What Determines Success?

Prepare for the worse and hope for the best. 

We are health care providers. We are nurses and respiratory therapists. Our success is not determined by how many sick people we care for. Our success is determined by how many people don't need our services.

Look at asthmatics as a good example. Back in the 80s, it was common to have sick asthmatics. In fact, it got so bad that asthma organizations were formed. Heads of these organizations, along with many of the top asthma research physicians in the world, put their heads together. They created asthma guidelines.

Today, regional asthma doctors are educated on how best to treat their asthmatic patients. Asthmatics themselves, in turn, are well educated how to stay healthy and out of hospitals. And it was a huge success. Today, we don't see a fraction of asthmatics we used to.

See, that is a success. The fact that most asthmatics are able to stay out of hospitals is a success. If they were still being admitted at record levels, that would not be a success. Sure, we would make more money if asthmatics were filling hospital beds. But, that they are breathing easy and avoiding us is a good thing, not a bad thing.

COPD right now is at epidemic levels. There are COPD patients getting admitted every day. There are also many COPD patients that become regulars. They are discharged and readmitted on a regular basis. That, my friends, is not a sign of success. It is a sign that we are failing them.

Let's talk intubation.

You don't want to intubate people. Sure, it's very profitable when we have ventilators. Sure, it might stimulate your excitement level. But, it's not something that's good. It's a last-ditch effort to save a life. It's nice that we have that skill. It's nice that we know how to save lives this way. It's great that we manage ventilators.

But it's not something we should look forward to. Someone comes in the door of the ER, we should be praying that they don't need us. We should be hoping they get better. But, I'm afraid there are many of us who hope, maybe even pray, that we get to intubate.

That is a sign of failure, not a success. Success is not needing to intubate.

Obviously, some people LOVE intubating. That's understandable. You want to do it to keep up your skill level. And Managers WANT ventilators. In most instances, they are very profitable for respiratory therapy departments.

But hospitals, especially the not-for-profit variety, are not in the market to make a profit. That's the whole point. We are here in case we are needed. We are the cost of being in the healthcare business.

The benefit of down time

One of the neat things about working for a small town hospital is you will have plenty of down time. During this down time I have seen nurses and respiratory therapists do an array of activities, such as play games, surf the net, Facebook, read, blog, and you name it.

Some people frown upon this and think that if you are on the job you should be working.  For instance, when you work for a restaurant and there is down time, you are expected to have a rag in your hand wiping down tables.

I don't see it that way.  I see down time as a benefit to the job.  I see down time as an opportunity to rest and prepare for those moments when you have to bust your but to get your work done.  I see it the same as I see health insurance and other benefits to working at a hospital.

Of course, the rule of thumb here is that you have to have all your work done before you can play.  Likewise, you cannot become so rapt in your play that you forget to check on patients who need checking on.  You must also not get so rapt in your work that you leave work for your replacement.

Still, I think of down time as good.  How bosses perceive down time varies from boss to boss.  Some are totally fine with down time, and they are fine with you taking advantage of it.  Others hate it and are always trying to find things for you to do.  Some are about half and half, okay with it but would prefer you find something to do.

This is one of the advantages of working night shift, because, so long as you get your work done, you can do whatever you want in your down time.  I have worked at some hospitals where the night shift workers take naps.  I'm not a fan of naps, although mainly because I like to be industrious with my time.

I think that's one of the main reasons I started writing medical blogs.  Here I am able to do something health related, something industrious, something useful.  Of course there are others who simply walk around and gossip or try to sell some kind of tonic to make your hair grow to their coworkers.

How to give a good report

I get quite a few questions about how to give a good report, particularly by RT Students.  Here is my pity answer.

Report should not be hard.  What kind of report may depend on who you are giving report to.  If it's the same person you got it from, then you might be able to get away with simply giving the time the treatment was done.  But if it's a different person, you should give more detail.  

Here's what I like in a report for those patients receiving only basic respiratory care (i.e. treatments).

1. Name of patient
2. Age
3. Lung sounds
4. Vitals (HR, RR, SpO2)
5. Oxygen (room air, 2lpm, 50%vm, etc.)
6. Level of alertness (awake, orientated, lethargic, coma)
7. Anything else that might effect how patient is approached (i.e. hard of hearing, blind, mentally challenged, dementia, depressed, Alzheimer's, nice, mean, laconic, loquacious, etc.)
8. Why were they admitted (i.e. COPD, Asthma, bowel obstruct, hernia, broken leg, etc.)
9. Why they are getting treatments (if different from diagnosis (i.e. admitted for heart failure or anemia or bowel obstruction, getting treatments due to asthma history or COPD history)
10. Are they on oxygen (if so how much and why)
11. Is the patient stable. This information is helpful in prioritizing what to do first.
12. Any other pertinent information (going for a bronch today, coughing up yellow or bloody sputum, pertinent lab values, x-ray results, etc. 

What you give in report starts in the report you receive. Write down what you learn.  Check the patient's chart and review doctor notes, lab values, ABGs, x-ray, for anything significant.  Write down what you learn. If the patient has a disease you don't know, look it up on Google.  

Give a pithy report on each patient.  If you are asked a question you can't answer, don't fret.  Most established RTs don't have all the answers either.

The sixth period of respiratory therapy: The RRP?

So if -- WHEN -- the respiratory therapy profession survives the fifth period of respiratory therapy, what will our profession be like.  Chances are we will not be the neb jockey's and ventilator button pushers that we are today.  Chances are we will have more responsibility, and therefore improved respect and probably better wages.

Am I dreaming here? Chances are that I'm not.  I think there is too much pressure on hospital administrators to find ways to cut costs, and surely there's no better way than to quit doing procedures that there's simply no need for.  This would include about 80 percent of breathing treatment orders, incentive spirometer orders, electrocardiogram orders, and a variety of other respiratory therapy related orders.

Surely we won't want to cut our way out of jobs, and surely those working for the AARC and NBRC don't want to lose their jobs either.  And surely hospital administrators, physicians, nurses, and respiratory therapists alike know that respiratory therapists are an integral part of the patient care team. So efforts will be made to keep us.  The question that remains is: what will be the scope of practice for the respiratory therapist.

First of all, I think all attempts at deregulating respiratory therapy will fail. What will happen is there will be a gradual shift from the respiratory therapist to the respiratory therapy practitioner. The first step will be offering a bachelor's degree in respiratory therapy, and this process has already begun. At the present time therapists may continue their education on a voluntary basis.

However, as is the case for many hospitals, as more therapist obtain their bachelor's degrees, there will be a push to hire only therapists with bachelors.  Or, perhaps, the incentive to obtain a bachelor's degree will be that only those with bachelors will be able to decide who gets what and when.  RTs with bachelor's will be, in essence, the team leaders, while all other RTs will be the educated button pushers.  

Eventually all therapists will have bachelor's degrees, and more respect.  The gradual next step will be the gradual assimilation of Respiratory Therapy Practitioners (RTPs).  They will be on the same level of respect as nurse practitioners (NPs), physician's assistants (PAs), and the nurse anesthetist. Our profession will finally obtain full the respect it deserves.

Fifth period of respiratory therapy: How will it end?

So at the present time our profession finds itself amid the fifth period of respiratory therapy, whereby many wonder if cost cutting measures will result in our profession being cut.  While we used to be a pay for service department, we are now mainly just a service department.  And while our services are essential to ideal patient care, there are those who believe our services have out lived their usefulness.

In many regards they are right.  For many years now our profession has sort of milked the system, as many of us find ourselves doing procedures that we know are pointless, but we don't say anything because we are being paid.

Hospital administrators don't say anything either, because they know, even though most of what we do is a waste of time, that many of the things we do are absolutely essential to good patient care. I mean, who gets called first when a patient is in respiratory distress?  It's the respiratory therapist.  In many cases, the therapist is called even before the doctor.

And even if the therapist isn't called first, the physician insists on the therapist being present. Ever watch one of those old movies when the doctor is doing all the work during a code in the ER and says, "Where the hell is respiratory?" While that's an inaccurate description of accuracy, it sort of portrays how the medical profession views our profession: they think we're a bunch of useless dummies, but in cases of emergency we are the first one called."  The point being: our services are needed, but they won't admit it.

The truth of the matter is, no one knows respiratory like the respiratory therapist.  I even had a hospitalist come up to me recently and admit this.  He said, "You respiratory therapists are our pulmonologists.  When we have a respiratory patient we call you and we heed your advice."

The fifth period of respiratory therapy exists in a time where the government is getting more and more involved in healthcare.  What this means is that many decisions regarding patient care have been removed from the physician, removed from hospital administrators, and given to government officials who sit in comfy leather chairs hundreds, if not thousands, of miles away from the patients they intend to help.

These government officials consider themselves the experts.  They know what's best for every patient in the United States even though the majority have no healthcare experience whatsoever.  This is where your protocols and order sets come from.  They say they are an attempt to improve patient care. But we know the true reason for them is an attempt to cut reimbursement costs to hospitals.

They say they are not being forced on hospitals.  But the truth is, if hospitals don't adapt them reimbursements will be cut.  So, in this way, hospitals are forced to adapt them whether they want to or not.  In the end, while the government saves money, hospitals have to eat the cost of implementing and enforcing these protocols and order sets that no one wants and that don't work.

In the midst of all this, sits the respiratory therapist in the RT Cave.  He grumbles and gripes under his breath when asked to do yet another breathing treatment on a patient who is not short of breath and probably doesn't need it.  Yet he keep his mouth shut for fear of alienating the very folks he relies upon.

Yet the time appears to have arisen whereby the word has gotten out, and certain members of Congress have established bills that would deregulate respiratory therapists in order to save costs. In other words, the process has begun whereby the powers that be will be looking at everything we do, and deciding if we are really needed.  There has even been talk of educating certain nurses to do what we do.  "After all," one nurse said to me, "All you guys do is turn knobs anyway, as most vents just work themselves."

You think that's true?  Most therapists know that we are more than just button pushers and neb jockeys: we are an essential part of the patient care team.  While most physicians, nurses, and hospital administrators understand this too, their hands might be forced to pull the rug out from under us for no other reason than to cut costs.

Will our profession survive?  Surely we will.  Yet the scope of our practice might result in us picking up duties we don't want to do, such as wiping butts and cleaning up puke.  Yet, if we play our cards right, it might evolve the other way too, where the scope of our practice allows us to remain an integral part of the patient care team.

Happy New Year

Every new year most of us make some sort of resolution that we vow to continue throughout the new year.  The RT Cave proposes that all respiratory therapists make the effort this year to focus, not the patient this year, but charting. 

I know we sound like RT Bosses in changing the emphasis from the patient to charting, but after the patient is taken care of, there is nothing more important than accurate charting, with part of charting being accurate billing.  

It's important, folks.  If you didn't chart it you didn't do it, and if you didn't do it the hospital can't bill for it.  And if you didn't do it, a lawyer can cause some major headaches for you.  

Every one of us charts by unique means, both individually and as an institution. We encourage you, by whatever means you chart, to slow down, chart correctly, and make no errors.  

If nothing else, your RT Boss will earn more respect for you.  

Next year's resolution:  no complaining.  

25 reasons why people go into respiratory therapy

In honor of respiratory therapy cave week I thought it would be neat to list some of the reasons we became respiratory therapists in the first place.  Here are some of the reasons I've heard over the years.

1. Love the money
2. Love helping people
3. Love working with people
4. Love the challenge
5. Love the feel of the rush during an emergency
6. Like the exercise from all the walking we do
7. Love bantering with patients
8. Love working in the air conditioning
9. I love the challenge of doing invasive procedures
10. I love helping people breathe better
11. I love the milieu of the hospital
12. The wait to get into nursing school was too long
13. I would rather do PEEP than POOP
14. Love the hours
15. Love the people
16. Knew the boss
17. Slept with the boss (okay, I just made that one up)
18. Wanted an easy job
19. I thought it would be a good career
20. It was the career I drew out of a hat
21. I accidentally signed up for the wrong class, and decided I liked it
22. RTs were in high demand
23. I could start working as soon as I got a degree
24. It was only a two year program
25. I heard if I could get my CRTT in one year and start working

Why did you become an RT?

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How do you store used nebulizers?

What do you do with the nebulizers after the breathing treatment is done? I find that every therapist I follow does something different, and every hospital I have worked at has a different policy.  Consider the following:

1. Stuff it in a bag with the tubing
2. Wrap the tubing around the neb and stuff all in a bag
3. Leave tubing over flowmeter, and stuff neb in bag
4. Leave bag on floor, and toss neb and tubing askew on window sill
5. Leave nebulizer on patient's face (yeah, you forgot to end the treatment)
6. Leave nebulizer and tubing on side of bed (yeah, you forgot to finish the job)
7. Coil the oxygen tubing around the nebulizer so it takes your coworker a full five minutes to uncoil the tubing. 
8. Leave the neb in a plastic bad, and the tubing hanging from the wall
9. Leave no neb in the room, leaving one to wonder "where is it?"

How do you store used nebulzers?

My argument against respiratory therapy practitioners

There is a lot of talk among the respiratory care profession about changing the RT degrees.  One idea as proposed by the National Alliance of Respiratory Care Professionals (NARCP) is to create a new profession of Respiratory Care Practitioners.  As noted on a recent Facebook entry: 

Much like nurse practitioners help to fill the shortage of doctors, we strongly advocate for the creation of cardiopulmonary practitioners and critical care practitioners; a mid-level Masters program for Respiratory Therapists that specializes in critical and cardiopulmonary care to help fill the shortage of critical care specialists and the rising number of patients with cardiopulmonary disease.

My argument is in opposition to the NARCP.  In response to the above, I wrote:

I think we are already qualified to do that.  i see no need to go to school for 3-6 years to learn what we already know after 2 years.

Their response to me was:

Frea: An mid-level provider will require more than an AS degree, and there is a vast amount to learn about cardiopulmonary disease and treating it.  We have the best foundation to advance to these levels.

That argument didn't settle me, and I wrote: 

It would make more sense if physicians would learn to respect what we already are - well qualified.  More schol will not make us smarter, IMO.  If someone wants to become a practitioner, they go to practitioner school.  If someone wants to be an RT, they go to RT school, for 2 years.  If the RT program was more than that, many of us wouldn't be here, and the profession would be losing out.  

I think this is so true.  School is expensive, and most of us chose this profession because it was less costly, and less time consuming, than pursuing a bachelor's or doctorate's degree.  And I can personally contest to the idea that the only reason I became an RT was because I could start working right away, and have a degree in only a few short years.  If the profession was anything more, your humble author here would not be doing this (or I'd be doing this for some other profession).  

A later response was by Jason Cook, who wrote:

We need both clinicians as well as technicians, and it depends on your personal mastery of the concepts.  I have met 2 year CRTs who knew more and could diagnose better than a physician, and likewise, I have met some RRTs with Master's degrees who couldn't wean their way out of a wet paper bag.  We need groungpounders as well as Top brass.  I'm just sayin, "Don't be hatein.  Somebody has to do the dirty work while the manager goes home to do whatever it is they do...

So, what are your thoughts on this?

One good thing and one bad thing about my job

I will say one good thing and one bad thing about my job. 

1.  The good:  My favorite part of my job is having intelligent discussions with my patients.  I love my patients.  I love my patients, and I'm good at what I do.  I love that I can get along with the same people I'm told no one else can get along with .  I love when I can make a grumpy lady smile.  I love it when I had a lady who was severely short of breath say, "YOU GUYS JUST DON'T UNDERSTAND HOW BAD I FEEL." And the nurse said, "Oh, you are so wrong!  Rick's been in your shoes before." That patient and I became good friends.  I love when I walk out of a room and I stand outside the door, and one little old lady says to the other, "That's a really neat guy.  I think you'll like him taking care of you." 

2.  The bad:  And this is gonno sound bad on the surface.  Sometimes I wonder what's the point of saving lives anyway.  If there's one thing I've learned in the medical field is that it is better to die with grace and dignity than for me to do to you some of the things I do to save you.  Medicine is great when you need us, but there's a lot of people who try to live forever, and they think we have the magic pill that's going to make that happen.  But we don't. Then instead of dying at home with dignity and grace in their own bed, they die in a hospital with no hair and nausea due to chemo, a tube in every orifice, and they continue to live another two years this way... it just drags on and on and all I can think is "you did this to yourself."  You talked to your doctor, and you decided you wanted everything.  You watch too much TV, where CPR works 60% of the time, and so you think that's how it is in real life.  But, in reality, we bring back only 7% of you, and only 2% of that 7% actually gets to go home. 

You have one job to do and one job only...

The following was submitted by Will Lessons, RRT, Retired:

I will be honest with you.  When I first became an RT I was scared shitless.  Here I'm fresh out of school and I'm expected to work nights by myself.  There's one way to learn -- the best way -- and that's to just be thrown into a stressful situation.  It's what makes you or breaks you. 

So I had no choice but to get better.  I had no choice but to get my feet wet.  I was essentially thrown to the wolves.  So I had no choice but to get better, more comfortable, and I did as time went by. 

I had to do this if I wanted to keep my job, and I did.  I needed money.  I needed to support my family. 

Then one day I realized there's nothing to worry about.  I have one job and one job only, and that's to manage the airway. 

That was when I became comfortable with my job. 

Thankfully I was thrown to the wolves on night shift, other wise it may have taken years to come to this realization.  Yet I would have come to it, eventually.  After I finished leaning on my coworkers. 

Most new RTs start out on nights.  It's not such a bad thing.  It forces you to jump right into situations you otherwise don't feel comfortable being in.  But if you were a good RT student, you should know what you're doing.  It's not that hard.  It's what you were trained to do. 

This type of experience, this reassurance, pushed me to that next level of expertise.  And I highly recommend to all you new RTs to just jump into the water as soon as you can and get your feet wet. 

We were all there once and we all know what it was like, so no one is going to let you sink.  Plus you can have the reassurance that every single ER and CCU nurse and doctor knows what you do.  They have all seen it a million times.  So if you're in a crunch, they can help you. 

Now on the medical/surgical floors that's another story.  Those nurses rarely see codes and aren't as competent as your ER or CCU nurses.  And thankfully most codes take place in the ER or CCU.  Chances are by the time you have a code in some weird place -- like x-ray or lab -- you'll have plenty of experience under your belt.  If not, it's all a learning experience. 

So don't sweat it.  Later on in my career when I was the RT educator at my hospital, I told all new RTs, "You have one job to do and one job only, and that's to manage the airway." 

After you do it a few times, it's like working in a factory; doing the same thing every time.  It's like a cakewalk.  It's like going for a dip in the cool, refreshing Lake Michigan on a hot summer day -- easy and refreshing. 

23 Tips to make yourself a standout RT

Want to be the respiratory therapist nurses love to work with?  Want to be the RT patients think of long after you clock out?  Want to be the RT the bosses think of when there's a fun conference that needs attending?  Then you'll want to be a standout therapist.  

The following are tips that will help you shine as an RT in the eyes of all the good folks you work with, around and for.  

1. Be prompt:  Show up to work on time
2. Be happy:  And show up happy
3. Be positive:  Be the person people love to hang around due to your positive attitude.  
4. Smile:  Do this often.  Do this every time you pass a person in the hall.  Do this every time you enter a room.  It's hard not to smile yourself when you see a smile, and this can help a depressed person feel happy.  It's hard to think of bad things when you're doing something happy, like smiling.
5. Say "Great!" or "Excellent:  When someone asks how you're doing, always say something positive like "Great!" or "Excellent!"  Say this even when you're feeling gloomy.  Not only will you feel better, so will the other person.  
6. Turn it off at the door:  If you're feeling gloomy, or upset, turn it off before entering the patient's room. It's not the patient's fault for your attitude, plus he or she deserves to have you at your best.  
7. Be a good teacher:  Explain what your're doing, and explain what the patient can do to get better and stay healthy.  Answer their questions in a pithy manner.  
8. Be diligent:  When caring for a patient, don't allow yourself to daydream or get off task. Stay in the room, offer companionship or empathy as appropriate, and have fun with your patient.  Again, your patient deserves your full attention.  
9. Ask if you can help:  Before you leave the room say something like, "Is there anything I can get for you."
10. Do what you say:  If you say you're going to do something, or get something, do it right away.  
11. Offer assistance:  If a patient or nurse asks for help, volunteer enthusiastically and be a good help.  
12. Accept challenges:  If your boss asks for volunteers to perform new tasks, such as stress tests, PFTs or EEGs, volunteer yourself.  You may also volunteer to teach classes such as oxygen therapy, Neonatal resuscitation, basic life support, and asthma education.  
13. Research:  Stay up to date on new respiratory therapy wisdom and offer to share your knowledge to your coworkers and bosses.  
14. Offer new ideas:  Share you ideas for improved charting mechanism, protocols, etc.  
15. Be a critical thinker:  
16. Be a good team player:  Do your part as a team play, and don't take credit for what you didn't do.  It's also fine to let others take credit for what you did.  
17. Be nice:  Niceness makes up for many flaws.  If a nurse requests a procedure be done on a patient, and it's not needed, kindly explain.  
18. Be efficient:  Be organized and manage your time wisely.  
19. Finish your work:  Your coworkers will be thrilled with you simply by getting your work done and not unfinished work for them.  Would you like it if your coworker left work for you?  I didn't think so.  
20. Offer thanks:  Thank members of the team for their help.  Thank often.  
21. Stock:  Make sure stock is replenished before the end of your work day.  This will help keep your coworkers happy, even though they probably won't even know you did it.  
22. Relax:  This helps you to stay focused and makes you easy to work with
23. And have fun:  Enjoy yourself.  Have a sense of humor.  Fun people make work more enjoyable. 

Things I love hearing a patient say

The following is what keeps me going:

1. I love it when I draw and ABG and the patient says, "That didn't even hurt."  
2. I love it when I do an EKG and the patient says, "That's it?"
3. I love it when I do a breathing treatment and the patient says, "Wow!  I feel much better.  I wasn't expecting it to work like that!"
4. I love it when a patient says, "The way you prepared me for and walked me through that extubation made me at ease about it."
5. I love it when you set up a patient on BiPAP and the next morning they say, "That was the first good sleep I had in ten years."
6. I love it when a patient says, "I feel at home here.  You guys are a great bunch."
7. I love it when a patient says, "The last time I came here a goofus asthmatic, and now I'm a gallant asthmatic having a bad day, and I all it all to you."
8. I love it when you talk to a person the day after doing CPR on him and he says, "That was a neat experience.  I saw my dad standing by the lights of the pearly gates and he told me to go back home."

What are some things you like hearing a patient say?

How to deal with refusals

You enter the room and the patient adamantly refuses.  You say "Okay, just let me know if you change your mind."  Or perhaps you're busy and don't want to do back, and you simply say, "Okay."  Either way, you did your job.

Is that right?  Perhaps not according to some physicians.  I know one doctor who hates it when an RT doesn't do a treatment.  She says, "If I order a treatment I want you to do it.  If the patient doesn't want it it's your job to talk them into it."

In the ideal world this doctor is right.  Yet in the real world we RTs are often inundated with an amalgamate of therapies we have to do on a daily basis, and many of them aren't needed for any other purpose than for the patient to meet reimbursement criteria.  So when a patient refuses we often feel relief and walk away.

Whether wrong or right, most RTs I know go on the three strikes and your out policy.  If you refuse three treatments in a row we just walk by your room after than.  If it looks like you're breathing okay then we just keep on walking.  In the ideal world it wouldn't be this way, but in the real world that's all we have the time or energy for.

And this is how it is whether the patient is has a PRN order or a specific frequency ordered.  If the patient doesn't want the treatment he probably doesn't need it anyway.  The only exception I make to this policy is when the patient is a fun discussion.

Discuss.

Does the job of RT suck?

Wow.  While surfing the net I came across this thread about the profession of RT.  It starts as one humble student asking questions about the field of RT:  "I want to be a respiratory therapist but everyone keeps asking me why? What do they do? So any respiratory therapists out there, what is the answer?

It lead off to a bunch of RTs trashing the profession:  "Don't do it!  This job sucks!  We get no respect!  RTs are the hospital's bitches, etc."

I wanted to be a teacher once, and the reason I decided against it is because I bravely went out of my way to approach some of my favorite teachers to ask them if teaching was a good career. They both told me it sucked and the pay sucked. 

So I ended up as an RT.  I like being an RT, yet I still dream of being a teacher and sometimes wonder how my life would have been different had those teachers said something nice about the teaching profession.  Two of my neighbors right now are teachers, and they both love their jobs.  Plus they get all summers off.  Plus they get paid better.

I agree with one fellow RT who wrote:  "If you hate your job so much get a new one."

Sheesh.  Get a life folks.  There are definitely times I get frustrated during the course of my work.  Just this past week I was ticked off at my bosses because they aren't proactive and don't go out of their way to make our jobs better.  They would rather sit and not make waves that might make their jobs harder.

Yet that's life.  No matter what job you do there's going to be things about it you don't like.  No job is ideal as the AARC pictures the profession of RT to be here.  Ideal is for dreamers and people who vote for socialists like Vladimir Putin.  In the real world nothing is perfect: Failure happens, Death happens, Poverty occurs, Dummies exist, People starve, Politics is real. 

In the real world people who eat bad, smoke and drink seem to live to be 80, and people who exercise and take care of themselves still get sick and die.  It's unfair, yet life is unfair.  Regardless of who you are, there is a risk to anything you do.

Yes, and smiles are fake.  Some person who says, "I feel great," is really having a bad day.

Sure, that's life.  Yet whether or not you smile and show your happy face and love your patients and love your coworkers and get along with people is up to you.  You can make it what you want.  You can say, "Yes, I'm having a great day!" even when you're really not.

Yet if you say, "My job sucks," then people will view you as the guy who hates his job.  Yet if you say, "I love my job," or, "I'm doing great today," people will see you as the cool guy who is always happy.  You can be the negative guy people want to avoid, or the happy guy people love to be around.

Life is what you make of it.  Complain sometimes to the right people, and don't lose your spirit.  Complainers are seen as unhappy and say more about themselves than what they are complaining about.

Does the job of RT suck?  It only sucks if you want it to suck. 

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How to get a job as a Respiratory Therepist?

For those seeking advice on how to get a job as an RT, you have come to the right place.  Keep in mind, however,  I can't guarantee the job you want will be available, and I can't guarantee you won't be up against more qualified candidates.  Yet what I offer here are simple tips to help you stand out to a prospective RT boss, and ultimately -- you hope -- make your file stand out upon his desk.

So, what can you do to be hired as an RT?  Here are some simple tips:

1. Study hard in school and work your butt off to learn as much as you can during clinicals
2. Create a simple one page resume
3. Send in your application and resume.  Most are available now online.
4. Wait about a week and call the hospital to get the RT Bosses phone number at work
5. Call the RT boss and say something like, "Hi, I'm Bob lookingforwork.  I put my application for a job as an RT a week ago and am wondering if you got it."  The conversation should take off from there.  If he has a lot of applications this will put yours at the top.  He will know you're interested and serious.  Do not make your initial contact by email unless that person has already contacted you.  You may contact this person once a week until you get an interview or a flat out no.
6. Be prepared. Learn as much as you can about the hospital you are applying to.  If you worked clinicals at this hospital that helps. 
7. Dress nice for the interview (but don't over dress), and bring a copy of your resume. Do not overdue the makeup, perfume, aftershave, etc.  You don't have to wear a suit.
8. Answer questions honestly. 
9. Ask questions.
10. Make nice comments about the hospital or department, such as, "I like the down home feel of your hospital."  Again, don't over do it.   
11. Know your weaknesses.  If you're a new RT, this is your weakness.  
12. Do not bring up pay at the initial interview. If you are asked, be reasonable
13. After the interview, make sure the RT Boss knows how much you want to work for him, say something like, (shake hands) "I look forward to working with you in the future."
14. If you don't get a call within a week after the interview, call the RT boss and say something like, "Hi Mr. RT Boss, this is Bob lookingforwork and I'm curious if you made a decision about your RT position."  You may also use email if you have the person's email. You should make sure you continue to make contact every 1-2 weeks until you are hired or hear otherwise.  
15. Spread yourself out if you want.  You can do this for as many hospitals as you want at the same time.  Just make sure you don't schedule two interviews at the same time.  Good luck. 

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Respiratory Therapy is a low stress job?

Some of my coworkers will debate me on this, yet I have and always will contend that the profession of RT is a low stress job .

Okay, allow me to add at least where I work.  And allow me to add this other little statement:  and most of the time.

Surely you're going to have your newborn baby who isn't breathing.  You're going to have a kid come in after an auto wreck.  You're going to have a relative come in some day in severe respiratory distress.  You're going to have your moments.

Some of you who work for trauma hospitals may see that stuff every day.  Yet usually you either see adults or kids, not both.  So after you do this for a while doing CPR will become as easy and nonchalant as picking up a tissue when your nose is dripping and wiping it off and tossing that dirty tissue in the trash. 

Seriously folks.  With the exception of the asthmatics who truly needs a breathing treatment, no one is going to drop dead if they don't get one on time.  Most patients won't even know you didn't show up if you were busy. 

ABGs are nice, but they are just procedures.  EKGs are nice, but they too are just procedures.  When it comes down to it you treat the patient, you don't wait to get a procedure.  You do what you were trained to do.  You think. 

Now, is thinking stressful?  It can be for some people.  It can be when the patient is a wreck or a conundrum.  Yet it shouldn't be.  If you studied in school.  If you paid attention.  If you still know your stuff.  If you read RT magazines and keep up to date on your RT wisdom, thinking shouldn't be a big stressor for you.  If anything it should be challenging and fun.

I like my job.  I like being an RT.  Yes there are stressful moments.  Yes there are days when I'd like to kick my boss in the butt for not wanting to make waves or for telling me what he thinks I want to hear rather than dog gone truth.

The pay could be a stressor too for some.  While there are some who say RTs are paid well, I beg to differ.  Yet no one ever died saying they wished they made more money.  Your money goes as far as you wisely spend it.  You can make $40,000 a year and be richer than a man who makes $70,000 a year and spends it unwisely.  So stresses over money are unfounded.

Yet this is a good job and a relatively stress-less job.  Plus where I work I get to do this (blog) and this is a major stress reliever for me.  What do you think?  Is your job stressful?

Note:  The comments section below is temporarily broken, so send comments via the email (contact me) in the right column. 

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What do RTs really do?

The American Association for Respiratory Care (AARC) lists the following tasks that respiratory therapists do:.

• Diagnosing lung and breathing disorders and recommending treatment methods.

• Interviewing patients and doing chest physical exams to determine what kind of therapy is best for their condition. 

• Consulting with physicians to recommend a change in therapy, based on your evaluation of the patient.   

• Analyzing breath, tissue, and blood specimens to determine levels of oxygen and other gases.

• Managing ventilators and artificial airway devices for patients who can’t breathe normally on their own.

• Responding to Code Blue or other urgent calls for care.

This list is an ideal list of the tasks RTs do.  For all you RTs out there in the real world, how accurate do you think this list is?  Does this paint an accurate picture to prospective RT students? 

Based on your responses I will update this list so that it is accurate if necessary.  So what do you think?

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Snot's easy, so be an RT!

Many nurses say they don't want to be RTs because they don't like to deal with snot.  Yet I contend that snot's much easier than dealing with wiping butts and turning patients all the time. And besides, it's not like we have to do snot all the time anyway. 

Plus doing snot (i.e. suctioning) is contained in the catheter, doesn't smell (well, most of the time) and is an invasive procedure that you can excel at.  In other words, you can get good at it just like wiping butts.  Yet excelling at snot sucking is something you can be proud of, especially as you develop a "schmood" technique.

So that's one thing I could never understand.  How can you be good at turning patients, wiping butts, and dealing with blood,  IVS, drawing blood, dealing with stressful decisions, not mixing up your drugs and giving them on time, yet not want to be an RT because you might on occasion have to deal with sputum.

Nice thing about being an RT is we don't touch anything below the belt. 

Yes I will say it here:  snot's easy.  Don't let snot sway you away from being an RT.

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Things that make our job easier/ harder

It seems to be my first 8 years as an RT saw many new things that made our job better. I'll list some examples here:

1.  Microprocessor ventilators:  work with patient instead of other way around
2.  Microprocessor BiPAPs:  easy to use, pts tolerate them, and they keep people off vents)
3.  Computer charting:  no longer have to hunt for charts, easy access
4.

However, in the past five years every thing added has made our job harder:

1.  Order sets:  RT procedures automatically ordered even so all bases are covered, increases workload
2.  Protocols called order sets:  increases workload
3.  Medicine locked up:  Inconvenient to get to medicine
4.  Obamacare:  Increased need for QA analyzers and order sets
5.  QA analyzers:  who constantly double check our charting (nit pickers, that's what I call them)
6.

Can you name any more things that have made our jobs easier or harder????

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