I have been really thinking about this a lot. The AARC had assigned a task force for a thing called "Transitioning the Respiratory Therapist workforce for 2015 and beyond" where they held three conferences between 2008 and 2010. They decided a lot of things and one of those things was that the CoARC needed to abandon the AS and AAS credentialing of Respiratory Programs and only credential BS degrees.
I originally agreed with this, because it makes sense; a BSRT means that you are more prepared than an ASRT, right? Probably not, actually. There has been no difference in the clinical judgement abilities of AS vs BS new graduates that I have seen, but with a BS we do have more opportunity for advancement through management; which is cool.
I have decided the change needs to be in the ability of an RT to climb a clinical ladder. There needs to be a Masters degree and a Doctorate degree available to an RT, where there currently is not.
I propose these additional program developments available to RT's
Masters of Science in Cardiopulmonary Medicine
"Pulmonology Associate" or "Pulmonology Physician's Assistant"
* Credentialed by the CoARC and the AAPA
You would become a credentialed PA by the AAPA, and the school would be accredited by both the CoARC and the AAPA. Prerequisit would be a requirement to hold a BS and be a Registered Respiratory Therapist.
The scope of practice and prescriptionary allowance would be the same as a PA.
Doctorate in the Philosophy of Cardiopulmonary Medicine
This would not require additional credentialing other than the normal PhD program requirements.
The idea behind this would be a Philosophy in Pulmonology allowing for Research Scientist work or the ability to be a highly educated, educator.
Creating a clinical ladder would help the field a great deal and stop people from leaving to join other ladders that have better growth options.
Respiratory Therapy is a very unique profession, we are an interventionist like no other and cannot really be compared to any other profession without a great deal of exception.
A blog about Respiratory Care by a Respiratory Therapist
NICU week 2
I have been in the Neonatal Intensive Care Unit (Level 4, Research Medical Center) for two weeks now. Tomorrow is my last day of the two week run. I will be here for two more weeks and then I move to the Pediatric Intensive Care Unit, I dont know what level - whatever the highest level is probably...
I have had only around 30 total patients with around 8 needing real therapy over the course of the two weeks, but even that load is pretty heavy considering the acuity.
I don't know how I am going to write about the cases specifically, I am attempting to stay as anonymous as possible, but when I know everything about the patients and apparently I think the world revolves around me; I can't help but feel obvious about who I am talking about.
This is something I suppose I will have to have someone read as a 3rd party before publishing to this blog.
In the most general of terms, hopefully I will get brave and get more specific later; I have managed some jet ventilators, some nitric oxide therapies, oscillators and a lot of conventional ventilators. I have bagged a 500g baby and have gotten really good at a task im sure is overlooked, the capillary blood gas (CBG). The CBG is so humdrum its almost not even worth mentioning when asked what you've been doing for the last hour, but as a new therapist, I can't help but get excited when I fill my vial without any errors.
Vent Checks are okay, but I wish that there was a system in place for recommending a ventilator change. In acute situations, we are allowed (RRT only) to use clinical judgement to change ventilator settings to fit the need of the moment, but for general care when everything is fine except maybe a blood gas tweak, it would be nice to have a place to submit a suggestion for physicians to view when they round.
Giving report is hard when some receiving therapists want to know nothing really, and some want to act like the clinicians we're supposed to be. I have started to give a full clinician report every time and just deal with the eye-rolling. I can't get in trouble for being too-informative, at least thats my mantra for the week.
I know this was choppy but I wanted to log something.
Talk to you soon.
I have had only around 30 total patients with around 8 needing real therapy over the course of the two weeks, but even that load is pretty heavy considering the acuity.
I don't know how I am going to write about the cases specifically, I am attempting to stay as anonymous as possible, but when I know everything about the patients and apparently I think the world revolves around me; I can't help but feel obvious about who I am talking about.
This is something I suppose I will have to have someone read as a 3rd party before publishing to this blog.
In the most general of terms, hopefully I will get brave and get more specific later; I have managed some jet ventilators, some nitric oxide therapies, oscillators and a lot of conventional ventilators. I have bagged a 500g baby and have gotten really good at a task im sure is overlooked, the capillary blood gas (CBG). The CBG is so humdrum its almost not even worth mentioning when asked what you've been doing for the last hour, but as a new therapist, I can't help but get excited when I fill my vial without any errors.
Vent Checks are okay, but I wish that there was a system in place for recommending a ventilator change. In acute situations, we are allowed (RRT only) to use clinical judgement to change ventilator settings to fit the need of the moment, but for general care when everything is fine except maybe a blood gas tweak, it would be nice to have a place to submit a suggestion for physicians to view when they round.
Giving report is hard when some receiving therapists want to know nothing really, and some want to act like the clinicians we're supposed to be. I have started to give a full clinician report every time and just deal with the eye-rolling. I can't get in trouble for being too-informative, at least thats my mantra for the week.
I know this was choppy but I wanted to log something.
Talk to you soon.
a month in acute care
I recently completed a month rotation through general care / acute care. In pediatric respiratory therapy this means I spent every day working with Cystic Fibrosis patients. Respiratory Therapy with a Cystic Fibrosis (CF) patient is a big workload. While admitted to a hospital, a CF patient receives respiratory therapy 4 times (QID) a day. Each segment of therapy requires around 60 minutes of constant therapy and atention to the patient. Meaning if therapy is given appropriately, a single therapist can not take more than three CF patients during a 12 hour shift.
Treatments are just like I learned in school, except we have some additional rules that I probably just forgot. Typically a regimen goes like this: Albuterol MDI or nebulized, wait 10 minutes for proper peak onset, administer hypertonic saline (percentage is different per patient, but 7% is standard for most kids) and then administer 30 minutes of chest percussion. Vest therapy can be substituted for manual percussion and in both every 5 or 10 minutes stop the treatment to get good strong huff coughs to help mobilize the secretions even more. After percussion, Pulmozyme (Dornase Alfa) is given and then any add-on steroid treatments.
Other than CF kids, I had a series of nasotracheal suctioning and a lot of PRN treatments. Acute Care in pediatrics is incredibly busy, though even being so busy - I don't have any remarkable stories, other than I made friends with my CF kids and their families, it would be hard not to. I spend at minimum 3 hours with them every day and if the kid is a handful even more.
I started the Neonatal Intensive Care Unit last week, I hope to include some cool stories about that soon!
Treatments are just like I learned in school, except we have some additional rules that I probably just forgot. Typically a regimen goes like this: Albuterol MDI or nebulized, wait 10 minutes for proper peak onset, administer hypertonic saline (percentage is different per patient, but 7% is standard for most kids) and then administer 30 minutes of chest percussion. Vest therapy can be substituted for manual percussion and in both every 5 or 10 minutes stop the treatment to get good strong huff coughs to help mobilize the secretions even more. After percussion, Pulmozyme (Dornase Alfa) is given and then any add-on steroid treatments.
Other than CF kids, I had a series of nasotracheal suctioning and a lot of PRN treatments. Acute Care in pediatrics is incredibly busy, though even being so busy - I don't have any remarkable stories, other than I made friends with my CF kids and their families, it would be hard not to. I spend at minimum 3 hours with them every day and if the kid is a handful even more.
I started the Neonatal Intensive Care Unit last week, I hope to include some cool stories about that soon!
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