Things all respiratory therapists have in common

Things common among most respiratory therapists.

1.  Usually listen to lung sounds from bottom up, side to side, and without telling the patient to take a deep breath. Because...

2.  We know that when they take a deep breath you hear adventitious lung sounds that are not bronchospasm noises (such as rhonchi and crackles)

3.  We understand that bronchospasm wheezes are only heard upon auscultation.

4.  We understand that if a wheeze is audible it's not bronchospasm but secretions or fluid sitting over the vocal cords (or upper airway wheeze, or rhonchi)

5.  After we listen for bronchospasm wheezes (which are not present for 80% of the treatments we do) we have the patient take deep breaths so we can hear those hidden crackles that are so often missed by others.

6.  We generally develop an apathetic approach to our work

7.  We develop dry senses of humor.

8.  We think we know more than doctors about anything respiratory

9.  We think we know more than nurses about respiratory stuff

10.  We can tell the difference between pneumonia and heart failure from bronchospasm without even looking at the patient.

11.  We can solve all the problems in the hospital because we have been exposed to so much ventolin to obtain the increased wisdom that results from it; in essence, we know more than administrators, but most of us still don't want to be them (why not?)

12-hour shifts work well, study says

Most respiratory departments staff for twelve hour shifts.  However, there are those who believe the end result of this is staff that are too tired, particularly at the end of the shift, resulting in too many errors.  Considering errors in healthcare may result in serious consequences, many hospitals are now shifting back toward eight hour shifts.

This was a subject that the Lincoln Police Department (LPD, of Lincoln, Nebraska, put to the test by performing a study.  Of a police force of 300 personnel, 37 officers and supervisors volunteered to work 12 hour shifts. Researchers went on to evaluate these workers on a basis of both their personal opinion and their performance.  

Two of the main concerns was fatigue at end of shift.  Getting enough sleep was a top priority, and the only time this became a concern was when a long shift turned into over time.  However, this concern was resolved.  As noted by the researchers: 

Supervisors played a key role in managing calls that came near the end of the shift, holding some and stabilizing others until fresh officers were available to work the call and complete reports. Officers were encouraged to manage their calls and to notify supervisors if a late call was likely to extend into overtime. The resentment that some officers might feel when someone appears to be ducking work was replaced with the realization that other officers would do the same for them at the end of the shift.

This is something that we respiratory therapists experience, and the solution was quite similar.  While we don't get a ton of overtime, there are times when doctor orders late in the shift were handed off to the oncoming shift.  However, most of us realize that we will be equally tired at the end of our shift, so as long as someone doesn't abuse this system, it usually doesn't cause resentment.

Upon interview, the majority of the people who participated in this study had positive opinions of 12 hour shifts.  However, it was noted that all of the participants willfully volunteered for it, so it would only make sense that they would support it.

While most people reported feeling tired at the end of the shift, 100% said they were fully capable of performing their duties.

At the same time, an evaluation of performance also had positive results.  During the period of the study, there were no disciplinary actions and no complaints related to the longer work shifts.  Productivity measures were also good, as the number of traffic tickets and and intelligence reports went unchanged.

In response to this, the researchers said:

Some officers reported a new enthusiasm for the job with the 12-hour shifts that had a measurably positive effect on their work output, but there was no evidence that satisfaction with the work schedule affected the total output of the team.

The researchers concluded the following

Officer perceptions of the 12-hour shift were extremely favorable. Two of the 37 officers reported that before implementation of the new schedule, they were actively looking for a career change. The 12-hour shifts provided the right balance in their lives and renewed their enthusiasm for police work. Job satisfaction and morale are extremely high with this group of employees. This reaction is not likely to be universal, however, as these participants had positive expectations going into the schedule change and bid into the schedule by choice. In the department as a whole, a significant number of employees have a negative view of the schedule, though the schedule has sparked growing interest and may be expanded within the department.

The employee survey also indicates that 12-hour shifts have a mitigating effect on the negative aspects of shift work. Officers report being more rested and ready to return to work after days off but also note there is little time for anything but work during their work days. A more scientific approach might provide more conclusive data, but the survey and employee comments suggest that in addition to being happier, 12-hour shift workers are probably healthier as well.

This is not much different to how most of the people I work with every day feel about 12 hour shifts.  Most people are tepid about working them, but once they begin they find that they have more time off, and therefore more time to spend with friends and family, and more time to catch up on sleep.

Furthermore, the researchers concluded:

Before implementation, the main concern was whether 12-hour shifts would have a negative impact on the quality of the service provided by the department. Objective data suggest that it does not. There was no negative fiscal impact, and a trend toward less sick leave use was noted.

Good managers always look for ways to improve employee job satisfaction that do not adversely affect the organization’s mission. For a significant number of police officers, 12-hour shifts have proven to be a dramatic improvement and a viable scheduling alternative

Bottom Line:  While this is just one study, it shows that 12 hour shifts improve satisfaction and result in similar, if not slightly improved, performance compared to those who work 8 hour shifts.  So, hospital administrators should not shy away from 12 hour shifts due to unwarranted fears of diminished satisfaction and performance.

Respiratory therapists are eubiquitous

Respiratory therapists are ubiquitous; seeming to be everywhere at the same time.  This is the nature of our game.  Wherever we are needed, that's where we appear.

Where might you find your respiratory therapist? The following is a typical day at a hospital near you.  You will find your RT:

1. Walking into the front doors with a cup of coffee in one hand and a lunchbox in the next
2. Punching in
3. Greeting his coworkers with "I'm doing great today!  How are you?"
4. Placing his keys in his locker, and lunch in the refrigerator
5. Taking report in the RT cave
6. Answering the phone at the secretary's desk
7. Reading yesterday's newspaper in the RT charting room
8. Discussing a new idea for a protocol in his boss's office
9. Bantering with a visitor in the waiting room
10. Guiding a lost visitor to the room his mother is in
11. Guiding a second patient to the front back lobby
12. Grimacing as his beeper goes off for the first time for the day
13. Running through the hallway on the way to the emergency department
14. Bagging a patient in the Emergency room, and then setting up a ventilator
15. Washing his hands behind the ER nursing station
16. Running through the hallway on the way to critical care
17. Assisting with an intubation in the critical care, and then setting up another ventilator
18. Walking through the hallway on the way back to the RT Cave
19. Grabbing a clipboard in the RT Cave
20. Washing his hands in the bathroom near the cave
21. Walking through the hallway on the way to do breathing treatments
22. Walking into a room, saying, "Well, are you ready for your med-day peacepipe?"
23. Giving an albuterol breathing treatment in a patient room, and bantering just as well
24. Giving an epinephrine treatment in recovery
25. Attending a code in the front lobby
26. Performing EKG or PFT on an outpatient
27. Assisting a physician do a stress test
28. Washing his hands once again
29. Grabbing his lunch box from the RT Cave
30. Gobbling his lunch in the cafeteria
31. Grimacing as his lunch is interrupted by his beeper going off
32. Trudging down the hall on the way back down to ER
33. Rushing room to room in ER doing several EKGs
34. Washing his hands by the ER nurses station
35. Pikcing up some medicine in pharmacy
36. Rushing back down to the emergency room
37. Trudging room to room in the ER doing breathing treatments and more EKGs
38. Setting up a holter monitor in the emergency room
39. Rushing up the stairs
40. Grabbing incentive spirometers from one of many satellite stock rooms
41. Walking room to room teaching patients how to do incentive spirometry
42. Instructing a middle aged woman on methods for quitting smoking
43. Grumbling as his beeper goes off, once again
44. Taking an patient on a ventilator to CT
45. Setting up on oxyhood in OB
46. Running a blood gas in the laboratory
47. Watching monitors in the sleep study lab
48. Checking on a BiPAP set up in critical care
49. Joking with a critical care nurse
50. Giving a breathing treatment and watching the Detroit Tigers with a COPD patient
51. Watching telemetry while the monitor tech takes a break
52. Eating lunch in the hospital cafeteria.  Whew!  A much needed break. 
53. Watching a C-section in surgery
54. Watching Matlock while giving a breathing treatment to an elderly lady
55. High fiving a happy, young child with down syndrome
56. Cheering up a child with stickers after the lab tech drew his blood
57. Rushing past the unit secretary on his way to the stairway
58. Trudging through the surgical doors, and down a long hallway
59. Searching for an EKG machine that was not put away
60. Smiling when he discovers the EKG machine is right where he left it
61. Doing a STAT EKG on a pre-operative patient
62. Joking around with the nurses in recovery
63. Talking with a volunteer on the way up the stairs
64. Talking in the break room with a nurse
65. Meeting in the doctor's lounge with a hospitalist
66. Attending doctor's rounds in the critical care
67. Searching for an old EKG in medical records
68. Watching a football game in the break room, at least until his beeper goes off
69. Grabbing stock from the basement stockroom
70. Grabbing a new oxygen tank on the way through the tank room
71. Enjoying the fresh outdoor breeze while taking a break on the loading dock
72. Surfing the Internet in the Computer room
73. Attending a meeting in the classrooms
74. Talking with the CEO in the administration building
75. Assisting a nurse boost up a patient in bed
76. Attending a Keystone meeting in the boardroom
77. Extubating a patient in the critical care
78. Watching telemetry as a DNR patient's heart decides to go flat line
79. Taking a dead body to the morgue
80. Walking some epaper work to a doctor's office
81. Walking through OB on the way back to the RT Cave
82. Stopping on a dime as his beeper goes off
83. Rushing to check on a ventilator that "won't stop beeping."
84. Suctioning a ventilator patient in the critical care
85. Washing his hands in the patient's bathroom
86. Walking through the hallway
87. Eating dinner in the break room
88. Discussing the end of the day plan with his coworker
89. Rushing room to room doing breathing treatments
90. Standing in the doorway of a patient room saying, "Well, if I see you again, I hope it's at Walmart or a Bar or sometihng."  
91. Touching a little old lady on the shoulder, and noting how she smiles
92. Standing in the doorway of the same room, listening to one old lady say to the next, "What a fine young man he is."
93. Returning to the RT cave
94. Leaning back on his chair an dputting his feet up on the desk
95. Placing the keyboard on his lap and charting his daily work
96. Giving report to his replacement RT
97. Bantering with his fellow RTs in the RT Cave
98. Standing by the time-clock watching the last minutes tick away
99. Punching out
100. Saying "have a wonderful night" to the folks working at the front desk
101. Walking to his car after a long day

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RTs save lives and create smiles

Pager says: "BiPAP BEEPING COME SOON! EMILY RN"

On a whim, the RT leaves the patient he's presently treating, and  rushes to the room with the BiPAP.  Upon arriving he hears the said beeping, and thinks it's not a good sign that it's still beeping.  He thinks: "Either the mask is off the patient, or the patient is not breathing."

He looks at the patient and then at the BiPAP and then back at the patient. While he's doing this, the nurse pops into the room and says, "I think you're BiPAP isn't working."

At this, the RT says: "I think your patient isn't working."

He sees that the patient BiPAP rate is 4, and the rate on the monitor was 42. He places a hand on the patient's chest and feels the respirations are simply not efficient. "She isn't generating enough flow to trigger the machine," the RT says. "Get the hospitalist here."

The RT turns up the rate to 14. About then the doctor comes in.

The RT says to the hospitalist,  "I realize there's not much you can do considering she's a DNR.  I just wanted you to know this was going on."

"Yes," the doctor says. "The family doesn't want anything more than this. We'll DC the ativan and xanax."

 RT is thinking, "Hmmmph. How much sedatives has she been given?  She's been on xanax the past ten years, but was she given too much?  Or, is she simply trying to die?"

Assuming she's trying to die, the family is called by the nurse.

The RT rushes back to the other patient, whose breathing treatment is now stopped.  "I'm a nurse," the patient's daughter says.  The RT apologizes and apologizes vigorously for rushing away, yet the patient and the patient's daughter are happy as can be.  A brief discussion ensues before the RT returns to the BiPAP patient.

The family is now in the room, and tears are flowing.  Both daughters hug the RT.  One says, "You're her favorite.  She loves you.  I think she'd like you to know that."

The RT smiles.  The RT didn't need to hear that because he had already assumed.  He had many great discussions with the patient and the patient's family.  Now there are tears flowing in the room as the family waits for this nice elderly lady to stop breathing.

Two hours later the therapist is in the room and no one else is. The patient is now breathing over the rate of 14, and the spontaneous rate is 28.  She opens her eyes and looks at the RT.

The RT looks into those eyes, and says, "There are your pretty eyes."  She smiles and goes back to sleep.

The family comes back into the room, and they are so thankful and happy.  The nurse is thankful and happy. The doctor is thankful and happy.  Once again the RT has a successful day outside the RT cave.

The RT wonders if he did something good, or simply prolonged suffering of the patient; it's hard to know for sure; there are no answers to such ethical questions.  Regardless, the smiles he creates force him to smile on the way back to the RT cave.  He thinks, "It appears this job is more than saving lives; it's creating smiles."

The 6 Types of Respiratory Therapists

The following post was originally written for RT Cave, and loved so much by the Rt Community that it was republished (and edited) for putmebacktogether.com. 

The respiratory therapy cave (a.k.a. department) presents with a unique milieu, and this is mainly because we Respiratory Therapists (RT) have a unique view from the head of the bed.  What we see is often based on what type of RT we are.  In this regard, there are six types of RTs:

1.  Stepping stones: These are your RTs who use this professoin as a stepping stone to a more illustrious medical profession. In my humble opinion, this is the way to go. There is no better way to learn how to assess and treat, and no better way to learn about people than from the head of the bed.  Some of the best administrators, physicians assistants and physicians got their start in an RT Cave.  They become the most respected. 

2.  Quitters: These are your RTs who simply hate working.  They wade through RT School under the ruse this job will be easy and they can just go for a cake walk.  Yet once they learn common sense, prioritizing and critical thinking come with sore feet and judgemental co-workers (see complainers below), they either quit or are forced out the door.  They are amiable at first impression, but once their true colors shine through they lose any friends they once had. 

3.  Contents: These are your happy-go-lucky RTs who tend to have a phlegmatic disposition even in the most critical situations.  They never complain; just lend an ear and listen -- with a smile.  Everyone loves them, and they are your favorite RTs to give report to.  They are happy with what they know and rarely seek out new wisdom.  They usually prefer not to work with critical patients, and when they do they rarely question doctors.  Some call them button pushers or neb jockeys.  They are your people RTs.  Usually you'll see them happily knocking off treatments on the floors, perhaps with a bubbly trot. They are your amiable RTs loved by all. 

4.  Complainers: Here you'll find about 60 percent of your RTs.  They tent to be very intelligent people, almost exorbitantly smart for the profession.  They find faults at things contents would simply brush aside.  They love the profession of RT, but hate the reality of it.  They're usually up to date on all the new technologies, and are very quick to question doctors or offer suggestions. These are your equipment experts.  However, while they are not happy, they do nothing to better their career field, and rarely support the idea of change. After working for a while, they become frustrated, apathetic, and then give up.  They're great workers, yet don't tolerate or are impatient to imperfection.  They are your judgers, your critics and won't shy away from telling you what they think (so be ready!). They aren't for keeping the peace, just satisfying themselves. Since they're good workers they are often tolerated by the rest of the gang.

5.  Philosophers:  These are your thinkers.  Surely they aren't as quick whited as your complainers, but they love to learn and they love to share their wisdom.  They devotedly attend meetings, seminars and are often rapt in a good book.  They aren't much for small talk, but if you want to talk business, politics and religion they are all ears.  These are your teachers, your writers, your idea creators. These are the folks you can thank for protocols and cheat sheets that make our jobs better. They judge not, and therefore people love them.  They work with leaders to solve problems, and often let others take credit for their ideas. They are the arbiters when fellow RTs have a dispute.  They are your piecekeepers.  Their optimism works to keep morale high.  Some call them brown nosers, perhaps out of jealousy. Yet they aren't brown nosers at all, just good folks who've learned how to get along with all personalities.  Leaders revere them and wish every RT was a philosopher. 

6.  The leaders: They are the few, the proud, the takers of the credit and the lead.  They make sure everything is stocked, that all i's and t's are crossed, and  listen to rants.  They usually side with the bosses, though (unless they are bosses, then they side with themselves). They judge and tell you what you did wrong, and are therefore resented.  They listen to philosopher's desire for change, but surreptitiously side with complainers desire for the status quo. They agree to some changes, yet prefer not to rock the boat.  While they may think alike, complainers detest them as much as philosophers tolerate them.  Contents have no opinion, and quitters are intimidated. 

Which type of RT are you?

An observation or a complaint!!!

One of the original posts I wrote for this blog was "The six types of respiratory therapists."  Recently I rewrote this post and republished it at putmebacktogether.com.  You can read this newer version here.

This was one of my better posts for this blog, and it continues to be among my most well read.  I've had comments from both ends of the spectrum on it.  "I love it."  "Best post eva!"  Yet on the contrary, I got some negative comments, such as: 

"I find your classifications of the types of RT's mildly amusing, however, there is a negative undertone running through out. I don't believe people are all so negative and prone to conflict as you represent them. I will not be sharing this w/ my staff."

This comment generated others like it, as well as some emails.  Although I'd like you to know a majority of all the comments were good, with my favorite being, "Best post eva!"  Regardless, a writer learns to enjoy all comments, especially the negative.  We are simply happy to be read, and negative comments are reassurances that such is the case.

My post here was not meant to be a negative post.  It was and still is an "OBSERVATION!"  It's the truth.  It's how it is in pretty much any RT Cave around the globe.  Whether you like it or not, it's how it is.  That, my friends, was the purpose of this post. And surely if you don't want the truth to be known, you'll resent it and not share it. 

I think it would be a travesty if someone was excited to become a respiratory therapist, spent thousands of dollars to be one, only then to learn the sun was bright every day in the RT Cave; that it was exactly as the AARC said it was.

Such is not the case with any job, unless you're so privy to get a job as  major league baseball player. And even then I doubt it's as cozy of a job as we make it out to be.  Even professional ballplayers have to deal with modesty and the media.  And then there's the stress of failure when you make it as far as the world series and lose.  There's pressure, and lots of it. 

If you're a wannabe RT, I think it's good to know What RTs really do.  This is not meant to be a complaint, it's simply the truth.  To be honest, it's probably not much different in the RT Cave as it is in any other profession.  None are ideal.  That, my friends, is life.

Criticism is good.  Any comment on my blog is a good one.  Keep them coming.

Related links:

• What do RTs really do?
• Why are RTs frustrated?

Large versus small hospital

When I first started out as a respiratory therapist one of the senior male RTs pulled me aside and said, "If you really want to harness your skills, I highly recommend you work for a large hospital, like Butterworth in Grand Rapids.

"If you work here you're going to lose your skills over time," he continued.  "And you're going to become complacent.  You need to work for a teaching hospital, a place where they have traumas, really sick people, RT Driven Protocols and lots of ventilators," he said.

"I think this small-town hospital is a great place to work, but it's nowhere to hone in your skills," he said. 

I kind of figured he was right, although being of a phlegmatic personality I wasn't motivated to hunt for a new job.  Plus all my friends were in shoreline, and I didn't want to have to make new ones.  Funny thing is, I met my wife while working, and when that happens you sort of give up your friends to raise a family.

So, in retrospect, and from discussing this topic with other bloggers and coworkers who work for large hospitals, I'd like to list some of the advantages of small town verses large town hospitals.

Small:

• Forced to learn quick because you have to do it all for all age groups, and often you work alone.  
• Lower patient load, so you may be asked to do things below your educational level, like EKGs
• You'll also have to do breathing treatments on people who don't need them so the hospital can justify your existence. 
• There's a greater risk for apathy
• Low times allow time to do other things, like blog
• Ability to spend more time getting to know, and taking care of, your patients due to lower patient loads. 

Large:

• More intense due to more critical patients and higher patient loads
• Can specialize in one area:  neuro unit, critial care unit, peds unit, neonatal intensive care unit,   adult general care
• More protocols that can result in better patient care, and better morale
• Patient overload, that can lead to burnout
• Doctors available at all times
• More risk for burnout. 

I could go on.  I'm still looking for a person who works for a large hospital to write me a post on life at a large hospital.  You can take any angle you like.  Let me know if you're interested. Or what you think.  

Advantages and disadvantages of being an RT

Just for fun I thought I'd make a list of the advantages and disadvantages of being a respiratory therapist:

Advantages:

1. Don't have to wipe butts
2. If a patient is annoying you do your job and get out
3. Joy of helping people feel better
4. Meeting people
5. Being part of a team
6. Saving lives
7. Your skills save live
8. Your medicine and tools make people feel better
9. Your company and soothing words makes people feel better
10. The challenge of managing a ventilator
11. The joy of a successful ABG poke
12. The joy of making something miserable simple
13. Educating patients
14. We are professionals
15. We can take a break whenever you want
16. We're not trapped in one area
17. If it's slow you can use the Internet or gossip
18. If it's slow you can read a book

Disadvantages:

1. Lots of walking
2. Stupid doctor orders
3. About 80 percent of what we do isn't needed
4. Doctors often don't care what you think
5. Hospital politics
6. Some nurses treat us as ancillary staff
7. Not many advancement opportunities
8. You carry a pager and it can go off when you don't want it to, like while you're eating
9. Respiratory Therapy Apathy Syndrome
10. Burnout from being overworked

Why are Respiratory Therapists Frustrated?

Your RT Question:  Why is it that so many respiratory therapist are upset about their jobs?

My humble answer:  I think most people are upset about their jobs because the image portrayed of this profession by the AARC isn't necessarily how the job is.  While we went to school for two years, continue to study, and have learned much from our experiences, many times our opinions don't matter.  Likewise, many RT bosses don't want to make waves and want to maintain the status quo rather than make life better for the staff.  While RTs are trained to know who needs what therapies and when, they usually end up just being neb jockeys and button pushers.  They are frustrated by this.  They want to be more than just jockeys and pushers.  They want to be able to use the wisdom they studied hard to obtain.  It's a similar frustration a doctor might feel if he were called Mister instead of doctor.  They worked to earn their title just as we RTs worked hard to earn the ability to use our skills and knowledge base to the benefit of patients, doctors and the profession as a whole.  Plus when you go to school thinking one thing, only to end up being something else, it's frustrating.  Plus many doctors have no clue what a bronchodilator is and they keep ordering them for every patient who wheezes or huffs and puffs or has a low sat.  Still, while this is all true, you can make of this job anything you want.  I actually do pretty well where I work because I'm not afraid to go out of my way to make recommendations to the doctors and nurses, even if that comes with making waves and irritating some.  Yet those who benefit are the patients we serve.  What you must remember is this is a job.  No job comes without politics.  No job is ideal. 

Still, I can understand the frustration of many RTs.  Surely some say if you hate your job you should just go get another job, yet that's not always easy, especially when you have a family to raise.  Think of it this way:

• Contractors are hired knowing they will have to work hard
• Road construction workers know they will have to work in the elements
• Doctors know they will have to work with irritating patients
• Teachers know they will have to deal with snotty kids
• Baby sitters know they will have to deal with intractile kids
• School bus drivers know they will have to stay awake while driving

Yet, we RTs are told the following that is not always true:

• We will assess and recommend therapies
• Examine patients and decide what therapies are best for that patient
• Consult with physician to recommend a change in therapy based on your evaluation of that patient

This is a young profession.  Yet unless those three sentences in red above are adressed, many RTs will continue to be frustrated.  Sorry, yet that's just how it is when you're a respiratory therapist.

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Things RT bosses can do to keep you happy

Studies have overwhelmingly showed that the more satisfied workers are the more satisfied their customers will be.  This provides bosses with an added incentive to keep workers happy.

That in mind, here are some ways your boss may try to keep you happy:

• Parties
• Birthday cards
• Bonuses
• Good benefits
• Annual raises
• Involving you in tasks (writing protocols, teaching nurses, teaching BLS, writing policy, etc.)
• Involve you in departmental decision making
• Creating protocols
• Listening to you
• Giving praise

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What did you do prior to becoming an RT?

The interesting thing about the profession of RT is few enter this field right out of high school.  Usually people work hard in another career before jumping into this one.  So, that said, what were you before you became an RT? 

Usually poeple choose the profession of RT because the one they are in now is too arduous, dangerous, and doesn't pay well.  So they switch to this one.  They appreciate the ups and downs of this profession because we work in air conditioning, work with wonderful people, are guaranteed a job, and can take the job anywhere.  It's good, fair work -- if  you want to work that is.

Many of them -- expecially those who worked in construction -- contend if you hate the profession of RT you should try working on a black top on a 100 degree day during a dust storm.  Sure this profession isn't ideal, yet what job is.  Work is work; work is pay.  That's usually why people choose this profession.

Here's a list of some jobs of those I've had contact with:

• House wife
• House dad
• Construction worker
• Painter
• Journalist
• Hair dresser/ barber
• Food service
• Pilot
• Factory worker
• Nurse
• Salesperson
• Telephone/ cable company
• Manager of small business
• Military

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Are Respiratory Therapists rewarded for their knowledge?

Your RT question:  Are RTs rewarded for their knowledge.  I know RTs go to school for two years and learn a ton.  Plus you guys have some good experience you learn from.  Do you get rewarded for your wisdom?

My humble answer:  Wow.  You got me there.  Great question.  We do learn a lot in this profession. We learn a lot about the lungs in school.  There's no one on the planet who knows how to diagnose and treat lung diseases than we do.  Your questions is, do we get rewarded for our wisdom.  Honestly, I'd have to say no we don't.  I know many of you were hoping I'd give a positive, optimistic answer to this question, yet I can't.  We are a young profession and growing, yet we still have a ways to go.  I think there are many times I make recommendations to doctors in nurses as to whether or not a treatment is indicated more often than not I'm told to do the treatment anyway.  So based on these experiences, I'd have to say that we are not rewarded for our wisdom, or any new wisdom we acrue.  We might win some friends, save lives and may impress some of our coworkers, yet we will not be paid extra for this added wisdom.  I'm assuming that by reward you're referring to pay.  Usually we RTs get pay raises at the end of the year equal to inflation, and our raises are not due to what we know.  Most raises are across the board or performance bsed, but not based on wisdom.  If we were paid based on our knowledge and not so much on performance, I think I'd be worth twice what I'm paid just for all the time and energy I spend bloggin here at the RT Cave. 

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3 types of respiratory therapists

After 16 years of doing this I've decided there are three types of respiratory therapists. 

1.  Neb Jockeys
2.  Respiratory Therapists
3.  Yearning

A neb jockey is a person who is just a task doers:

• Does what the nurse or doctor says just to keep the peace
• Uses politics to smile and keep the patient happy
• Travels room to room in the hospital setting doing tasks, such as EKGs and nebulizer treatments. 
• Once he's finished he travels back to the RT cave and continues reading his novel or blogging, blogging on the Internet, or some other similar activity
• He finds it easier just to do the treatment than to challenge himself or the doctor or nurse
• They might recommend no treatment be given and be called a half hour later to do one anyway
• They are treated as ancillary staff

A respiratory therapists is what we read about at AARC.org. They are actual therapists and not just doers

• They work with doctors and nurses in making decisions to benefit the patient. 
• Diagnose and make treatment decisions for breathing disorders
• Interview and exam patients and relay our opinions to physicians and nurses
• Analyze lung sounds and ABGs and EKGs and make recommendations to the benefit of the patient
• Managing ventilators and other airway equipment
• Educating patients and families about lung disease\
• Their recommendations are respected
• They are treated as professionals

I find that most respiratory therapists are treated as neb jockey respiratory therapists as opposed to the ideal respiratory therapist respiratory therapist (if you get my drift).

Contrary to popular belief, here at the Respiratory Cave we're neb jockeys.  I'd like to say it's not by our personal choice nor due to educational restraints on our part, yet part of me wants to say it is our fault.  Think about it:  it's easier to just do the treatment than to think; it's easier to just do it and be done than to assess, talk to the doctor, fill out paper work, and reassess after the treatment and then reassess again.  Can you see?  It's easier to just do it.

Plus there are those among us who are afraid if we move into the future it would result in protocols (more work and more thinking) and this might result in fewer treatments (the fear of layoffs).  Yet by the evidence of those who currently have protocols, that rarely ever happens.  The work will remain there.

There are a few RTs like myself who are neb jockeys respiratory therapists who try to be respiratory therapist respiratory therapist.  And this brings me to the 3rd type of respiratory therapist:

Yearning Respiratory Therapists:  These are neb jockeys not by choice but because their bosses and coworkers don't want to make waves.  They are neb jockeys who pretend to be respiratory therapists.  They tend to be among your more frustrated bunch because they expected the profession to be as the AART described, yet realize at some point the ideal world is, well, not so ideal after all.  The picture painted by the AARC is not the real world.  They are neb jockeys not by choice but because their department made them that way.  When they are young and fresh they try to change things, and when they fail (90 percent do fail -- at change I mean), they give up and decide it's easier to just do the treatment.  Then they reserve themselves to silly blogs and making RT humor .

So you have your three types of RTs:

1. Respiratory Therapist Respiratory Therapists (ideal)
2. Neb Jockey Respiratory Therapist (real)
3. Yearning Respiratory Therapist (dreamers of the idea)

What kind of RT are you?  Are you that way by choice, or because your department has made you that way?  Are you a fighter for change, or have you given up? 

Also read:  The six different types of respiratory therapists

Note:  The comment section on my blog is broken, so you'll have to send me an email.

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"Hey Respiratory!" RT Rule #53

I'm sure you've heard it where you work:  "Hey respiratory!"  It's the default way to get the attention of the respiratory therapist.  "Hey respiratory guy!" 

I hear a lot of respiratory therapists who feel they are so little respected that many nurses and doctors just call them by their profession: "Respiratory!" 

Working for a small, close knit facility where I work this doesn't happen too often.  Usually the people who call me that are new nurses or new doctors in the Emergency Room.  Otherwise I'm usually referred to by my name.

That is, unless there's a page over head.  Then it's "Respiratory STAT to..."

I think most RTs that are called by their profession are generally those who come from larger facilities.  And the recommendation they give is this:

"I don't answer them if they say "hey, respiratory" or "hey, breathing guy". I just look at them and keep doing what I am doing until they call me by name. Seriously. Try calling them by saying 'hey, nurse'. See how they like it."

I really don't care what people call me.  If you want to call me respiratory that's fine by me.  Yet I understand where the frustration comes from. 

RT Cave #53:  Keep your respiratory therpast happy by calling him/ her by name.  Do not refer to your respiratory therapist as respiratory.  Do not say, "Hey, respiratory!"


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Respiratory Therapy Fun and Games

While nurses are stuck in one unit taking care of only a few patients (how boring), we RTs have free roam of the hospital, which means we can have a little fun on the side. That's right: we RTs like to have fun.

Here are some games we RTs are known to play from time to time:

EKG clock: Take some EKG stickers and toss them at a clock on the wall. Whomever can get the most stickers to stick on the clock wins. You can also play by adding up the points for the hour or minute the sticker is closest to, or by seeing who can get closest to the bulls eye. By this you can have a little fun on the clock (pun intended).

Vent race: Ready set.... you and your co-worker each grab a vent, line-up at the beginning of a long hallway, and the first one to the unit wins. This is a game better off played during night shift when the halls are silent.

Stair spit: Climb to the top of the stairs, and then you lean over so you can see the bottom floor between the steps, and you spit. The challenge here is to get your spit all the way to the bottom. Winner is whomever accomplishes this goal, or comes the closest.

EKG race: Your humble RT is proud to claim pride in the name, "fastest EKG draw in Michigan." That's right. To earn this prize, time starts when you unplug the machine and ends when you plug it back in. The trick here is you have to have good patient technique, and the EKG has to be of good quality.

Ventilator fart: This is my favorite game. You walk into the room of a patient who is on a ventilator and you let out a silent fart. The goal is you can't get caught, and the nurse has to be convinced the patient needs his diaper changed. Then you stand by the nurses station and giggle when the nurse says something like, "It was a false alarm." This is also a fun game to play by yourself, with a good laugh as the reward for victory.

Sleep time: Perhaps this isn't so much a game but a necessity. Whatever RT can get the most amount of sleep without missing out on required work wins the prize. One former co-worker put his head on his pillow at 2 a.m. and forgot to wake up until 30 minutes before shift's end. We all helped him get his work done, because otherwise we'd all be busted. Goal was accomplished as we all sat down in the RT Cave mere seconds before the morning workers shuffled in. As you can see, this also makes for a good team game. Plus if you push the limits as we did, it makes for a good story.

Sharps shootout: Fill your pocket with empty amps of ventolin, and find an empty room. Line two chairs opposite the sharps container, and whip the amps across the room at the opening on the sharps container. The RT with the most amps inside the sharps container is the winner.

Persistent Pessimism: This game involves being aware of the pessimist. You know who they are. Ask them how they are doing and wait to see how long it takes them to start complaining. They might say things like, "Oh, my back aches," or, "I'm soooo tired," or, "Jack is soooo annoying," or, "I'm soooo burned out," or, "I'm so tired of this job." Then you just sit back and smile. I'm telling you, melancholy folks are very consistent.

RT lecture: I've noticed from time to time RT Bosses like to show off their power by lecturing an RT or two about some piddling little task that wasn't done completely right. Now you know no patinet was harmed, and the only reason you are getting lectured is because of process, "We won't get reimbursed if you don't do this." I've noticed that it's easy to try to defend yourself or te get mad at your boss. You know how your blood can boil when your boss starts to rip you apart. The goal of this game is to stand there like a man the next time you are being humiliated by your boss, smile and say, "Thank you!" The objective of this very difficult game is to get the better of your boss.

Rules:

1. If your RT Boss catches you having a little fun, don't act scared. Ask him to participate. That's right. You know darn well he had a little fun when he was in your shoes.
2. Use common sense.
3. Pick an appropriate time to have your fun (Pick a down time)
4. Games are best played during night shift or on weekends when RT bosses are out.

Regardless, RT games are a good way of taking the monotony out of long 12-hour shifts. If you've participated in an RT Game not mentioned here, let me know.

Respiratory Therapists: There when you need us

We are your respiratory therapists, a part of a well-respected patient care team at a hospital near you. We are the experts when it comes to the heart and lungs, and we are always at your side when you need us.

You’ll see us everywhere in the hospital from the emergency room to obstetrics, from the patient floors to recovery. We evaluate and treat all types of patients from the tiniest newborn whose lungs are not quite ready to the elderly whose lungs are diseased.

We treat patients with respiratory ailments from COPD and asthma when they are having trouble breathing, to patients with heart failure and pneumonia. We do everything we can to help them breathe better from giving breathing treatments to offering our professional advice to nurses and physicians.

We work with patients that aren’t having trouble breathing too, as you’ll see us with any patient who can’t get out of bed or has recently had surgery. We encourage them to take deep breaths. We do this to prevent them from getting illnesses like pneumonia.

We love to educate. We work with smokers on how they can quit. We work with our COPD, asthma, heart failure and pneumonia patients and teach them what they need to do to avoid needing us again. Yet we assure them if they ever have trouble we are right here when they need us.

The procedures we perform are from the simplest breathing treatment to managing the most complicated breathing equipment, such as ventilators that keep people alive when their lungs aren’t working or simply need a rest. Likewise, we provide emergency services to any patients having respiratory distress, heart attacks, strokes, shock or who are involved in personal injury accidents.

Along with the nurses and physician, we work hard to make sure the patient is comfortable and breathing easy during difficult times, and we educate family members so they’re always aware of what’s going on and have all their questions answered.

You’ll see us in the respiratory therapy department performing outpatient tests such as pulmonary function testing that help physicians diagnose lung diseases, and we do tests that help physicians diagnose and rule out heart problems such as EKGs, Holter Monitors and Cardiac Stress Testing. Wedraw ABGs (a poke in the wrist) to see how well the lungs are working. Some of us do other procedures too, such as EEGs to rule out neurological problems, and even EMGs too.

We are your respiratory therapists: there when you need us.

21 Virtues of Respiratory Therapy

So I wrote earlier about Ben Franklin's 13 Virtues to his success, and how he believed anyone who followed these virtues would be bound to successful lives. That in mind, I've created a list of 21 virtues to becoming a respiratory therapist.

The following virtues, or personality traits, are required of all respiratory therapists.:

1. empathy: You have to show some sort of understanding of what the pt is going through
2. priority: You have to be good at arranging tasks by priority
3. acceptance: you have to be able to accept that of which you have no control over
4. punctual: You have to pay strict attention to time, and never be late without good reason (yet you must never make excuses).
   
5. honesty: You have to prove to others that you can be trusted
6. transcendence : Going above and beyond the call of duty. Exceeding expectations
7. political: Know when to speak and when to keep quiet and bite your tongue
8. candid: You have to be open honest and straightforward with patients, doctors and nurses. This has to be balanced with political.
9. cooperation: You have to be able to work with a team to attain a greater purpose
10. perseverance: Regardless of setbacks you trudge forward, even if your boss or a doctor scolds you, you don't let that set you back
11. decisive: Coming to a quick resolution, answer or solution
12. Friendly: Get along well with people
13. Reliable: You are dependable to get your stuff done.
14. Confident: Knowing what you know and not hesitating to do it or say it
15. Competent: Being efficient at the few tasks you're expected to perform
16. Creative: Ability to fix equipment problems in unique ways
17. Insightful: Ability to see the unseen
18. Proactive: Ability to use unsightliness to solve a problem before it occurs
19. Observant: Ability to see what is obvious.
20. Communicator: Ability to share what you know, learn and think.
21. Listener: Ability to comprehend what other speak
22. Equanimity: You must be the calmest one in the room

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Word of the day: Pertinacious: Persistent, tenacious, unflagging and assiduous commitment; holding tenaciously to a purpose, course of action, or opinion

A pertinacious respiratory therapist is the one who gains the most respect.

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RT profession growing and gaining respect

It's RT Care Week! It's time to reflect on the fact we are leading the charge to improving a profession that is still in its infancy. We are, as they say in sports, not rookies, but not even in our prime yet. We are, as they say in fantasy sports, the sleepers, the prospects with a lot of upside.

You'll see your friendly neighborhood respiratory therapist walking room to room giving breathing treatments, participating in friendly discussions, and cheering up overworked and exhausted nurses and sick patients with their dry humor.

Yes we are an interesting bunch. Some of us grumble and gripe at each new stupid doctor order. Some of us are cheerful no matter what. Some of us are the kings and queens of hospital gossip. Some of us trudge from room to room without saying much of anything.

Yet, no matter what personality RT is taking care of your patient area, you should always know your RT is available to lend a helping hand. If you need an extra body to boost a patient, your RT will be there. If you need help holding down a child for his daily lab draw, your RT will be there.

You also should know that any time you walk into a patient's room and the patient just doesn't look right, that you should always call your RT. He might look at the patient and say, "Oh, he looks fine," or he may say something along the lines of, "I think this patient is wet. It is my humble opinion he might need Lasix. Let's check the i's and o's, though, before we call the doctor. Perhaps we should also get vitals so the doctor doesn't get mad because we don't have all this information available."

This great profession has come a long way since the day of the OJT; since the day when RTs were nothing more than button pushers, or ancillary staff. Yet, while many physicians, nurses and RT bosses have grown with the RT profession and learned to trust the opinions and expertise of the now well trained through qualified RT programs, continued education and experience RTs, there remain many still stuck in the past who still think of RTs only as an ancillary service.

Yes, even recently I have seen both sides of this coin. I have gone down to the ER, seen a patient in respiratory distress, made the appropriate decision based on my 11 years of experience as an RT and 38 years of experience as an asthmatic, and the patient benefited as a result.

When I was finished, I approached the ER physician and informed him of what I did. He enthusiastically said, "Great job! Thank You! I love it when you take charge! You did a great job!"

I was riding high. I did not grow a big arrogant head by no means, but it felt so nice to have a physician not just respect this profession, but to realize how we can be part of the team, and because he actually told me how well he respects me.

It made me feel good because recently I started an Albuterol treatment on a patient I suspected of being in bronchospasm, and the physician working the ER that day said, "What is this?"

"The patient's short of breath and his lungsounds were diminished," I said.

"Well, we don't start breathing treatments without talking to me first. I'm the doctor and that's my job."

I was beside myself. I took the nebulizer from the patient and dumped it into the sink. If this was a rude thing to do, I wasn't thinking of that. I wanted to simply give up. I wanted to take my brain filled with RT wisdom and go home. I wanted to quit.

But I didin't. I swallowed my pride and stood there feeling like a five foot fifth grader standing in the principal's office waiting to be scolded.

The physician turned to me and said, "I want Xopenex and Atrovent."

So, while this profession was once seen as 100% ancillary and 0% professional, it is now seen as ancillary about 50% of the time and professional about 50%. It basically depends on what nurse is working, and what physician is working.

This is progress. This is good. Yet, while the nursing profession is seen as a well respected profession, the RT "profession" is still lagging behind -- yet growing.

My advice to aspiring RTs is this. If you are looking to be an RT, go for it! This is a great profession and you and I can be part of the effort to driving this profession into the future. The RN profession was once in its infancy and through the years physician's learned that by respecting RNs not only do they benefit, but so to does the patient.

The same will hold true with the RT profession, only we who are presently working in the field have a unique ability to shape it into the form of our choice. So, if we stand by and let stubborn physician's pent on holding onto the past shape this profession, they will define our future.

Yet, if we stand firm, be patient, step forth, and continue to voice our opinions in a professional manner, we will shape this profession into the mould of our choice.

Yes, this is a slow, humble, and political process. It's changing the mind of one RN, one doctor, one RT, one RT boss, one administrator at a time. But we know it can be done. We know this because, as Jane Sage wrote in a recent post, the RT profession has already grown since the days of its infancy.

Sometimes I think we RTs are underutilized. Sometimes this irritates me. Sometimes it makes me feel apathetic. Yet, I also know there are many nurses who call us every time they suspect something is wrong with OUR patients. They know that we are specially trained in an area they glossed over in RN school, and they highly respect our opinions.

I recently overheard one sagacious long-time RN say to a student: "Don't be afraid to call RT. They have saved me many times."

We assess patients. We have listened to so many lungsounds that we might just be better than physicians at noticing little trends, at noticing early pneumonia, CHF, pulmonary edema. "This patient is wet!" The RT might say. "You need to call the doctor right away!"

Or, perhaps the RT was not called when the patient was blue around the lips. The nurse who held onto the old-school belief of RT as an ancillary service may have called the physician panicky. The doctor would order an ABG and write an order for more oxygen.

The nurse who learned to respect the RT on duty called the RT, and said, "The patient is blue, and I just wanted your opinion before I called the physician."

On a whim the RT enters the room and checks to make sure the oxygen is still on and connected. As it turns out his whim turns out to be a good idea, because the oxygen was on but disconnected. Once the problem was fixed the patient pinked up. The nurse was ecstatic, and never had to call the physician. We are a TEAM. What one of us doesn't pick up the other does.

Yes, you can see that we RTs, doctors, and RNs are part of the patient care team. Like RNs, we are not only well educated, we are licenced professionals. We are trained to assess, evaluate, think and communicate. We are not physicians, we are not nurses, and we are RESPIRATORY THERAPISTS.

We are part of the patient care TEAM!

It is now RT Care Week, a time to reflect on a profession that is still in it's infancy and growing in every area. We need to feel proud and joy in all we do, and we certainly hope RNs, physicians and admins appreciate what they have by the RTs working around them.

The debate: Are RTs professionals or Ancillary

My boss referred to us RTs as ancillary staff in a recent meeting. I personally have argued against this term for RTs, claiming that we are professionals. Yet the debate continues.

How about if we define these terms before we go on:

Ancillary staff: These are workers who are told what to do, and do them as instructed without asking questions.

Professional staff: These are professionals who are involved in the care of the patient and are a part of the team that "thinks" of solutions to acute and/or chronic problems the patient is confronted with.

By these definitions, the following are ancillary services:

1. doing abgs
2. doing breathing treatments
3. being a treatment jockey
4. performing ekgs
5. doing cpt
6. assisting with a boost

By these definitions, the following are professional services:

1. interpreting abgs
2. understanding what decisions to make based on your interpretation of it
3. educating a patient
4. questioning a physician order
5. knowing what to do as a patient is failing
6. delving into the patient's history to solve an acute problem
7. recommending new therapies to the attending physician
8. researching and coming up with new ideas to help the patient
9. researching and coming up with new ideas to help the RT department or hospital

So, I think the RTs of old may have been ancillary, and I can think of a few who exists in the RT Cave today who would qualify as ancillary RTs. Yet I am convinced most of us work alongside the patient with RNs and doctors for the benefit of the patient, and are thus professionals.

What do you think?

Hard work is the only way to succeed in life

I answered quite a few questions the past couple weeks about surviving in the field of respiratory therapy, either in RT school or in the RT Cave. I described that success is not defined by how smart you are, but by how hard you work.

Of course this is common sense, but I did find this described in greater detail in a book I found in my basement: "The Psychologist's book of Self Tests." Thus, as the author describes, a high IQ score does not necessarily equate to success:

So, what does it mean if you obtained a high score on this test? Consider yourself fortunate. It is a clear advantage to be born intelligent. People with high IQ scores get better grades in school, score better on achievement tests, go further i school, and have a greater likelihood of having a professional career. Also, there is a tendency for extremely bright people to have higher self-esteem, more energy, more athletic ability, happier marriages, and even better sex lives. These people also have a lower than average incidence of a variety of problems, including severe psychological problems, alcoholism, and criminality. Of course there are exceptions, but taken as a whole, highly intelligent people do stand out in a number of ways.

You high scorers shouldn't be too smug, though. A high IQ score is by no means a guarantee of success. Every year countless college students with impressive Colllege Board Scores flunk out of school while their modestly endowed peers make the Deans list... the reality is that qualities such as motivation, perseverance, and curiosity more than make up for a modest IQ score. What you do with your life is much more important than how you score on a standardized test.

As evidence of the importance of personality characteristics, it has been demonstrated that while intelligence does predict one's level of occupational status, it does not predict one's degree of success within a particular occupation level. So if you are bright enough to make it through medical school, for example, you have as much of a chance to be a successful physician as your more intelligent classmates. It does require a certain level of intelligence to master complex material, but as long as you have the requisite mental ability, your personal qualities will then determine how good you are in your chosen field.

So, there you have it. Whether or not you succeed as an RT, or any other field for that matter, is not determined by how intelligent you are, it is determined by how hard you work.