Save the RT Profession!!!!

So it appears that the Michigan Office of Regulatory Reinvention (ORR) has "recommended the deregulation of 18 occupations -- among them respiratory care.  It also recommends eliminating the Michigan Board of Respiratory Care.  The ORR claims to have carefully considered the public health and safety benefits' of these occupations and determined that they do not require regulation."  That's according to the editorial, "Save the RTs!" for the August issue of RT Magazine by Marian Benjamin.

She offered her debate why regulation in the profession of respiratory therapy is necessary, and how a deregulation of the profession in Michigan could result in a slippery slope that could effect the RT profession, the medical profession, and the overall quality of patient care.  Her arguments are well founded, or so we here at the RT Cave think. She provides a link to this petition you can sign if you're concerned about how this might negatively effect the profession and patient care. 

I guess I have a couple thoughts on this.  For one thing, if the deregulation of the RT profession is so important, then why did Jennifer Granholm sign on to legislation to license Michigan RTs.  Why is it necessary to force us to pay $175 a year for a license if what we do isn't necessary?  So we're basically paying $175 a year so you can deregulate us?  That's not money well invested. Now it looks more than ever like the legislation was passed simply to raise more money for the state. 

I also believe that about 80 percent of what we do is a waste of time or delays time.  I'm referring to breathing treatments for any of these reasons.  It seems like Albuterol is among the most abused medicine in the hospital.  I also don't think it requires a person getting paid $20 an hour with respiratory therapy training to babysit a patient during a breathing treatment either.  However, this is the cost of doing business.  Because while 80 percent are non indicated, that one time a respiratory therapist walks into a room, sees that something isn't right with the patient (something a high school educated on the job trainee wouldn't recognize), and starts a chain of events to fixing the patient, is worth that cost of doing business.  Respiratory therapists have saved many lives this way, and in turn a lot of money. 
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There's also the other side of respiratory therapy, the side that involves doing CPR, intubating, managing airways, and managing ventilators.  You can pull anyone off the streets to push ventilator buttons, but you can't pull just anyone off the street to perform the critical thinking skills necessary to speed a patients recovery. 

Too often what we respiratory therapists do goes unnoticed.  Most patients probably don't even know who we are nor what we do.  Yet we are there behind the scenes, at the head of the bed, saving lives.  So perhaps member of the ORR are among this bunch.  To deregulate our profession would result in the opposite effect I think the ORR is yearning for.  What do you think?

Are we respiratory therapists or respiratory jockies

Sometimes I wonder if we're respiratory therapists or respiratory jockeys.

Allow for some definitions:

Respiratory Therapist:  Provides therapy, educates, and offers expert opinions to doctors and nurses. Education, experience and thought are needed to benefit the patient.

Respiratory Jockey:  Therapists who just do a task and ask no questions.  They are essentially button pushers.  Not much thought is needed.

Thankfully, most nurses and doctors treat us as therapists. Still, there are days when it feels we are just jockeys.  Allow me to provide a simple example.  I was called to the room to give a breathing treatment.  Upon my assessment the patient had crackles in the bases, his spo2 was 90% on 4lpm and after interviewing the nurse learned the patient had aspirated.

Based on my assessment, I recommended no bronchodilator.  Yet I recommended the nurse call the doctor because I was concerned the patient might be wet.

Thirty minutes later I was called because the doctor ordered a bronchodilator.  In this case, both the nurse and doctor completely disregarded my expert opinion.  My opinion was based on science and a good assessment, and their opinion was based on feelings:  it feels good to treat a low spo2 with Albuterol. 

In this example I was treated not as a respiratory "therapist" but as a respiratory jockey.  My opinion mattered not.  I was told to do the treatment and whether or believed it wasn't needed mattered not.

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Is the Job of RT getting easier or harder?

Your RT question:  I've been an RT for about ten years now and it seems we are working harder than when I started.  Do you think this profession is getting harder as the years go by?

My humble answer:  It seems you might have made a good observation, as I've thought the same.  It seems we do twice as many EKGs as we did ten years ago, and we do a ton more treatments and definitely more ABGs.  So it makes you wonder if something is going on here. 

You can look at it this way:

The first 8 years I worked as an RT everything new made the job easier.  Examples include:

• Better EKG machines
• Microprocessor ventilators
• Protocols

The last 8 years I've worked as an RT everything new has made the job more difficult:

• Protocols create so much paperwork it would be easier to just be a button pusher
• Order sets double our workload
• Government regulations setting criteria for reimbursement that has scared hospitals into ordering treatments automatically for some disease conditions (see order sets above)
• Fear of malpractice has doctors over treating patients (as I wrote here)
• Pharmacies have cut back on RTs carrying their own meds, meaning drugs must be double and triple charted

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Here's how I became a good student

In High School I was a bad student. My teachers always told me I could get good grades if I applied myself, but I never did. Well, it's not like I was sitting around watching TV. That wasn't the case at all.

It seemed like at the start of every Semester I'd say something like, "This Semester I'm going to study hard and get good grades." Yet, I'd start to study and my brothers would decide to play a game of football. They would need me to make even teams. So, I'd end up playing football. By the time I got to my reading it would be after the sun went down and I was too tired to focus.

In retrospect, I am glad I spent time with my brothers. Yet, I wish my parents would have helped me organize my time better.

I got C's and B's without trying much. In my first two years of college this trend continued. I made some friends real quick and they acted like my brothers, always dragging me away from my studies.

In fact, my Freshman year in college I think I actually got D's in math and English. I was a poor student who would go out and party on some nights I should have been studying. I was a poor manager of my time.

However, my room mate and best friend named Frank at that time got all A's in everything. He would party with us too, but when he wasn't doing anything he'd discipline himself and study his butt off while I would sit around watching TV.

He even went out of his way to improve the scope of his learning and read as much as he could possibly absorb. In class I would take a note here and there, but Frank would write down everything. Then, when he was back in the dorm room, he would rewrite all of his notes in a separate notebook.

This was a lot of work for Frank. But it paid off. Frank was well respected by my classmates and teachers because he was such a hard worker. He ended up graduating top of our journalism class, and ended up the Editor and Chief of the newspaper.

After we got our Associate's degree in journalism I moved on to the Advertising program. Frank decided to pursue a career in journalism, so he transferred to the University of Indiana. I never heard from him again until the advent of the Internet and email. By this time, however, I decided I needed to become a better student if I was ever going to succeed. So I started reaping the rewards of having a great former room mate like Frank.

I don't know if Frank ever had a great IQ or not. The truth was it didn't matter, because, he was just a hard worker. He was a great organizer. He made very good use of his time.

I'll give you an example of something Frank would do that others would not. During our first year working for the student newspaper the Editor and Chief would get stories from the student reporters and she would peruse them quickly after they were edited and publish them. As a result, there were usually some errors or flaws in the published paper. I would guess 90% of newspapers are published in this matter. It takes a lot of time to make a perfect paper, and since life is busy most people don't take that extra step.

When Frank was Editor in Chief, on the other hand, he took the extra step. He wanted to be the best reporter/ editor he could be. Frank would literally stand in the copy room and read EVERY single word in HIS paper. He wanted every paper to be the best. He settled for nothing less. And, every paper was the best. So now, not only did he get the best grades and have the respect of everyone, he also had the best newspaper ever made at Ferris.

Finally Frank and I graduated with our Associates degrees in Journalism from Ferris. Frank knew exactly what he wanted and he transferred to the University of Indiana to pursue journalism further. I also remember him saying one day in passing he thought it would be cool to be a lawyer some day, but I don't think he really said that thinking he'd actually do it. I said in passing I wasn't sure journalism was for me, and thought that my real calling was probably respiratory therapy, "but how do you go from journalism to respiratory therapy?" I said.

I graduated from Ferris with a Bachelor's in 1993 in Advertising. After Frank left my grades went up some, but I still think I graduated with a C. Then, after working as a journalist for three months I was fired. Journalism simply wasn't for me. That was when I realized I had taken the wrong path. Little did I know then I would end up using these skills in the blogosphere.

I ended up taking a year off. Then I got this exciting job as a hotel desk clerk. I did that for about a month before I decided I better get my life in gear. Here I was with a Bachelor's degree making less than $5 an hour.

So I signed up for the RT Program at another school in the area. I didn't want to go back to Ferris because I thought people would wonder about me if they saw I was still there five-six
years after I already got a 4 year degree.

So now, in 1995, I found myself in the RT program. I thought I would be the oldest person in the class, but I was not. It turned out that most people who go into the RT program are older people -- housewives, former construction workers, asthmatics who failed at other things, moms and dads of asthmatic kids, former alcoholics, and a few kids right out of high school.

This time around, though, I knew I could not fail. I had to succeed. So, while I was still a front desk clerk, I borrowed someones anatomy and physiology book and medical terminology book and studied them every night I was working. I wanted to have some core knowledge before the RT program started. I was not going to fail. I couldn't fail. I needed a paying job with medical benefits (I had asthma you know, and I was about to be kicked off my parent's insurance). I knew I could not fail this time. I could not go to school another four years and not get a job in return.

So I decided to take the route Frank took. Instead of hanging out with my friends I stayed in my apartment studying. I never missed a class. Keep in mind here that I know for a fact I was not good at retaining what the teacher was saying in class. So, for that reason, I would sit there and write my ass off nearly every word the teacher said. Then I'd go home and type my notes on the computer and organize them that way. Usually, by the time I had this done, I had most of the stuff memorized. But I would still at least try to peruse my notes for each class as often as possible. If a teacher discussed old material, it was right there handy too. And, whenever I needed to study, it was all right there neat and organized.

Also I should add that every moment I had open I was pacing my living room or sitting on my bed studying my notes. I had to do this because I didn't trust my memory. I don't have a 150 IQ or book smarts where I can read something once, or listen to one lecture, and have it memorized (or even understand it). Many times when I left class I had no clue what the teacher even talked about, but I had the best notes ever. I'd go home and sort things out, maybe review the topic he was talking about in one of the RT books, and voila, it would all make sense. That's basically how I studied.

By the time the test came around, I never studied 24 hours prior to the test. I made sure I had all the information in my long term memory by then. Then I would take the test (or quiz) and do pretty well usually.

There was one test early in the RT program I got 98 questions out of 100 correct. The highest grade under me was a 63. So, needless to say, I blew the curve. I didn't say anything, but since there are only 10 people in our class, it didn't take long for them to figure out who the "culprit" was. So, after that, everyone wanted me to study with them. Oh, and they all wanted copies of my notes. I could have sold them but I never did. I actually enjoyed studying with my classmates -- or tutoring actually, and that actually made studying easier. For some reason when you teach something you retain it better.

Again, I am not smart. I do not have a high IQ. In fact, I actually know my IQ. In 1985 when I was at the asthma hospital a psychologist performed 2 IQ tests on me and I think I scored somewhere around 105 or something like that. See, I'm no genius. But I read something in an IQ book once that a persons IQ does not determine ones level of success. Success is determined by how hard a person works. If I learned nothing else from Frank's success, that was it: I learned how to succeed. And, in 1997 I graduated tops in the RT program for that year. I did not have a 4 point or anything even close, but I still did pretty well. So, you can say, I earned the respect of my teachers and fellow students by working hard like Frank did years earlier.

My point here is that if you want to get good grades in the RT program, or any other program for that matter, you have to work hard. You have to sacrifice your free time and study. And you can do this knowing that once it is all said and done, and you have your job in whatever career you are pursuing, you will have all the free time that you want.

I lost touch with Frank for the next 20 years. Recently, when I found his emial address, it was on the home page of a law firm. In a recent email duscussion we marveled at how we both ended up changing to the career we talked about that one night. Frank is now a well respected lawyer, and I'm an RT.

For more tips on how to do well in school, click here.

The growth of the RT profession

While there is still room for growth, respect for respiratory therapists has grown immensely since the profession was first created in the 1940s.

In the 1940s and 1950s respiratory therapists were called inhalation therapists, and there job was to set up and manage oxygen, do intermittent positive pressure breathing (IPPB) treatments, do CPR when needed, and manage negative pressure ventilators when needed.

In the 1970s and throughout the 1980s EMTs and nursing assistants did many of the duties that respiratory therapy performs now. Other people were hired off the street, and were trained on the job (they were called OJTs). For the most part, they were button pusher. Doctors told them what needed to be done, and they did it no questions asked.

By 1969 the National Board of Respiratory Care was established to create schools and testing criteria for those interested in the profession of respiratory care. Yet, while there was increasing demand and few people interested in going to school, few in this profession were interested in becoming formally educated.

Yet this gradually changed, mainly due in part to the efforts of the NBRC. One of the methods of generating respect for this profession was to create better educated therapists who would do more than just push buttons. But this would be years in the making. The first step would be to encourage or provide incentives for OJTs to go to school.

Yet another challenge occurred in the late 1970s and early 1980s as positive pressure ventilators were invented and became popular. It was determined, more so than in the 1950s with negative pressure ventilators (iron lungs), specially trained people were needed to run this equipment and assist physicians. This caused an increase in demand, once again, for RTs.

This resulted in hospitals hiring in more people to fill these positions from the streets. While this was contrary to the wishes of the NBRC, more people who lacked any respiratory education were hired to become respiratory therapists.

Because many didn't want to go to school (mainly because they didn't need to), programs were set up where therapists could sit through day long classes for one or two days and when they were finished they qualified to take the test. If they passed they earned their CRTT certificates. The same process was continued on the way to earning an RRT.

So you can see that slowly but surely respiratory therapists became better and better educated. Eventually the field became saturated and requirements to becoming an RT were increased. To get a CRTT you had to go to school for one year. To get your RRT you had to finish a two year program.

Then, at the turn of the millennium, the requirements were increased once again so that you cannot even get a CRT (changed from CRTT) until you have finished two years of RT school. So, basically, the CRT program is pretty close to being all but phased out. Because as long as you've already finished your two years of schooling, you might as well just take the test and get your RRT.

So, as the requirements to become an RT have improved so has the educational level for RTs. Where I work, and in other hospitals in this region, hospitals will only hire RRTs.

Like nurses, we are put under the same level of educational stress. We are trained not just about respiratory, but about the entire body and how it relates to respiratory. We are not just trained about oxygen and respiratory equipment, we are trained to think along the same lines as physicians.

And, therefore, by the time we become full fledged RTs we are fully capable of working alongside with nurses and physicians rather than for them. We are fully capable of making recommendations and suggestions to improve patient outcomes. We are now the well educated profession the NBRC set out to create nearly 40 years ago.

Yet there is still room to grow. There are still old school nurses and physicians who still think of RTs as button pushers. They have trouble setting aside their pride and giving up the autonomy
necessary in trusting the wisdom of the new improved RTs. Instead they overrule us and order useless treatments anyway.

And, to be fair, there are still some RTs who are afraid to take on responsibility and prefer to be button pushers. While these RTs may be great people, they do nothing more than set this profession back. When old school doctors and nurses work with these RTs, their old notions about RTs are confirmed.

Likewise, you still have RT complainers who also do little to move this profession forward. Instead of working to improve respect and come up with ideas to make the job better for all, they complain. Now, to be honest, we all fall into this trap from time to time, but it accomplishes little.

Unlike the profession of nursing, respiratory therapy is still a maturing profession. If you refer to the 40s and 50s as the infancy of this profession, we are now entering adulthood.

This might be the best time to enter this profession, because the respect we earn, and the protocols we create, will set the way for all who walk in our shoes in the future.

So you can see there remain obstacles to the zenith of respect for the RT profession, but we have made great strides from the day of the OJT.