Over the last couple of centuries, I have come to realize that often people neglect their "Saturday-night essence" and fall into the first job that comes along. They stay in that dead-end job because soon thereafter they marry, start a family, and feel like they can't do what they really would like to do.  Over time, stagnation sets in and creativity and true happiness dwindle.

A question we all have to ask ourselves at some point in our lives is this, am I a respiratory therapist because I love what I'm doing and I'm creating something of great value for society or did I just fall into this profession because of circumstances and a quick way to make a decent income that would enable me to support a family in a way that I wanted?   Only you, of course, can answer that question. 

That brings me to the Saturday-night essence.  What is your Saturday-night essence?  What do you look forward to doing Saturday night or on your day off work?  What hobby or hobbies do you have?  What do you do for fun?  What is it that you would rather do more then anything else?  Whatever that is, that's your Saturday-night essence and it should guide you or perhaps even guide your children in choosing a vocation. 

Many years ago, as a new high school graduate, I went to work in a hospital as an orderly (which should age me very quickly... It may have even been before Inhalation Therapy. I remember moving a lot of "H" cylinders throughout the hospital without the aid of a dolly.)  I learned a lot and discovered that I didn't want to be an orderly the rest of my life.

I observed other healthcare professionals at work and when a position for a surgery technician or scrub nurse opened, I applied for the position.  I must admit I think I had a little help in getting that job as my father-in-law was an anesthesiologist at the hospital and I knew the director of surgery from various social gatherings at my in-laws' home. It was my father-in-law and later two brothers-in-law, both physicians, who suggested that respiratory therapy might be something to seriously consider.  My father-in-law was an excellent mentor and I probably had more intubations before I started respiratory therapy school then most RT's have in their careers.  I also worked for several years as a perfusionist and surgery assistant.

As I gained experience it became obvious to me that respiratory therapy was indeed my Saturday-night essence.  As a result, it has been an exhilarating experience of creativity and of social value for me.  Doors have opened that I'm convinced would have forever remained closed if I hadn't followed after and successfully achieved my Saturday-night essence.

Much has been said and many suggestions offered regarding hiring the right person or A-Team for any profession, but especially respiratory therapy.  Searching for the prospective employee's Saturday-night essence during an employment interview may secure the right person for the job and help retaining that right person in your department. 

I certainly have made my share of mistakes in hiring people whose Saturday-night essence was not respiratory therapy and, in every case, the ending was not a happy one for either of us.  I am fortunate today because I have a staff of respiratory therapists who are passionate about their profession and they look forward to coming to work everyday and they are happy, having fun and enjoying the journey.

Your thoughts?

I was talking with a colleague who is also a manager of respiratory care and she indicated that she was overwhelmed with work and didn't know how she was going to be able to accomplish all that is being asked of her to do. 

I initially made the assumption that she was understaffed and doing a considerable amount of patient care herself in addition to all of her responsibilities as a department manager.  However, I was wrong in my assumption, because she is fully staffed and the hospital census is down significantly. So, why was she overwhelmed? 

I wondered if my definition of "overwhelmed" was the problem, so I looked up the definition in my trusty dictionary and it gave this definition: "to overcome completely in mind or feeling, to load, heap, treat, or address with an overpowering or excessive amount of anything, to come, rest, or weigh upon overpoweringly; crush."

Well, that was pretty close to what was running through my mind. But I wondered why she felt this overpowering or crushing feeling. 

Since that conversation several weeks ago, I have heard this same comment numerous times from other managers of respiratory care.

I have never experienced the "overwhelming" feeling and I am beginning to think that I am either very weird or too old to feel or allow anything to overwhelm me.

Are there times when you feel overwhelmed by your workload?  If so, why is that?  Are you understaffed or is it just too much work to complete in too short a time? 

If you haven't felt overwhelmed by the amount of work you are asked to do, why is that?  Your suggestion should be helpful to those that do feel overwhelmed.  I look forward to hearing from you.

Even health care professionals have felt the effects of the latest economic downturn.

I was reading news reports on the economy and noted that the unemployment rate nationally is over 8 percent and in some states, over 10 percent. Job cuts began early last year, as the housing and construction industries slowed down.  The collapse of the financial industry in the fall battered white-collar workers.  Soon after, layoffs spread across industries and income levels.  The darkest days for the job market are almost certainly still ahead. 

The situation does not look much brighter in the housing market. Many of us have first hand knowledge of the free fall in home values. And 12 percent of homes nationally are in foreclosure or the owners are behind on payments. 

The news media reports that the Dow Jones industrial average and the Standard & Poor's 500 index have lost more than half their value since the stock market peaked in October 2007.  Some even predict that the Dow might fall below 5,000 before we hit bottom. 

Many of us who were thinking about retirement in the near future, now see our retirement nest egg either gone completely or so significantly reduced that retirement is no longer an option. 

So you ask, how can this be the best of times? 

Muscles do not grow or strengthen unless there is resistance. Isn't that the same with us? The numerous problems and challenges that come into our lives are nothing more then opportunities in work clothes.  When things are going great, an old song says, "On a Clear Day You Can See Forever," but on cloudy days with a myriad of challenges and problems before us it is difficult to see across the street. 

Opportunity knocks!

We have to look for new ways of doing things.  What can we do differently? What would happen if we as a group of healthcare professionals collectively used our experiences and wisdom to change the way it has always been done?

Perhaps we need to think of new ways to reduce expenses, or think up new services or procedures our hospital or departments could offer our communities.

In respiratory care, we could begin

• polysomnography
• cardiac and pulmonary rehabilitation
• holter monitoring
• EEG
• PFT
• ECP
• new protocols

Or we could initiate using the protocols we have, and initiate using newer longer acting medications that are given BID or once a day,

All of these will improve efficiency, improve effectiveness, reduce unnecessary medications or procedures, reduce temporary personnel and increase revenues.

Perhaps we also need to look at new ways of purchasing goods and services for our profession.  New technology is evident everywhere and perhaps new technology could reduce costs, reduce or eliminate expensive temporary help, improve efficiency, improve productivity and increase profits.

The challenges of today are the opportunities of tomorrow and by working together we can change the cloudy days of today to a brighter future tomorrow.  To achieve real results we need to take our profession to the next level of thinking. To do this will require us to imagine our profession in an entirely new way.  

What say ye?

Have you ever wondered what the profession of Respiratory Care will be like in ten years? 

As I meander down memory lane, I can hardly believe the tremendous changes that have taken place in our profession in just the last ten 10 years. 

Ten years ago, we were still using Bear 1 ventilators and the Baby Bird ventilator for neonates and then we purchased a used Bear 1000 ventilator with graphics and wondered why we needed "graphics."

Ten years ago, we had no respiratory therapy protocols and were constantly being challenged with new technology and new medications.  Today, we have about 30 respiratory care protocols, state of the art ventilators with automatic weaning features and also auto-titrating CPAP machines and medications that are superior to many of those medications of yesteryear. 

Where will our profession be in 2019, just ten years from now?

I attended the AARC International Congress in December and Dr. Bruce Rubin, MD, FAARC made a presentation on "What does the Future Hold"?  If Dr. Rubin's predictions come to fruition we better buckle up for an adventure at warp speed. 

About 50% of Dr. Rubin's presentation went right over my head and I realized that I am falling behind and need to do something to stay current with the many advances in our profession.  For example:  Dr. Rubin mentioned several new medications that are being developed or are already in clinical trials and that if his predication come true physicians will be prescribing medications based on your genetic profile sometime in the next decade.

We truly have an exciting profession. The future is very bright and will require respiratory therapists to be better educated; undoubtedly everyone will need at least a bachelor's degree or higher in the near future.

Gone are the days when RT's only nebulized bronchodilators. A basic understanding and knowledge of biochemistry, physiology, molecular biology, and pharmacology will be necessary for the proper use of the new medications that will be coming in the next decade to stretch our imaginations and tweak our intellect. 

What are your thoughts on the future of Respiratory Care in the next ten years?

In these challenging economic times-when many hospitals have imposed a hiring freeze, eliminated unfilled positions, initiated staff layoffs, increasingly restricted or totally eliminated travel and education budgets, and reduced or frozen capital budgets-I believe it is more important then ever to find ways to retain good employees.  

In the past, I've tried many things to attract prospective employees to our facility and create a working atmosphere that retains employees. However, I think a little different approach could have an even greater impact on retention than all the other methods I've used.

Here's the idea: everyone instinctively wants to experience joy and be happy. Yet varied challenges stand in our way.

How do we, as leaders in our various facilities and as department managers, supervisors, and lead respiratory therapists, meet the daily challenges that affect our staff and ourselves? How do we create a feeling of happiness and joy no matter the challenges?

This is indeed a formidable task.

Happiness comes to man by putting value into society. We especially admire those geniuses of society, the great value-and-job creators, who raise our standards of living. Man is a social animal, so this happiness is felt during time celebrated together with loved ones, friends, and co-workers.

How often have you heard an employee say, "I hate my job, but I need the money, so I stay day after miserable day"?  How do we change that feeling about work from (as one commercial puts it) "have to" to "want to"? How do we help our staff members develop this happiness in the work place?  What creates happiness in our profession?  It is the opportunity for each of us to produce or create value for society. 

People want to work where they feel that they are needed, wanted and appreciated. With that in mind, here are a few suggestions you might want to consider for you department:

• Create or initiate new procedures that will add value to your department, the hospital and society. For example, arterial line insertion, bronchoalveolar lavage; polysomnography, EKG, holter monitoring, EEG, PFT, PICC line insertion, cardiac and/or pulmonary rehabilitation, stress testing, ECP (or EECP as some folks call it), Acapella, PEP, intubation of all age groups for all RCP's, or attendance at all c-sections and high-risk deliveries
  
• Work with a pulmonologist to do basic spirometry (PFT) at health fairs or county fairs, or  do a special day of screening at your hospital.
  
• Initiate new protocols that will allow your staff to use their knowledge, skills, training and experience to provide better outcomes and increase efficiency and effectiveness. Some ideas include an RT Assess & Treat Protocol, a RSV Protocol, a Ventilator Management Protocol for all age groups, a Ventilator Bundle Protocol, a Nasal CPAP Protocol, a MDI Protocol, or a Polysomnography Protocol. Some facilities prefer to start simpler, with protocols like an Oxygen Protocol, Pulse Oximeter (SpO₂) Protocol, Bronchodilator Protocol, Lung Expansion Protocol, Bronchial Hygiene Protocol, or ABG Protocol. You might even consider disease related protocols like an Asthma Protocol, Pneumonia Protocol, or COPD Protocol.
  
• You may also consider initiating telemedicine consults for patients in rural isolated communities that lack physician specialists or are an underserved population. You might want to mull over telepulmonology, telecardiology, telerehablitation (for cardiac and pulmonary rehab) or telehealth video conferences for COPD education or other healthcare educational issues and concerns. There are now billions of dollars available from the Economic Stimulus Package that can help with purchasing the needed equipment. Partnering with other departments to gain access to this equipment can help rationalize the costs. Some potential practices include Telepsychiatry, Teledermatology, Teleophthalmology, Telepsychology, Telespeech Therapy, and Teleaudiology.

New procedures and protocols allow your staff to use their knowledge, skills, training, and experience to provide value to their patients. That creates a feeling of being able to contribute additional value to our society. It is well established that protocols save unnecessary treatments and often hastens discharge for patients so they can return to their home, family and loved ones.

Some of these suggestions such as the Polysomnography are wonderful revenue producers for the department and hospital. Perhaps, these projects can also help create new positions or more FTE's.

What are your thoughts on how we can attract and retain more good employees at each of our facilities?