I recently changed positions/responsibilities at my job to Cardiopulmonary Outpatient Services Coordinator. This is just a fancy way of saying I am now running all of the outpatient stuff at our facility. Our outpatient services has been an after thought for some time now and the cardiopulmonary department director thought that, in light of the ACA push for outpatient and preventative medicine, this needed to change and she thought I would be a good one to do it.
This position didn't come with a significant bump in pay but it does offer better hours (I get to come in at 0900!!) and a schedule that is
more flexible around what I need to do (for any of you parents out there, you know how priceless this is) and I will no longer need to work PRN weekly.
As Outpatient Services Coordinator I will be responsible for all cardiac and pulmonary rehab patients, PFTs, cardiac and nuclear stress testing, bronchiolitis clinic, and cardiopulmonary specialty clinician requests. This
new position will also allow me to use my AE-C and get referrals from the clinic to do asthma education, something I am really looking forward to. Right now I am trying to get all of our outpatient programs organized and polished up and then in a month I am going to do a presentation to the providers about what all we have to offer.
What this change in position also means is that I will now rarely work the floor or ER (which breaks the heart of the trauma junky inside me) and I will no longer be able to work PRN weekly. Working PRN is kind of a double-edged sword in that I do love working at different facilities and working with RTs that I don't see every day and get the experience of a busy ER, but it also involves getting up super early before
it's light out to drive 45 minutes away from my wife and kids and not get home till long after it's dark. There are some days when I work PRN that I don't see my kids at all and this really gets the "cat's in the cradle"
spinning in my brain. So in the end, though I will still work PRN every now and again to help out when short staffed, I think the trade off is worth it and I am looking forward to this new phase in my career.
Patient's don't always die with dignity. We all know this. Either their families won't let them, they won't let themselves or, worst of all, their provider won't let them. Only one of the three do I find acceptable. Patients should be able to choose their end-of-life care -- excessive or minimal, it should be up to them. But there is really no excuse for a family or provider to make that call.
Healthcare is a tricky field to work in. It seems like often times we are fighting a losing battle against time and/or disease, and sometimes we are too invested emotionally or otherwise in our patients to see what is reasonable and what is not. Unless an intervention is in line with the patient's wishes, why do we go to extreme measures to "fix" our patients if our battle is obviously a losing one? More often than not we are sacrificing the patient's quality of life to satisfy our own need to feel like we are doing something.
Death is a complicated thing and it would be nice to have an outside panel to take these complicated issues to when said issues arise. I am not advocating death panels or anything, just an in-hospital board that could make the call or stop treatment when treatment is fruitless and/or the patient's dignity is no longer considered and/or the patient's wishes are not being followed. The hospital where I work does not have an ethics committee. But there are many times that I wish it did have an outside entity to take a reasonable assessment of the situation and say "enough is enough" when, indeed, enough really is enough.
I would be interested in hearing from any readers out there who have served on an ethics committee or have one available in the organization where you work.
In light of the holiday I would like to post the top 10 things I am thankful for as an RT:
10. My trusty pulse ox. I know you are just a trending tool, but what a trending tool you are. We have been through a lot together. That 80-year-old with the cold hands. Wait, all those 80-year-olds with cold hands. I did a clinical at a facility where RTs did not carry pulse oxs ... not sure how an RT can function like that.
9. My COW - Computer On Wheels. Before I had my COW I had to jot all my charting on a scribbled up note pad of nonsense and then try to decipher when I got back to the department, praying I got it all done before they stopped serving breakfast. Now I chart at the bedside and know breakfast will still be nice and hot when I get done.
8. Well-fitting scrubs. I have worn scrubs that were either too big, too small, too tight, not enough pockets, too many pockets ... scratch that, you can't ever have too many pockets, but you get the point. Scrubs that are ill fitting or ill equipped for the job can ruin a shift.
7. Protocols. Evidence-based medicine at it's streamlined finest.
6. Providers that are open to suggestion and conversation. Really, is there anything better than when you make a suggestion and it is taken into consideration and used. Even if it isn't used, in my mind there is nothing better than an open dialogue between an RT and a physician that leads to optimum patient care.
5. My watch with a second hand. I broke a watch one time and went a week before I got another one. A watch with a second hand might not be something you notice every day, but you sure notice when you don't have one.
4. PRN work. What other line of work, other than healthcare, can you go to another facility and plug right in and do your job and get paid well to do it?
3. Good nurses. This could easily be #1. There is nothing better than a helpful, confident and competent nurse.
2. My "ears". Do I really need to explain this one? I would be like a carpenter without a hammer if I didn't have my stethoscope.
1. My coworkers. I work with some wonderful RTs, and I want to take a second to list them by name: Jennifer, Nancy, Jenny, Kerri, Chris, Jason, Tiffany and Kim. I have learned so much from all of you and am thankful to have you as coworkers and confidants. You are all great RTs and it is a pleasure to work with you. You make it fun to come to work and I can't thank you enough for that.Happy Thanksgiving!
It seems like I got my AE-C at the right time. Instead of having to renew via exam every seven years, certified asthma educators can now renew via CEUs every five years. After taking the exam and the months of prep that went along with it, I can tell you that this is a good thing.
One of my RT instructors while I was in school was an AE-C, or she was at one time. She had let her AE-lapse because it wasn't worth it to her to spend the hours studying, pay another $200, and retake the exam when her seven years were up. This instructor is one of the smartest people I've ever met but she told me she did not think she could pass the test again without a few months prep and didn't have the time nor want to spend the money.
Now you might think, (annoying self-righteous voice), "Well if it isn't worth it to you to go through all that to renew your credential, then you don't deserve to have it, meh!"
It isn't like that. Imagine if you had to renew your RRT or CRT every 10 years or so by retaking one or all of the exams you already passed. We all know that real hospitals don't run like the NBRC hospital, and over time we have all forgotten all the formulas and mundane information that we had crammed into our heads to spew all over our exams, only to start working and realize that NO ONE uses the Alveolar Air Equation or air entrainment ratios in every day practice. (For those of you who do -- annoying sarcastic voice -- Congratulations! You are so cool! ) The AE-C is no different. I can't tell you the oddities I had to memorize that I will no doubt have forgotten in seven years.
This is what happens when you require renewal via exam instead of CEUs: You lose quality therapists because they either view it as not worth the hassle to renew, or because they have forgotten the mundane details that the exams require you to know for the exam only.
It was late. I don't really remember the hour but I know that as I was wheeling the Bipap back to the department from the ER, down a side hallway that wasn't lit up because it was the weekend, and only staff uses that hallway on the weekend. I looked out the glass doors that lead to the precious outside world and saw that it was dark, as it was when I arrived at work that morning, 14 hours before. That was where I saw her standing in the shadow of a dimly lit exit sign, looking out at the parking lot and the stars above it.
I recognized her. A short woman of about 80. Silver grey hair, wire-rimmed glasses around brown eyes. I had seen her in her husband's room over the past few weeks, always by his side as he grew weaker and weaker with each passing day. (COPD is a progressive disease and, though it can be controlled, it does not get better. Eventually you run out of air.) A few days before, I had to give his treatments with a mask because he was too weak to hold the neb. Earlier that afternoon we had D/C'd his treatments as he had expressed his wishes to go home on hospice the next morning so that he could die at home.
"Hello!" I said, trying to act cheerful, though I felt anything but. It had been one hell of a shift. Two babies, one RSV kid, a code blue and one therapist trying to squeeze 20 nebs in between all the chaos. I was wiped out, hungry and hadn't seen my kids all day. I just wanted to go home.
"He has decided to go home," she tells me between tears, "It was his decision; it is what he wants." She told me they recently celebrated 60 years together. All of their five children and their families, which included untold legions of grandchildren and great grandchildren, came to help them celebrate. She said they will always have that memory.
She told me how excited he was to get home and see his dog, a beagle, who has howled for him non-stop since he went to the hospital a few weeks ago and hadn't been back since. "He is going to die at home," she told me, tears framing her eyes. "The doctor said he has one to two weeks, maybe less, and he wants to die at home."
I told her I wished that there was something I could do. She said I could give her a hug.When I got home my kids were sleeping, so I kissed them all on their cheeks and ate some cold pizza that I never thought could taste so good. I held my wife and told her I loved her. I told her I had a good shift. 14 hours well spent.
A few weeks ago I was enduring a rather slow stretch at one of my PRN jobs when the RT director said to me, "Put down your stethoscope and warm up your muscles, we are going to move the rehab room." The department had been in the process of moving for about a month and so far I had been able to avoid any of the heavy lifting ... but on that day it looked as if my luck had run out. I don't mind a little manual labor; I used to do it for a living. But is it something that I expect to do now that I am in the healthcare field? Well ... no.
And therein lies the caveat of being an RT. If the nurses station was moving down the hall, would the nurses be expected to shoulder the brunt of the physical labor? No, I don't believe so. There would be a crew of maintenance men ten deep to do all the moving so the nurses could focus and be available for patient care, even if "being available" meant having coffee in the break room.
Now before I get myself in trouble, it isn't that I don't believe nursing capable of doing some heavy lifting, it is just that I don't think they would be asked to do so. But here I am: Mr. RT, loading up a treadmill that is as heavy as ten donkies, onto a cart which I have to push uphill, into the wind (author acknowledges a slight exaggeration) in my scrubs -- which are really just a working man's pajamas -- and crocs. Why? Because if we, the RTs, did not move that treadmill, it simply wouldn't get done. There was no maintenance crew lined up, it was just me and the RT director sweating it out, risking our backs for the good of our patients ... and because the CEO said we had to move our rehab.
Poor me, right?
Then again ... it was nice to have a change of pace in the daily routine. There wasn't really anything much on the floor or ER that needed my attention and I had my pager in the event that there was, so why not get out and use those dormant muscles of mine that, at times, seem as floppy as a lunger's lungs? It is nice to prove to myself every few months that my low impact, scrub-wearing job hasn't made me soft, and that I can still flex when I need to.
Just so long as it isn't every day...
As of Oct. 19 I am officially Kevin Johnson, RRT AE-C. That's right, I passed my asthma educator boards and am a Certified Asthma Educator! I have to say it was one of the harder tests I have ever taken. I felt like there were some questions that had three correct answers.
They alloted 3.5 hours for the test and I took almost two of them to get the test done. I can tell you I have never been so nervous and unsure to get the results from an exam... and have never felt so rewarded as when the lady at the H&R Block said, "Congratulations...you passed."
It was like the weight of the world had been lifted. I had been studying for about three months straight, denying myself the reading of any book or magazine that wasn't asthma-related. As an avid reader this was hard to do ... but it paid off!
So now the question is, where do I go with it from here? I want to start setting up sessions with asthmatic patients as soon as possible, and have a pretty good idea about how I am going to go about it, but I need to get a concrete plan developed.
I am interested in doing community education classes in conjunction with the hospital's chronic disease management classes that are held monthly. I was even asked today if I wanted to go to chronic disease management training by my hospital's education coordinator. I definitely want to pursue any and all avenues that my new credential can take me down. But first I want to go the library and check out a book that doesn't even mention the word "asthma."
I was at a family gathering a few weeks ago, when an elderly family member of mine fell and hit his head hard on a table, leaving him with about a six-inch gash. This family member had leukemia and was bleeding profusely from the wound. My father, being the experienced former EMS provider that he is, immediately held pressure to the wound while I ran to get towels and call 911.
I have to say I was impressed with how quickly my dad responded to the situation, he was down on the ground holding pressure to the wound before I even realized what had happened. I, on the other hand, admittedly felt a bit of hesitation on my part because this person wasn't just a patient ... that was Grandpa lying there with blood pouring down his face.
Working on family members and/or close friends is a common occurrence in a rural area. And chances are if you don't know your patient on a personal level, you know someone who does. I am not from the small town in which I work, so this isn't as big of a deal for me, but the longer I am here the more and more I see people (in the ER, on the floor, in OB) that I see out and about: at my kid's school events, at the grocery store, softball leagues, at church. I always try to remain professional but it can be hard not to let emotions or personal grudges seep into your work. And it seems the longer you have known the person, the harder it is.
The hardest thing for me is to see these people out and about in the "real world" after I have worked on them as patients. Especially if I have worked on them when they were in compromising positions, then trying to pretend that I didn't see them naked or that I know nothing about their genetic, weird-smelling, bowel thing they got going on. But I guess that is the burden of the healthcare provider. Keep it professional.
Fortunately, outside of Grandpa busting his head, I have not had to "work" on any member of my family. Or worse, I can't even imagine what it would be like to code a close member of my family ...and I hope I never have to.
We recently had our quarterly "all-employee" meeting where it was noted that the hospital was not on par with last year's financial performance at the same time last year. This left me and my co-workers scratching our heads. First off, we have been much busier this year vs. last year at this same time. We have a new surgeon, granted he is just getting established, and as the CFO's presentation showed, our volumes were up, employee health claims were down and we should be on par for a stellar year financially. If not for one little problem...
Due to the Government Sequester our Medicare reimbursement was reduced by 2% across the board. This might not seem like a lot to those of you in metropolitan hospitals, but trust me, a 2% decrease in Medicare reimbursement -- especially when 90% of our patient population is Medicare -- hits like a brick to the head. The hospital is still doing "well" as compared to other facilities in the area, but it is frustrating to see numbers proving we should be having a banner year ... if not for donkey brained politicians on both sides of the aisle. I knew this reduction was coming, but it didn't really hit home until I saw the bottom line.
So what does this 2% reduction in payment mean to me? Am I looking at possibly losing my job? Like I said, we are doing fine and there has been no talk whatsoever of layoffs. What I am looking at is losing my yearly bonus, a bonus that has never been guaranteed but is something that I definitely look forward to. It would be one thing if we were just slow and didn't have the numbers or census to justify employee bonuses, but this year that isn't the case. The problem is in Washington, DC, and that is why this is so hard to take. I am fortunate in that I am not at risk of losing my job, but I am sure that threat is very real in many rural, critical care access hospitals similar to mine, and that would be 100 times worse than losing out on a bonus.
I spoke with our CEO and asked if the reduction in reimbursement is just how it is going to be from now on. "Is this going to last forever?" I asked.
"No," he said, "if the politicians can get their act together and get a balanced budget passed, I think reimbursement should go back to what it was."
In other words, this could last forever.
Our department is not fully staffed 24/7. We are staffed from 0700 to 2000, but we offer 24-hour "on call" coverage. With a department of four full-time staff, this means I am on call one to three nights a week. Couple that with a newborn baby boy at home and a 2-year-old that seems to have perpetual nightmares, and I don't get a whole lot of sleep. So there is really nothing that irks me more than when I get a call in the middle of the night from a frantic nurse informing me that a mom is complete and I need to come in for a delivery ... and I get to the hospital and hear those five dreaded words: "We're going to labor down..."
So basically I got out of bed and raced up to the hospital for nothing? Well, not totally nothing, Doc wants us ready-to-go when the moment comes, so we can't go too far from OB.
Fortunately for me, my boss is cool, and when those situations arise we have been instructed to stay clocked in, find an empty room ... and sleep!
That's right, sometimes it is OK to sleep on the job.
I don't find hospital beds particularly comfy, and the couch in our department isn't long enough for me to stretch out on, so it isn't like I am going to get any solid rest out of it ... but it is nice to have the option.
When I was a student there was a site where I did a few clinical rounds that had a sleep lab attached to the hospital itself. The lab was nicer than any hotel I could have ever afforded to stay at, at that time. The TV was huge and the bed was king-sized. There was only one problem, this little red blinking light from the camera in the room would not shut off. I solved that one by putting one of the blankets over it and then slept like a baby. Unfortunately those cameras were set at specific angles and I had knocked it off it's angle so they had to cancel the sleep studies for that night until they could get a specialist in to recalibrate that particular camera. That was the last night I was given the option of staying in the sleep lab, but it was still the best night's sleep I've had in a hospital.
Maybe I need to lobby for our department to start a sleep lab...
We have a new surgeon. He is a general surgeon and I don't expect that he will have any crazy cases, at least not right off the bat, but he had promised our department that we will be keeping vents in-house instead of just long enough to see them head out the door with a transport team.
Since we are a critical care access hospital, and the majority of our funding is based on this classification, we are only able to keep these vent patients in-house for 72 hours before extubation or transfer to a facility of higher acuity. This is new and exciting ... but somewhat nerve wracking.
To be honest, other than the patients we put on the vent to ship, I haven't managed a vent patient since I was in RT school two years ago doing my ICU rotations. I feel very competent and confident that I can handle this, but I still feel like there will be a period of dusting off the cobwebs before I am totally comfortable. I know that I can handle whatever comes my way -- I had good schooling and feel confident in my skills as an RT. But when you haven't done something for two years there has to be an adjustment period while the proverbial knife is re-sharpened. My coworkers and I have taken some vent retraining and are going out to an ICU at a bigger hospital in a month or so for a refresher, so I know we as a department will be ready when it finally happens.Change is a good thing. Managing vent patients is something that I have missed doing and was sad to think I might never do again once I finished up my ICU rotation. But now that the prospect is real and right around the corner, I guess I'd better be ready, because here it comes!
I went in to HR a few weeks ago and asked for a raise. I didn't do this on a whim or anything. I had been carefully planning what I would say and how I would ask for weeks. I followed the chain of command and was led to our HR director for the moment of truth. I am not going to say if I did or didn't get the raise I desired, because that really isn't the point I want to make. What I want to discuss is the general attitude, as I see it, about getting a raise in healthcare.
Asking for a raise is very common in the working world, be you a factory worker or a teacher or a mid- level accountant; management pays to hold on to those that bring value. But it doesn't seem to be as common in healthcare. At most hospitals, at least the rural ones I have worked for, employees get a 3% cost of living raise (if anything) per year and there is usually nothing given beyond that. The prevailing thought seems to be, "If I ask for more money, they will find someone else to do my job, so I better just be quiet" -- and the underlying thought being, "There is someone else out there who can do my job just as good as I can."
It seems the general plan or hope to increase personal salary in healthcare is to move up into management or continue your education and become an advanced practitioner or physician. Times are lean and with the uncertainty about the Affordable Care Act I understand why hospitals, especially rural hospitals, aren't doling out the cash ... but that doesn't mean one shouldn't get paid for the value one brings to any position, be it RT, nurse or environmental services. If you are confident that your value is premium and the ability you bring can't be replaced, put your cards on the table and make management play their hand.
I am a firm believer that if you do not proclaim and leverage the value you bring to the workplace, those you work for will be more than happy to let you continue to be your valuable self at the least amount of expense to them as possible. It is rare that management will come up to you and say, "You are doing a great job! How does $5K more a year sound?" Most of the time you have to ask for it.
I am a member of several respiratory therapy groups on different social media websites. I find these groups to be, for the most part, good for the profession in terms of the camaraderie and discussion that they generate. Topics range anywhere from, "Hey, I am a RT student studying for boards..." , to "Does anyone use Atrovent as a drying agent?" Lately, there has been a lot of talk about the formation of a midlevel respiratory care practitioner, that would be on par with a nurse practitioner or a physicians assistant. I do not claim to be an expert on all the ins and outs of this new position, but I will explain it as I have come to understand it, and if I am wrong feel free to light up the comments board and let me know where I went wrong.
Apparently, some time ago, there was an initiative that was put before Congress called the Respiratory Care Initiative. In this initiative, there was a provision that would allow RTs with a certain degree of education to practice under the direct supervision of a physician, much like a nurse practitioner. For whatever reasons, this part of the bill did not pass or was tabled, though from my understanding it is now under discussion again and will be put into practice within the next 5-10 years, depending on who you talk to.
As I understand it, there are a few hang-ups with the RC midlevel position at this time. There is no consensus that I can find that says exactly what level of education will be required. Some I have talked to say just a bachelor's degree; some say any bachelor's will do and others say BSRT. Some say it will require a masters in respiratory care. Basically, there doesn't seem to be a clear-cut outline as to how this credentialing will be laid out or how it will be implemented, only that there is a pretty big buzz that it is for sure going to happen.
This is great news for the profession, even if it is mostly up in the air at this point. A respiratory therapy midlevel position is a huge breakthrough for our profession which has always played little brother to nursing. I want to encourage all readers of this blog to visit www.aarc.org/advocacy/ and write your congressman in support of this bill.
My wife, daughters and I welcomed our first son into the world last Sunday. This was a joyous experience filled with laughter and tears and also sleepless nights and endless diaper changing. For me it also meant a week off of work that was much needed.
When you are part of a small department, it doesn't take much to become burned out: burned out from working a lot of hours because your co-workers have family/medical emergencies and are unavailable, burned out due to personality conflicts, burned out because ... well, work in general has a way of doing that. So it is nice to be able to step away for a week or more, knowing that you will come back with a clear focus and a renewed tolerance for the little things that grind on a person after a while. I definitely needed to step away from my job for a bit, but not necessarily for the aforementioned reasons. I needed this time off to remind myself about what is really important in my life and why I go to work in the first place. After all work is really just a means to an end.Don't get me wrong, I love my job and I love what I do, but I didn't go back to school, and don't spend countless hours at the hospital or on call away from my kids and wife, just because I love being a respiratory therapist. I do it so I can provide a good life for them; so we can afford everything we need and most of what we want. My problem is I can easily become a workaholic if I am not careful. I get so focused on making money and rising to the top of my profession, that I forget why I am making money in the first place ... children have a way of reminding a guy.
This is an old, mundane adage that everyone's grandma instilled in them since birth ... so why do I find myself still judging a book by its cover?
The other day, I was called into an outpatient room to do a stat EKG on a patient who was complaining of chest pain during routine outpatient IV therapy. It wasn't like I was busy, but I had better things to do, i.e. get to the cafeteria quick before the line for quesadillas got too long. So off I trudged to IV therapy and when I got there I took one look at the patient and made snap judgments about: (a) his socioeconomic status and (b) his intelligence.
He was wearing a dirty grey T-shirt with the sleeves cut off, a can of chew sat on his bedside table, and his smile looked to be missing a few teeth. He immediately started talking to me in a friendly but jabbering manner, telling me about his cows and roping fences. My first thought was hillbilly, my second thought was, "There is no way I am getting a quesadilla ... I am going to have to eat the salad bar." I tried not to, but I'm sure I looked annoyed. As I was hooking him up to the EKG he asks me about my boss, whom he knew by name. He then goes on to tell me that he is on the hospital board of directors.
"Really?" I thought, immediately forgetting about the quesadilla that wasn't meant to be, and plastering my face with a jolly, "how-can-I-help you?" grin.
Now, it is not uncommon to have a working cowboy/farmer/hillbilly on a hospital board in Kansas. In fact it is quite likely. After all, out here they have all the money, but that really isn't the point. I am recanting this story to you because I am embarrassed about my pre- and post- attitude towards this gentleman. It shouldn't matter if my patient is on the hospital board of directors or homeless, they both deserve my best shot and my best smile every time I walk into a room.
I am a big preacher about giving the best care to all patients regardless of socioeconomic status and/or intelligence, but part of being a caregiver is being friendly and kind ... and I am embarrassed to say I forgot that the other day.