RT equanimity is an essential RT trait

I walked back to OB this morning and a nurse of 30 plus years walked up to me and said, "Hey, I wanted to thank you for all your work the other day. You were so good you made our jobs that much easier."

She was referring to a neonatal patient that had a diaphragmatic hernia and had to be ventilated and ultimately intubated and set up on a ventilator. While this was the only time in the 14 years I've been at Shoreline I did this task, it was a piece of cake.

It was a piece of cake not because I have a ton of experience with neonates, because 98% of my experience is with adults. It's because we probably spend 60% of all our preparing time studying and practicing with neonatal ventilator scenarios. What do we do if we have a bad baby.

Being a small hospital, we all have to care for all age groups, yet we seldom get a neonate or ped in distress. So, needless to say, that's where all our research goes.

So, by the time it comes to where we actually need these skills, we are know what we are doing. It's like clockwork. I had the ETT ready, and knew vent settings, before the baby was even born. When the doctor said, "We're going to intubate!" I asked, "Is a size 3.5 ETT okay? How about 20 tidal volume!"

He was impressed, and so were the nurses, yet I never noticed. I never noticed until this morning.

When I have a bad baby I recall my days working at a larger hospital, on my first day, when I was told that if I ever have a bad baby, it is important that you, the RT, are the calmest person in the room. If the RT is calm, the nurses and doctors will be confident in them, and can do a better job at what they do.

RT Equanimity is an important tool, essential for things running smoothly in the hospital setting. When an RT is cool, calm and collected, it shows he's competent and confident at his skills.

RT Cave Rule #46: It's important to keep up on your RT Wisdom and practice scenerios occasionally, especially regarding procedures you rarely do. Thus, a well prepared RT is the calmest person in the room.

RT Cave Rule #47: RT equanimity is the most important RT trait. It allows the nurse and doctor to concentrate on their jobs instead of yours.

Please don't abuse the word STAT

If I am called to the emergency room STAT and I get down there and have to stand around for five minutes before the patient even arrives, then I didn't' need to be called STAT.

If I am called to the emergency room STAT only to be told the ambulance is still 5 minutes out, I didn't need to be called STAT.

If I am called to recovery STAT only to find out the surgeon wanted a pre-operative EKG, I didn't need to be called STAT.

If I get called to a patients room STAT, and learn the doctor wanted the routine ABG or EKG done before he had to leave town to go fishing, I didn't need to be called STAT.

That in mind, allow me to restate here an old RT Cave Rule:

RT Cave Rule #6: STAT means that you need to get to the patients side right now. We are talking about a life and death situation.

That said, there is another rule that must be re-emphasized about the word STAT, and that's this: if you're going to abuse the word STAT, then you are going to desensitize RTs to its meaning.

Thus, if you keep calling me STAT for BS reasons, I'm going to stop dropping what I'm doing when I hear it. This brings me to our latest RT Cave Rule:

RT Cave Rule #37: If you don't want to desensitise RTs to the word STAT, make sure you don't abuse the word STAT.

I think the word STAT is one of the most important in the entire hospital industry, so it must not be abused. We RTs are just as busy as doctors and nurses and are required to prioritize therapies. Don't force us to sacrifice the care of one patient for your inappropriate STAT call.

There are more appropriate ways to inform or page the RT of an impending situation. For examle, you can type the following page:

1. The doctor wants you in room 231 ASAP
2. Ambulance 5 minutes away
3. EKG in ambulatory ASAP

Any further questions you can contact me:

A more detailed description of slippage

So long as we are on the topic of slippage (I wrote about it here), perhaps we should expound on this a bit. We are all expected to maintain a certain level of dignity. We are all supposed to maintain a certain level of modesty. We are all supposed to maintain a certain level of respect for our superiors, friends and co-workers.

Slippage: failure to maintain an expected level, fulfill a goal, meet a deadline, etc.; loss, decline, or delay; a falling off -- dictionary.com

When we are out in public, many of us try to maintain a certain level in our appearance. When we go to work, for example, we are expected to look our best, to smell our best, to wear our best smile and personality. We are supposed to be the utmost professionals when we are amongst our co-workers and, most important, our patients.

When things happen that we disagree with, when a doctor orders something we think is going to harm the patient, it is our job to bring this to light in a professional manner. When a doctor orders something stupid, it is expected that we will not complain. It is also expected that we will not complain when we disagree with an administrative decision. We, as expected, will be the utmost professionals and, to put it lightly, just do as we are told.

The gossipers will gossip. The unhappy people will complain. As I am doing my rounds through the hospital I hear these things going on, and I wouldn't necessarily call all of it slippage. There are certain people who are hotheads, and they tend to argue with every single person every single time something meets their disapproval. I would not call that slippage. I would call this disrespectful, perhaps.

When someone does something that is expected of them, it is not called slippage. When the hot head gets hot, it is not slippage because that is the standard that person has set for himself. Sure, he might not be very popular, but his being a jack ass is not slippage. When the complainers complain, when the gossipers gossip, that is not slippage either, unless it comes from an unexpected source.

Slippage, therefore, is when a person does something he that is completely out of character. Slippage might be what you would call it when a person who is normally quiet and reserved bursts out of his shell and tells you all the things he hates about his job; or a person who is respected in the community gets drunk and starts talking about how many women he has gone to be with.

Ah, to find a perfect example, one might simply look at the headlines in the newspaper. When Ted Turner ran his mouth the other day and said the world is going to be destroyed in ten years because the world is overpopulated, I would not call that slippage because we expect such nonsense from him.

Then again, when Mel Gibson rattled on about how he hates the Jews when he was drunk one night, that is slippage. We did not expect such filth from him. Sure, we might have suspected that he held such opinions, but he had made an effort to maintain a certain level of dignity, or respect prior to that one night, and had kept his mouth shut.

When you keep your mouth shut you greatly decrease your chances of slippage. When you do not drink or do drugs, you greatly diminish your opportunities for slippage. However, we all have our moments. I have had my moments. You have had your moments. We all remember our parents, or someone we loved, having their moments too. Our friends definitely have their moments too. That's life.

When our perfect example of equanimity, Dr. Cool head, got ticked off because he was working all weekend and was called every hour on a very stressful weekend at Shoreline Medical, and he blew up at the kind nurse who called him for the first time ever at 4:00 a.m., that would be a good example of slippage. It was totally out of character for him.

I can give you two of my own personal examples of slippage. For example #1, you can see my blog entry from yesterday. For example #2, I can tell you this normally reserved, humble, and greatly respected RT had just spent the greater part of the night with one young lady in respiratory distress and had just headed upstairs to take care of more short-of-breath patients, when he was paged to go back to the ER and set up a holter monitor.

Many times he had thought to himself how ridiculous it was for a doctor to order an outpatient procedure to be done in the emergency room, but, ou of respect, he grumbled to himself but not to the middle person who gave the order, and definitely not to the doctor and, most important, he was the utmost professional in front of the patient.

But not last night. Last night he provided a perfect example of slippage. Last night he stormed down the the emergency room and told the nurses and the doctor point blank that he would not be setting up "that stupid thing that shouldn't even be ordered in the emergency room."

"You mean you don't have a holter monitor," one nurse said.

"No. I have no clue if we have one or not. What I'm saying is I'm not setting one up right now period. I have a sick patient right down here that I've spend the majority of the night with, I have a Q1 hour treatment upstairs, I don't have time to spend a half hour setting up a holter."

"Well, can you just bring the holter down if you have one."

"Are you going to do it?"

"No. That's your job."

Ah, slippage. What alcohol did for Mr. Gibson's mouth being burned out did with mine. Slippage.

Later in the night, after I had reasoned with myself and had reluctantly dedicated a portion of my time to set up the holter (and was the utmost professional with the patient of course), I met these emergency room nurses up in the CCU when they transferred a patient up there.

"Hey, and thanks for your help," I said. "Oh, and sorry I was so grumpy last night."

"Oh, I didn't think you were grumpy," one of the RNs said, smiling.

"Oh yes I was," I said.

"Oh yes he was," said the second RN. "I've never seen him get upset before. He's always so calm and cool."

"It was a little slippage," I said.

We all participate in slippage from time to time. I would like anyone who has not participated in slippage to raise his or her hand. If you haven't' slipped before, that would mean you are perfect. And, as the old saying goes, perfection in itself is a flaw.

Which brings us back to that infamous RT Cave rule: We night shifters never hold what one of us does or says as a result of exhaustion or burnout against one another. Because we all slip from time to time.

So long as we don't slip too far.