Compassion, Real or Fake?

I've came across a observation that I have finally seemed to put my finger on and it deals with compassion towards our patients and with all health care workers that I have dealt with.

First off how about a definition which I took off of Wikipedia:

Compassion is an understanding of the emotional state of another or oneself. Not to be confused with empathy, compassion is often combined with a desire to alleviate or reduce the suffering of another or to show special kindness to those who suffer. However, compassion may lead an individual to feel empathy with another person.

Now that that is out of the way I will continue.

As health care workers we need to be able to show compassion and empathy towards people who are not feeling well or even dying. This is something we are told in school that we need to use is compassion towards our patients.

Understand that not everyone in health care is able to show compassion and those are the one try entirely to hard to fake showing compassion. This is what my observation is about. I have noticed that it is really easy to spot a person who really doesn't have a whole lot of compassion and is just doing this as a good paying job, but they are not necessarily suited for this type of job.

Some jobs take more than just understanding and knowing the position and knowing how to do that particular job. Need more than just schooling and getting a good GPA in their degree.

Let me try some examples:
A photographer can know all the settings, but they also have to know how to see the world, how to work with their subjects.

A bartender can know how to make every drink in the book but still needs to be able to listen and talk with people, who wants to sit a bar and have a unsociable bartender.

A teacher could of graduated with perfect grades from college, but still has to be able to communicate to the class, and be able to be a mentor.

A Psychologist can know everything there is to know about Freud but they also need to know how to listen and get a person to trust them.

A waitress/waiter needs to know what is on the menu but also needs to be able to be personable with the customers, who wants a unfriendly waitress...sorry no tip.

OK by now I'm sure you get the idea. We, RT's, nurses, doctors, xray techs, lab techs, hell anyone who works with sick or injured people has to be able to show compassion to these people, let them know we do care that they are ill and wish for them to get better and that we will do what we can to help them.

I've come to notice that there are some people out there who do not possess this skill, but do know their job. These people try to disguise this by being overly compassionate, looking to eager to do their job, almost forcefully doing their job. Just plain faking it. It's it totally obvious if you look, you can see it in their faces, hear it in the tone of voice and especially notice it as they walk out of the room.

The people who are compassionate do not try to force their way through the job, they just do their job. Just watch the nurses you can tell, the ones who are good are the ones who don't get overly rattled, the ones who look more relaxed and not rushed. When they talk to the patient their words and expressions don't look like they are acting, they look comfortable and not trying to hard to be overly nice.

Oh yes just look around and watch, you can definitely tell.

I feel like I'm compassionate with my patients and I don't force it, I just be myself and I usually get along with my patients. I don't fake anything, I just am who I am.

Don't fake it, people can always tell ... Yes ladies even your boyfriends and husbands can to.
;)

Nothing to do but keep busy.

I am back out of a busy time at my place of business. We have gone from 8 patients with treatments through the night, 3 bipaps and 1 ventilator running back to just having one Q6 during the night now, actually only 4 patient with breathing treatments in the whole hospital, wow what a change huh.

This got me wondering what do people do at their hospital when they have nothing to do? What are some things to keep you mind from total boredom?

This list below are some of the things that I know of from different places I have worked at, some current and some not so current. In my current job I am the only night person on in my department at a time so we have to find things to do, if there was 2 of us here we could take turns being on call, but as you see that isn't possible.

Things to do when you patient load is down:

• Catch up on some reading, personal or work related. A library card is nice to have for this.
• If you have internet access take a online college class. Great time to do homework
• Bring in your laptop and rent some movies or T.V. series. I now have seen all 3 seasons of Lost, which I now am hooked on, all of Entourage which I fully recommend, and in the 3rd Season of Soprano's. I have been watching these at home also on days off. We had a lot of downtime this summer. This is a good reason to use Netflix.
• Learn to program different languages on your laptop.
• Learn to speak a different language.
• Enter Photoshop contest's on Worth1000.com.
• Play games on the laptop.
• Work on your skills with paper football.
• Blog
• Write articles or edit articles on Wikipedia.
• Terrorize the nurses by going into a empty and pushing the call light and hide.
• Explore the hospital. I have noticed in the different hospitals I have worked at that there are some interesting areas and to find. Little nooks and crannies.
• If you hospital has a Physical Therapy gym you can use, life some weights or get on a the treadmill or bike.
• Play hackey sack.
• Do some checkbook balancing and pay some bills.
• Play online poker, never done this at work but would be nice if it wasn't blocked.
  Old school ETT tubes used to come in a Long hard plastic tube. Well in the military we figured out how to make a blow dart gun out of it and I.V. needles. Then we would use a dartboard and have contests. Lots of fun.
• Tackle you colleague, wrap him up in ace bandages and Kerlex like a mummy, carry him up the elevator to a medical floor, toss him out and yell help. Umm I might of seen that happen one time.
• One Military hospital I worked at we would bring in a Playstation and have Madden Football tournaments.
• Hook up a ekg training module to a beside monitor in the ICU of a patient who has a brand new nurse and have it run different rythm's on the monitor and watch the new nurse freak out. Sorry nope never seen that happen.
• Actually learn something new, or refresh something you know about your job.
• Work on something you can improve in your department.
• Find a place, take a catnap.
• Go out to the floors and socialize with the nurses and tech's. This is a good thing to do because they get board also and it makes a stronger relationship between RT and RN's and other support staff like Xray and Lab. I recommend doing this once a shift. Funny thing I actually had a night where I was just tired and didn't feel much like talking with people and a Nurse from the ICU paged me just to see if I was ok and what I was doing. Kind of nice.

That's about all I can think of right now but would like to hear any other RT's ideas of what they do when there is nothing to do.

When you bored you can either make the time productive or just have fun with it and relax, I guess it's up to you and how you department its.

Take care.

Mean Patients Suck!

Is it just me or does anyone else find it fun to antagonize Mean Patients?

You know the ones who come into the hospital but don't want anyone to do anything with them and are just plain mean and unruly. Now these are the ones I like to stay in the room with and just keep irritating them. The ones that yell "Get the hell out of my room!" when you come in. Now is the time to institute operation sarcasm, within limits but it can be a fun game.

Then there are the ones who tell you to "Get that f*&^ing thing away from me, I can't get any damn sleep around here." Well sir your not here to sleep only to get that infection out of your body and when you finally get home then you can sleep.

There are many patients who don't realize that a hospital isn't a place for rest and relaxation, no it's not R & R time, it's healing time. If your admitted to the hospital it's because you need some extra help that you cannot get at home and you will get this help all night long. In reality the doctor's don't care if you get much sleep, they just want to kill off that bacteria or virus you might have. They want to stop your lungs from bronchospasming by any means necessary and if that means we wake you up every 2 hours to get you better, then so be it.

Of course there are mean people due to confusion and there is not much we can say about them except that confused people are much more fun when they are happy confused and they say some funny stuff. I had one patient watching Tiger Woods riding a horse on the roof outside his room. He watched him for hours and I be it was interesting to watch.

I do like to tell my tired patients to take a extra day off of work when you get home to get some good rest because being in the hospital can become like a good jetlag and your sleeping pattern can become very disrupted. Sleep is needed but the hospital is not the place for R & R it's a place to get rid of a sickness or injury, sorry there is not Red Roof on this inn.

What's what my inspiration for this post, well that guy yelling at me to "Get the F*&^K out of his room" and then commenced to try to hit me with his call light, hmm what do I chart now.....REFUSED TREATMENT, PATIENT COMBATIVE. I'm off to see a patient who really needs help.

Drive on RT's

The Calm Before the Storm

Only 2 patients tonight, one a Q4 and one a Q2, yep nice and quiet. This actually give me 2 more nebulizer treatments I have to do than the last shift I worked, of course the Q2 isn't as bad as this person is thought to be, but no protocol is wanted on him so I kind of feel bad waking this patient up and taking loudly just to keep him awake and deep breathing. So ok he is wheezing and sats do drop without O2 so there is a need for something.

Wow ER just paged for a EKG....
Turns out nothing exciting, patient just left 10 days ago and has a Doctor appointment tomorrow oh and yep EKG was fine, doc says it's probably musculoskeletal pain, now get out of here and go home.

There has been some lazy shifts lately for my old RT department but isn't that how this job goes the patient load ebbs and flows like the tide. Feast or famine, you either run all night or you might sit all night and chat with the nurses or better yet blog about it.

Over my time in the profession I have noticed some trends of things where the patient load with increase or decrease and most of these have been fairly consistent, I'll try and lay them out and explain the idea behind these times.

Things that cause patient load to INCREASE or decrease:

• Summertime causes a decrease due to it being nice outside, and who wants to be stuck in a hospital when it's nice outside so more people come in for injuries than breathing.
• Exception to summertime is when humidity is high there is a increase, bring in the COPD'ers.
• Wintertime there is a major increase, it's cold outside and there are more sicknesses, cold air can set off a asthma attack, RSV is back along with croup.
• The night of or day after Thanksgiving there is a increase. Why you ask? Here you will see a large amount of Congestive Heart Failure patients because of the large amount of food people eat with a large amount of SALT which cause fluid retention.
• Christmas and Easter see directly above. Same thing with the CHF.
• Holidays in general you will see a surge of Frequent Fliers. Now these are mainly nursing home frequent fliers who want attention from the family during the holidays so on comes the sickness. I have seen this and could pretty much track it, when the holiday came so did these people.
• A Full Moon. I don't care what anyone says but a full moon always brings in more people, superstition or not. I have also read that the closer the moon is to the earth there is a larger gravitational pull on fluids which can affect fluid retainers.
• After the Super Bowl. The excitement of the game, the drinking, and the major one is the eating. Here you will get asthma attacks, CHF, and chest pains. Mainly this is evident in the ER but it's true.

Well these are the major ones I have noticed but of course there are other trends for different places in the hospital like the ER, for example the weekend magic hour is about 02:30 am, this would be the end of bar time....let the drunks get hurt and sick. Never know whats going to happen at any given time in the world of health care but some things just seem to fall into place.

I would like to hear any other trends that people have figured out, I'm sure there are more.

Drive on RT's

A Stereotypical Patient

Everyone has some patients who are just stereotypical patients. The ones who are they way they are because of how they are. What I am going to do is try and describe a type of patient that I have noticed at every place I have worked as a RT and the reason they are this way.

Yep you might of guessed it, these types irritate me a bit because of what they could do to change their symptoms.

• They become short of breath with exertion.
• They most likely are diabetic.
• They are usually younger 30-50 years old.
• They have "Exercise Induced Asthma".
• They have hypertension.
• They seem to have back problems.
• They like to sleep and are become tired a lot.
• They like to order food at all hours, or have a stash of snacks in the room.
• They have decreased lung sounds.
• They get pneumonia a lot, or just plain sickly.
• They give a very lazy effort when asked to do a peak flow.
• They have that certain smell about them.
• They all seem to smoke.
• They seem to be on public aid.

Now you ask what patients am I talking about here, well these would be the morbid obese younger patients who have no motivation to help themselves. Just think how many trips to the hospital they could save just by losing weight.

Their breathing problems with exertion would be less, hypertension could be better controlled, diabetes better managed, they would have more energy, back problems could be gone, they could get a better job or a job in general with insurance and there possibly is not real asthma component. Finally that smell could disappear.

Now I'm sure this sounds like I'm bashing overweight people but I'm really not. The people I'm talking about just do not take care of themselves, are lazy and leech off the system. There are many overweight people who don't fit into this mold at all, but as for who I'm talking about...You RT's and RN's know exactly what I'm talking about.

Feel free to comment me on this but as always

Drive On RT's

Different Hospital, Different Rules.

As you might have noticed that this blog is just ideas that come into my head or interesting things that I come across at my place of work. The idea behind "Different Hospital, Different Rules" is about how hospitals differ on how the utilize their Respiratory Therapists. Now you might ask where do I get my knowledge about this, well it comes from the 6 different hospitals I have worked at in my almost 12 years as a RT and I welcome comments on other hospitals out there to on how they utilize their RT's.

This might be more geared to new RT's or students to give them a idea how you will work in the real work, but also can give insight to RT's who have worked in the same place the entire time they have been a RT. I personally think it is interesting as to how many hospitals really don't have a clue on what we learn in school and what our scope of practice could be. Without further chatter, here is how mine are different.

William Beaumont Army Medical Center, El Paso Tx - This was my first stop as a RT, here we had 2 ICU's and a step down unit along with 3 floor units. This hospital took civilian population along with military also. The RT's did the ABG's on the floor but not in the ICU or the ER, but we did run a ABG lab and ran the blood. Did all the nebulizer tx's but the mdi's were turned over to nursing on the floors. As for the Vent's we were mainly button pushers there were not protocols for us for anything. We did respond to all and every code in the hospital.

Kenner Army Health Clinic, Ft Lee VA - One of the rare opportunities for a RT to work in a clinic setting. Here myself and another RT ran a PFT lab 3 days a week along with giving nebulizer treatments if asked to in the hospital. There were not vents here and VERY RARELY were there codes. On the days we didn't do PFT's we were supposed go to the different areas and work as a CNA or Medic (all Army RT's have to go through combat medic course) but respond to any respiratory issue that might arise in the clinic. Most of the time we would just hang out, here I became proficient in the downloading of MP3's and how to look up information to help place bets on games. We were also able to take a 1 1/2 hour lunch so I would go and bowl 3 games almost everyday of the week, I got pretty good. All in all they really didn' t know how to utilize us. Not sure if we were supposed to be there really.

Provena Covenant Hospital, Urbana IL - Now here is my first place after the military, and this is quite possibly the best place I worked to use my RT skills. Here we used many protocols on vents, treatments, and oxygen. Vent protocol was great, the Doc would give us ABG parameter and we adjusted the vent to stay in them until he have us a wean to extubate order and it was all up to us. We decided when to draw ABG's, and what to do with the vent. On the floor we were able to change treatment orders as they fit into the protocol parameters, this was nice. In the ER though we pretty much were given what the Doc wanted done, but we had some say in how things were done, there we also good chances to intubate depending on what Doc was on. Now this was nice, we did all the ABG draws from sticks to Arterial Lines even in the NICU and as for the Arterial Line we put in all the Arterial Lines. If there was a order for a A-Line we were called, now talk about fun. We also did O2 rounds throughout the hospital, which is easy work along with maintaining the Glucose check machines, don't ask how we got those but we just maintained them didn't draw sugars for them. Overall this was a nice teaching hospital that utilized our skills nicely, but I still wish we could of intubated more often though.

Freeport Memorial Hospital, Freeport IL - Smaller community hospital here. One 10 bed ICU, a pediatric unit, 3 floors and a ER. During the day we also covered the Bronchoscopy lab and assisted along with PFT and EEG's. No protocols here, mainly a Neb Jockey and Button Pusher besides being able to turn over the patients who were on maintenance medications to the nurses if we were becoming to busy, we didn't have many RT's here. ABG's were all done by RT's and we ran them on our machines. In the ER there were times when we got the chance to intubate patients, but not to often. Really it is just a place where RT's go through the motions but are able to assess patients and make recommendations. We could have been better utilized here.

Rockford Memorial, Rockford IL - Bigger hospital, 2 ICU's, Large NICU, PICU, Peds Unit, Oncology Unit, 4 different Floor unit areas and a busy ER. When is came to vents we were button pushers, Doc wrote the orders and we changed it, unless it was a CABG patient and we had free range to wean to extubation. In the NICU we seemed to be just there to push buttons, very protective Doc's up there until they get to know you. Now here I did train and was on a Neonatal Transport team where we would fly or drive to get babies going bad from different hospitals, or transport babies to Chicago, this was fun to do. You did more on the team than in the hospital since it was just you and the nurse. Great experience. We were the only PICU in the area so all the very sick kids came to us. Now this hospital was in the rough side of town so the ER could get hopping with drug OD's, shootings, stabbings, drunks ect. It wasn't uncommon to have our ER or ICU's locked down for fear of either retaliation or someone trying to finish the job, could become interesting. Of course since we had a NICU there is a OB for birthing babies and as the NICU RT we in on every C-Section and rough vaginal birth so we had to be NRP certified. So I've seen some interesting births here good and bad. On the floors we are mainly a neb jockey with but also respond with the Rapid Response Team along with doing EKG's on the floors. One aspect we did nothing with was ABG's, lab took care of all this analyzing and the RN's did the drawing, I didn't like that to much. This was a good hospital to gain experience and to what people might call getting hardened to seeing different things.

The Monroe Clinic, Monroe WI - Current place of business, a small town community hospital where we only have 1 RT at night...Me. Why did I come from the excitement of the big city, well a couple of different reasons: 1. Better Schedule 2. Was getting burned out and to hardened 3. Money. Now here one thing I noticed right away that I like is the attitude difference from the bigger city hospitals, a lot more friendly both the staff and patients. Freadom over at the RT Cave talks about working in a small town hospital and puts it well and I totally agree with him. Here at mine we have a ICU, 1 Floor Unit, 1 Pre-Op unit on days, L & D, and a ER. Those are what we cover as RT's. In the ICU's we are mainly button pushers but have the luxury of most Doc's listening to our opinions. We do all the nebs, mdi's, I.S.'s, ABG's, EKG's and stock oxygen tanks throughout the hospital along with maintaining our ABG lab. Sounds like a lot but it really isn't much. Just recently we installed a medication and treatment protocol here that is great at containing all the unnecessary neb orders, we can now change the orders to what we deem appropriate and I'm sure we will be working on more protocols later. The day shift RT's also help in the Bronchoscopy Lab and do cardiac stress tests as they are scheduled. I do enjoy this hospital so far and yes it is comfortable and I can see us gaining more and more responsibilities as time goes on.

What does this posting say, I like to think that we are not fully understood by the places we work at and it's not very often that all our skills are fully utilized. If we were there could be a lot of useless calls to Doctors through the day and especially in the middle of the night. Hope everyone understand that each hospital out there seems to be unique for the RT's are used and that you should find one you feel you fit in with.

At any one place you could be a button pusher, neb jockey, ABG King, Transport RT, intubate patients, run EKG's, perform a stress test, insert a A-Line, restock Glucose machines, do PFT's or EEG's and the list goes one, we can wear many hat in this profession but either way it is a good and rewarding profession.

Drive on RT's....

RT's vs. RN's

I was out just searching around the old Internet when I ran across this discussion: Respiratory Therapist VS Nursing and it got me to thinking of the differences between the two. Now I know there are nurses who appreciate us RT's and on the flipside of the coin I know there are RN's who think of us as a highly paid nurses aide or trained monkey. So what are the differences between us? Who really works harder? So here I go with another list of the differences between RT's and RN's.

1. You can become a RN in either 2 or 4 years of college. Wow you there are 2 and 4 years school's for RT also, along with the 8 month route with a commitment to the Military.
2. RT's specialize, RN's don't but they can specialize.
3. RT's know a lot about the Respiratory system, RN's know a little about a lot of different systems.
4. RN's have a bunch of patients on a floor, RT's have a bunch of patients on a lot of floors. So we walk further.
5. RN's make more money, that's a given but we seem to be creeping up.
6. RN's do have more opportunities of different places to work like hospitals, clinics, doctor's offices, jail's, factories, home health, and of course as a school nurse. RT, well not so many. Mainly just hospitals and home health.
7. Everyone knows what a RN is, but not everyone knows what a RT is, we are small stealth unit like special forces.
8. RN's are stuck on a floor so a lot of times they don't really know many people in the rest of the hospital. RT's get all over the place, so we know people all over the hospital.
9. RN's get a big todo for nurses week. RT's have to do something to get RT week known.
10. RN's are the one's who call RT when the patient is going downhill fast.
11. RTs get to shove RNs out of the way to get to the head of the bed during a code. (Thanks Freadom of the RT Cave)
12. RT's don't have to talk to the family (Thanks Freadom of the RT Cave)
13. When a codes over RT can split, while the RN has to clean up. (Thanks Freadom of the RT Cave)
14. RTs have to pay more than twice as much for their license, at least in Michigan, (Thanks Freadom of the RT Cave) and in Illinois and Wisconsin which is cheaper than Illinois.
    

Ok this is mainly just for fun and that's just a short list off the top of my head. Overall nurses work hard and so do RT's, just in different ways and of course both are needed to make the hospital run smoothly. My wife is a ER nurse and I have utmost respect for her as a ER nurse because I know the crap they deal with and the disturbing things they see. All in all it takes a certain type of person to be either a RT or a RN, but RT's don't let those "high on their horse" RN's talk down to you like we are a hired hand and they are the ones in charge. Sorry a little rant there, could be from running into a certain type of RN, or not.

Anyways...

Drive on RT's and Happy Respiratory Therapy Week.