existentialism

I am deciding between a non-nurse to DNP program or an MD(or DO) program.

I feel like I need to do something else.  They've been cutting our jobs and cutting our hours and it makes me nervous for the future.

9 things I wish I could say to a candidate.

1. I want you to be likable.

2. I'm taken aback when you say you want the job right away.

3. I want you to stand out....

4. ...But not for being negative.

5. I want you to ask lots of questions about what really matters to you...

6. ...But only if the majority of those questions relate to work.

7. I love when you bring a "project."

8. I want you to ask for the job... and I want to know why. (I wouldn’t literally say “Can I have the job, but tell me WHY you want it.”

9. I want you to follow up... especially if it's genuine.  

To read the full article by Jeff Haden click the link below.

 http://www.inc.com/jeff-haden/9-things-you-wish-you-could-say-to-job-candidates.html

tragedy

my heart is broken for the families involved in this terrible tragedy.

Levels in Health Care

Job Description: Respiratory Therapist

Respiratory Therapists serve as a specialist in Respiratory Care and provide examination, diagnostic and treatment services for patients who have medical problems characteristic of this specialty, and including the more complex cases where symptoms are difficult to identify, treatment regimens involve use of prolonged or complicated procedures or new techniques, or where patient's condition is critical.

Serves as consultant in the field for physicians, nurses and other providers in this and other specialties.

Examine patients and provide care as prescribed or by established protocol.

Provide appropriate documentation.

transillumination

performed an emergency transillumination for the second time ever and first time alone today.

confirmed pneumothorax

inserted chest tube into 5th intercostal space

pneumothorax corrected.

Before you yell at a Respiratory Therapist...

Before you yell at a Respiratory Therapist consider that you may in the future need to yell for the Respiratory Therapist.

one line stories

I have a very intimate relationship with ketamine.  Trust me when I tell you those sighs are normal.  I am proud of you for recognizing them, no one has noticed them for the past 100 sedations.

The Ten Commandments of Respiratory Care

1. Thou shalt answer all STAT pages within one (1) hour.
2. Night shift workers shall end their naps at least five (5) minutes before day shift arrives.
3. Stand not before the open ET tube, lest the wrath of glob be upon you.
4. Thou shalt refuse to perform anything termed "pulmonary toilet".
5. Thou shalt not take the name of ones obnoxious patients, coworkers or supervisors in vain.
6. Thou shalt never rush to fulfill a STAT incentive spirometry order.
7. Thou shalt not suggest Bi-PAP or serial ABGs on DNR patients.
8. Thou shalt always show up to work with a pen, stethoscope, watch and clean lab coat.
9. Thou shalt alays have someone "bag" during circuit changes, no matter how fast thy thinks thy are.
10. Thou shall not answer to "Hey Respiratory", or otherwise adulterate thyself.

Get the flu shot

Don't be a dingus.

Please act like you have the academic degree you're supposed to have.

Lets review the literature.

http://www.ncbi.nlm.nih.gov/pubmed/22463979

http://www.ncbi.nlm.nih.gov/pubmed/20971112

Scope of Practice FAQ

This is a general FAQ for the Scope of Practice of a Respiratory Therapist.  Obviously some states do not allow some RTs to do things and allows others to, and some states allow RTs to do literally anything.  Scope of Practice hinges on Education Preparation/Personal Competency, Legal Allowance and most importantly for an RT is the 3rd part which is institution allowance.  An RT may not be permitted to perform these skills at their institution but this list is a demonstration of what is a standard scope for an RT.

Respiratory Therapists:

• Administer medications including narcotics.
• Diagnose acute emergencies using diagnostic tools (ie pneumothorax)
• Insert chest tubes
• Perform a chest decompression
• Maintain a patent airway by the most appropriate means (Intubate, etc)
• Start IV, Arterial or central accesses (all access, including IO)

im still here

I am still here.  Studying for my MCAT.
I need to tell more stories, but I am sleepy.
Maybe I will think of one to tell today.

an excerpt from a cover letter

In an application for a Registered Respiratory Therapist availability this was the second line:

"My Associate of Applied Science in Respiratory Care will benefit me in my job as a Respiratory Therapist"

Good job slugger.  I wouldn't call the minimum degree something that will add "benefit" your practice.

Bridge Programs

I have seen this topic come up over and over and I wanted to share with you bridge programs for advancing your career.

Physician Assistant to MD Bridge Program

Lake Erie College of Osteopathic Medicine
Doctor of Osteopathic Medicine 

Respiratory Therapist to Nurse Practitioner

coming soon

Respiratory Therapist to Physician Assistant

coming soon

Respiratory Therapist to Registered Nurse

Miami-Dade College
Associate of Applied Science in Nursing (Bridge)

Respiratory Therapist, Registered Nurse, Physician Assistant to Paramedic

Brookhaven College
Dallas County Community College District
NREMT-P

Lets change the world.

I think that I think too much.  I have always had a problem trying to make everything I am involved in better or more efficient or more fair or cleaner or whatever.  I always try to improve things.  I can't help but do it, I dont know why. 

So it has been a very interesting time in this profession.  Respiratory Care and all that.  I think we have a problem with trying to copy other structure without really even looking at our own.

This is targeted toward Respiratory Therapists, so I am assuming you already understand our structure.

I think our new structure should be

Respiratory Therapist.

end of structure.

It is silly to have a hierarchy.   I think that the RRT examination should be entry-level from here on out.  All CRTs and RRTs should be consolidated into RT and CRT/CRTTs should be grandfathered into the program.  We will require the RRT to become called an RT at all but those currently in practice should just be lumped in with the RRTs. 

Doing this will help clarify our roles, since they aren't much different.  It will help streamline legislation and policy.


We could change our entire title to Respiratory Practitioner, insinuating a clinical emphasis and direct practice.

We could still have alphabet soup if we wanted to, but it might be cleaner.  John Smith, RP, SDS or Jan Smith, RP, NPS

Also, with this I would suggest the requirement of a Bachelor of Science in Respiratory Care as the additional minimum entry-level.  Obviously all of the Associate Degrees would be grandfathered in as well.

This helps ensure quality of practice and as a beneficial side effect it stops the over-saturation of our profession and stops it being viewed as a temporary job that's easy to get certified for.

Proud to be a Respiratory Therapist

a quick story

I was giving a baby a breathing treatment with a dragon-nebulizer mask last night and she made a raptor roar and I said "aww you're a little dinosaur baby, rawrrrr!" and her dad said "No, she's not."

I let out an awkward giggle and then finished up, when I did my followup assessments I was happy her dad was asleep.  How awkward.

Maybe he didn't realize why I said that and he thought I was being really weird and rude.

Pulmonological Terminology

I have a nasty habit of giving things names that are unconventional.  I think I either developed it because I work in pediatrics, or I had it already and it made me better suited for pediatrics.  I thought I'd share with you some of my official terminology.

• Wiggs - Chest Wiggle Factor, High Frequenty Oscillator Ventilation wiggle
  "We've got good wiggs"
• O's - Oxygen FiO2
  "Slammin' him with O's!"
• Boogz - Secretions
  "I got out some nasty yellow thick boogz" or "Do you think he might need suctioned more?" "nah, I havent gotten a single boog out all night"
• Cards - Cardiology
• Surf - Surfactant
• Poop-face - The angry face a baby makes as it brady's itself down having a poop
• Brewing-a-poop - tummy grumbles prior to a poop.
• Tummy-grumps - Tummy grumbles!
• Grumps - Grumpy kid!
• Pterodactyl - a certain angry sound neonates make
• Raptor roar - another type of angry sound neonates make

Code in Unit B

I received a text page on my pager "Code in Unit B".  Usually they hit the code button which calls RT and the MD.  I suppose it wasnt working, so they text paged us.

Oh how weird to get that text page and see the doctor running full throttle passed our office.

Home nebulizer

A Resident calls me and says "Hey, so I have this kiddo in room 8 who sounds pretty bad, could you take a listen and see what you think?  If you agree we can probably start him on a continuous albuterol or something.  I don't know if you can but the Mom also asked if you could look at her home nebulizer because it wasn't working earlier"

I say "Yeah, I will go ahead and take the stuff in there for the albuterol neb.  I don't know if I can help with the home nebulizer, thats really something she needs to ask her pharmacist or home-supply company about"

He replies "Yeah, I figured, but maybe its something simple"

"Okay, Ill be right over there"

I go over, this kid is having such a hard time I give him almost a max-respiratory-distress score, start the continuous nebulizer and then look at the home nebulizer machine.

I plug everything in, put some normal saline in and it immediately begins misting.

Mom says "Wow! I didn't know there was a button on the side to turn it on!"

I handle the situation gracefully and full of tact and then go talk to the resident about positive pressure for the kiddo and let him know I fixed the home nebulizer.

Meconium?

I have been reading some other blogs and I like their short-post technique.  I feel like maybe I won't have this urge to write something instructive or educational or big and long and boring if I copy them.  So I am.

I get called to a code-blue in labor and delivery the other night.  I am hauling balls into the room with a nurse and there is a non-responsive baby just hanging out in the isolette all alone.  The L&D nurses are with mom and dad and the midwife or OB or whoever is looking at us bust in.

We immediately begin resuscitation, I bag and then suction and subsequently intubate.

The Neonatology Attending is not just an attending, he is a professor, not associate or assistant professor but senior Professor of Neonatology.

He walks in during the intubation, gets like an inch from my face and says in a very thick Indian accent

"This is weird right?, This is not normal?"

He moves away and I don't respond because I know him, I know its rhetorical, and I am sort-of busy.

We throw the baby into a transport isolette and we rocket off to the NICU.

We get to the NICU, which is only down the hall a bit, and I have a nurse bag while I hook up a ventilator.

When setting my ventilator settings the Attending asks me what I am setting, and just nods at me.  I draw a gas and another RT takes it to the lab to run it.  The other RT said the Attending followed her to the lab and asked why it was taking so long to run the gas about every 5 seconds, while a countdown was on the screen.

The Attending returns with the RT, who hands me a copy of the gas and I say to the nurses and doctors "7.18/72/22/base -11".

The Attending immediately starts reading the numbers again

"SEVEN ONE EIGHT, SEVENTY TWO... IS NO ONE LISTENING? NO ONE CARES? NO ONE CARES ABOUT THIS BABY? NO ONE CARES."

After being scolded by the Charge Nurse, (and there are not many people more intimidating than a Hardcore NICU Charge Nurse) he apologized and offered to get us all sandwiches and then laughed like buying us sandwiches is some sort of inside joke that he forgot we weren't a part of.

For the rest of the night, "This is weird right? This is not normal" became our slogan.

Interviewing tips

I have been tasked with helping run a peer interview team for the least few weeks.

I have never interviewed anyone professionally, though I do admit I have been the interviewee 50-100 times for various volunteer agencies, jobs and for school; so I have some experience in being in the other seat.

 This experience may cause my advice to not be the most normal advice you typically get in a "column" or an article, but I think my perspective after interviewing around 30 candidates will help out.

 Tips that will absolutely help: 

1. Make sure your resume and application have no type-o's
2. Do not use the Microsoft Word Resume Template, everyone does.
3. After the interview, send a followup Thank You email to everyone you interviewed with.
4. Dress in business formal (This means a suit for men, formal wear with closed toe shoes for women)
5. Understand the interview you're in and try to answer questions for the interview, an interview with a hiring manager is about you being psychologically stable and not a murderer or a thief.  An interview with an educator is if you're able to be taught. An interview with a peer-interview-team is to see if you are a narcissist and willing to throw yourself under the bus instead of everyone else.

 Resume specific tips: 

1. Include a list of your skills and rate them on "Entry" "Intermediate" or "Expert" level. Entry is okay on everything, mostly the interviewer will be impressed you outlined a list of skills. 
2. Do not include "REFERENCES UPON REQUEST" anywhere on the resume.
3. An "OBJECTIVE" paragraph is not necessary.

An example outline for a resume for a Respiratory Therapist:

1. [Name]
2. [Education]
3. [Experience]
4. [Clinical experience if a new graduate]
5. [Certifications and Licenses, with active and expired dates and numbers]
6. [Skills and proficiency]
7. Other notes: save in PDF format and don't worry if its 2-3 pages long, its expected in healthcare to have a huge resume.

An example process

1. Application to job
2. Followup e-mail and phone call to "touch base"
3. Interview
4. Followup thank you e-mail.
5. 7 day followup phone or e-mail
6. 14 day e-mail
7. Upon a bad-news letter, e-mail with a "thank you for your time and please keep me in mind e-mail"

Become a Respiratory Therapist

The BECOME series is a very straight forward set of articles on this blog setup to outline the general process for becoming eligible to practice in a profession.  This advice is accurate to the best of the authors knowledge.

Bachelor of Science in Respiratory Care

1. Take the ACT or SAT or college specific entry-level placement examinations
2. Apply to a College or University that is accredited by the Committee on Accreditation for Respiratory Care.
3. Once accepted, apply to the Division/College of Respiratory Care.  Sometimes this requires that you have taken 1 year of freshmen courses as "pre-requisite" courses in order to be accepted. 
4. Take pre-requisite courses as outlined by the degree curriculum.
5. Once accepted to the Division of Respiratory Care, complete the course-work as outlined.
6. Graduate with an Associate of Science in Respiratory Care, a Bachelor of Science in Respiratory Care or a Master of Science in Respiratory Care.

After Graduation

1. Apply for the National Board for Respiratory Care (NBRC)  Entry Level Examination
2. Once you've passed the Entry-Level examination, you are a Certified Respiratory Therapist.  A CRT is eligible to sit for the NBRC Advanced Practice Examinations
3. Apply for the Written Registry Examination and Clinical Simulation Examination
4. Once you've passed the Advanced-Practice examinations, you are a Registered Respiratory Therapist (RRT) You may apply for a state or regional license to practice.
5. Some states allow a RT to be a CRT but most require an RT to be a RRT in order to apply for a state license.
6. A Respiratory Therapist with a University degree, registered by the NBRC, and licensed to practice is now a "Respiratory Therapist" and may practice respiratory care in the place they are licensed.

Professional pathway is accurate as of May 30, 2012.  This is United States specific.

S B A R - Patient signoff

S - Status
B - Background
A - Assessment
R - Recommendations/plans

Examples:

S - Patient is intubated with a 3.0 @ 7(lip) ventilated in PC-IMV, 15/5 +5 f40

B - 27+2 week 2 month old neonate, apgars were 0,1,1. Last gas was 7.33/44/80/24 with a Lactate of 1.1. We also have tracheal stenosis, PPHN, sp VA-ECMO.

A - CTAB, frequent suction is required and the secretions are white+frothy

R - Ventilation status is going to remain because we're going to OR on Monday and then we're just waiting on weight-gain.

A Day in the Life of a NICU RRT

18:33 - Arrived in parking garage and begin walking briskly toward the hospital.

18:42 - Clocked in at first available time-clock.

18:46 - Walked into the 5 minute team-meeting announcing new practices and mistakes to avoid.

18:55 - Arrived in the NICU respiratory office, dropped off backpack and begin taking SBAR report on all 70 patients.

19:15 - Signoff/report is interrupted several times for various reasons.

19:30 - Report is finished and the 70 patient assignment is split between two respiratory therapists using ventilators as major acuity guides.

19:30 - I am called stat to initiate a high frequency oscillator and inhaled nitric oxide on a patient.

19:45 - I am notified of 2 patients going to MRI on ventilators

19:47 - I call house supervisor to have coverage for the transport.

20:00 - I am called stat to patients room to change ventilator from high-frequency oscillator (HFV-A) to high-frequency jet (HFV-P).

20:10 - Transfer complete to HFV-P.

22:20 - I am called stat to bedside. Upon arrival discover patient arresting, code called entire medical team works to revive patient.

23:10 - Code is stopped.

23:20 - I am called to patient bedside for loose endo-tracheal tube. Retaped tube without incident.

00:00 - Called stat to OR-2 for twin c-section

01:25 - Called stat to Labor and Delivery 9 for meconium

02:00 - Lab machine goes into self-calibration setup, so all gases are tubed to another unit to be run.

03:00 - Still waiting on machine to come into service, been cleaning up the lab with no calls.

04:00 - Lab machines are still down, check all ventilators with no discrepancies, no issues.

05:00 - Lab machines come back up, just in time for 5am gases.  Draw and subsequently run 35 capillary gases.

06:00 - Prepare signoff report to oncoming Respiratory Therapists

06:50 - 4 Relieving RRTs arrive to take SBAR report.

07:36 - Clock out and head out to the parking garage.

Aimee Fortney's spicy Caribbean fish sandwiches

Youcan make these as spicy as you desire with 1 or 2 habanero peppers! So easy and so very yummy!

Place the following ingredients in food processor:

1 large clove of garlic
1 habanero pepper, stem removed (if you like things really hot, use 2 habanero peppers)
1 small carrot, quartered
1 bunch cilantro
1 small sweet onion, quartered

Remove mixture from food processor and place in a large bowl.

Add 1 pound Tilapia, to food processor and pulse to very small pieces.

Remove Tilapia that has been pulsed and add to vegetable mixture. Next add:
1 teaspoon ground black pepper
1/4 teaspoon cayenne pepper
dash of ground cumin
1 beaten egg
1 cup bread crumbs

Stir to mix well.

Heat your griddle, skillet or cast iron skillet to medium heat and spray with cooking spray. Use an ice cream scoop to form sandwich, then cook on griddle or cast iron skillet for a 3 to 5 minutes on each side until cooked. (The vegetables being chopped so small in the food processor help them to cook faster). The cilantro lime cream sauce really helps "tone down" the heat.

Buns of your choice

Serve with Cilantro Lime Cream Sauce:

1 cup sour cream (or Greek Yogurt)
1 large lime
1 bunch cilantro
pinch of salt and pepper

Pulse sour cream (or yogurt), lime juice, zest of lime and cilantro in blender. Add pinch of salt and pepper to taste.

Neonatal & Pediatric Transport

Recently I was asked to join the neonatal and pediatric transport team. This team goes all over the world, but most usually all over the region to pick up high-risk neonates and general pediatric patients where the facilities are not comfortable with the patient. It is very interesting. I hope to have some more things to say soon!

Golf Terminology

I have recently begun playing golf.  A sport I thought I would hate because I get very bored very easily.   This blog is a perfect example. :-)  I promise to start posting more often, but until then, check out some terminology!

It is also very important for Respiratory Practitioners to be able to at least accept invitations from executives to golf outings!  So here ya go!


Abnormal Ground Conditions: An abnormal ground condition refers to any casual water, ground under repair or hole, cast or runway on the golf course which has been made by a burrowing animal, reptile or bird.

Ace: You are said to make an 'ace' when you sink your ball in one shot on a par 3 hole.

Address: The way that a golfer positions his or her body immediately before hitting the ball. Every golfer has his or her own unique address.

Alignment: The way that you position the clubface and line up your body at the address.

Amateur: Golf players who play competitive golf but who do not play for prize money. In order to earn prize money from golf tournaments, a player has to compete as a professional.

Approach Shot: A shot which aims to place your ball on the green area.

Away: You are said to be 'away' when you are the farthest distance from the hole.

Baby Shot: A shot which is much shorter and softer than would normally be expected from a club which is ordinarily used for that shot.

Back Nine: The second half, or last 9 nines holes, of an 18-hole course.

Backspin: A reverse spin on a golf ball which has been hit towards a target.

Backswing: The initial part of the golf swing which finishes as the club stops moving above your head in preparation for the downswing.

Balata: A type of tree sap which was formerly used the manufacture of golf ball covers.

Ball In Play: A ball is in play as soon as a player makes a stroke on the teeing ground and remains in play until it is holed, except when it is lost, out of bounds or lifted, or another ball has been substituted, whether or not the substitution is permissible. A ball which is substituted becomes the ball in play.

Ball Marker: Any small flat object which is used to mark the position of your ball when it is on the green.

Ball Mark Repair Tool: A fork-shaped tool which is used to fix marks made when your ball lands on the green.

Baseball Grip: A specific grip used to hold the club in which all 10 of your fingers remain in contact with the club grip.

Best Ball: A golf game in which the better score from a 2-person team is counted.

Birdie: You are said to make a 'birdie' when you sink your ball in one less shot than the par for a specific hole. For instance, if the hole is a par 4 and you sink your ball in only 3 shots then you have made a birdie.

Blade: A term which can be used as both a noun and a verb. As a noun it is used to describe the club head of an iron. As a verb it refers to hitting the ball on its equator with the bottom of the blade.

Blocked Shot: A blocked shot occurs when a ball is hit straight ahead by a right handed golfer but then sweeps to the right of the intended target.

Bogey: You are said to make a 'bogey' when you sink your ball in one more shot than the par for a specific hole. For instance, if the hole is a par 4 and you sink your ball in 5 shots then you have made a bogey.

Break: When you are putting on the green and your ball begins to turn, the term break is used to refer to the amount of turn which occurs.

Breaking Down: The term breaking down refers to the movement of your wrists as you bend them while putting.

Bump & Run: As the name suggests a bump and run describes a ball which is hit into the air flies towards the target and then 'bumps' into the ground and 'rolls' the rest of the way towards its target.
Bunker: A bunker is a hazard area which is filled with sand in his usually sited near the green or on the fairway.

Caddie: Caddies are individuals who are paid to carry your golf clubs around the course for you and who are also able offer advice on how to play the course.

Carry: The carry is a term which refers to how far your golf ball flies through the air.

Cart: A golf carts can either be a small vehicle which players use to drive around the course or a small dolly which travels on 2 wheels and is pulled manually.

Casual Water: Casual water refers to puddles of water which have accumulated on a course as a result of rain, as distinct from designed water hazards on a course.

Cavity Back Iron: A cavity back iron is a particular type of iron which has the majority of the club head's weight distributed around its perimeter. The back of the club head is basically just a large cavity and this helps to reduce the mass in both the center and the back of the head, thereby creating a bigger head and a larger 'sweet spot' on the face.

Certified PGA Professional: A certified PGA professional golf player is any individual who has attained or exceeded the golf teaching standards of the Professional Golfer's Association of America.

Check: A check refers to the action of the golf ball as it stops rolling as a result of the amount of backspin on it.

Chip: The chip is a shot that is normally played from just off the green.

Closed Face: A club face is described as being 'closed' when it points to the left of the target (This term is normally applied to right handed golfers).

Closed Stance: A closed stance refers to a stance in which your body alignment is facing to the right of your intended target (This term is normally applied to right handed golfers).

Club Face: The club face is the bottom part of the golf club which makes contact with the ball.

Clubhouse: A clubhouse is normally an indoor area located on a golf course which provides services such as the golf pro shops, restaurants, restrooms and sometimes conference rooms.

Collar: The collar, which is similar to a fringe, is the strip of grass which runs around the green and which is usually longer in length than the grass on the putting surface.

Coming Over The Top: Coming over the top is a phrase used to describe the movement of the club as it travels through the downswing and into a right-to-left pathway across the ball (for right handed golfers). Another term sometimes for this movement is the out-to-in blow.

Compression: Compression refers to the squeezing in of a golf ball when it is impacted by the head of a golf club.

Course Rating: Every golf course is given a rating which refers to the degree of difficultly of the course. The higher the course rating, the more difficult the golf course is to play.

Crossed Over: Crossed over is the term which describes the shaft of a golf club when it is at the top of the backswing and facing towards the right of the target (for right handed golfers).

Cross Handed: A 'cross handed' grip is a specific putting grip in which the left hand is positioned below the right hand (for right handed golfers).

Cup: The cup is simply another word the hole in the green which is the ultimate target for the golf ball.

Cupped Lead Wrist: A cupped lead wrist refers to a backward bend in your lead hand when you strike the ball. The lead hand is the hand which is nearest to the hole once you are set up for your swing. (For a right handed golfer the lead hand is the left hand)

Cut: A cut is another term for a shot which bends towards the right (for right handed golfers).

Deloft: 'Delofting' a club is simply decreasing the amount of loft on the club face by tilting your club shaft in the direction of your target.

Dimple: Dimples are small indentations which cover the surface of a golf ball.

Divot: A divot is a small piece of turf which is removed by your golf club when you hit a ball. Divots should be repaired (replaced) as a matter of basic golf course etiquette.

Dogleg: A 'dogleg' refers to the curved pathway (right or left) from the tee to the cup.

Double Bogey: You are said to make a 'double bogey' when you sink your ball in two more shots than the par for a specific hole. For instance, if the hole is a par 4 and you sink your ball in 6 shots then you have made a double bogey.

Double Eagle: The double eagle describes the completion of a hole in 3 shots under par.

Downhill Lie: A downhill lie refers to a stance in which your front foot is below your back foot when you are addressing the ball.

Draw: A draw describes a shot which bends to the left (for right handed golfers).

Drive: The drive is the initial shot on each hole which is taken from the tee.

Driver: The driver is the longest club in your golf bag and is the club which gives you greater distance than any other golf club.

Driving Range: A driving range is an off-course facility which is designed to allow golfers to practice their swing. Driving ranges has individual 'booth-like' areas from which you can practice hitting balls as long and as far as you want. In some cases driving ranges also have areas for you to practice your short game.

Drop: A drop is the practice of returning your ball to the course by dropping it onto the playing surface after it has been hit out of bounds or into an area from which it is unplayable.

Duff: To duff is simply to miss or totally mess up a shot.

Eagle: You are said to make an 'eagle' when you sink your ball in two less shots than the par for a specific hole. For instance, if the hole is a par 5 and you sink your ball in only 3 shots then you have made an eagle. You can also 'eagle' a par 3 hole but, in this case, you are said to have made an 'ace'.

Executive Course: An executive course is a small 9-hole par 3 course that can be played in under 2 hours.

Explosion Shot: An explosion shot is a bunker shot which sends an 'explosion' of sand flying through the air.

Fade: A fade is a shot which sends the ball veering slightly to the right (for right-handed golfers).

Fairway: The fairway is the entire in-bounds distance which runs from the tee to the green and which is kept neatly trimmed.

Fat: A 'fat' occurs whenever your clubface strikes the ground before hitting the ball.

Flagstick: The flagstick is the flagged pole that rests inside the cup to mark the position of the hole on each green.

Flex: Flex refers to the amount of bend within the shaft of a golf club.

Flier Lie: A flier lie is the lie that you have after you take a swing and too much grass comes between the ball and your clubface. This also has a tendency to reduce the amount of backspin on the ball.

Flop Shot: This is a form of pitch shot which shoots the ball high up into the air after which it falls short and lands softly.

Follow Through: Having taken your swing and made contact with the ball, the 'follow through' refers to the subsequent movement of your club and your body.

Forecaddie: A forecaddie is an individual employed by the Committee to indicate the position of balls to players during play and is an outside agency.

Fore: The word 'fore' is shouted loudly as a warning signal when a ball is hit and heading in the direction of another player.

Forms of Match Play:

• Single. A match where one player plays against another player.
• Threesome. A match where one player plays against two other players and where each side plays one ball.
• Foursome. A match where two players play against two other players and where each side plays one ball.
• Three-Ball. Three players play a match against one another with each playing his own ball. In effect, each player is playing two distinct matches.
• Best-Ball. A match where one player plays against the better ball of two other players or the best ball of three other players.
• Four-Ball. A match where two players play their better ball against the better ball of two other players.

Forms of Stroke Play:

• Individual. A competition where every competitor plays as an individual.
• Foursome. A competition where two competitors play as partners and play one ball.
• Four-Ball. A competition where two competitors play as partners with each playing his own ball. The lower score of the partners is taken as the score for the hole. If one partner does not complete the play on a hole then there is no penalty.

Fringe: The fringe is a collar of grass which surrounds the green in which the length of this grass is typically shorter than that of the fairway but longer than the green itself.

Front Nine: The first half, or first 9 nines holes, of an 18-hole course

Gimme: A 'gimme' occurs when your ball lies on the green so close to the hole that your playing partner does not require you to actually hit the ball in.

Glove: Golfers typically wear a glove on their lead hand to help their grip.

Grain: The grain refers to the direction in which the grass on the green is growing.

Green: The green area is a closely mowed area on which the hole is situated. It is also referred to as the putting surface.

Green In Regulation: This is a term used for getting your ball onto the green in one shot on a par 3 hole, in two shots on a par 4 hole, or in three shots on a par 5 hole.

Greens Fee: This is the sum of money charged for playing a round of golf.

Grip: The grip refers to either the manner in which you hold your club or the rubber covering on the shaft of a club where you place your hands.

Grooves: Grooves are the etched lines on the face of the club which are designed to help you to put the desired backspin on the ball.

Ground Under Repair: Ground under repair refers to any part of the course marked as such by order of the Committee. All of the ground (and any tree, bush, grass or other growing thing) within the ground under repair are deemed to be part of the ground under repair. Ground under repair includes such things as material piled for removal or a hole made by a greenkeeper. Grass cuttings and other similar material left on the course which have been abandoned and which it is not intended to remove are not considered to be ground under repair unless so marked.

Handicap: A handicap is a system of adjustment to the score system so that golfers of different skill levels can compete with one another without the better players dominating the game.

Hard Pan: Hard pan refers to areas of ground on the golf course that are extremely hard-packed.

Hazard: Hazards are area of the golf course (typically sand and water) which are designed to make life difficult for players.

Hole: The hole (or cup) is the ultimate target for the golf ball on each hole.

Holed Out: A player is said to 'hole out' when his ball enters the hole.

Honor: To be 'given the honor' is to be granted the privilege of playing first within your group.

Hook: A hook shot is a shot which bends to the left (for right-handed golfers).

Hosel: The hosel is the part of the clubhead which attaches it to the shaft of the club.

Impact: Impact refers to the moment at which that you hit the ball and the clubface 'impacts' the ball.

Impediment: An impediment is loose debris around the ball which is obstructing your shot and which can be moved away from your ball.

Interlocking Grip: This is a form of grip in which the index finger of one hand is 'interlocked' with the small (pinky) finger of the other hand.

Iron: An iron is a club which uses a metallic blade for the clubhead. Most golfers carry in the region of 8-10 irons which range from a number 2 iron to a sand wedge. Each club is designed to provide a different degree of loft on the ball.

Lag Putt: A lag putt is a long putt the goal of which is to have the ball stop within a short distance (typically 2 feet or less) of the hole.

Laid Off: This occurs when the club shaft is pointing to the left of the target at the top of the backswing (for right-handed golfers).

Lateral Water Hazard: A lateral water hazard is a water hazard or that portion of a water hazard which is situated so that it is impossible, or impracticable, to drop a ball behind the water hazard. All of the ground and water within the margin of a lateral water hazard are considered to be part of the lateral water hazard.

Lay Up: This term refers to a shot which is deliberately intended to fall short of the green in order to avoid getting into trouble.

Lie: The lie is the position of your ball following a shot and, in particular, refers to the condition of the ground in the area in which the ball has landed.

Line of Play: The line of play is the direction which a player wants his ball to take after playing a stroke, together with a reasonable distance on either side of the intended direction. The line of play is considered to extend vertically upwards from the ground, but does not however extend beyond the hole.

Line of Putt: The line of putt is the line that a player wants his ball to take following a stroke on the putting green. The line of putt includes a reasonable distance on either side of the intended line but does not extend beyond the hole.

Lip Out: A lip out occurs when the golf ball travel right up to the hole and teeters on the edge of the cup but, instead of dropping into the hole, rolls back from the hole.

Loft: Loft can refer to the angle that the head of a golf club with the ground and to the relative height to which a particular club will hit the ball.

Loose Impediments: Loose impediments are natural objects including leaves, twigs, branches, stones, dung, worms and insects (and the casts and heaps made by them) which are not growing or fixed, solidly embedded or ahering to the ball.

Lost Ball: A ball is said to be lost if:

• It is not found (or identified as his) by the player within five minutes after the player, his partner(s) or caddies(s) have begun to search for it.
• The player has hit a provisional ball from the spot where the original ball is likely to be or from a point nearer the hole than that place.
• The player has put another ball into play under the penalty of stroke and distance.
• The player has put another ball into play because it is known or almost certain that the ball has been moved by an outside agency, is in an obstruction, is in an abnormal ground condition or is in a water hazard.
• The player has made a stroke at a substituted ball.

Marker: A marker is an individual who is appointed by the Committee to record a competitor's score in stroke play. A marker may be a fellow competitor. The role of the marker is solely to record the competitor's score and he is not a referee.

Matchplay: This term refers to the original manner in which golf was played, which was on a hole-to-hole basis. The player with the lowest score on the first hole is the winner of that hole and goes 'one up'. If that player is then the winner on the second hole then he goes 'two up' and this scoring pattern continues for each hole thereafter. Should you lose a hole then you go 'down one' and if a hole is tied you then 'halve' the hole. The outcome of the matchplay is decided by how many holes you are either up or down by in relation to the number of holes left. For instance, if you are 4 up with only 3 holes left in the game then you are the winner of the match.

Mulligan: A mulligan is an illegal second attempt at a shot which went wrong.

Municipal Course: This is a golf course which is both owned and operated by the local authority and is also often referred to as a 'muni'.

Nuked Shot: A nuked shot is a shot which is hit far harder and longer than you would normally hit the ball with a particular club.

Nearest Point Of Relief: The nearest point of relief is the reference point used for taking relief without a penalty from interference by an immovable obstruction, an abnormal ground condition or a wrong putting green.

Neutral Grip: This grip is one in which a right-handed golfer is able to see 2 knuckles of the left hand when looking down at the grip during address.

Neutral Stance: This stance is one in which both feet are in line and parallel to the target line.

Observer: An observer is an individual who is appointed by the Committee to assist a referee in deciding questions of fact. An observer is also responsible for reporting any breach of a Rule.

Obstruction: An obstruction is anything which is artificial (including the artificial surfaces and sides of roads and paths and manufactured ice) except:

• Objects defining out of bounds areas, such as walls, fences, stakes and railings.
• Any portion of an immovable artificial object which is out of bounds.
• Any construction which is declared by the Committee to be an integral part of the course.

An obstruction is said to be a movable obstruction if it can be moved without undue effort, without overly delaying play and without causing damage.

Open Face: The club is said to have an 'open' face when it is aligned to the right of the target line (for right-handed golfers).

Open Stance: This stance in one in which your body alignment points towards the left of the target when set up (for right-handed golfers).

Out-of-Bounds: This is the area which is outside of the course and which is often marked with white stakes.

Out-to-in Blow: This term is simply another way of saying 'Coming Over The Top' which describes the movement of the club as it travels through the downswing and into a right-to-left pathway across the ball (for right handed golfers).

Outside Agency: In match play, an outside agency is any agency other than either the player's or opponent's side, any caddie of either side, any ball played by either side at the hole being played or any equipment of either side. In stroke play, an outside agency is any agency other than the competitor's side, any caddie of the side, any ball played by the side at the hole being played or any equipment of the side.
An outside agency includes a referee, a marker, an observer and a forecaddie. Wind nor water are not considered to be outside agencies.