Not everyone enjoys coming to work during the holiday season, but some warm touches around the department can make working a little bit more enjoyable. Every department should have holiday parties of some sort, both on site and off, so everyone can attend. 

Decorations should fill the department, and a holiday card should be sent to each staff member from its director/manager.

Everyone is part of the team, and we must remember that the holiday season does not always bring good memories to everyone. You would be surprised how many people sign up to work the holidays because they have nowhere else to go or it just keeps their mind off  it.

Treat each person as an individual and respect their wishes during the holiday season. And keep the department's appearance as uplifting as you can! You will be surprised at the difference it can make.

You just might enjoy coming to work yourself!

 Yes, many of you have been wondering about the fears and outcomes of the H1N1 vaccines and what to expect.  I can tell you first hand after seeing more than 2,200 H1N1 vaccines given here what to expect.

First, the vaccine comes in the live virus nasal mist version and the dead virus injection version. As of this writing over 2,200 vaccines of combination have been given without any side effects.

I received my injection over two weeks ago. Surprisingly the injections are much less "painful," if you will, than the seasonal flu shot. 

Our supply of the H1N1 vaccine was distributed under a very controlled condition, mainly due to supply and demand, and every dose is reported to the CDC for maximum distribution efforts.

We have no problem finding individuals who want the vaccine. Here in Massachusetts, it is apparent that the H1N1 vaccine's "dangerous" outcome appears to be a victim once again to our infamous media hype.

I encourage everyone who has reservations regarding this vaccine to "take another look" and make a professional choice. 

We are now experiencing an upswing in H1N1 cases and have an anticipated 40 percent decrease in our staffing levels in the next few months to come. Our staff is now more at ease knowing the vaccine they once feared is not what the media made it out to be.

Hope your experience is as good as ours!

The one thing we created that worked out great for our department was a "hurricane cart."  This was a large, tall crash cart that was stocked with hand-helds, cannulas, masks, regulators, portable air compressors and oxygen keys. I think you get the idea.

Every time a hurricane came through, we would wheel this cart down to our auditorium, which could function as a temporary "mash" unit. We were ready and sharp!

We even found this cart useful during our peak flu season in the winter months a couple of times during an "internal" disaster when an influx of patients from the emergency room overwhelmed us. 

Now with the fears of the peak flu season coming up amidst threats of having 40 percent of our staffing out, it's time to "stock up."

We may not use all the ventilator circuits or breath-actuated nebulizers on hand during the winter, but we will before the fiscal year is over. At least we won't need to worry about back orders! Anyway, that's the plan. 

The problem for many hospitals in disaster planning is they have never been through a disaster. Therefore, it is difficult for the powers to be to finance the items needed for any "impending" disaster.

It's not like a hospital that goes through a hurricane every other year and staff will use its excess generators, ventilators, concentrators, cots, bedside commodes, and stand up curtain dividers and then store them in a warehouse when not in use.

So many hospitals document a "perfect plan" but never invest in the items needed to carry it out until it's too late.

It's a waiting game; however, your respiratory care department can be ready by making a few minor preparations now.

This knee-jerk reaction by our government to do good is a result of those who have abused the system; and it has caused me to rethink our thoughts of our vendors. 

On any given day, I can open a journal or magazine, find an advertisement, and call the company and ask for some product information. Within a few days, I can have a vendor in my office with the product for me to hold and someone who is more than willing to answer all the questions I may have.

These vendors are road warriors who give up countless weeks of seeing their families and loved ones and drive or fly for miles just to see me! They fight the parking lot traffic in hopes of finding a spot, navigate through the corridors of unfamiliar hospital territory to my office, and pray I have not forgotten our appointment or that something more "important" has not come up.

Then they show their wares time and time again, going from place to place, conference to conference, in hopes to make the sale or keep the sales going.

I cannot think of a product any of us use that at some time or another was not introduced to us by a vendor. For that reason alone, I feel that for Respiratory Care Week, instead of us holding our hands out for food and pens, we should be thanking them! It is their week too; invite them to your function!

I say to all vendors of all kinds: thank you for bringing the tools of our trade to our field of respiratory care. You are one of us! Thank you!

As respiratory care directors create staffing plans for the upcoming peak illness seasons, which is expected to be augmented by H1N1 fears, many have found RT students want to help too!  In states like Massachusetts, second-year respiratory care students can obtain a state license to work in the respiratory care field.

At our hospital system, we are creating a large PRN student pool.  This has brought about a great deal of excitement among the students and the department's seasoned therapists.  First, the students get a chance to practice what they are learning and get paid for it; and at the same time, the department staff will undoubtedly get some relief from the expected heavy work loads.

Second-year students are not able to take on ventilators; however, they will be able to "get into the thick of things." With a hospital as large as the University of Massachusetts, we can have 15 therapists working days or nights.  Adding students on top of this gives therapists time to not only take the added precautions they need to take but also to put on their mentorship hats.

Remember, we were all students once!

When the students graduate next spring, we will have a great pool of therapists from which to choose for our openings; and we will have a great feeling that we have given something back to the field of respiratory care, namely experienced graduates!

Every day, we as respiratory therapists see family members struggle to make the right ethical decisions about their relatives' care. While eliminating life support seems to be a direct contradiction to our purpose, as caregivers we have an opportunity to act as a "support angel" to these confused family members.

Many times we find end-of-life decisions are not the strongest areas of communication for many physicians. However, family members can't make educated decisions if they are not given the correct information in a compassionate way.

I have received letters from families commending my staff members on their heartfelt interactions and sensitivity in explaining what they are doing and what is occurring. 

I experienced this first hand with my grandmother several years ago. I was the only family member with medical training of 12 sitting around Grandma's hospital bed listening to physicians explain that Grandma had had a major stroke and the CT showed a total bleed out with no chance of recovery.

Grandma was 100 years old and lived a wonderful life, and yet the physicians were talking about all the invasive procedures they were going to do before sending her off to a nursing home to pass on.

It was then that I spoke with my family members and explained what had happened, what the doctors wanted to do and what Grandma would probably have wanted.  The family decided to go to "comfort measures only." Grandma passed on in peace four hours later.

Not every family has someone in the medical field to offer advice. However, they may have a compassionate respiratory therapist in the background to act as a surrogate. Take the time to assess the entire situation spreading out before you; don't just make another vent check or another round. Lend an ear or a hug.

Yes, you need to be careful about what you say; but you could be someone's angel as they wind their way through tough decision-making processes.

I spoke up to make the following comment: During my six years as a director of multi-departments in Florida, we were hit by many hurricanes.  If I recall correctly, those hurricanes just didn't hit our hospital and not touch anyone else, they hit everyone! 

The point I am trying to make is that if you are hurting for staff, so is the next guy.  Yes you may be able to tap into the traveler pool, but just for so long. 

Why not make some changes now and protect your staff?

First, the standard flu shots are now out and you should have your staff get them.

Second, look at the way your department provides its care.  Do your manual resuscitator bags have filters on it?  Why not?  Are you putting on the gown, glove and mask only to bag the patient through the hospital, exhaling microorganisms in every direction?  How about filters on your vent circuits? Of course you have them, but what about your high frequency ventilators?  Filter them! Filtered circuits are now available for many of the high frequency models.

When you do have staff that become sick, make sure they stay home! 

Finally and most important--we have all heard this over and over--there is no replacement for hand washing and no excuse for a lack of it!

Remember the greatest asset you have is your staff!  Reward and encourage dedication!

As department leaders, we know the Joint Commission requires us to document that each of our associates are competent in equipment and therapy that is "high risk, low utilization."

The question is how, and when is the right way and time to document this on an annual basis? If you include your staff in the process, they can share their knowledge with co-workers, build self-confidence, and gain ownership in the department.

In past positions, my departments held a bi-annual "skills fair" to meet this need. This mandatory one- or two-day event occurred during the late spring or early fall. Experienced therapists were appointed to a "table" of their expertise.

For example, some would man the adult ventilator mode table, others the high frequency or intubation tables. There would be a neonatal specialty table and so forth -- whatever the department needs. Each staff member would be required to rotate to each table, participate in a 20 minute hands-on demonstration, and then document on a post-test their competency. For larger hospitals, you can divide the competencies between spring and fall into categories.

If your facility has a "slow season," fit the dates to meet your needs. Always provide light food or snacks and ask for written feedback so you can fine-tune your skills day. Lastly, make it fun!

'Til we blog again,
Scott

It's important to know that everyone gets sick, and we don't want them at work infecting others when they should be home. So these guidelines are for the "sick time abusers." Trust me, you're "engaged" staff will appreciate it when you address the topic.

Make sure your policy is precise and states exactly what the expectations will be and what corrective action will be the result. Should a staff member fall outside the policy be prepared to carry out the action. If employees call out on their weekend to work, they should be required to work an extra weekend the following month or schedule (whichever doesn't create overtime). 

Staff also should contact a member of the leadership team when calling out sick and give appropriate notice as set per your policy. Document time and date and mark it on the schedule. Also, create a "sick call book" with a section for each employee.

Even if employees stay within their allowed number of sick calls per 12-month period, you can still find the pattern. Look for those calls that come before or after the weekend, holiday, or vacation. Don't forget FMLA. You also may find call outs around then as well.

Create a document with different colors representing a sick call that follows a holiday, vacation, weekend, or FMLA. With this type of documentation laid out before the employee, union rep, and human resources, there's not much wiggle room. Once this is addressed, you will notice your sick call outs drop.

Don't get me wrong, this flu season will be serious and we need to be prepared for it, but a little common sense will go a long way. Massachusetts has currently successfully treated close to 5,000 cases of H1N1 with the proper antibiotic. As the leadership team of our respiratory departments, we must make sure the following areas are covered:

• Hand hygiene is a must; wash before and after each patient.
• Expiratory filters should be used for all equipment when possible.
• Consider breath actuated nebulizers in place of standard nebulizers as these devices do not leave the room filled with 15 minutes of aerosolized microorganisms but nebulize only on inspiration. They also can complete the treatment in as little as three minutes.
• Have the N95 mask stocked and ready to go.
• Be prepared for backorders from everything from vent circuits to N95 masks.

While many folks feel the CDC is taking H1N1 to the extreme, I would rather have my department ready. Plan for the worst, pray for the best.

Lead by example, manage by walking around, walk the talk and don't fake it, and be honest and sincere. Whether you are rewarding, disciplining, or just hanging out in the break room, saying the right thing the wrong way can be catastrophic and the impact of the words we put forth can make or break our departments. Not only are your associates looking up to you but so are other departments and your administration. Be the role model, the measuring stick and set the standards for your organization.

Let me give you an illustration. On average, today's cruise liners weigh 116,000 tons, carry 3,000 passengers, and are almost 1,000 feet long. However, the most powerful part of the cruise liner that determines which way the ship goes is amongst the smallest part of the boat: the rudder. Compare this to the department leader. He or she can lead with the best of them, have the charisma to gather the masses, but a tongue that is misused can turn people away on a dime. We have all heard the phrase that we are given two ears and one mouth for a reason.

Use your tongue wisely! Let's face it: There are some people we just don't want to be around. However, if you really look at it, you will find something good in everyone. Everyone adds value, even if it is not for your department. Help them find the place they can grow. They will thank you. Trust me, I have been thanked more than a few times by individuals I had to terminate. Yes, closing one door forced them to move on to a place where their true strength was.

'Til we blog again,
Scott

As respiratory therapists, we see every day how fragile life is: from the motorcycle trauma in the ER to the unexpected heart attack of what appeared to be a 42-year-old healthy male.

However, when was the last time you did something just plain fun? Like, run through the sprinklers with your children? Teach your little boy how to fish even if you don't catch anything? How about making cupcakes with your daughter even if it means you're going to mess up the kitchen beyond recognition? I had a chance to look through my old family photos the other day and it brought back what was really important.

Yes, you can love your job. And, yes you can have fun at your work and you should. Just remember a couple of things. Don't take yourself seriously, nobody else does. Forget about yesterday, live for today, and pray for tomorrow. Appreciate what you have; even if it is not much, it is more than it could be. Reach around and give yourself a big hug. You deserve it. Take care and enjoy the moment!

I know this can be a tough time, so here are some tips to help you out on your path:

• Dress for success. I wore my suit, red tie, white shirt, and black shoes. This is the power color combo for male candidates. Females should wear a conservative dress and little jewelry, and go easy on the makeup.
   
• When you fill out your application, check all the boxes: days, evenings, nights, part time, and especially per diem. You need to get your foot in the door. Even if you need benefits, a per diem job today may be a full-time job tomorrow. Most employers "hire their full-time employees from within." This only makes sense since they're committed to full-time status they know what they're getting. Also, it's easier to fire a per diem than a full-time employee. Just a fact of life.
  
  
• Follow up with your applications. Find out who's the department director or the supervisors.
  
  
• Network. The majority of the jobs out there aren't advertised in the paper, magazines, or journals. Get to know your friends in the field; get to know someone on the "inside."
  
  
• Get your credentials and certifications ASAP. All of them: CRT, RRT, BLS, ACLS, NRP, PALS, Prenatal Specialist, CPFT, RPFT. The more you have, the better sell you are.

Right out of high school I was an apprentice for a local mortuary and then I went into respiratory school. I kept my mortuary job during my search for respiratory. Every time I had to make a "removal" from a hospital, I would stop by the HR and respiratory departments to see the directors to reintroduce myself and let them know I'm still looking to join their wonderful team. It soon paid off as I received a PRN job at one of the local hospitals that I frequently visited for removals.

The fact is if I could get a job in respiratory care against five other schools pumping out therapists, you can too. Your time is coming. Be ready!

'Til we blog again,
Scott

First, you must know the hierarchy of the "crisis" of capital as viewed by the board of directors and your administration. Here they are from most important to least:

1. Emergency (service will shut down if not replaced)
2. Replacement (return on investment, ROI, makes sense to purchase over leasing)
3. Replacement (manufacturer no longer supports system)
4. New equipment for new service or additional equipment (must have a positive ROI or business plan).

Most manufacturers support their equipment for about 10 years, so check with them. Your biomed department can help with this, or a letter from the company will do. Always go for replacement equipment if possible unless it is an emergency. Do your homework; show the increase in volumes and the amount of service the new product produces.

Another approach is from a quality or infection control angle. If you can show how your request can decrease the length of stay, decrease mortality, and increase productivity, you are well on your way. Also, don't forget to get your medical director's buy in.

Look for hidden points or rebates. For example, most hospitals have the pulse oximeter modules fitted into the monitors. The nursing floors purchase the disposable oximeter probes at a contracted price per purchasing and the oximeter company in return for the modules. The hospital receives so many points for the number of probes it buys each month. Many times the hospital purchases more probes than the contract states and has plenty of extra points sitting around. Look for these points and see what you can use them for. The company may sell other products that your department can use.

Check with your purchasing department to see if there are any other purchases that are planning to be made from the facility through the vendor you are interested. Remember many vendors are partners with different franchises. You would be surprised how many times you can get a major discount by including your equipment purchase with another purchase being made from another department.

Be capital savvy. Once the fiscal year starts and capital is approved, don't wait -- buy. The longer you wait, the greater your chances of losing it to another department or having it being put on the "frozen" list because someone else's poor planning became the emergency that used up your capital. Good luck and remember: Your staff deserves the best, and it's your job to get it for them.

'Til we blog again,
Scott

Now that you have your diploma in your hands and you are hitting the streets for your first real job, there is still something you need to ask yourself. Do I take the CRT now, or do I wait until I get more experience under my belt?

In my position, I ask that question at every interview for new grads and hear plenty of excuses. Sure, it costs money, and I know you need a break, and so on and so on. But here are the facts: The longer you wait, the harder it will be to retain the knowledge. Also, the NBRC has created the CRT exam to cover every type of delivery of respiratory care.

So, it does not matter if you are employed in a 1,000-bed level 1 trauma center or a small home care center, you will be taking the same test. Your best resources for passing the test are usually those that you are working with. Every good department wants to "take in" their new grads. For those who do not have a job yet, the same is true. Study and take the test, even if it requires you to attend a CRT prep course. Your future employment will stand a better chance if you have credentials.

Take heed new grads. When you are interviewing and your prospective employer asks when you plan on taking your CRT exam, say "Now!" Or if you just passed your CRT exam and you want to impress him or her even more, say you are planning on taking your RRT exam next. Let's just say they are your final, final exams!

'Til we blog again,
Scott