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Different Hospital, Different Rules.

Posted Sep 11 2008 8:42pm
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....
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