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June
2009—Issue 2
Editor House of Delegates Officers: Thomas Lamphere, RRT,
RPFT Dawn Rost, BS, RRT / Secretary Debra Skees Frank Salvatore, Jr., BS,
RRT, FAARC |
In This Issue... | |
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Time To Step Up “Call Me, Send Moohlah Moo– Affiliate Best |
Camden J. McLaughlin
Tom Lamphere Sandra McCleaster Dawn Rost
Gerald Ebert Debra Skees
Ken Thigpen Frank R. Salvatore Jr. Ed Thomas |
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Speaker’s Report Camden J. McLaughlin Becoming a leader is a lot like investing in the stock market, writes John Maxwell. If you hope to make a fortune in a day you are doomed. It’s what you do day by day, over the long haul, that matters most. If you continually develop your leadership, letting your “assets” compound over time, the investable result is growth. I am excited about the opportunity to serve as your Speaker and look forward to following in the heritage of my great predecessors. I know that I will learn from your leadership along with our House Officers. and will appreciate your strength, vision, and particularly your experience. Time is fast approaching for the 31st annual Summer House of Delegates meeting at Marco Island, July 20–21. The House Officers and I have begun to develop the initial agenda for what we hope will be a useful and productive meeting. Business will be conducted as usual with committee reports, resolutions and certainly discussions of current issues. Keep in mind that the summer meeting (and only this meeting) is when House Officer nominations are taken and voted on in at the fall House meeting. Additionally nominations for AARC Bylaws and Elections Committee will be taken at both the summer and fall House meetings. As always there will be presentations by the Best Practices Committee. Of particular interest we will be holding to focus group sessions on day 1. The focus groups relate to one of the Speaker’s goals for this year. More details will be forthcoming. There has been a lot of activity with most all of the HOD Committees preparing for the summer meeting. We are in preparation for an upcoming E-Vote to ratify committee members and charges which will provide additional time in July. You will note that most committees have selected a co-chair to share responsibilities and each committee has a House Officer as a liaison to the committee. Each of these are moving to meeting Speaker goals for mentorship. The House officers attended the AARC Board of Directors meeting in March. This was time well spend providing us with an excellent opportunity to become familiar with discussions on current issues and recognize goals and priorities of President Myers. As I have noted before, the three speakers (past, current, and upcoming) participate monthly in conference calls with the two Presidents (past and current) along with the executive office. Communication is open, good, and maintains positive relations with the BOD and HOD. Being a person of “impatience” I came across a quote by George McDonald that I continue to find appropriate as many times as I have read it. I hope you will find it interesting: “ Learn these two things: never be discouraged because good things get on so slowly here, and never fail daily to do that good which lies next to your hand. Do not be in a hurry, but be diligent. Enter into sublime patience of the Lord. Be charitable in view of it. God can afford to wait; why cannot we, since we have Him to fall back upon? Let patience work and bring forth her celestial fruits. Trust in God to weave your little thread into a web, through the patterns show not yet.” I look forward to seeing each of you in July! Wishing you the best for safe travels and if there is anything that I can do for you please do not hesitate to contact me at 540-230-7023 or avthoke@comcast.net. ... [Top] |
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House Guests The Respiratory Therapy program at Kapi’olani Community College in Hawaii continues to take very seriously its responsibility to cultivate future leaders for our profession. For the second time, a Kapi’olani student has traveled across the Pacific to attend an AARC House of Delegates meeting–this time in Anaheim in December. Michelle Low, a third year student, made the decision to be a respiratory therapist when she attended a student orientation session. That’s where she met and spoke to the RT program director, Steve Wehrman. To Michelle, Steve’s passion for our profession was contagious and in her own words, she wanted to “be a part of that.” The need to nurture future professionals is not lost on the HOD. The 100+ members welcomed Michelle with open arms. For her part, Michelle’s eyes were opened wide. She was witness to the organizational aspects of the profession that a student could never otherwise know or appreciate. Michelle reports that she was so impressed by both the spirit of patient advocacy and by the collective strength of the House in moving the professional business forward. By the time the meetings were over, there was no doubt in Michelle’s mind that the AARC is paramount to the profession of respiratory care. She publicly addressed the House, speaking with stage presence and aplomb, thanking us all for the opportunity to be there. Both Steve and the program’s Director of Clinical Education, Ed Borza, recognize Michelle’s potential. They’re confident that Michelle will one day be taking a leadership role in serving the profession. So confident are they that Steve and the Hawaii State Society (HSRC) pledged funding for Michelle’s trip to Anaheim. Since her experience at the House of Delegates, Michelle herself aspires to serving on the HSRC Board of Directors and perhaps even being the delegate some day. Isn’t that exactly what we’re all striving for? In most colleges, the development of student leadership skills is not part of the academic curriculum. Observing the structure and dynamics of an organization such as the AARC is an important point in student learning. Attendance by an RT student at the AARC HOD serves as an outstanding and innovative complement to the classroom experience, one that may help ensure that students are as well-equipped as possible to step up to positions of leadership in respiratory care.... [Top] |
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Time To Step Up or Step Aside… Tom Lamphere Turn on the news and you’ll no doubt be reminded of the current economic crisis facing the country. It seems that each day brings a further drop in the stock market, increase in the unemployment rate and more fears that we have not yet hit bottom. Many companies have already instituted layoffs and hiring freezes and some have put these in place for the remainder of 2009! No matter who you are or what industry you work in, you can’t help but be affected by the economic crisis. It might be that your company is laying off workers, cutting back on benefits and pay raises (or eliminating them) or simply not using as many employees to do the same work, thereby demanding increased production from current employees. If you’re one of the lucky few whose company has been largely unaffected by the economy, you’re still affected when you fill your gas tank, buy your cup of coffee or pay your monthly bills. Everything has gone up in price and there’s no escaping it! What about hospitals and the respiratory therapists they employ? It’s no secret that most hospitals are operating on a VERY thin operating margin (perhaps 1-2% profit per year) and, in many cases, some of that profit is coming from investments. Those investments are now doing poorly and can no longer be liquidated to help fund new construction, pay unbudgeted costs, or support the overall health of the facility or healthcare system. In addition, more and more patients are out of work and many of those patients will no longer have health insurance, thereby increasing the number who are unable to pay their hospital bill. Add in the increased costs associated with running a hospital and it’s easy to see a bleak outlook at least in the short term. So…what about the respiratory therapists working in these facilities? Are they at risk of losing their jobs? More importantly, are they at risk of losing their jobs before other positions in the hospital? Unfortunately (or fortunately…depending how you look at it), our profession has been through this before. We can remember back in the late 1990s when “Patient Focused Care” began sweeping the nation as a way to “cut costs“. Entire RT departments were eliminated and many traditional RT responsibilities were given to “other” healthcare workers to perform, including nurses, nursing aides, and others. Fortunately, Patient Focused Care fell flat on its face and facilities reinstituted the RT departments. What should we have learned from that experience? First, that respiratory therapists were NOT viewed as vital personnel by upper management. In fact, we were seen as expensive personnel who performed TASKS that could be done by other, and in some cases, cheaper personnel! We should also have learned that nursing outnumbers us by a very large number. While this in itself is not a problem, the fact that all, or nearly all, RT licensing boards will allow RNs to perform tasks that are in the RT scope of practice IS a problem! Although we all know that RNs simply do not have anywhere near the same amount of knowledge as an RT when it comes to the cardio-pulmonary system and the therapies and equipment used to treat those systems, the fact is that nearly everything in the RT scope of practice is in the RN’s scope of practice. The bottom line is that, in most parts of the United States, an RN can legally do just about anything an RT can do. So how can respiratory therapists best protect their job? Simple. Be an RT and not a treatment jockey! Now more than ever, RTs must use all of the knowledge and skills they learned back in school and have accumulated during their careers. It is simply NOT acceptable for any RT to “go through the motions” and not provide the best possible care for their patients. What’s the value of an RT to any healthcare facility? It’s not how many treatments they give or how many vent checks they perform (although there are many therapists who THINK that’s their value). Instead, the value of an RT is using their knowledge and skills to move the patient towards health more quickly and thus, out of the hospital more quickly! In today’s reimbursement system, the only way a hospital can make any profit is to make sure the expenses incurred in caring for the patient are less than what they receive from the insurance company. So how can a respiratory therapist step up and make a difference? To start, EVERY facility needs to be using protocols and more than just one protocol! There is sufficient evidence that proves that protocols eliminate unnecessary treatments, reduce costs, and improve the efficiency of care. RTs need to begin pushing their hospitals to use protocols or, if their facility has already instituted protocols, RTs need to make sure the protocols succeed and grow! What else can a respiratory therapist do to make a difference? Stay educated on the latest technologies, treatments and medications. When the RC Journal arrives, READ it! RTs should attend seminars and pay attention to what’s being said and should always be questioning how they can improve their knowledge and skills. What about the many RTs who simply don’t want to put out that little bit of extra? It’s time for them to step aside. The good news is that if they refuse to step aside, they’ll find themselves out of a job when hospitals begin to take a closer look at who’s valuable and who’s not!... [Top] |
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Take Up the Challenge Karen Schell You can make a difference. When Tom Kallstrom challenged state society’s to contact High School Counselors to recruit students to join the profession at the end of last year, Kansas took the challenge seriously. The KRCS decided to make it a top priority and see if they could make a difference. Since the KRCS budget runs from January to January and it was after the first of the year, they needed some “seed” money to get the project started. The society contacted the ARCF for possible grants and discovered that funds were available for such a project. They wrote a grant, received $1000.00 and the project was off and running. Their public relations chair searched the web for the High School Counselors information and came in contact with a source and was able to purchase booth space at a meeting in February in Great Bend Kansas with the potential of 400 attendees. The board directors approved the proposal of setting up a booth, providing a packet with the breath of life video, list of schools in Kansas, two AARC publications for recruitment and individual contact information. They were off and running. They purchased DVD’s and made packets and a booth was prepared for the conference. Three board members drove to western Kansas and manned the booth for two days during the conference. Not only were high school counselors present but other counselors also attended the conference. Due to the weather and the economy, the number of attendees was less than expected. Those counselors that did attend were grateful for the information and the packets were well received. The low attendance did not deter the committee, the public relations committee took the booth to the state educational meeting in Wichita in April and distributed some of the packets to individual RT’s that could make contact with counselors in their communities while thinking of a new plan of action. While the process of distributing the information at the state meeting, the KRCS got a lucky break, an attendee worked for the Kansas Board of Regents, Don Richards, Associate Director of Career and Technical Education, (his is an RT also) and he guaranteed that he could get a packet to every counselor high school and middle school at conferences planned this summer and next February. Success! (We may have to budget for more packets by the end of the year). Persistence pays off! The challenge is there, just get out the word and you will be surprised of the results. If you would like information about our project, you can contact Karen Schell, Public Relations Chair of the KRCS at ksschell@newmanrh.org.... [Top] |
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A Point of Order Sandra McCleaster In 1867 Major Henry Robert, a retired Civil War engineering officer, was asked to preside over a church meeting. He quickly realized he didn’t know how, but he figured he’d try anyway. By his own admission, he failed miserably, both in his attempt to control the church membership and to bring the church business to any productive conclusion. Throughout his military career, Robert had attended many important meetings and wrote that he’d often encountered “parliamentary anarchy.” He was also involved with several social clubs where there too, he noted the absence of any consistency for conducting meetings. We can only guess that the chaotic church meeting was Major Robert’s last straw. A self-proclaimed “parliamentarian”, he began studying the rules of the House of Representatives, originally drafted by Thomas Jefferson and rooted in English parliamentary procedure. Based on that study, he laid out some guidelines of his own, rules that he believed would help to bring order to an organization’s meetings. Thus Robert’s Rules of Order were born. At first blush, Robert’s Rules can seem mind-numbingly technical, in both jargon and in process. What with motions, amendments, amendments to amendments (not allowed, by the way) and finer points of order, it may seem as if nothing gets accomplished. On the other hand, uncontrolled meetings can be frustrating to all and at the very least, will render an organization inefficient. We’ve all been there. Groups as large and feisty as the AARC House of Delegates can often be difficult to bridle. But Robert’s Rules help keep our House chaos at bay. Properly applied, the rules assure that all members of our group can contribute and reach consensus. They also help to protect the rights of the minority view. Robert’s Rules have become a time-tested method of conducting business at meetings and other public gatherings. Today, Robert’s Rules of Order Newly Revised (10th ed. 2000) is the basic handbook of operation for most clubs, organizations and other groups. The 11th edition is scheduled for 2011... [Top] |
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“Call Me, Send it to Me in an Email” Dawn Rost Most adults, okay let me change that, most teenagers and adults carry cell phones, BlackBerry, I Phones, or some other type of instant communication device and rely on them to maintain some of our most important information; our entire list of contacts! Within that list of contacts are the people we talk to most, and…there are also the people we screen calls from because we utilize caller ID. Our parents, friends, relatives, and also our business contacts are likely all listed in our directory. Take a look at an email address book and you will find another wealth of information as to how to get in touch with likely these same people. We are engaged in using a dynamic system of how to contact others through the use of electronic devices. We store, transfer, edit, and share all sorts of information, hoping it is current and up to date. I think about some of the numbers that are listed in my contacts. I do know for sure that my mom’s number is in there, but I cannot recite what that number is. I either need to use the speed dial number she is assigned to, or pull up her name and request my phone to “call, text, email” or somehow contact her. If my mom were to change her number, it would be imperative that she told me so that I could be kept “up to date.” She recently retired from her job where she maintained her primary email address and it was a good idea that for the last couple of weeks of her job she spent time sending out mass emails to her contact list as to what her new email address was going to be. It was important for her to do this because along with a change in her email address, her actual home mailing address was changing as well due to relocation to a new home. This is not uncommon when we have job changes, position or title changes, or when we move to a new home or city. To remain in contact with the people and groups you are involved with when you have changes that occur in your life, it is imperative that you update others and provide them with new numbers, addresses, and most importantly email addresses; that is typically the quickest form of communication (as long as you read your email on a regular basis). Remember that cyberspace, unlike the postal service, does not have a “forward to addressee” option. Mail is typically not forwarded if an email address becomes invalid. To remain current with receiving information from list serves, group emails, or committees that you may serve on in a volunteer capacity, please be sure to update your contact information on a regular basis. It is always a good idea to look at typed documents to be sure your email address is spelled correctly, that it has the appropriate dashes, spaces, underlines, or characters included so that it arrives in your inbox and is deliverable to those who need to send you information, documents, or announcements. My point being is that you make sure all of your contact information is correct that we have for you. If you see that something is incorrect please notify me and I will make sure is it corrected.... [Top] |
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RCP Residency Program Gerald Ebert Children’s Hospitals and Clinics of MN Respiratory Care department announces a new graduate respiratory residency program. This unique program was designed to transition new graduate therapists from the academic to the professional respiratory therapy environment. This 18 week program combines didactic and precepted clinical experience within the organization. Key components of Children’s RCP Residency program:
Patient care experiences: Precepted orientation: Reflection: Didactic and Simulation: We had 12 applicants apply for 6 RCP residency positions this year. Applicants came from 4 states and from 7 respiratory care schools. All applicants needed to complete the following:
Literature from a successful nurse residency program showed: increased job satisfaction, improved recruitment and retention, increased self esteem and improved ability to handle stress. Our RCP residency program hopefully will have a similar success story in the years to come. ... [Top] |
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Moohlah Moo–Treasurer’s Report Debra Skees One of my charges as Treasure for the House of Delegates is to participate as a member of the AARC Audit and Finance Committee. The audit of the AARC’s financial position was completed by the accounting firm of Salmon Sims Thomas & Associates as reported on February 25th and to the Finance Committee and Board of Directors in March. As expressed in the Auditor’s report, “the financial statements of the AARC and its subsidiary are reflected fairly, and conform to generally accepted accounting principles in the United States”. In general, the AARC continues to hold a strong financial position despite the volatile economy. As can be expected, the most significant change from the previous year was in the area of investments ($3.5 M loss). Who hasn’t grimaced when looking at their 403B or other retirement savings plans? These are the times when we must chant the mantra “keep the faith, baby” and remember that in the market, what goes down must come up. Even since the audit in February, the “bear” stock market has provided some reasonable gains in both dividends and stock investments. Besides investment income, the AARC has also been secondarily impacted by the pains experienced at our hospitals and businesses. The crunch for vendor marketing dollars and hospital imposed limitations for education and travel budgets were seen last year in the decreases in revenue from publications and advertising as well as convention attendance. The good news is that membership revenue was up 6% from 2007, aided by the strategies and actions at the affiliate level to increase membership numbers. In addition, expenses were held to a modest increase of about 1% from the previous year. Of special note for the current fiscal year, is that the Board authorized the Executive Director to freeze salary increases for all AARC employees through March 2010. This speaks to the attention and preparedness of the AARC for what could be a long, dry spell. I believe the AARC finance expertise of Tony Lovio, Controller and Robert Lyons, Accounting Manager have provided common sense guidance to this organization for these difficult times. All this talk about finances makes me think of that
country song by Steve Azar called Moohlah Moo. The lyrics go something
like this: It’s got a catchy tune and makes light of the everyday financial reality. Lord knows we need to something to make us smile these days. Here’s wishin’ your cash cows are grazin’ in the sunshine. Moolah Moo!... [Top] |
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Affiliate Best Practices Committee Karen Schell Are you ready? This is your time to share. The Affiliate Best Practices Committee is ready to present you with several topics this summer. As a result of the survey taken in December of HOD members, the following topics will be addressed. The Committee will be offering (15 minutes) presentations on the following topics on the second day of meetings:
We are always interested in any topics you may wish to share. Feel free to bring your ideas to the meeting and we can do some brainstorming on what you would like for future meetings. We want to know what your state society is doing to make it bigger and better. As we begin to gather information from societies, we could use your help. If you are doing any projects that would help our fellow professionals, let us know. The more information we can gather, the better. Remember you can find previous presentations at http://www.aarc.org/state_society_aarc_hod/. We are looking forward to presenting at Marco Island. If you have any questions or suggestions, please feel free to contact me at kschell@newmanrh.org... [Top] |
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Marco Island–Here We Come! Ken Thigpen Well folks, in just a few weeks we’ll hit the sands of Marco Island with our work cut out for us! Many of you may be returning to the House for what seems like the umpteenth time while others may be preparing for your first meeting. Here’s the deal–there’s certainly no intent to slight the experienced Delegates but the focus of this missive will be geared toward those who are new or relatively new in the House… There are several resources available to you which should insure that you find that soft place to land (and it’s not in the sand!). On the AARC website, there’s a special section geared directly toward the members of the AARC House of Delegates. The web address is: www.aarc.org/state_society/aarc_hod I would strongly encourage you to check out some of the items you’ll find in this section as they can unveil much of the mystery that is the House of Delegates. There you will find an Orientation Video which will give you a great snapshot of what to expect in our New Delegate Orientation in Marco Island. Spend some time exploring the resolutions process, what comprises a good resolution, etc. Check out the information on Parliamentary Procedure, too. I’ll probably be walking with you through much of this process during the Orientation Session. These are great preparatory materials for getting you ready to be an effective and contributing member of the House! Something that always helps me out, too, is spending some time looking at the Delegates Roster–it gives you a headstart on putting names with faces once you get to the meeting. I have a hard time keeping everyone straight as I only see most folks a couple of times a year! I would also strongly encourage you to spend some time in your Delegate Handbook. There is a ton of useful information there which comes in pretty handy at times. It’s full of what we do, how we do it, how we check ourselves as well as what we’ve done historically. Lots of good reading! Finally, I would encourage you to check out your Delegate’s Book you will receive for this meeting with all its reports and timely information. Take a look, identify any questions you might have as you glean through the reports and feel free to contact the author of the report with any questions you might have prior to coming to Marco Island–it’ll help things to keep moving smoothly and you’ll arrive much better informed and ready to make a positive contribution. We’re glad you’re on board! Please let me or any of the other
House Officers know of any questions or concerns you might have as to
how this process unfolds. We are all privileged to work with a great
group of leaders and we’re all here and eager to serve you. Don’t
forget your sunscreen! See ya soon! |
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Our Role in Changing Our Profession Frank R. Salvatore Jr. Let me dispense with the formalities before I get into my article for this month: Past Speaker Goals and Objectives for 2009:
Our role in changing our profession. As I noted in my last article, times have changed for me. I work at Orange Regional Medical Center in Middletown NY. For the first time in my life, I am a commuter and have a 60+mile commute each way. This change has definitely opened my eyes. No one really knows how things are unless you get outside of your comfort zone. Making the move from Danbury after 21 years definitely took me well out of a comfortable zone. Where I work now is the antithesis of Respiratory Care compared to where I was. There are opportunities for change around every corner. There are some that say a person would be nuts to take on a role in such an organization. Nevertheless, think about it. For the headaches that will surely come, what is the reward if things change for the better? Too many times, we try to take the easy way toward our goals. What happened to taking the road less travelled? So what if the road is not only less travelled but it contains potholes the size of Texas? Our country was not founded on principles and ideals that came easily. Change is good, but you have to have the desire and drive to effect change. This is what I would like to speak to in this month’s Record article. We need to create change not only in our personal lives, but we must continue to evolve through change in our professional lives. I believe Respiratory Care is not for the faint of heart. We need to harness our efforts to positively affect the patients we care for. I am not advocating changing your life as drastically as I did this year. However, look at the profession as it is today and tell me we do not need to change. Unless you are living under a rock, you are shaking your head “yes” to the need for change. I feel we need to focus on two things when it comes to changing our profession. First is membership and strengthening our ranks. How can you help? Start by asking one person to join the AARC. This action alone would help build the voice of the AARC when it advocates for our profession on any level. The second is the one thing I have been working on since the late 90s and that is legislative advocacy. Too many of our therapists do not think this is important. I know this because the number of people who write to Congress is nowhere near where it should be. If I told you that there was legislation in Congress right now that would remove respiratory therapists as a provider in healthcare, what do you think would happen? There would be such an outcry that a hundred thousand respiratory therapists would write letters and march on Washington to tell them how wrong they are. Why then do we not have the same level of commitment towards our patients who do not have access to respiratory therapists in areas other than hospitals? Too often, I hear grassroots therapists explain that they do not know what the 435-Plan is. Even worse is many have a dim view of the fact that the current Medicare legislation we are advocating for has a Bachelor Degree requirement and do not know why it was written that way. I cannot tell you how many therapists, once we explain why it is written that way, come around and tell us they understand. So what is the second thing you can do to change your profession? Not just write a letter to Congress, but also set up your soapbox somewhere near therapists you know and talk about legislative advocacy. In closing, I really am starting to feel a great period of service in my life ending. Before you know it, we will be in Florida for the summer HOD meeting and then San Antonio for the fall meeting. My service to the HOD will be in the downward slope when you finally read this. If I can leave one legacy in my time serving our profession in the HOD, I would like there to be a renewed vigor toward advocating for our profession and the patients we serve. I would like to thank you again for the opportunity to serve. If you need to get hold of me, please feel free to contact me at anytime. You can reach me at fsalvatore@ormc.org or you can call me at (845) 551-8945. I look forward to seeing all the delegates in Florida this July.... [Top] |
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Looking Back Ed Thomas Some of us early respiratory therapists recall setting up a Continuous Positive Airway Pressure (CPAP) on an infant in the NICU or adding Positive End Expiratory Pressure (PEEP) to an adult ventilator by obtaining a glass IV bottle, filling it with water and submerging the expiratory line beneath the water level to obtain the level of pressure you wanted to achieve. A strip of white tape on the bottle measured off the centimeters below the surface of the water and a manometer was in-line to verify the cm/H20 pressure you were trying to achieve. You frequently needed to remind the other members of the medical staff not to knock over your “bottle of water”; otherwise, your CPAP would be quickly lost. A simpler method was developed by the Emerson Company, the manufacturer of the Emerson Post-Op ventilator. Their solution was the Emerson PEEP valve.
The construction was simply a plastic column built over a rubber diaphragm that had the ability to create a seal for any exhaled gases channeled beneath it coming from the expiratory leg of the ventilator circuit. The column was marked showing the level of expiratory pressure in centimeters of water pressure. If water was placed into the column, say up to the 5 cm marking, it would allow all gas pressure exceeding 5 cm to escape and retain the 5 cm of pressure in the circuit. The gas pressure would simply lift the column of water and escape. If more pressure was needed, additional water was added. If less was needed, water was removed. Later versions of the valve came with a bracket that held a baby bottle and a turkey baster to easily add or remove water from the column. ... [Top] |
Expiratory circuit of vent connected to this end