicated you would do it. I had this same problem yesterday with Dave. He refused to suction a patient last night. Deja vu." She smiled.

"Well," I said, "I've been more than patient and professional with Cindy. And she seemed like she was really nice about the whole thing, but she didn't seem to be understanding what I said to her. But I certainly didn't think she would complain about me.

"Well, she did."

"I told Cindy very clearly that it was perfectly fine if she didn't agree with me, that she could suction if she wanted. Nurses can suction too."

"I told Alex that I backed you, like I backed Dave last night."

Certainly is nice to have the support of your boss. Damn nice.

Then, to be diplomatic, I said, "I could be wrong, Boss. I mean, when do you think suctioning is indicated? I mean, I think suctioning is very traumatic, so when would you determine to do it."

She said, "When a patient is full of secretions, gurgling, and the secretions are effecting her breathing."

"Okay, then we're on the same page."

We started down the hall toward the cave when the patient's doctor breezed around the corner.

"Hold on a minute," I said as I turned around. "I'm not letting this linger this time. I'm ending this once and for all."

I rushed to the nurses station where Dr. Matt was shuffling through the patient's chart. "Dr. Matt," I said, "May I have a quick word with you."

"Yes."

"Would you recommend that we NT suction this patient."

He looked at me like I was an idiot. "Absolutely not! It's all in her throat. If we could just get her to cough I think she'd be just fine. You can use a yankaur if you want, but I definitely wouldn't deep suction her."

"Thank you."

I turned around and saw that Cindy was standing right behind me, and a rush of joy flowed through my veins. I couldn't help but to smile. I said nothing and walked away.