Being a Respiratory Therapist

I'm not sure I even know why I think Respiratory is so cool. It's probably not just one thing--and I guess I can think of three right away: 1) the science, 2) the devices, 3) the physical action.

I am at heart, a scientist. Probably that is why I get so annoyed, sometimes outright angry, when I am ordered by docs to do things that cannot be supported scientifically. It is an endless frustration of our profession to be at the direction, at least at times, of those who do not understand our modalities, and apply them because of the fated "we just think it will help". And this is one reason, I believe, that therapists get the "stuff" taken out of them. You can take the time to counsel with doctors, nurses, and whoever, provide excellent reasoning, and still get overridden on their whim.

I've always thought ventilators are cool. My favorite has been the workhorse Servo 900C, ever reliable. We use a lot--maybe too many--different devices at our shop. One of the great stresses of floating to the units, is that we haven't limited the scope of which devices we support. There's a tendency at our hospital to rent anything we don't have if a doctor wants to give it a try. The doctor who knows it is then the specialist in the equipment, and the therapists are sort of winging it. I think that the constant quality of dealing with the totally unexpected and largely untrained equipment situation contributes significantly to the low morale amongst our respiratory department.

Armchair type jobs don't suit me. I like the fact I have to run all over the place (and sometimes under!) to get at what I need to do. But I'm not getting any younger, as my feet especially will tell you. I have pretty significant foot problems, which is a major factor in considering a career switch.

I'm in a slump: I have an interview pending, but am suspecting they are going to want a lot of traveling, which is probably not going to happen if I have kids. A lot of the other positions that I've been looking at that would be a step up, also require extensive traveling. I'm not going to take that kind of time away from my family.

So I think I'm just flowing through the summer, dealing with our ups and downs at work. Ultimately, if I land the right health IT job, I could choose to do contingency to keep up my respiratory skills. Thing that worries me there, is that not doing it every day thing, where I will be perpetually a little rusty.

Just Musing.

Someone Beat Me To It!

At the beginning of the month I told my boss I need to write an article for the Respiratory Care about the need for informaticists specific to respiratory care. We need people with an IT background as well as a deep understanding of respiratory devices, modalities, and clinical terminology.

And then I get the April 2008 copy, with an article titled "Respiratory Care Informatics and the Practice of Respiratory Care" (Constance C Mussa, MSc, RRT). She is calling for respiratory care to focus on it's informatics needs, and to begin by developing our taxonomy and ontology.

Good idea! I wish I had thunk it!

Resume Writing

I think that RT's tend to under-appreciate themselves. I also think it's advisable to rewrite your resume every 6 months or so, whether you are looking for a job, or not. For one thing, it makes you prepared if you have a sudden need to look for another job. For another thing, it would be a good thing to review when you have the chance to talk to your employer about your accomplishments.

But the biggest reason I think you should do it, is to remind YOURSELF how valuable you are.

You may not think you have done much this year. But if you sit down and think about it, you will probably realize you've done quite a bit. How many patients or their families have you taught? How often have you added a new piece of equipment to your knowledge base? Have you provided any impromptu inservices on any devices or therapies, to staff, physicians, or patients?

Below I have, not my whole resume, but a sort of timeline of my career. I'm posting it, mostly because I am actively looking for a job. But maybe you can include some of the same events in your "brag list".

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Presently: Acting as SME and liaison for the Department of Respiratory Care in our hospital’s transition to a new electronic medical record system. (EPIC)

• Attend sessions with physician, nursing, HIT, and ancillary stakeholders to craft the ClinDoc interface for our unique needs
• Communicate with the respiratory staff to ensure a detailed workflow and equipment documentation analysis for the new interface
• Represent the Department of Respiratory Care and defend their interests in this implementation
• Educate respiratory therapists in the EPIC software and the changes as they are implemented

March 13, 2008 Coursework in Medical Informatics

• MMI, Northwestern University Evanston, IL
• Technical Acquisition and Assessment
• Introduction to Medical Informatics

March 2007, Pediatric Advanced Life Support

August 1997-August 1998 Microsoft Certified Professional

• Windows 95
• NT Workstation 4.0
• NT Server 4.0
• Networking in the Enterprise with NT Server 4.0.

December 1997 Customer Service Award from IKON Office Solutions for work done as a technical analyst at Heitman Financial, LLC.

1996-1998 BS, Technical Management

• DeVRY Institute of Technology Chicago, IL

1996 Certified Pulmonary Function Technologist

August 1992 Authored "Firing the Magic Bullet", RT Magazine, Aug/Sept. 1992, a history of surfactant replacement therapy

1989: CPR Instructor Trainer: Using AHA materials, taught CPR Instructors how to teach CPR.

1989 Registered Respiratory Therapist

1988-89: CPR Instructor: While still a student in respiratory care, utilized instruction materials and paraphanalia to teach 15-20 students at a time American Heart Association CPR.

May 1989 AAS, Respiratory Care

Please Don't Smoke

This photo was taken on the man's deathbed, and says it all. You can find the story Here.

I guess the photo won't save, so I hope you can view it on flickr.

How to Wreck a Respiratory Department

Ahhh, enlightenment. . .

I've blogged about the attitudes in our department. I had a chance to work with some of our PFT lab folks, who have been RTs at our hospital for many a year, and they were able to explain a little history to me.

In the 70s, the hospital restructured. Without any advance notice, the therapists were notified that they would be dissolved as a department, and placed under nursing. The house therapists were placed under the nursing direction of the pulmonary floor, NICU under NICU nursing, PICU under PICU nursing. Everyone in a middle or upper management job had to reapply for the job. In the opinions of the historians, the person that was chosen to manage the actual staff members was, out of 8 candidates, the least qualified to be managing respiratory therapists.

I don't know how long that situation lasted--I'll have to do some follow up. But eventually, Respiratory was returned to it's own department. With a wonderfully kind, but very weak manager, and a medical director who is basically absent, an "approachable" guy who never stands up for respiratory.

So now I get it, so much of what makes our department the most dysfunctional respiratory department I've ever worked in.

The house and the units never work as a team. They are in competition, at odds, disrespectful of each other. When there are staffing needs, the discussion isn't aimed at teamwork, it's aimed at who is more important, who is going to get shit on.

The staff rebels against the management. The various clinical specialist and managers work very hard and speak loudly and often about how important they as individuals are, how indispensable. They are competitive with each other, and undermine each other's efforts and those of the staff to advance in any way.

And the doctors and nurses piss on us. This could be a whole other post, how we are not backed up, only the experts when there's an airway problem, the rest of the time we are peons to be written up every time someone doesn't get suctioned or a treatment is a half and hour late.

This may sound like a whine. Maybe it is. But I've worked in three different states, and something like seven different hospitals, and I've never, ever, worked with RTs who are so contemptuous of each other. The senior people with all sorts of knowledge, silent, getting their jobs done, waiting to retire.

So to all of you administrative types, here's your recipe for destroying the morale and quality of your respiratory department.

EPIC Next Session

We are validating our respiratory content. It's quite a tedious process, but I think we are building a fairly decent ClinDoc for our department. Of course I expect everyone else to think I'm wrong on that.

There is actually a lot of work that could get done in our department, at this time, as well as in the future. I'm exploring an article in this month's Journal of the American Medical Informatics Association, on Computerized Whiteboard System for an ED. I think it could present an excellent solution for how we manage our treatments and assignments.

Another project I have is to help my Department Head create a business case for hiring "someone"--hopefully me--to be a respiratory informaticist. I want to develop this into a paper worthy of Respiratory Care.

So we'll see what I can accomplish. I'm also poking away at html. This week we are in the validation sessions, but my boss has taken me out of the clinical role for at least the next schedule, so I can work on this transition.

How lucky am I?

Work Flow Analysis

We have begun the design and validation phase of our conversion from our old computer charting system, to EPIC, a more fully integrated and flexible electronic medical record system.

I am on this project as a "smee"--Subject Matter Expert for respiratory care. I have spent the last three days in particular creating work flow diagrams and detailed outlines of the procedures and details of our work and how we would like to document it.

I am a bit surprised that I am enjoying it so much. I'm also surprised that I am enjoying working alone. I think I'm ready for programming.

I suppose, as I complete this implementation phase--a project that should last for about 4 more months, I can learn HTML in my spare time. That way, when I am done, I can market myself as a programmer with clinical, IT, and EMR implementation experience.

My manager has talked of getting it in the budget to have an informaticist specific to the Respiratory Department. I think this is wise, and intend to develop a business case for it.

I also want to develop a paper for "Respiratory Care", putting forth the case for hiring respiratory informaticists.