Pissing in the RT Pool (AGAIN)

[ISU_Steve]

In Advance for Respiratory magazine, this was my response to a letter to the editor in reply to a reply to a letter I had written that was recently published:

In response to Ms. DuBois' reply to my letter that was recently published, first let me say that I am sorry that to hear that she is saddened by the truth. It must be nice to work and live in a place where the flowers bloom, the birds sing and we can all join hands and applaud because of the good works of the AARC and its associated subsidiaries.

The AARC has done nothing to help us rise "to a higher level", as she maintains. Instead they have further fueled a degrading and time consuming debate in regards to the credentials. Last time I checked, there is no national standard saying that a CRT has any less authority to do their job than an RRT, and any higher level stems only from the fact that one must be a CRT before becoming an RRT. The only difference is that the RRT is a few hundred dollars poorer because they have decided to go along with the hypocritical party line of the AARC.

As for how membership in an organization makes a difference in whether you support your job or not, I guess I don't see the point in joining an organization or groups of organizations that are leading the field into the ground. It's not that I don't support respiratory as a career- if you choose to do it as a career, then you have my respect- it's that I choose not to support a group that is being malicious in its approach to a majority of therapists. And yes, it's totally a matter of what you get out of it that spurs your membership- you feel good about yourself, and judging from the tone of your letter a little full of yourself, because you're a card carrying member of the AARC and you think you're benefiting from it in some manner, no matter how indirect. Good for you, but don't lie and say that your motives are altruistic when all you are trying to do is better your own stead in life. There is something respectable about being open and honest, even if your motivations are less than stellar, and something totally blatantly disreputable about claiming to be a member of a national organization for anything other than some personal benefit, even if it some manner of self-gratification.

Since you decided to mention that at your facility RT is well recognized, good for you. I just started at a new facility and I must say that I really do like the way we are treated here- we aren't treated as a lower class of employee by our colleagues in nursing and other departments. I really do enjoy my job, for the first time in a very long time, but that has nothing to do with what I am doing, but rather with whom I work- everyone is treated as equals and that is why I like going to work. I still don't enjoy what I do for a living all that much, I love taking care of people, but the nature of the patients we see in this field is depressing and disheartening to a great degree. Put it this way, what field other than nursing deals with more terminally ill patients, more incurable conditions than respiratory? We can not stop or, in many cases even slow the progression of the diseases and disorders that make up the vast majority of our patients. I guess I have seen the futility in a lot of what we do, and I am not sure whether, many of the therapists I have worked with are either oblivious or simply choose to keep their observations to themselves (I am operating off the assumption that it is more of the latter than the former since many of the therapists I work with are brighter and more observant than most of the doctors I know). This is the main impetus for my seeking a career outside respiratory- I am tired of seeing people die and being forced to stand, more or less, idly by. I want to feel like I am doing something constructive for at least the majority of my patients, not just the small number that can be effectively cured.

Which brings me to the topic of people leaving the field, and also the comment made about specialty organizations, because I believe these two are interconnected. Using nursing again as an example, there is a nearly endless spectrum of possibilities for a career in nursing- CRNA, nurse practitioner, nurse-midwife, etc, etc. What are the possibilities for respiratory therapists? Sleep lab, NICU, cardiopulmonary rehab, general care, home health, and maybe academics or research if you happen to possess sufficient education. Can anyone else see why people are leaving left and right?

Ms. DuBois did make a very valid point when she pointed out that it was her choice to become an RRT and achieve the NPS credential. It is our choice, and it should remain our choice to achieve credentials which for many of us do not increase our paychecks any appreciable amount, or garner any more prestige (except perhaps from other therapists who are obsessed with the letters after their name) or earn us the right to do additional things for our patients. Now if you work in a NICU or PICU, then you should have to earn the NPS credential- that's just basic common sense because it is a set of knowledge that is not adequately proved simply by possessing an CRT or RRT.

Speaking of credentials, and this will be my closing for this letter, next time you decide to take someone to task over their beliefs or stand on an issue or set of issues, please have the courtesy to at least spell his or her name correctly and, especially since you seem concerned with credentials, make sure you get their honoratives correct. I'm an EMT-I, as in Intermediate, not an EMT-1 (which is what a Basic EMT is called in several states)- unlike the CRT and RRT credentials, there is a major difference between what a Basic EMT and an Intermediate EMT can do. I realize it was just a spelling error and probably a mistake in reading my signature on my last letter, but it does not bode well in a letter over a credentialing debate when you appear to bust someone in rank from the ability to push medications and intubate to someone who can do neither.

If anyone would like to take this discussion further (or would like to attempt to further lambaste me for my views) feel free to e-mail me at [email protected]

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[ISU_Steve]

This was the letter to which I was replying:
Negative Talk Saddens Therapist

I read with interest the letter to the editor written by Stephen R----, EMT-1, CRT, in the June 13 issue. It saddens me that such negative talk centers around a profession that one chooses to enter. I have been in this profession for almost 19 years, and during that time, I have been a member of the AARC, NBRC, TSRC and MD/DC Society of Respiratory Care.

During that time, I have heard numerous times the same comments listed by Mr. R---- regarding licensure and supporting our profession. I was fortunate to see the society in action as licensure for respiratory therapists became a reality. I have been aware of bills before Congress that would impact my profession and saw who was there representing all the respiratory therapist in the field, regardless of membership or not.

Mr. R---- is right when he states that many leave the field for other positions, as do nurses, clinical techs, radiology tech, etc. What he does not state is that for RNs, the percent who support a professional membership have to choose from more than 20 societies.

In nursing, for every specialty, there is a professional membership. For respiratory therapists, there is just one national and then the state societies.

What do they do for us? They give us the opportunity to rise to a higher level. That is just it, an opportunity. The choice is ours. It was my choice to sit for the NPS exam and the RRT exam. It is my choice to be a part of this profession. Membership means only that I support my profession, not what I get out of it.

Money is a motivator only for a short time. A bad job is still a bad job if you do it just for the money. I best can answer the question as to why one enters respiratory care. I know why I did, and it was not as a stepping stone to something else. Maybe that is why I support it.

As for gaining recognition for what I do, here at Children's Medical Center of Dallas, respiratory care is recognized. We are held to a higher standard and it shows. We are not just knob turners or neb jockeys. We must know what we are doing. We are challenged to be better than average, and we are rewarded by a clinical ladder.

Being better than average comes with more responsibility, and most of the time it allows us to challenge new therapists as well. To have a better profession, the body of professionals who comprise the majority should be challenged to that higher level.

One last thought. When I started in respiratory, my class began with 40 varied individuals. Only 20 graduated and about 12 remain in the field. I choose to think the best survived the cut. It must be the glass half empty or half full.

As in all areas of life, you get what you put into it. I quote from Eleanor Roosevelt: "When you stop contributing, you start to die"

Jean M. DuBois, RRT-NPS
Cardiac Intensive Care Unit
Children's Medical Center of Dallas
Dallas, Texas

 

[ISU_Steve]

And this is my letter that started my involvement in this debate:

RC Brain Drain Continues Unabashed

I just finished reading Douglas Laher's well written letter in the May 16 edition, and I must say he does make a couple of very valid points. At the same time, he does engage in a fair degree of fear mongering and bully pulpiting in regard to his views on professional organization membership. He cites the 30 percent membership among RTs and lays the blame for reimbursement shortcomings squarely on those of us who do not see fit to swear blind obedience to a pair of organizations who do seemingly little to help the average therapist and, in the eyes of many, do far more harm than good.

Before placing fault, perhaps he should look at the professional membership rates of the health care professionals to which we are most often compared. Nurses run a paltry 5.6 percent when it comes to professional "representation." Only one out of every 18 RNs belong to the American Nurses Association, yet nurses don't seem to be having the issues our career faces.

Perhaps before chiming in that if each of us submits $90 to the AARC and all our problems will be solved, it might be wise to consider that the very organization he has so much faith in might very well be contributing to our problems more than they are solving them.

As for the credentialing debate, I am preparing to take my RRT exam; but personally I could care less about what credentials will follow my name. It is not going to put more money in my pocket (a paltry 35-cent per hour raise is all it will earn me), increase the level of self-respect I have for myself as a practitioner, improve the already outstanding level of care I deliver to my patients or suddenly make RNs or MDs look at me any differently. To them, I will still simply be "respiratory." To the patient, it is what is between my ears that really matters. I am taking the exam so I will no longer have to listen to the petty degradations of my fellow therapists. I almost feel like a sellout to my fellow CRTs.

I have zero interest in advancing in the field. I am a therapist, and that is what I will remain for the time being. I certainly do not aspire to any manner of leadership role that would require an RRT credential. I long ago decided that, unless drastic changes occur, this career field is doomed to continue in a vicious cycle of eating its young.

Personally I'm finishing up my BS degree in biology and will be going on to dental school. Like so many of my fellow RTs, I have come to realize that respiratory care is not a long-term profession but rather a temporary job, not because of credentialing, practice limitations, or a lack of opportunities in a broad spectrum of settings, but because of the pervasive negative attitudes of those in positions of power in this field.

Of 20 therapists under age 30 I have worked with over the past few years, six have left or plan to leave the field for professional schools, two have become RNs and three have completely left the health care arena.

Until the infantile actions of the self-appointed "Illuminati of RT" cease, expect to continue to see the best and brightest either avoid respiratory care altogether or for the field to continue to hemorrhage its best.

Stephen ---------, EMT-I, CRT

 

[Weebils-Wobble]

Ah, Respiratory Care.

I have barely mentioned those days of anguish in nearly 10 years.

I came charging into the field out of a little-known academy in Arizona in '89. I was full of pride for what I knew and what skill I would certainly aquire. The future was bright and endless as I calculated the possibilities. I had much to learn out in the real world of respiratory care but was sooooo excited to gobble up all I could.

The first thing I learned was that the guy with a 4-year degree and 10 years experience does the same thing I do.......and will do it for ETERNITY. My dreams start to wither as he is showing me how he varies the amount of nss in the nebs so he can run 3-4 at a time. He does that so if one of the other 2 pagers he caries goes off he has a chance to get his pt load completed before the next rounds start as to avoid being written-up for missing Q6s with clear bs that don't even know they have an order for them.

The nurses call him "the tech" and often talk about him as if he is not there. CNA to LPN, "hey, do you think we should have the tech give that psych job in 10 a tx to shut him up?" LPN looking up from magazine "Sure, that would be ok. Tell him to go ahead" The "tech", knowing there is no order because he still checks charts at the start of rounds from a habit formed during 4 years of clinical hours says "does 10 have an order?" LPN now getting perturbed "naw, I guess you'll have to get a phone order" RRT "What reason could I possibly give to the doc since the bs are clear and he has no resp distress?"
The battle lines are drawn. The education of a specialist with a 4-year degree, that knew this after about a week anyway, is being challenged by someone with the equivalent of his prerequisites and very little actual science.

He is of course written-up, and put on probation after being forced to meet with the Nurse Manager and the Head of Respiratory on HIS DAY OFF for the month. He is allowed to keep his job as long as he is a "team player" for the rest of eternity and will never forget that he will NEVER rise above the bottom of the food-chain.....so get used to it.

After being labled the villiage idiot while doing the same job as the therapists with a 4-year degree, because I came from an academy, I decided to "prove" myself by taking the RRT. The same board that let me sit for the CRTT and pass on the first try, would not allow my school credits to sit for the RRT.
I would have to take all my classes at an approved college program because my former one had lost its accredidation with them. Somehow the classes that allowed me to qualify to run nebulizers as a CRTT did not qualify me to run nebulizers as an RRT

I did manage to find a rural rehab hospital that let me use some skills and that turned out to be ground zero for my final catharsis.

There was a protocol in place that allowed me to intubate patients in the event of resp failure. It was not the norm. Only in the most desperate situation with no hope of the anesthesiologist arriving in time. Evetually lightning struck. A patient didn't look right to me. I ran ABGs and monitored his condition. The nurses disagreed and were upset with my prodding and keeping him awake. The next gases were worse and I called the doc. The code was called (with me still trying to convince the nurses)and the anesthesiologist was still too far away. I intubated the patient and he was alert by the time the anesthesiologist got there. I explained to him what had transpired and he acknowledged that I handled it well except for a slight displacement of the tube. Being my first time, I wasn't surprised.

Did ANYBODY even mention my name in connection with that code???

Nope. It was as if I never even existed. The small talk about the code, as was the habit to decompress and review the facts, never included me or my expertise in ealy recognition and handling the situation for the nurses. His nurse, who wanted him to sleep, soaked up all the accolades about her fine care as a patient advocate...................sure was smart of her to get the "tech" involved huh?

Disallusioned and bitter from the whole "tech" experience, I left healthcare entirely for the last 5 years and am now just focusing on a real career in it.

I little off the topic but still symptoms of the disease.

 

[ISU_Steve]

Ah, yet another disgruntled RT.

 

[CCEMTP2DOC]

Ah, yet another disgruntled RT.

As a seasoned paramedic, and 8 years as a critical care medic, I too feel the wrath towards CRT's/RRT's. I have been in the field for 3 years,all as a RRT.
Imust admit...I am bored!!!!!!! I do like the field but feel very unchallenged.
That is why I have decided to attend PA school. It is a good field, but a lot depends on the hospital and area you work in/at. We are, for the most part, treated well and respected. There just seems to be to much restriction on what I can do. I understand this, but I need more. The field is definitely worth looking into, but just know what you are geting into.

 

[ISU_Steve]

The advice I give people: It's a good field if you like routine. It's not a good field if you like to be challenged every minute you are at work.

 

[guetzow]

Is the true title of that rag. Former hemorrhage"ee" here. Now laughing all the way to the bank as an ortho PA. Advice: do "Not" go into cardio (I tried it, way too high strung...).

 

[ISU_Steve]

Thought I might share one of the responses I have received to the letter I published including my e-mail.....from the Ms. DuBois, who originally responded to me in the copy of Advance:

I wish to address the issues that you brought to light in you last published letter. I will start with those as you listed them. I do work in a great facility that is dedicated to making life better for children. I choose to ask my co-workers why they entered the field and if the concensus was that we were in a dying field.

This is what was gleaned from those answers. If you were looking for a job that was easy or paid like gold, then you should not choose health care. It is a battle to make sure funding is not cut by congress to cover Medicaid. And let's not forget malpractice insurace premiums and law suits.There are issues in all areas that cause frustrated healthcare workers, nurses, respiratory therapist, physcians, clinical techs, pharmacist, etc. to leave the field.

Over worked and understaffed hospitals with demands to do more with less. If you notice, there is a nationwide shortage for all of them. Look at the class size in our colleges. Our field is a fairly young profession, 1947, and we have grown each and every year. We have gone from pushing oxygen tanks to actually caring for patients. In the facility that I work, we are in every area of the
hospital, thanks to some very proactive management therapist. We have the CHOICE to work in the cath lab, surgery, pulmonary lab, research, development, radiology for sedations, management, accredition, sleep lab, any of the clinics, cardiac icu, trauma icu, general icu, general care, community education, hospital education, product evaluation, emergency department, asthma management,
transport,NICU, quality improvement, policy and procedure, and the list goes on. This facility offers an option that if there is a need, then you can go with it. We have a clinical ladder that recognizes that the more that you do ,the more you compensated for it.

We are not only compensated for "adding more letters to your name" but you are reimbersed for the exam. This facility does hire CRT with eligibilty for RRT, but the time limit is 6 months of hire and therapists are paid for those accomplishments. Not everyone likes this type of structure, that is a choice. What is amazing is the team work that exisits with a medical team..that includes
ALL diciplines. As for joining the AARC, that too is a choice. It is not a requirement for hire..and those of us that are "card carrying menbers that pay our dues" know that those who do not choose to be members benefit equally from the work done by the society. If you are happy with this, I support your decision.

I want to address my motive to provide the best care that I can and dispell the comment that I lied. In 1985, my first grandaughter was flown by Life Flight to Hermann Hospital in Houston. I was not involved in healthcare at that time. She was on life support for 2 weeks without a diagnosis for why she was so sick. For the length of time she was there, the care of the nurses and therapist was
above and beyond what we could have ever asked. That group of care givers, treated not only this baby, but, the family. We hung on every word, every facial expression,ever turn of the knob and hoped for any thing that would give us any hope. On the evening of
the 9th of April she died. Six weeks later, the autopsy report came with six words that would change my life: No reason why this child succumbed. My search as to why, in the best facility with the best care and the best phycicians, did she die. She died of Legionnaries Disease at 5 months of age...almost unheard of. I entered the Respiratory Care Program one year later. Mr. R----, at
no time did I consider that this would be just bettering my own place in life as you alluded to. Do I understand that we cannot save everyone? Yes...maybe in a perfect world. I resent the comment that you made, saying that you stand idly by and watch your patients
die. Those who cared for our baby did not stand by idly, they did all they could with the equipment, knowledge, and medicine available. My motive is to give back..all my patients deserve that, and if I cannot do that, then I need to leave the field. I admire and respect the staff that I work with and although I do not know all of them, there are over 100 therapist at this facility,
I know that their quality of care is the best. It is not the letters behind my name that motivates me, it is the fact that I choose a profession to care for those who are ill and they deserve the best that I can give, and that includes furthering my education to learn to continue to provide that care.

My question to you is what do you do that benefits this profession? What is it the shows that you continue to seek education that might show a better way to provide care. Do you take note when Congress has a bill up for a vote that might impact money provided for healthcare. If you think the AARC is "malicious", did you contact them to find out why? Is this the only forum that you chose
to vent your frustration over being unhappy in your field?
I will tell you that I support your decision to speak your mind and voice your opinions.

Jean DuBois, RRT/NPS
Children's Medical Center of Dallas
Dallas, Texas

My reply:
Ms. DuBois:

First thing, let me say I am sorry to hear about your granddaughter.

I never said you had malicious intentions for being in RT, nor did I say that looking for your own interests is a bad thing- but saying that you are simply looking out for the best interests of the field in which you are in is to deny that you are helping yourself (albeit while helping your patients).

By the way: I never went into the medical profession for an easy or well-paying job. And I don't believe we are standing idly by in a literal sense- rather in a figurative one; we have little we can do for our patients in many cases. It is the futility that drives me mad, and when added to the politics and bickering in the field that makes me want for a different aspect of health care.

It is not that I do not wish to see respiratory care advance, nor am I maligning how far we have come-I just see that there are many problems that are not being addressed in an appropriate fashion. The credentialing debate would be much better ameliorated by eliminating the CRT credential altogether, which I bet is the last thing you would expect me to advocate for. Personally I think it should be a field with one level of credentialing with specialty qualifications (specializations like nursing has currently). Speaking out against the AARC's lack of support and strategic vision in regards to maintaining those people we have and attracting new people to the field is not heresy or disloyality- dissent is the most honest form of patriotism. Things need to change if the field is to continue to grow.

As for what I am doing to improve myself and the level of care I provide, I present the following examples:

-Organizing a research project to evaluate the role of the ---------------- among COPD patients, as well as to determine the prevalence of psychological dependence --------------- among these same patients **EDITED TO PROTECT MY RESEARCH**

-Finishing up my AS in Respiratory Care so I can sit for my RRT credential (even though I will be no longer working as a respiratory therapist, I feel it's important that I sit for the test if I am possible simply because I am proud of my training as an RT)

-Completing a Bachelor of Science in Life Sciences (Cell biology emphasis),a Bachelor of Arts in Languages, Literatures and Linguistics (German linguistics emphasis), AND a Bachelor of Science in Psychology with the intention of attending dental school followed by a residency in oral and maxillofacial surgery (which will gain me my MD as well) with the intention of specializing in facial reconstructive surgery.

What else do you wish to see a person in my shoes do to further improve the already excellent level of care I provide?

On the matter of the bill before Congress, well, I'm sorry but the AARC speaking up about something in regards to profits for hospitals and funding for care, doesn't make up for their lack of support for the average therapist where it is most needed. Yes, they need to speak up about that bill, and I applaud them for that aspect of their activities, but it is one of the few nice things I can find about the AARC.

They are our union (or at least the closest thing that we have to one) and therefore they need to act like one- by listening to what the MAJORITY of therapists feel is best, not what is the opinion of an elite few and this means on all topics- not simply those which will benefit someone's or a group's bottom lines. And by the way, I feel that the AARC has become a puppet of the moneygrubbers at the NBRC in regards to credentialing and licensure issues; the fault lies more with the NBRC in a direct sense, guilt by commission, but the AARC is guilty by omission for not standing up for their constituents.

Have a nice day.

Sincerely and respectfully,




Stephen R.

 

[ISU_Steve]

And I must share the smart response I received from a fellow RT who has been following all of this (and to whom I forwarded the e-mail from Ms. DuBois, as well as my reply):

Hi Stephen:

Well, I read her follow up letter to you and it is much as I would have suspected. It's like disagreeing with the war in Iraq, no longer are you an American entitled to an honest difference of opinion, but an anti American terrorist loving Saddam hugging SOB! And now, you are also in the position of attacking a grandmother who lost her grand daughter, you animal you! You can't win when the other person is barreling along on emotion, reason tends to take a back seat. The real issues are left by the wayside and you have to navigate through the morass of intellectualized stupidity. This is a most difficult and unsatisfying way to proceed.

I would also be willing to bet a goodly sum of money, that virtually no "opportunity" she alluded to as open to RT's, is a separate and independent job title. I would be fairly certain that patient care is still your primary job, you get a patient load, so to speak, and do any of the other things on an "as time permits" type of arrangement, with very few exceptions. I do see where she left out a few other jobs open to the well trained RT, however. We keep our department clean by tidying up and even vacuuming, as needed, so that there is the all important Respiratory Housekeeping position. In ER when a patient is agitated, it is not uncommon to lend a hand, hence the equally important Respiratory Restraint professional. Again, people just can't seem to focus on the issues, but this is no longer a great surprise to me.

Also, you listed some of your major accomplishments and goals for the future. I can almost guarantee that, that info went in one ear and out the other. You may get a cursory, "nice job" type of comment back from her, but no real understanding of the passion you have for what you are doing and your dreams and hopes for what you can accomplish in the future. She happens to work for one of the very few hospitals in this country that may have a different pay scale based on your education, and this is good if it is so. But that is not the point, nor is that type of pay structure widespread, by any means. I have come to the same point as you in that the CRT credential should be eliminated and the RRT credential left as the sole credential. We will of course see that when the proverbial "hell freezes over" is realized! The only way the NBRC would voluntarily give up that kind of revenue is by doubling the cost of the RRT test, which Dubois wouldn't care about, since she gets reimbursed, or by coming up with a whole new layer of mandatory credentials, and I stress the word mandatory, in collusion with the AARC and State licensing boards.

Well, I've gotten kind of long winded, there are just so many facets to this whole issue. Making the process even more difficult is feedback like that from Dubois. She is so tightly encased in her little world that she apparently has lost the ability to see that not all people live in that world, governed by those rules. Thanks for sharing her letter. I look forward to talking with you again. Let me know how the letters are stacking up. Also, best of luck in your future goals.

Mike

 

[guetzow]

Try RN (Good management prospects) or Mid-Level Provider (Past clinical experience will serve you well). Avoid drug rep (To many burnout losers doing that, and there's massive layoffs afoot presently).

 

[ISU_Steve]

Thanks for the advice, but....I'm going to become a dentist (hopefully an oral surgeon or orthodontist).

 

[Lumbee.Dr]

Thanks for the advice, but....I'm going to become a dentist (hopefully an oral surgeon or orthodontist).

I truly fit into this thread. I am also an RRT, and I have worked in the NICU since the age of 19. I must admit that I was captivated by the field of respiratory therapy for the first couple of years. I thought I was rich bringing in $1200 every other week and working night shift was so cool. However, those feelings changed after my 2 sons were born. I gained a new perspective after missing many Christmas mornings with my family, falling asleep at Thanksgiving dinner, and turning into a real "B" due to my work schedule.

I started to feel as if the NICU was turning into a cruel joke. As many of you know, NICU therapist are now drawing labs, changing diapers, moving beds, and the list goes on. I am glad that I have moved on now.

In just 2 days, I am starting dental school. I finished my BS in Biology while working 36-hour weekend night shifts. It wasn't easy, but I don't regret it at all. Over the last 10 yrs, I have gained valuable experiences as a respiratory therapist, many that will help me in my career as a dentist. However, I really feel sorry for all of the intelligent minds that will retire from the field of respiratory therapy; they will miss out on a great world out there.

I will embrace my new career in dentistry, and I will adore the respect and family-friendly lifestyle being a dentist will give me. Thanks for this thread ISU_Steve, see you back on the other side.

 

[guetzow]

Way to go guys. I had a Navy RT buddy who went to dental school, too. Sounds like a trend.