Once upon a time I introduced you the five types of RTs, cfive types of COPD patients, and the 11 types of asthmatics, and the six types of doctors. Now it's time for the 13 types of nurses.
No group of individuals is more vital to good patient care than our beloved nurses. Nurses are great, and I've had the honor of working with nurses on both the receiving end and as fellow professionals.
So, without further adieu, I present to you the 16 nursing types:
Consensus:
About 80% of RNs fit into this category. These RNs respect, seek out, and listen to the opinions of other members of the staff. They tend to work well together as members of the team to come up with a "consensus" as to what might be wrong with the patient and what to do about it. They are aware that they lack the experience in all areas, that they don't have all the answers, and are willing call upon their coworkers, including doctors and respiratory therapists, to help them to best care for their patients. These are similar to your gallant doctors.
Contents:
These nurses are set in their ways, and prefer not to sway from their routine. They believe they know what needs to be done, and they do it. They tend to not seek out other opinions, and usually don't consider the opinions of others. They consist of about 10% of all nurses. They will often perform procedures (such as increasing oxygen) without seeking expert consultation. These are similar to your goofus doctors.
Prospects:
These are your newbie RNs or, perhaps, soon to be RNs. Most are eager to learn and are more than willing to go out of their way to help out. Some are mature, independent and trustworthy enough to work on their own, while others have less confidence and need quality assistance. Look at these folks carefully, because in a year or two they will morph to a different type of RN. Some will grow dogmatic and become contents, while others will grow and smile and become consensus. These consist of about 10% of all nurses.
Cordial:
We all hope that Beginner RNs turn out to be of this type. They know they do not hold all the answers, have a friendly disposition, and are more than willing to take the extra step, even when they're burned out. They tend to smile and lend a helping hand to patients and coworkers. Their ears are always open. They are most often social, may often bring in treats to work to keep the peace, and are likely to remain in one department for several years, if not their entire nursing career. You'll find them mainly on medical/surgical floors, although they generally don't fit in fast pace departments such as critical care and emergency. Some people refer to this type of RN as Happy or even Friendly RN. Most staff and most patients love cordial RNs. They almost seem to be flawless. These usually consist of most LPNs and about 20% of Consensus RNs. Most of them work on the med-surg floors, but a small percentage wander down to the ER and critical care.
Receptive:
These are your nurses who are constantly looking to become better nurses, read medical journals, magazines, read online sources such as blogs and articles, and are more than willing to listen and retain the wisdom of their fellow workers. They like to learn not just to better themselves, but the institution as well. They tend to be more observant and receptive when it comes to new ideas. They also tend to be proactive (or think quickly) to emergency situations. They can be friendly, but tend to be more serious and bossy under pressure, and may even appear to be condescending at times. They may start their careers on medical/ surgical floors, but generally branch out to more challenging areas such as emergency and critical care. Many are likely to further their careers by earning their bachelor's or even Master's degree, and it is from this group you get your future supervisors, administrators, nurse practitioners, and occasionally doctors. They consist of about 20% of Consensus RNs.
Dogmatic:
This type of RN has a definitive way of doing things. They are relatively laid back in their personality (type b personality) however they have created a set way of doing things to protect themselves from making mistakes. Patients love them because dogmatics tend to be overbearing and attentive to their patent's needs. If a doctor orders for teeth to be brushed every two hours, they will do it every two hours whether it's needed or not, and whether they have to wake the patient or not (patients don't like this part). They are also very particular about specific doctor orders, and call to report even slight variances. For example, if the doctor writes an order to maintain a sat of 92%, they will call the doctor and RT even if the sat is 91%. They will often guilt you into staring at the monitor hoping the vitals improve by your looks alone. Thus, they are known to make a big deal of trivial things. In this way, they tend to irritate doctors and RNs. Although they are so nice it's hard to stay mad at them. However, patients can be guaranteed to get a good wash per shift, to be rotated regularly, have fresh blankets and sheets and towels and a good assessment frequently. Any slight change in lung sounds will be noted. But, the bottom line is, they do this because they legitimately want the best for their patients. Bosses love them too, because, like type A or anal RNs, they are perfectionists with their charting. They make good friends, and are relatively happy except under pressure. Oh, and one more thing, their rooms are spiffy clean. If you leave something laying around they will not say anything, but they will clean it up. They consist of about 10% of Consensus RNs.
Compulsive:
Like Dogmatic RNs, they are guaranteed to do full assessments, and will do everything the doctor orders to a tee whether they think it's needed or not. They will never question a doctors order. Actually, they are under the belief that if the doctor ordered it, it's needed. If you say something is not needed, they will defend the doctor as a "god." They too will have you staring at monitor values that are "barely" below the accepted range. But if an RT refuses to continue staring at the monitor saying something like "that sats fine," he will get mad at you and tell you that you are not caring for your patient. If you don't follow the rules, or directly follow a doctor's order, he will approach you. He's also prone to writing variances for even the silliest of detail. They are type A personalities, although are generally very precise and attentive to their patients. Yet they too can be overbearing, and tend to be hard to work with. Unlike Macho RNs, they often seek the help of others, but tend to get upset when others disagree with them, or don't provide the answers they want. Therefore, it's easier to pretend to agree with them than to show them how they are incorrect. They expect equal perfection from their coworkers, and are known to look over your back. Sometimes they are referred to as snoops, or sometimes worse. So, when you are working with these RNs, you need to careful. Oh, and one more thing, if you leave your ABG kit lying on the patients bed, they will make you well aware that you messed up their room. These consist about 5% of consensus RNs.
Macho:
These tend to take things in stride, and not make big deals over trifles. They would be content to live with a sat in the mid 80s, will use common sense, and will not call RTs and doctors over such trivial things. They tend to use the word "common sense" a lot. They tend to be cool. They tend to have a dry sense of humor. Many tend to be men, but not all. Nothing seems to bother them, and they do a good job with their patients with the advice of others or without. They tend to have a high degree of intelligence, yet are often seen reading science fiction or mystery novels in their free time as opposed to medical stuff. They tend to hold their own. They tend to work in CCUs, and are very confident. They consist of about 5% of Consensus RNs.
Complainers:
Nurses do not have as much time to complain as RTs do because they are busier. When RTs complain, they complain about stupid doctor orders or how doctors refuse to give them autonomy. RNs complain not about their job per se, but about the hospital in general -- too many patients, not enough pay, too many rules, change is not needed, paper charting was better, insurance isn't fair, so and so gets treated better by the boss, etc. They tend to be busy bodies while taking care of their duties. When you pass them as you are entering work, they are known to say things like: "You definitely don't want to be here tonight," or, "Welcome to hell," or, "This schedule sucks," or "I hate Michelle, she's always picking her nose." For the most part, complainers tend to be stuck working on med-surge floors, and consist of about 20% of all Consensus RNs.
Busybodies:
These RNs consist of the RNs you never really get to know because they are busy, busy, busy. They are fast moving, going from room to room, chart to chart, and phone to phone. They never run, but walk at a vary fast pace. They tend to be thin. Some of them work on the med-surge floors, but the majority work in the emergency room. The tend to be very business-like, but when you get a chance to sit down with them they are very fun to talk with. Yet they are known to take off mid sentence. Getting a complete conversation in can be a challenge. Likewise, they are not good listeners. Actually, they are awesome nurses and are very knowledgeable. Because they are so busy, some of them tend to skip corners. The RT bosses may complain to them occasionally, but considering they are such great workers, they don't make a big deal about it. These consist of about 10% of Consensus RNs.
Arrogants:
They always have that smirk on the corner of their lips, and walk with their heads high. They are usually friendly and easy to get along with, but they tend to believe that they know everything and don't need to hear from you. Since they know so much, they tend to compete for supervisor jobs, and seek to become RN Bosses. When they do become RN Bosses, they tend to not keep many of their friends. These consist of 15% of Content RNs.
Old-Schoolers:
These are very wise and sagacious RNs. They can pick up on even the most simple thing wrong with the patient. Their patients are usually well taken care of, and they have little need for other members of the team. They are not arrogant by any means, and are usually great teachers. The problem with this type of RN is they are set in their ways, and are not quick to adapt to changes. They tend to believe in old theories such as the hypoxic drive theory, prefer paper charting to computers, and may tend to wine when they are told to break from their routine. If you are not intimidated by them, they can be fun, or at least educational, to work with. About 50% of Contents are Old School.
Content Contents:
They are happy-go-lucky and when we RTs tell them a treatment is not needed they will look at you with crazy eyes. They do this not because they don't like you, but because they don't understand why you just didn't do what you were told. They say things like, "The patient is wheezing. He needs a treatment." They tend to refer to RTs as ancillary staff, and have little use for them other than for them to do what they are told. They are usually opposed to protocols and rapid response teams (RTT) because those elevate RTs to the same level as RNs, and they know that shouldn't be. And, even if a hospital has an RRT, they will never call for one. Attempts to educate them are futile. They are wonderful people and make great friends otherwise, and are great nurses, but they are incapable of learning new things. They consist of 25% of Content RNs.
Besetting:
I'm sorry, but these guys tend to not be happy -- ever. Nobody gets along with them, probably not even the patient. But when all is said and done, they are very good with their patient when it comes to picking up on things early. However, when it comes to little things like brushing their patient's teeth or giving baths, they think those tasks belong to lesser people like Nurses Aids. Unfortunately, these RNs tend to work in Critical Care Units where AIDS are far and few. They have few friends. They hate you and more than likely you can't stand to work with them. If you do something wrong, they will not be nice and give you a warning, they will simply crab to you and make you feel miserable, or they will simply go over your head and write you up. They consist of 5% of Content RNs, so thankfully they're a rare breed.
Boors:
They tend to be very similar to Macho RNs as listed above, except that they have no use for "ancillary staff" other than to provide their duties. They consider anyone besides doctors and nurses as ancillary, so RTs are ancillary. If they ask you to do something, you do it and do it now. If you don't do exactly as you are told, you will have to deal with the consequences. They are usually very quiet, and are very opinionated at the same time if you get them going. They can also be hot heads if you say something they disagree with. They will put you on the spot. If you ask a question, they will ask a question back. They hold grudges, and may go days without talking to you if you said something to irritate him. For example, if you are discussing politics with him, and everybody in the room disagrees with him, he may give you all the cold shoulder. He's modest, smart, quick witted, and can be hard to work with. He has no problems making enemies. But if you are intelligent or important, you may be his best friend. They are rare and far between, or less than 5% of Content RNs.
Chiefs:
Here we lump all levels of RNs from supervisors on up. Usually, but not always, RN bosses come from the ranks of the Receptive (85%) or Arrogant (15%). Arrogant RNs don't necessarily care what people think about them, but Learners do. Learners go out of their way to please. The farther away from the duties of RN work the RN Bosses become, the greater the chance that The Institution moves ahead of The Person. That doesn't mean they won't try to be friendly, but the bottom line is not necessarily keeping the patient load low, but making money for the institution and keeping their own bosses happy and keeping their jobs and the higher wages that come with it. The RN bosses closer to the working staff (the supervisors, the lead RNs), tend to fit in nicely with the other workers. They do not complain. They are very helpful. They tend to be good workers. Yet they are often political, defend policy regardless of usefulness, and generally will tell you what you want to hear and then either ignore you (Arrogant) or make an attempt to help through the general chain of command -- a process that's really slow. As a general rule, they don't like to make waves, and the longer they have their jobs, the smaller the waves become.
Showing posts with label nurses. Show all posts
Showing posts with label nurses. Show all posts
Friday, May 6, 2011
Saturday, March 20, 2010
The impressive nurse
Erica was a relatively new nurse, and I had actually gotten annoyed with her before because she keeps calling me to give breathing treatments on patients where none are needed. Once she called me to give a treatment because, "the sat's only 89%."
However, oppinions are meant to be changed. A "Code Blue!" page rang out overhead, and I rushed to OB. As the code on the neonate progressed, I was getting tired of bagging and doing CPR. Then Erica showed up and joined in the rotation of bagging, cpr and rest.
She was so impressive, so calm, that I figured she had to be an old pro. Later, after the emergency was over, I approached Erica. She said, "That was the first code I had ever been to, and it just happened to be a baby."
I said, "That was your first code! Holy cow! You were so calm and cool and did such an awesome job I was sure you had done this many times before. I am very impressed!"
Nurses like this are definitely teachable, and fit onto our team well. I also think it's a good thing to compliment our fellow workers on a job well done, even if the outcome isn't what we expect.
However, oppinions are meant to be changed. A "Code Blue!" page rang out overhead, and I rushed to OB. As the code on the neonate progressed, I was getting tired of bagging and doing CPR. Then Erica showed up and joined in the rotation of bagging, cpr and rest.
She was so impressive, so calm, that I figured she had to be an old pro. Later, after the emergency was over, I approached Erica. She said, "That was the first code I had ever been to, and it just happened to be a baby."
I said, "That was your first code! Holy cow! You were so calm and cool and did such an awesome job I was sure you had done this many times before. I am very impressed!"
Nurses like this are definitely teachable, and fit onto our team well. I also think it's a good thing to compliment our fellow workers on a job well done, even if the outcome isn't what we expect.
Saturday, January 30, 2010
Poor planning results in busy nurses
She was an RN. Her boss sat next to her as she was finishing her charting and asked her if she would work tonight. The RN said she was unable. The boss lectured her that "we are all in this together, and part of being a team means we all need to do our part."
The RN said, "I am doing my part. I work my one day a week and that's all I want to work. If I wanted to work more I would schedule myself for more."
The boss was dumbfounded. She picked her ear with one hand, and with the back of her other hand wiped away the drool swirling around the corner of her lower lip as it dropped almost to her jaw.
I thought for a moment she might cry. I, for a brief moment, felt empathy for this boss. Finally she said, "We need you. We're in a crisis here and we really need you."
"Look, I don't mean to be disrespectful," the RN said, "But poor planning on your part doesn't constitute an emergency on mine."
That ended the discussion. I won't go on about how it ended. I won't explain how I so happened to be there to hear the discussion, for neither of those facts matter.
Tonight I was sitting in the ER. I noticed that the charge nurse was sitting at the unit secretaries desk putting in all the orders. From time to time she'd get up, run to a patients room, do some chore there, and return to finish typing away, and flitting through sheets of paper.
"Why are you doing all this work?" I asked, knowing she didn't have time to talk with me.
She leaned back in her chair and smiled, "The unit secretary went home at 2:00 in the morning. The rest of the night we have to go without her and without any nurses assistants or techs to help us out. Plus Janet is going home at 3:00 and so is Jim. So basically it will be just me and Susan."
"So basically the powers that be want you guys to work at unsafe levels."
"Wow! That words it about right."
That was the end of that discussion.
A few years ago another nurse named Peggy was sitting in the nurses report room about 40 minutes after her shift was supposed to start. I said, "Why are you sitting in here when all the nurses out there appear to be overworked."
She said, "I'm refusing to take report because they want me to take 14 patients, and I think that is unsafe. I'm not going to put my license on the line because of their poor planning on their part." She was referring to the RN boss.
Due to her persistence another nurse arrived a half hour later and Peggy finally took report on seven patients, a load that she said was safe.
With respect to hospital bosses it is not possible to know when business is going to be swarming and when it's going to be slow. But still, poor planning on their part does not constitute an emergency on the part of the nurse.
The RN said, "I am doing my part. I work my one day a week and that's all I want to work. If I wanted to work more I would schedule myself for more."
The boss was dumbfounded. She picked her ear with one hand, and with the back of her other hand wiped away the drool swirling around the corner of her lower lip as it dropped almost to her jaw.
I thought for a moment she might cry. I, for a brief moment, felt empathy for this boss. Finally she said, "We need you. We're in a crisis here and we really need you."
"Look, I don't mean to be disrespectful," the RN said, "But poor planning on your part doesn't constitute an emergency on mine."
That ended the discussion. I won't go on about how it ended. I won't explain how I so happened to be there to hear the discussion, for neither of those facts matter.
Tonight I was sitting in the ER. I noticed that the charge nurse was sitting at the unit secretaries desk putting in all the orders. From time to time she'd get up, run to a patients room, do some chore there, and return to finish typing away, and flitting through sheets of paper.
"Why are you doing all this work?" I asked, knowing she didn't have time to talk with me.
She leaned back in her chair and smiled, "The unit secretary went home at 2:00 in the morning. The rest of the night we have to go without her and without any nurses assistants or techs to help us out. Plus Janet is going home at 3:00 and so is Jim. So basically it will be just me and Susan."
"So basically the powers that be want you guys to work at unsafe levels."
"Wow! That words it about right."
That was the end of that discussion.
A few years ago another nurse named Peggy was sitting in the nurses report room about 40 minutes after her shift was supposed to start. I said, "Why are you sitting in here when all the nurses out there appear to be overworked."
She said, "I'm refusing to take report because they want me to take 14 patients, and I think that is unsafe. I'm not going to put my license on the line because of their poor planning on their part." She was referring to the RN boss.
Due to her persistence another nurse arrived a half hour later and Peggy finally took report on seven patients, a load that she said was safe.
With respect to hospital bosses it is not possible to know when business is going to be swarming and when it's going to be slow. But still, poor planning on their part does not constitute an emergency on the part of the nurse.
RT Cave Rule #41: Poor planning on the part of administrators, bosses and supervisors does not constitute an emergency on the part of the staff.
Saturday, June 20, 2009
It's best to smile and go on with your business
I was in the middle of a series of breathing treatments in the ER on one of our regular COPD patients when I over heard the following over the din of the ER rush:
"I suppose I better page Rick again," it was the unit secretary, "he's notorious for not getting his pages."
"Um, he's already doing the treatment," a nurse said in defense of me. "In fact, he happens to be standing right there."
I turned around, stared viciously at that cranky unit secretary and said, "You know what, I wouldn't take so much time getting down here if you guys didn't call me for so much crap. I'd say 80% of the stuff you call me for is B.S!"
Okay, so that's what I wanted to say. What I really did was go about my business, smile, and pretend I didn't hear that exchange. And the rest of the night I smiled, was my normal cordial, phlegmatic, equanimitous self, and went about my business.
I'm telling you guys, when you work in a busy hospital around an amalgamate of people with an amalgamate of personalities, you learn to take such things with a grain of salt -- especially when you work nights.
"I suppose I better page Rick again," it was the unit secretary, "he's notorious for not getting his pages."
"Um, he's already doing the treatment," a nurse said in defense of me. "In fact, he happens to be standing right there."
I turned around, stared viciously at that cranky unit secretary and said, "You know what, I wouldn't take so much time getting down here if you guys didn't call me for so much crap. I'd say 80% of the stuff you call me for is B.S!"
Okay, so that's what I wanted to say. What I really did was go about my business, smile, and pretend I didn't hear that exchange. And the rest of the night I smiled, was my normal cordial, phlegmatic, equanimitous self, and went about my business.
I'm telling you guys, when you work in a busy hospital around an amalgamate of people with an amalgamate of personalities, you learn to take such things with a grain of salt -- especially when you work nights.
Thursday, October 30, 2008
Here's a great reason why RTs are NEEDED
We RTs think alike. A great example of this just occurred to me.
I was minding my business taking care of a real COPD patient in ER, when I was paged by a nurse in recovery. I called her.
She said, "We have a patient down here who has sats in the mid 80s, and I can't get them up no matter what I do."
I said, "What device are you using?"
"A face tent."
"Well, that explains why--"
"Dr. Umabalabamalamala wants you to set up CPAP when the patient gets upstairs."
"Why does he want that."
"Because he thinks the patient isn't taking deep enough breaths."
"Umm, CPAP doesn't help patients take in deep breaths," I reassured her.
"Well, that's what he ordered."
So, as the patient rolled into her room I disconnected the face tent from the patient and plugged in a nasal cannula, set it at 5lpm, and connected it to the patient. The spo2 was initially 85%.
"See," the recovery RN said, "That's the sat we kept getting in recovery. No matter what we did it wouldn't go higher."
Just then the SpO2 jumped up to 94% and stayed there. "Are you breathing okay," I said to the patient.
The patient said, "I'm breathing fine. Do I have to wear that thing. I was on it last week and I hated it."
"I will call your doctor," I said. She smiled.
I got the CPAP changed to prn. I said to the pt. "You saved yourself from this machine because you're so healthy." Again, she smiled.
The moral of this story: Hospitals NEED RTs.
Now, ironically, just after this happened, I return here and check out My RT Life, where the Trauma Junkie wrote about what hospital life would be like without RTs. So, I am linking to his excellent post here.
Not only did the doctor have no clue what a CPAP machine does, neither did the nurses have the knowledge to question the order. And neither one of them had knowledge enough of oxygen therapy to maintain an SpO2 without invasive therapy.
Yes, America, we RTs are needed.
Click here to learn the basics about CPAP.
I was minding my business taking care of a real COPD patient in ER, when I was paged by a nurse in recovery. I called her.
She said, "We have a patient down here who has sats in the mid 80s, and I can't get them up no matter what I do."
I said, "What device are you using?"
"A face tent."
"Well, that explains why--"
"Dr. Umabalabamalamala wants you to set up CPAP when the patient gets upstairs."
"Why does he want that."
"Because he thinks the patient isn't taking deep enough breaths."
"Umm, CPAP doesn't help patients take in deep breaths," I reassured her.
"Well, that's what he ordered."
So, as the patient rolled into her room I disconnected the face tent from the patient and plugged in a nasal cannula, set it at 5lpm, and connected it to the patient. The spo2 was initially 85%.
"See," the recovery RN said, "That's the sat we kept getting in recovery. No matter what we did it wouldn't go higher."
Just then the SpO2 jumped up to 94% and stayed there. "Are you breathing okay," I said to the patient.
The patient said, "I'm breathing fine. Do I have to wear that thing. I was on it last week and I hated it."
"I will call your doctor," I said. She smiled.
I got the CPAP changed to prn. I said to the pt. "You saved yourself from this machine because you're so healthy." Again, she smiled.
The moral of this story: Hospitals NEED RTs.
Now, ironically, just after this happened, I return here and check out My RT Life, where the Trauma Junkie wrote about what hospital life would be like without RTs. So, I am linking to his excellent post here.
Not only did the doctor have no clue what a CPAP machine does, neither did the nurses have the knowledge to question the order. And neither one of them had knowledge enough of oxygen therapy to maintain an SpO2 without invasive therapy.
Yes, America, we RTs are needed.
Click here to learn the basics about CPAP.
Friday, August 8, 2008
Choosing a career: RN versus RT
I am aware that a large portion of my readers are individuals who are surfing back and forth between RN and RT blogs trying to decide: Do I want to be an RT or an RN?
Respiratory Therapy Driven touched on this topic once. He wrote a nice post called RT -vs- RN. I wrote a humorous take on his post, What RTs can do that RNs can't.
I can rattle off the advantages and disadvantages of being an RT, and why I prefer being an RT over an RN. However, this would be skewed from an RT persective.
I can honestly say I enjoy sputum, while many nurses I talk to say they wouldn't want to be an RT because "sputum is gross."
"Well," I say, "I think handing someone a tissue is far better than wiping his butt."
But, like I just wrote, it depends on who you are. Some people might actually enjoy helping someone wipe. Besides, you are helping someone. You have a skill at taking care of sick people, and one of your responsibilities is wiping.
That, however, is a minor task as far as an RN is concerned. They also get to help the patient feel better by giving a bath. Or, perhaps, they delegate that responsibility to a nurses aide, while the RN helps the patient bandage an oozing wound.
Personally, I don't care to do that. My responsibility as an RT is with the airway, and any other holes in the body are left for the RN to take care of. Sputum is the least of my worries.
"But sputum stinks," a nurse said to me once.
"Not as much as that other stuff stinks," I said. "Besides, sputum doesn't stink very often. Poop stinks every time. And if it's of the GI bleed variety, we RTs don't have to stick around once our breathing duties are finished."
So, I've had this debate many times. Nobody ever wins.
Anyway, you don't decide RT over RN because you like sputum. And you don't become an RN because you like to wipe. It's not that simple. There is far more to the decision.
It is true that RNs get paid more than RTs, and actually get more respect nationwide because it has been a well established profession since the Civil War. RTs get paid less, but that doesn't mean we have less responsibility.
You, as an RN, have care to for the general welfare of 1-7 patients. You have to stay in one area of the hospital. You basically cannot leave your patients. We, as an RT, get a variety of patients all over the hospital. While you have to stay by your patients, we get the freedom of roaming the hospital.
That's not to say we don't occasionally have patients that need our one on one care.
RNs give the medicines, and insert the IVs, and we RTs are called when the patient cannot breath. We are the experts at knowing when to call the doctor because a patient can't breath, or simply giving a breathing treatment.
While RNs know a little about a lot of diseases, we RTs know everything about the lungs and heart, and we even know enough about the other organs as everything in one way or another is connected to the lungs: they all need oxygen.
When someone stops breathing, the page is heard loud and clear: "RESPIRATORY STAT TO ROOM 214!"
While the RNs are busy inserting IVs and inserting syringes, and taking care of any wounds on the body, we RTs are continuously managing the airway. We monitor breathing. We insert artificial airways, and run blood gases, and do EKGs and, best of all, we set up and manage ventilators.
We RTs are the team mates of the RN. We all work together. Whether or not you decide to be one or the other is basically a personal preference.
There are other advantages to being an RN beyond the job. We RTs are stuck working in the hospital setting. In Shoreline, there is only one hospital, and only one RT department. RNs can work in the hospital, and can choose between many departments of which to work.
If an RN gets tired of working on the med-surge floors, she can transfer to OB. When she gets tired of working there, she can transfer to surgery, or ER, or back to the patient floors, or the critical care.
She can also get a new job working in Grand Rapids, and can get a job doing any of the above in a busier hospital, perhaps one with a trauma center or burn unit. While working in GR, she may choose to work only with neonates and pediatrics.
An RT can work with neo and peds too, but the options of transferring are far less. An RN can also provide independent services by helping a patient one-on-one in his home. She can do home health care if she wants. She can work in a doctors office for a slight deduction in pay. She can work in a nursing home.
There are far more options for nurses than RTs. That is a simple fact. And, even while RTs and RNs can both rent their services for far more than they'd ever make in the hospital, RNs still will make more than RTs -- that's a simple fact.
Still, knowing all that, I love being an RT. I wouldn't want to do what RNs do. Another thing is, RNs are responsible for keeping all those meds straight. I certainly wouldn't want that responsibility. I'm responsible for only a few respiratory medicines.
Yes, it is true that my breathing machines keep people alive, and things I do could end a life if I made an error, RNs are inserting medicines into the IV that, if given in incorrect doses, could kill or save a life.
The challenges of being an RN or RT are phenomenal. It's the challenges, the working with each other and the doctor to find out what a patient needs. That is the most rewarding part of being in the medical field. It's the teamwork.
Personally, I would never be an RN. That's just not my thing. However, would I ever recommend anyone become an RT? Well, that depends on what your goal is in life.
Are you 28 years old, have already failed at another career, and simply need a job. That's how I became an RT. It was the fail safe for me. Despite popular belief, I did not choose this career because of my asthma. However, it was my asthma that made me aware the job of RT existed.
A lot of people become an RT for reasons similar to mine. Some go into this field because they love to work with people, but don't want the stress of being an RN, or they don't want to wait three years to get into RN school.
There is a greater chance that an RN can move up the ladder. There are simply more opportunities. RNs can get a bachelor's degree. RTs can too, but the benefits from doing so are hardly worth it (at least in my neck of the woods. It's not even offered around here.)
How hard do you want to work? How hard do you want to stress your mind. Are you good at prioritizing? These decisions come to play in both these careers. RTs can be paged three places STAT all at the same time. Which one do you go to first. This is especially important if you are working alone?
There are definite advantages and disadvantages to being an RT or an RN. For one thing, there will always be sick people, and there will always be people in need. Likewise, there will always be people who need help with their breathing.
And, on occasion, there will be people who stop breathing and need the services of both an RT and an RN.
Personally, I'm satisfied with my decision to be an RT. You can read my list of why I love being an RT if you want. Still, would I chose this career again if I had to do all over again. The answer would depend on what day you ask.
Would I recommend you be an RT? Again, it would depend on what your goals are in your life. If you want to be the sole income for your family, you better find some other career. This is not the most financially rewarding job in the world. Still, you could do far worse.
Personally, if I were advising my child, and he were vying RN or RT, I would tell him to be an RN. Why? Because RNs get paid better, and there are far more opportunities available for RNs than RTs.
Still, he might be like me, and simply prefer the RT rought.
Both of these careers can be rewarding. Both can be frustrating as any job.
And both have their advantages and disadvantages. Which one you choose depends on your preferences, your personality, your location, and your goals in life.
Respiratory Therapy Driven touched on this topic once. He wrote a nice post called RT -vs- RN. I wrote a humorous take on his post, What RTs can do that RNs can't.
I can rattle off the advantages and disadvantages of being an RT, and why I prefer being an RT over an RN. However, this would be skewed from an RT persective.
I can honestly say I enjoy sputum, while many nurses I talk to say they wouldn't want to be an RT because "sputum is gross."
"Well," I say, "I think handing someone a tissue is far better than wiping his butt."
But, like I just wrote, it depends on who you are. Some people might actually enjoy helping someone wipe. Besides, you are helping someone. You have a skill at taking care of sick people, and one of your responsibilities is wiping.
That, however, is a minor task as far as an RN is concerned. They also get to help the patient feel better by giving a bath. Or, perhaps, they delegate that responsibility to a nurses aide, while the RN helps the patient bandage an oozing wound.
Personally, I don't care to do that. My responsibility as an RT is with the airway, and any other holes in the body are left for the RN to take care of. Sputum is the least of my worries.
"But sputum stinks," a nurse said to me once.
"Not as much as that other stuff stinks," I said. "Besides, sputum doesn't stink very often. Poop stinks every time. And if it's of the GI bleed variety, we RTs don't have to stick around once our breathing duties are finished."
So, I've had this debate many times. Nobody ever wins.
Anyway, you don't decide RT over RN because you like sputum. And you don't become an RN because you like to wipe. It's not that simple. There is far more to the decision.
It is true that RNs get paid more than RTs, and actually get more respect nationwide because it has been a well established profession since the Civil War. RTs get paid less, but that doesn't mean we have less responsibility.
You, as an RN, have care to for the general welfare of 1-7 patients. You have to stay in one area of the hospital. You basically cannot leave your patients. We, as an RT, get a variety of patients all over the hospital. While you have to stay by your patients, we get the freedom of roaming the hospital.
That's not to say we don't occasionally have patients that need our one on one care.
RNs give the medicines, and insert the IVs, and we RTs are called when the patient cannot breath. We are the experts at knowing when to call the doctor because a patient can't breath, or simply giving a breathing treatment.
While RNs know a little about a lot of diseases, we RTs know everything about the lungs and heart, and we even know enough about the other organs as everything in one way or another is connected to the lungs: they all need oxygen.
When someone stops breathing, the page is heard loud and clear: "RESPIRATORY STAT TO ROOM 214!"
While the RNs are busy inserting IVs and inserting syringes, and taking care of any wounds on the body, we RTs are continuously managing the airway. We monitor breathing. We insert artificial airways, and run blood gases, and do EKGs and, best of all, we set up and manage ventilators.
We RTs are the team mates of the RN. We all work together. Whether or not you decide to be one or the other is basically a personal preference.
There are other advantages to being an RN beyond the job. We RTs are stuck working in the hospital setting. In Shoreline, there is only one hospital, and only one RT department. RNs can work in the hospital, and can choose between many departments of which to work.
If an RN gets tired of working on the med-surge floors, she can transfer to OB. When she gets tired of working there, she can transfer to surgery, or ER, or back to the patient floors, or the critical care.
She can also get a new job working in Grand Rapids, and can get a job doing any of the above in a busier hospital, perhaps one with a trauma center or burn unit. While working in GR, she may choose to work only with neonates and pediatrics.
An RT can work with neo and peds too, but the options of transferring are far less. An RN can also provide independent services by helping a patient one-on-one in his home. She can do home health care if she wants. She can work in a doctors office for a slight deduction in pay. She can work in a nursing home.
There are far more options for nurses than RTs. That is a simple fact. And, even while RTs and RNs can both rent their services for far more than they'd ever make in the hospital, RNs still will make more than RTs -- that's a simple fact.
Still, knowing all that, I love being an RT. I wouldn't want to do what RNs do. Another thing is, RNs are responsible for keeping all those meds straight. I certainly wouldn't want that responsibility. I'm responsible for only a few respiratory medicines.
Yes, it is true that my breathing machines keep people alive, and things I do could end a life if I made an error, RNs are inserting medicines into the IV that, if given in incorrect doses, could kill or save a life.
The challenges of being an RN or RT are phenomenal. It's the challenges, the working with each other and the doctor to find out what a patient needs. That is the most rewarding part of being in the medical field. It's the teamwork.
Personally, I would never be an RN. That's just not my thing. However, would I ever recommend anyone become an RT? Well, that depends on what your goal is in life.
Are you 28 years old, have already failed at another career, and simply need a job. That's how I became an RT. It was the fail safe for me. Despite popular belief, I did not choose this career because of my asthma. However, it was my asthma that made me aware the job of RT existed.
A lot of people become an RT for reasons similar to mine. Some go into this field because they love to work with people, but don't want the stress of being an RN, or they don't want to wait three years to get into RN school.
There is a greater chance that an RN can move up the ladder. There are simply more opportunities. RNs can get a bachelor's degree. RTs can too, but the benefits from doing so are hardly worth it (at least in my neck of the woods. It's not even offered around here.)
How hard do you want to work? How hard do you want to stress your mind. Are you good at prioritizing? These decisions come to play in both these careers. RTs can be paged three places STAT all at the same time. Which one do you go to first. This is especially important if you are working alone?
There are definite advantages and disadvantages to being an RT or an RN. For one thing, there will always be sick people, and there will always be people in need. Likewise, there will always be people who need help with their breathing.
And, on occasion, there will be people who stop breathing and need the services of both an RT and an RN.
Personally, I'm satisfied with my decision to be an RT. You can read my list of why I love being an RT if you want. Still, would I chose this career again if I had to do all over again. The answer would depend on what day you ask.
Would I recommend you be an RT? Again, it would depend on what your goals are in your life. If you want to be the sole income for your family, you better find some other career. This is not the most financially rewarding job in the world. Still, you could do far worse.
Personally, if I were advising my child, and he were vying RN or RT, I would tell him to be an RN. Why? Because RNs get paid better, and there are far more opportunities available for RNs than RTs.
Still, he might be like me, and simply prefer the RT rought.
Both of these careers can be rewarding. Both can be frustrating as any job.
And both have their advantages and disadvantages. Which one you choose depends on your preferences, your personality, your location, and your goals in life.
Saturday, July 12, 2008
Humility is the key to success as an RT
I would like to ad something to what I wrote yesterday. That along with all the great things about being an RT, the politics gets pulled right along. And the best way of dealing with politics is good old fashioned humility.
Sometime in life we have to do things we don't want to do. One of the biggest reasons for this is pure-D-politics. As much as we hate politics, we all get caught into it on a daily basis whether we want to or not.
Yesterday I wrote that I have learned that it is best to keep my mouth shut than to have the nurse telling me I'm a lazy RT who is just trying to get out of work. I'm not trying to get out of work, just being honest. That, my friends, is politics.
One of the things I have realized about the drug Albuterol, is that it basically has no side effects. It might make a person shaky, but that's a mild problem. It may make the occasional heart palpate, but that incidence is far and few between now that the "bronchodilator" has been so chemically refined.
And doctors know that. So, they decided long ago that it is better to give a bronchodilator than risk being seen as doing nothing. It is easier to just give the bronchodilator, than to assess the patient and waste your time thinking.
There are RTs that do this. There are RNs and doctors who are victims as well. When an RT does this, they are called treatment jockeys (more on this tomorrow). When doctors and RNs do this, they are just doing their jobs.
None of this would be possible, however, if not for the fact that this drug has been so refined. This refining has made the perfect medicine for bronchospasm.
But, with all good things must come the bad. The bad is that the refining has taken away our need to second guess whether a treatment is needed. "Oh, there are no side effects, so let's just give this treatment and see what happens."
And, if the RT complains, it's because he or she is lazy. So we RTs have learned to do our own PR and do not complain where others can hear us (well, most of us don't, or most of the time we don't). Then we just shut up and give the treatment.
You want to know why I really give the treatments even though I don't think they are
indicated?
Because in life nothing is certain, and nobody is perfect, and I could be wrong.
And, even though sometimes I am quite certain I am right, humility, keeping the peace, is often more important that being right.
Allow me to quote something Biblically. This is not from the Bible, but it comes from a religious pamphlet, so it's pretty close to the Bible: "Lowliness of mind, or humility, can help you suppress the urge to insist on being right in a disagreement."
So, I suppose, what it comes down to is humility. And, to put it simply, humility is the key to success as an RT, especially when it comes to maintaining a good rapport with the rest of the people we work with.
Sometime in life we have to do things we don't want to do. One of the biggest reasons for this is pure-D-politics. As much as we hate politics, we all get caught into it on a daily basis whether we want to or not.
Yesterday I wrote that I have learned that it is best to keep my mouth shut than to have the nurse telling me I'm a lazy RT who is just trying to get out of work. I'm not trying to get out of work, just being honest. That, my friends, is politics.
One of the things I have realized about the drug Albuterol, is that it basically has no side effects. It might make a person shaky, but that's a mild problem. It may make the occasional heart palpate, but that incidence is far and few between now that the "bronchodilator" has been so chemically refined.
And doctors know that. So, they decided long ago that it is better to give a bronchodilator than risk being seen as doing nothing. It is easier to just give the bronchodilator, than to assess the patient and waste your time thinking.
There are RTs that do this. There are RNs and doctors who are victims as well. When an RT does this, they are called treatment jockeys (more on this tomorrow). When doctors and RNs do this, they are just doing their jobs.
None of this would be possible, however, if not for the fact that this drug has been so refined. This refining has made the perfect medicine for bronchospasm.
But, with all good things must come the bad. The bad is that the refining has taken away our need to second guess whether a treatment is needed. "Oh, there are no side effects, so let's just give this treatment and see what happens."
And, if the RT complains, it's because he or she is lazy. So we RTs have learned to do our own PR and do not complain where others can hear us (well, most of us don't, or most of the time we don't). Then we just shut up and give the treatment.
You want to know why I really give the treatments even though I don't think they are
indicated?
Because in life nothing is certain, and nobody is perfect, and I could be wrong.
And, even though sometimes I am quite certain I am right, humility, keeping the peace, is often more important that being right.
Allow me to quote something Biblically. This is not from the Bible, but it comes from a religious pamphlet, so it's pretty close to the Bible: "Lowliness of mind, or humility, can help you suppress the urge to insist on being right in a disagreement."
So, I suppose, what it comes down to is humility. And, to put it simply, humility is the key to success as an RT, especially when it comes to maintaining a good rapport with the rest of the people we work with.
This brings us to RT Cave Rule #25:
RT Cave Rule #25: The key to maintaining a good rapport with the other people we work with is good old fashioned humility. It's okay to not let people know that you are right.
And now for RT Cave Rule #26:
RT Cave Rule #26: A good RT will admit when he is wrong.Allow me to add to this post one quote I read in a good book that fits in well here. In fact, I'll just make this another RT Cave Rule:
RT Cave Rule #27: "When a person complains, he is saying more about himself than about the person he is complaining about." Therefore, the most respected people in life are those who do not complain.
Thus, it is just better to bite your lip and get yourself burned out doing frivolous therapies than to complain.
There are exceptions to this rule, however. If there weren't exceptions, there would never be change brought about, and we would not have protocols. There are those among us who have the ability to get their way. They are the smooth talkers.
So, if you are not a smooth talker, like I'm not, you're better off using your humility and just keeping the peace.
An RT co-worker of mine likes to refer to us RTs as keepers of the piece. He says that one of the main jobs of us RTs is public relations. We are the PR department.
Which isn't so bad I suppose.
That, my good friends, is the deep thought of the day.
There are exceptions to this rule, however. If there weren't exceptions, there would never be change brought about, and we would not have protocols. There are those among us who have the ability to get their way. They are the smooth talkers.
So, if you are not a smooth talker, like I'm not, you're better off using your humility and just keeping the peace.
An RT co-worker of mine likes to refer to us RTs as keepers of the piece. He says that one of the main jobs of us RTs is public relations. We are the PR department.
Which isn't so bad I suppose.
That, my good friends, is the deep thought of the day.
Friday, July 11, 2008
An honest RT has "A bad attitude"
I didn't mean to be rude to the nurse, I was just being honest when I said, "This patient is wet, he doesn't need a breathing treatment."
"That's a bad attitude," My RN friend said.
"I'm just being honest."
That's exactly why we RTs go about our work, keep our mouths shut, and grumble and gripe to ourselves when we get tired of being called every five minutes for another treatment for some stupid reason.
This time, the patient had swollen ankles, diminished lung sounds coupled with a throat squeak indicative of CHF. Oh, and he also had a cardiac history.
I thought for a second about educating her on why I thought a treatment wasn't indicated, but decided better. It's easier just to keep my mouth shut, and let her think I'm just being grumpy.
"That's a bad attitude," My RN friend said.
"I'm just being honest."
That's exactly why we RTs go about our work, keep our mouths shut, and grumble and gripe to ourselves when we get tired of being called every five minutes for another treatment for some stupid reason.
This time, the patient had swollen ankles, diminished lung sounds coupled with a throat squeak indicative of CHF. Oh, and he also had a cardiac history.
I thought for a second about educating her on why I thought a treatment wasn't indicated, but decided better. It's easier just to keep my mouth shut, and let her think I'm just being grumpy.
One of my co-workers told me he told a nurse the other day a patient didn't need a breathing treatment, and the nuse said, "You're just trying to get out of work."
In other words, we RTs are lazy. We just want to sit in our RT Cave without being bothered.
So, basically, when we are called because a patient is SOB, or has some annoying lung sound, we have no choice but to give a treatment, whether it's indicated or not.
Mind you, it's no big deal sticking a pipe in some one's mouth, it's just the principle of the matter that counts.
It should speak highly of us RTs that more often than not we simply give the breathing treatment just to keep the nurse happy; to keep the peace. At least that's how I usually work.
For me, secondary to taking care of the patient, there's nothing more important than maintaining a good rapport with the nurses.
This brings us to RT Cave Rule #24:
RT Cave Rule #24: It's better to just keep your mouth shut and give the breathing treatment, than to risk being told that you are lazy and just trying to get out of work.
That, my friends, is the thought of the day
Wednesday, March 5, 2008
Grumpy doctor's like to share their misery
It's busy here tonight, and I don't have a lot of time to write, but I'm here anyway. Both the day shift RTs were not in the cave when I arrived, and that was a bad sign right off the bat.Then the phone rang. Dee was in ER with a patient who had coded on the way to her doctor's office, and Jane was busy with a phych patient who's having hallucinations, on BiPAP due to low sats, and keeps trying to rip the mask off.
Before I took off for the CCU I figured I'd at least put my work shoes on, but there was a new key pad on the storage room door, so I ended up setting up a vent, before I even got report, with my boots on.
No big deal. The patient will be fine.
However, when I did her 10:00 vent check I noticed her BP had dropped significantly, and Sandy just happened to come into the room at that time and she told me she was going to call doctor Mark about it.
I watched as she hung up the phone. "What's wrong. You get chewed out too."
"Yes, " she said, "Dr. Mark said, grumpily, 'Why are you calling me for this? Is the patient sleeping. It's normal for blood pressures to drop when a patient's sleeping.' And I wanted to say to heim 'The patient's pressure was in the 70s. I don't care if she's sleeping or not. It's my job to call you.' but I held my tongue like I always do."
Later the patient who was on BiPAP was pulling off her mask, and when she did so her sats dropped into the 50s. Michelle gave some Haldol to the patient, but that didn't seem to calm her much. So Michelle called Dr. Mark.
While she was on the phone I went into the patient's room and pretended to do something to the Vision.
"What are you doing?" the patient asked.
"I'm fixing this machine so it works better for you." I lied. "There, how's that?"
"Oh, it feels much better now," she said.
"Great. You're doing a great job. This thing is working so well for you." That was the truth. However, I knew if I could keep this patient on calm terms, and she kept the mask on, she'd be fine. The alternative was to be intubated.
I stepped out of the patient's room and saw that Michelle seemed to be defending herself on the phone. Then hung up.
"Dr. Mark is such a crab ass," she said to me.
"She yelled at you, hey," I said.
"Yeah. She said if we can't keep the mask on her that we need to call the anesthesiologist to intubate her, and if we're going to do that we better do it before eleven, or at least before the anesthesiologist goes to sleep because we don't want to inconvenience him more than we have to."
"Well, the patient's calm now. She should be okay for a while anyway."
"Good. I'd hate to inconvenience Dr. Mark again."
It ticks me off when a doctor gets mad at an RN or RT for doing his or her job. If something's not right with the patient, like a significant drop in pressure, we can't just sit on it. Not only did these nurses have to call the doctor out of good conscience for the patient, but to protect their licences.
But Dr. Mark wasn't going to be satisfied until he shared his grumpiness with those two nurses and made a valiant attempt at ruining their nights too. But that wasn't to be. We all know Dr. Mark has his nights.
I left the unit and knocked off five treatments, all on out to lunch patients who would have survived just fine if I never gave them their treatments.
My next stop was in the emergency room. After I did an EKG I went to hand it to Dr. Call, perhaps the nicest doctor on earth, but he was on the phone with DR. MARK.
My next stop was in the emergency room. After I did an EKG I went to hand it to Dr. Call, perhaps the nicest doctor on earth, but he was on the phone with DR. MARK.
"Hmmm," I whispered to Sue, "Do grumpy doctors chew out other doctors, or is it just RNs and RTs they treat like scum? Because Dr. Mark just got done chewing out both nurses in the unit, and they called him for a legitimate reason."
Sue smiled and said, "He has his nights."
Tuesday, February 5, 2008
Good co-workers make our job easier
Sorry for the rant in my last post, but it really is the truth. I received some much needed empathy from my RT blogger friends, and I suspected as much. I imagine some of you guys work equally as hard probably on a regular basis.
One person smpathised with me and wrote that it's nice to be around fellow RTs when you have busy nights like this. She said, "There is something comforting about walking past another RT in the same hell and muttering 'Kill me now' under your breath. That smile or quick laugh makes everything okay."
I do miss that being the lone night shift RT at Shoreline. I have to give so much credit to my co-worker Jane Sage who works the 9 a.m. to 9 p.m. shift. Even though she was as burned out as me, she stayed until 11 p.m. every night this past weekend, even though she had to be back to work at her regular time the next day. Having her there was literally a stress saver.
And as Dee Brown walks into the RT Cave in the morning and observes me playing a game on the Internet and smiles instead of complaining that I didn't start all the QIDs or do any of the morning EKGs, I feel joy. We are a team. We RTs stick together in our frustration when we have hell nights.
Yet, while I work the bulk of my hours as the lone RT, I know that I have many wonderful RNs here at Shoreline to say "shoot me." We are equally busy. While I walk the 20 miles on my own, the RNs may be caught in a pile of poop provided by just one patient. Those nights can be equally hellish.
One really great thing about working at a small town hospital, and I think one of the reasons I've stuck with this particular hospital as long as I have, is that the RNs have a certain degree of empathy for us RTs when we are busy -- and vise versal.
There have been two ocassions I walked down to ER this past weekend alone and dropped a handful of Duoneb amps on the counter and said, "You guys are on your own." While I might have been blunt, they had empathy for me and did not complain.
There were several occasions when the ER nurses did my EKGs without as much as a grunt. And there was one time I was in ER and a nurse did my EKG just to be nice. She knew it was my fourth swamped night in a row.
I smiled and said, "This is the happiest I've been all weekend. You ER nurses are the best."
Of course if I were in the unit it would be, "You CCU nurses are the best." You know what I mean. You have to be political.
And politicalness is important when you are the lone shift RT, because when the nurses like you, they can make your job a heck of a lot easier than if they didn't -- and vice versal I suppose. However, I pride myself in knowing that I get along with all people. It's better that way.
One of my co-workers who recently resigned used to buy pizza every Saturday night of his weekend on. Once I asked him why he did this, and smiled and said, "If I make a mistake I want to have many friends to back me up."
Last night the nurses organized a pot luck, and all I had the energy to bring was a bag of chips. And my co-worker and I were so burned out we ate the whole bag while giving report.
However, the nurses weren't going to let me skip out on the midnight meal. Midnight meals are cool; a big stress reliever. Even while I had only a moment to munch, the aura of the moment, the hanging out with my co-workers in the lunch room, was all the comfort an RT needs.
One person smpathised with me and wrote that it's nice to be around fellow RTs when you have busy nights like this. She said, "There is something comforting about walking past another RT in the same hell and muttering 'Kill me now' under your breath. That smile or quick laugh makes everything okay."
I do miss that being the lone night shift RT at Shoreline. I have to give so much credit to my co-worker Jane Sage who works the 9 a.m. to 9 p.m. shift. Even though she was as burned out as me, she stayed until 11 p.m. every night this past weekend, even though she had to be back to work at her regular time the next day. Having her there was literally a stress saver.
And as Dee Brown walks into the RT Cave in the morning and observes me playing a game on the Internet and smiles instead of complaining that I didn't start all the QIDs or do any of the morning EKGs, I feel joy. We are a team. We RTs stick together in our frustration when we have hell nights.
Yet, while I work the bulk of my hours as the lone RT, I know that I have many wonderful RNs here at Shoreline to say "shoot me." We are equally busy. While I walk the 20 miles on my own, the RNs may be caught in a pile of poop provided by just one patient. Those nights can be equally hellish.
One really great thing about working at a small town hospital, and I think one of the reasons I've stuck with this particular hospital as long as I have, is that the RNs have a certain degree of empathy for us RTs when we are busy -- and vise versal.
There have been two ocassions I walked down to ER this past weekend alone and dropped a handful of Duoneb amps on the counter and said, "You guys are on your own." While I might have been blunt, they had empathy for me and did not complain.
There were several occasions when the ER nurses did my EKGs without as much as a grunt. And there was one time I was in ER and a nurse did my EKG just to be nice. She knew it was my fourth swamped night in a row.
I smiled and said, "This is the happiest I've been all weekend. You ER nurses are the best."
Of course if I were in the unit it would be, "You CCU nurses are the best." You know what I mean. You have to be political.
And politicalness is important when you are the lone shift RT, because when the nurses like you, they can make your job a heck of a lot easier than if they didn't -- and vice versal I suppose. However, I pride myself in knowing that I get along with all people. It's better that way.
One of my co-workers who recently resigned used to buy pizza every Saturday night of his weekend on. Once I asked him why he did this, and smiled and said, "If I make a mistake I want to have many friends to back me up."
Last night the nurses organized a pot luck, and all I had the energy to bring was a bag of chips. And my co-worker and I were so burned out we ate the whole bag while giving report.
However, the nurses weren't going to let me skip out on the midnight meal. Midnight meals are cool; a big stress reliever. Even while I had only a moment to munch, the aura of the moment, the hanging out with my co-workers in the lunch room, was all the comfort an RT needs.
Wednesday, January 2, 2008
I'm going to be written up -- I hope
I'm going to be written up, and I'm happy about it.About seven hours into my shift I had a patient with a bad heart of whom the ER doc had already decided to ship. I had a bad feeling about this patient, so I decided to hang out in ER until the patient was secured into the ambulance, and the ambulance was gone.
Leaning against the wall, being cool, I casually looked down at the counter and saw that someone had written something on a note pad. This is what it said: "Respiratory did not respond to do an EKG after 2 pages."
I smiled, stood by coolly, and pretended I didn't see it. Most ER nurses understand that I am the only RT on duty, and that my other patients are just as important as ER patients, but this new nurse, her name is Mary, hasn't figured that out yet.
During my recent stay in the hospital, she was the only nurse who didn't treat me like royalty. In fact, when she was my ER nurse, that was the first time I had met her. Now I'm quite certain that not only is she a bitch from the patient POV, she is also a bitch from this side too. She is a rare and unfortunate scar on an otherwise awesome staff here at Shoreline.
Despite my opinion, which is subject to change once I get to know her, I continued to treat her with respect, and I continued to coolly smile at her each time I passed her. And, to my surprise, she was quite nice to me the rest of the night. She even smiled once.
As you guys know from a previous post, I have a proposal for ER EKGs that I have yet to take to the powers that be here at Shoreline. If I get written up here, I am going to use this as a prime opportunity to state my case for STAT reform.
Instead of paging me "EKG in ER" I think I should be paged "STAT EKG in ER" or "Just because EKG in ER" so that I can prioritize appropriately. However, I did tell this to a nurse once, and she paged me STAT for every EKG, because, as she said, "All ER EKGs are STAT."
"No they are not," I said.
"Everything ordered down here is STAT."
"That's not necessarily true." And I proceeded to give her many examples: Treatment for sputum induction, treatment on a not SOB patient, pre-op EKGs, etc.
I said, "If you start paging me STAT to all EKGs, then I'm going to get numb to the word STAT. It's not fair to my patients on the floor if I drop what I'm doing every time I get a STAT page, especially when the EKG in ER isn't needed."
When this nurse I do not like paged me the first time, and to my defense, I was with another patient. I did get the page. I was tied up in another room. And, since about 80% of ER EKGs are done just because, I figured I'd finish up what I was doing before going down to ER. And, lo and behold, I received a second page three minutes later, and still decided to finish up what I was doing.
I was swamped all night.
Okay, yes I could have called. I am at fault there. However, most of the time I call to say I'm going to be a while getting down there, I get down there 20 minutes later to find the EKG is still not done, so why bother calling.
Now, you might be thinking, "If they thought to page you a second time, didn't you think that perhaps they thought the EKG needed to be done urgent?"
No. The reason I didn't think that was because ER always pages me three minutes after the initial page, especially if I don't get down there right away. I get tired of it, especially when I drop what I'm doing and the patient has an EKG ordered for a hang nail or something stupid like that.
I'm the kind of RT who gets along with everybody for the most part. I never complain. In fact, just last night I walked into a room to do a STAT EKG on a patient who was being packed up to be shipped to the CCU, and I observed the patient's NC was hooked up to a tank.
"Is that tank even on," I said while hooking up my leads.
"Yeah, I'm sure of it," the young nurses aid reassured me.
I casually unplugged the tubing from the tank and hooked it to the flowmeter, and turned the flowmeter on. Then I checked the O2 tank. Yes, it was on to 2lpm, but there was something she didn't notice: the tank was empty.
Now, instead of jumping all over her and telling her she was a stupid ass like some people might do, I used this as a teaching opportunity. She probably thinks I'm going to write her up. I won't.
Why won't I write her up? Because I know that some day I'm going to do something stupid. We are a team. We need to stand up for one another.
This ER nurse however. I am very confident that once I get her trained I will get along with her just fine, so long as there is any humanity in her. In the meantime...
I hope she writes me up.
Friday, December 28, 2007
Rapid Response Teams are awesome
I thinkRapid Response Teams are really cool.
I can't even count how many times I've had a patient who doesn't look good to me or the nurses, only for the nurse to call the doctor and the doctor say, "Mumble, mumble, mumble... Give 20 of Lasix, mumble, mumble, mumble."
Click.
That's okay sometimes, but I know there have been many times we've stressed out the rest of the night about the patient, especially if the lasix didn't work. Sometimes these patients end up in the CCU and we saw it coming.
Now if a patient doesn't look good the nurse pages the RRT and an RT, a CCU nurse and the RN supervisor go STAT to the patient's room. We assess the patient and perform procedures and tests we feel are appropriate.
Tonight I had such a call. The patient was sitting on the edge of the bed, arms spread across the bedside table, paradoxically breathing. I arrived and took charge.
"It looks like she's wet." I said before I even assessed the patient. After doing this job for so many years you become good at observations. However, a full assessment would be needed.
"That's what I was thinking." The nurse, Abba, was setting the pulse ox probe on the patient's finger. The sat read 86%. "Her blood pressure is also way high."
Peering up at the monitor, the BP read 192/124. I reached for my handy dandy stethescope and took a quick listen. Happy, the nurses supervisor, and a second nurse arrived and were now standing by my side.
"What do you think? Wet?" Abba asked. She was a good nurse. I had her trained well. A less worthy nurse would have said, "We need a treatment," without further assessment. This was working out just perfect. The way it should be done.
"Yep." I said.
"I think we should do an EKG, ABG and perhaps a treatment." Wow. It feels good using my brain.. A rush of joy filled my veins. Man, it feels so good to use my skills..
I paused a moment. I looked at the patient. Her head was now bowed between her arms so the back of her head stared at the ceiling. It's a miserable feeling not being able to breath. I understood completely.
I paused, however, because I wanted to make sure I wasn't overstepping my bounds. I didn't want to do a bunch of procedures that were not necessary. Rather, I didn't want the nurses in the room to think I was on a power trip like the Air-Flight nurse the other night. I looked at Happy. "Do you agree?"
"Oh, definitely," she said.
As per protocol, the doctor was called before the tests were completed. As I arrived back at the nurses station after running my ABG, the nurse set the phone on the receiver and peered over at me. "He said, 'Mumble, mumble, mumble, give her 20 of Lasix, mumble, mumble, mumble.'"
"As expected," I said, smiling.
"I told him that we did the treatment and the ABG, and he slammed the phone in my ear." She smiled as though she had expected as much. "I guess he doesn't care. So I'll write the order for those."
I said, "Hey, that's fine, because at least now we don't have to stress out about not knowing what her status is. We got all the test results done before the doctor was called. How many times do you sit and worry about a patient the doctor appears not to care about?"
"Not any more," she said, " But I'm glad we did the EKG at least, because her blood pressure is still in the 190s. He didn't seem to care at all about that. And I told him we did the ABGs and he still hung up the phone in my ear. It was almost as though he was annoyed that I even called."
"Well, perhaps we overstepped our bounds a bit. But I think it's great that we have this team. And I think we should always call the RRT before the doctor is called on these patients so we can do the tests we think are needed that the doctor won't order."
"I absolutely agree. I mean, we are the ones at the patient's bedside. We see right up close how the patient is doing, how she feels. The doctor just wants to get off the phone so he can get back to bed."
"Well, to be fair not all doctors are like that, but that one is."
I checked on the patient. She was snuggled under the blankets and the head of the bed was all the way down, a sure sign she was fine now. Despite that, I said, "Mrs. Beer, are you feeling better."
She nodded, turned to look at me, "Yes."
"Did the treatment work for you?"
"Yeah, I'm still a little short of breath, but I feel much more comfortable."
I know you guys are saying: "Why the hell did you give the breathing treatment when you figured the patient was wet? If a doctor did that you'd complain about it."
True. But sometimes pulmonary edema can cause bronchospasm, and sometimes a treatment can help treat that symptom. What I hate is when the treatment is ordered Q4 after the fact, when they are no longer needed. I have no problem trying one treatment.
I checked on her a few times the rest of the noc shift and she was sleeping comfortably each time, which meant the doctor was right on this one.
The patient gave us no further trouble, which was a good thing, because a half hour after I was finished with her, "SIGNAL ONE in CCU!" railed across the overhead speakers.
It was one busy night. But one in which I used my skills. It was awesome.
I can't even count how many times I've had a patient who doesn't look good to me or the nurses, only for the nurse to call the doctor and the doctor say, "Mumble, mumble, mumble... Give 20 of Lasix, mumble, mumble, mumble."
Click.
That's okay sometimes, but I know there have been many times we've stressed out the rest of the night about the patient, especially if the lasix didn't work. Sometimes these patients end up in the CCU and we saw it coming.
Now if a patient doesn't look good the nurse pages the RRT and an RT, a CCU nurse and the RN supervisor go STAT to the patient's room. We assess the patient and perform procedures and tests we feel are appropriate.
Tonight I had such a call. The patient was sitting on the edge of the bed, arms spread across the bedside table, paradoxically breathing. I arrived and took charge.
"It looks like she's wet." I said before I even assessed the patient. After doing this job for so many years you become good at observations. However, a full assessment would be needed.
"That's what I was thinking." The nurse, Abba, was setting the pulse ox probe on the patient's finger. The sat read 86%. "Her blood pressure is also way high."
Peering up at the monitor, the BP read 192/124. I reached for my handy dandy stethescope and took a quick listen. Happy, the nurses supervisor, and a second nurse arrived and were now standing by my side.
"What do you think? Wet?" Abba asked. She was a good nurse. I had her trained well. A less worthy nurse would have said, "We need a treatment," without further assessment. This was working out just perfect. The way it should be done.
"Yep." I said.
"I think we should do an EKG, ABG and perhaps a treatment." Wow. It feels good using my brain.. A rush of joy filled my veins. Man, it feels so good to use my skills..
I paused a moment. I looked at the patient. Her head was now bowed between her arms so the back of her head stared at the ceiling. It's a miserable feeling not being able to breath. I understood completely.
I paused, however, because I wanted to make sure I wasn't overstepping my bounds. I didn't want to do a bunch of procedures that were not necessary. Rather, I didn't want the nurses in the room to think I was on a power trip like the Air-Flight nurse the other night. I looked at Happy. "Do you agree?"
"Oh, definitely," she said.
As per protocol, the doctor was called before the tests were completed. As I arrived back at the nurses station after running my ABG, the nurse set the phone on the receiver and peered over at me. "He said, 'Mumble, mumble, mumble, give her 20 of Lasix, mumble, mumble, mumble.'"
"As expected," I said, smiling.
"I told him that we did the treatment and the ABG, and he slammed the phone in my ear." She smiled as though she had expected as much. "I guess he doesn't care. So I'll write the order for those."
I said, "Hey, that's fine, because at least now we don't have to stress out about not knowing what her status is. We got all the test results done before the doctor was called. How many times do you sit and worry about a patient the doctor appears not to care about?"
"Not any more," she said, " But I'm glad we did the EKG at least, because her blood pressure is still in the 190s. He didn't seem to care at all about that. And I told him we did the ABGs and he still hung up the phone in my ear. It was almost as though he was annoyed that I even called."
"Well, perhaps we overstepped our bounds a bit. But I think it's great that we have this team. And I think we should always call the RRT before the doctor is called on these patients so we can do the tests we think are needed that the doctor won't order."
"I absolutely agree. I mean, we are the ones at the patient's bedside. We see right up close how the patient is doing, how she feels. The doctor just wants to get off the phone so he can get back to bed."
"Well, to be fair not all doctors are like that, but that one is."
I checked on the patient. She was snuggled under the blankets and the head of the bed was all the way down, a sure sign she was fine now. Despite that, I said, "Mrs. Beer, are you feeling better."
She nodded, turned to look at me, "Yes."
"Did the treatment work for you?"
"Yeah, I'm still a little short of breath, but I feel much more comfortable."
I know you guys are saying: "Why the hell did you give the breathing treatment when you figured the patient was wet? If a doctor did that you'd complain about it."
True. But sometimes pulmonary edema can cause bronchospasm, and sometimes a treatment can help treat that symptom. What I hate is when the treatment is ordered Q4 after the fact, when they are no longer needed. I have no problem trying one treatment.
I checked on her a few times the rest of the noc shift and she was sleeping comfortably each time, which meant the doctor was right on this one.
The patient gave us no further trouble, which was a good thing, because a half hour after I was finished with her, "SIGNAL ONE in CCU!" railed across the overhead speakers.
It was one busy night. But one in which I used my skills. It was awesome.
Saturday, December 22, 2007
The best Christmas gift may simply be a smile
We know sometimes we have a tendency to shoot the middle person. While this isn't something I personally do on a regular basis, I've had my lapses like the best of them.It's the Christmas season, and a perfect time of year to remind ourselves that the middle people are just doing their jobs.
Who are the middle people who need to be recognized?
- Unit Secretaries: Most of them are very nice people who simply have the bum luck of having to call us RTs about new orders. It's not their fault that you "were just down there" or "that treatment is not indicated."
- Nurses: Again, most of them are great people, many of whom are our friends. They are often overwhelmed and simply trying to do the best for their patients.
- Supervisors: They have to tell you when you make mistakes. It's their job.
- Schedulers: This is the most unappreciated job in the world. Need I say more.
'Tis the season to show appreciation for these hard working people.
Regardless of how busy you are this Holiday season, no matter how much your inner voice is shouting for you to grumble and gripe, smile instead and be happy.Quite often the best Christmas gift you can give is a simple smile, or at least a friendly voice over the phone.
Saturday, December 15, 2007
Here's my advice for hospital patients
Based on my own experience as an in-patient earlier this week, I've come up with a few bits of good advice for anyone going to the Emergency Room, or who might be a potential hospital in-patient.
- Know your rights as a patient
- Make sure you have someone with you.
- If you think a therapy might be ridiculous, you may be right
- Know you have a right to refuse therapy.
As you know from reading earlier posts on my blog, there are a lot of frivolous doctor orders pertaining to respiratory therapy. Knowing this, I ask nurses all the time if they get stupid orders, and usually they tell me they do, but can never think of anything off hand.
With no disrespect to doctors, I know they have a tendency to write orders out of habit and not necessarily because they are all necessary. Now that I've been that patient, I saw first hand what some of these frivolous orders are.
After I was told I was going to be admitted, and after I was stoned on phenergin, my ER nurse approached me carrying a foley kit. "The bad news is we don't have a male working who can put this in."
"I...don...crrrr..." slipped from my lips. I was trying to tell her that I didn't care who put the damn thing in, it wasn't going to happen.
Thank God I followed patient rule #1, because my wife was sitting right there and refused for me. She made sure the nurse was aware that we had a pact that the only time anyone would stick a foley in me is if I end up on a vent.
I like to call it a DNC order: DO NOT CATH.
"Why do you need to put a foley in him," my wife asked. "He can get up and pee."
"I don't know," the nurse said, and tossed it aside.
My wife added, "Just make sure you keep good track of your pee."
That was the end of that. In retrospect, I think this RN wanted me to refuse; that she knew it was a dumb order, but out of respect for the doctor she couldn't come right out and say it. I suppose this was not unlike me when I know a patient doesn't need a treatment.
Later that night, after I was admitted to the floor, a nurse woke me from a sound sleep. "I have to put these on you."
"What?" I said, groggily.
The RN said, "Sequential compression devices (SCS) to prevent you from getting clots."
"What do I need those for?" I know what they are for, but why do I need them?
"It's protocol to prevent clots." Clots? I can flip myself over no problem. And I didn't get clots when I slept in my own bed just last night.
"Okay," I said, "I'll try it." Why the hell am I agreeing to this? This is ridiculous.
Those damn things made my legs sweat, were excessively loud, and were extremely annoying. Not only that, but they made it nearly imposible for me to sleep on my side, which is how I like to sleep. These are coming off as soon as that nurse gets back in here.
"Why do I need these things again?" I said when she checked on me a half hour later with a syringe in her grasp. I proffered my arm.
"We have a standing protocol that all patients have to get these to prevent clots." She inserted the syringe into the IV.
"Every patient has to have these?"
"Yes."
"Well, that's ridiculous.
"I know." She's agreeing with me. That's it. She knows it's a stupid order.
"I thought it was just respiratory therapy that got stupid orders." Okay, shut up man; you're crossing into grumpy patient category.
She didn't say anything, finished her work on my IV. The machine beeped momentarily as she pressed a few buttons, and then she stood by the side of the bed.
What? Are you waiting for my order. "Then take these things off. I'm a young guy and I don't think I have a problem with clots."
"Okay," she said, and pulled the blankets from over my feet without hesitation. She's not argueing with me. That's reassurance enough. I heard the rip of the valcro as she stipped those things I couldn't remember the name of off.
I felt fresh air upon my ankles. Ah, that feels good. I rolled over and within a few moments was having pleasant dreams again.
"Do you think I need those things," I said to my wife when she arrived after breakfast the next morning.
"No," she said, "but I know sometimes doctors write orders just out of habit."
"I kind of figured that."
"You know you almost agreed to a foley last night? You were lucky I was here."
"Thank God for you."
She told me she remembered a time when she was working in OB when the doctor ordered a cath on a lady. She approached the doctor. "Why does this patient need a foley?"
"Oh," the doctor said, "I just wrote it out of habit. I'll DC it."
Dr. Tree said nothing about me not having a foley when he checked on me that morning. I wondered if he even knew he ordered it.
Sunday, November 25, 2007
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.
Friday, November 9, 2007
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.
Thursday, November 1, 2007
Kid Albuterol season opens today
With the start of school comes the inevitable baby with cold, flu or Respiratory Syncytial Virus (RSV). And when doctors see these patients with their congested lungs and runny nose, a page to the respiratory therapist for a breathing treatment is eminent.Amid my run of 10 p.m. breathing treatments tonight, I was called to the ER twice to give a treatment to 4-month-old babies with high respiratory rates, stuffy heads and snotty noses. I noticed no difference with either of the treatments.
"Oh, much better," the nurse said as I was finishing up the second treatment. "He should be able to go home now as soon as Rick does an RSV swab."
What evidence she used to come to that conclusion I had no idea.
Over thinking things as I usually do, I often wonder if breathing treatments even get down into a baby's little lungs. The particle size of medicines in the mist of a treatment is 5 microns, and that's the perfect size to fit into the bronchioles of an adult patient. But baby lungs are smaller than an adults, so how does the Ventolin fit in there.
I looked on the insert of a box of Albuterol, and it reads: " Albuterol... is indicated for the relief of bronchospasm in patients 2 years of age and older with reversible obstructive airway disease and acute attacks of bronchospasm... The safety and effectiveness of Albuterol... in children below 2 years of age have not been established."
Obviously they were thinking the same thing. Regardless, Albuterol is the treatment of choice for stuffy and uncomfortable children under 2.
One study I read a few years back indicated that suctioning the airway was more effective than breathing treatments in treating patients with RSV. A breathing treatment may be attempted once, but if no improvement is observed, then no further treatments are indicated. In this case, I'd simply make this patient Q4 PRN.
Since these new studies and recommendations came out, not only do we give routine breathing treatments Q4, but we also use BBG nasal aspirators, otherwise known as booger be gones. That's progress I suppose.
Reasearch by American Family physician must have shown treatments do little for RSV patients, since their clinical practice guidelines state, "routine use of bronchodilators is not recommended.", and, "Studies also have not shown that bronchodilators have a long-term impact on the disease course."
The Cincinnati Children's Hospital Medical Center came to the same conclusion. Their guidelines also call for suctioning often.
Then again, everybody is subject to their own opinion. And, as has always been the case in the medical field, trying something as safe as a bronchodilator is better than doing nothing at all.
I know that there are certain qualifications that have to be met in order for insurance to pay, and breathing treatments for diagnosis of RSV is one of the qualifications. I personally think that's a puerile policy, but that's the way it is. Quite often, other than to make the family think we are doing something, this is the only reason I think we are doing most of these treatments. And this is unfortunate for me, because it burns me out, and for my asthma and COPD patients of whom are more deserving of my Albuterol Ampules.
Likewise, upon assessing hundreds of these children, I rarely notice a change in lung sounds, nor any improvement in retractions or nasal flaring if evident. There are obviously exceptions to the rule (baby's with real bronchospasms), but I find this to be true in most cases.
In all my research, I have never come across a study that conclusively confirms treatments do anything for these kids. I wonder if doctors are privy to esoteric knowledge, are grasping at old beliefs, or are simply ordering treatments because of the philosophy, "if it's pulmonary it should be treated as bronchospasm."
There is one other theory I have on the matter, and that is that the doctor orders Q4 ATC for no better reason than to make sure a respiratory therapist is checking on the patient. Some doctors, if this theory is accurate, feel more comfortable sleeping at home when they know their patients are in the high qualified and well respected care of the respiratory therapist.
Monday, October 29, 2007
Ways RNs can irritate RTs
We have some of the best nurses in the world here at Shoreline hospital, and for the most part we work together well as a team. However, there are times when we don't see eye to eye.
Here I have composed an extemperaneous list of ways an RN can annoy an RT. If you're an RN go ahead and try one of these. We might grumble initially, but that's only if we're tired. Don't worry, we RTs don't hold grudges.
Here's the list:
1. Ask the same question 10 different ways and have RT paged for each question.
2. Wait for RT to leave and page them right back.
3. Call for stat Incentive Spirometers when you know they are busy.
4. If Sats drop, call for STAT breathing treatments. If patient doesn’t have treatments ordered call Dr. and get treatment ordered.
5 . Let the RT think she is smarter than you. This is cool, because you snicker while listening to her grumble about how a breathing treatment is not indicated, and then you turn around and call the doctor and recommend treatments anyway.
6. As a rule of thumb, if the therapist asked you to check the I&Os, be sure to get treatments ordered.
7. Any irritating lung sounds merit a breathing treatment.
8. If possible, do not ever call RT prior to calling the doctor, for doing this will merely build up their ego.
9. Complain about the RT being too slow getting to the ER, even though you know they were busy.
10. After a patient's been on treatments for two weeks, put the pt in MRSA isolation.
11. Better yet, let us assume all nursing home patients have MRSA, especially if they have bronchodilator.
12. Tell RTs that all treatments are needed because the DR. said so.
That's all I can think of for now. If you can think of any more let me know.
Later in the week I'll tackle ways Drs can irritate RTs.
Here I have composed an extemperaneous list of ways an RN can annoy an RT. If you're an RN go ahead and try one of these. We might grumble initially, but that's only if we're tired. Don't worry, we RTs don't hold grudges.
Here's the list:
1. Ask the same question 10 different ways and have RT paged for each question.
2. Wait for RT to leave and page them right back.
3. Call for stat Incentive Spirometers when you know they are busy.
4. If Sats drop, call for STAT breathing treatments. If patient doesn’t have treatments ordered call Dr. and get treatment ordered.
5 . Let the RT think she is smarter than you. This is cool, because you snicker while listening to her grumble about how a breathing treatment is not indicated, and then you turn around and call the doctor and recommend treatments anyway.
6. As a rule of thumb, if the therapist asked you to check the I&Os, be sure to get treatments ordered.
7. Any irritating lung sounds merit a breathing treatment.
8. If possible, do not ever call RT prior to calling the doctor, for doing this will merely build up their ego.
9. Complain about the RT being too slow getting to the ER, even though you know they were busy.
10. After a patient's been on treatments for two weeks, put the pt in MRSA isolation.
11. Better yet, let us assume all nursing home patients have MRSA, especially if they have bronchodilator.
12. Tell RTs that all treatments are needed because the DR. said so.
That's all I can think of for now. If you can think of any more let me know.
Later in the week I'll tackle ways Drs can irritate RTs.
Saturday, October 27, 2007
What RTs can do that RNs can't
Djanvk made a great post on his blog about the differences between RTs and RNs RTs vs RNs
I have to say this is a great list. I will make a facetious version of the list here:
1. RTs get to leave when the patient poops.
2. An RT can tell a coworker to beep him in 5 minutes so he has an excuse to leave the room of a loquacious patient.
3. RTs can silently fart in an obtunded patient's room and snicker as the RN takes a peek at the patient's bottom.
4. An RT can sit in his cave all night while the RNs think he's working hard. This is a good excuse when you're late for a treatment or feeling lazy and know the RNs are busy with a patient.
5. If there's an annoying nurse the RT can get his work done and leave.
6. An RT can take a break when he gets a minute, and for me right now that's been the past 90 minutes.
I have to say this is a great list. I will make a facetious version of the list here:
1. RTs get to leave when the patient poops.
2. An RT can tell a coworker to beep him in 5 minutes so he has an excuse to leave the room of a loquacious patient.
3. RTs can silently fart in an obtunded patient's room and snicker as the RN takes a peek at the patient's bottom.
4. An RT can sit in his cave all night while the RNs think he's working hard. This is a good excuse when you're late for a treatment or feeling lazy and know the RNs are busy with a patient.
5. If there's an annoying nurse the RT can get his work done and leave.
6. An RT can take a break when he gets a minute, and for me right now that's been the past 90 minutes.
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