Every respiratory therapist out there today got into the profession to deliver hands on care to patients. But somewhere along the line, someone no doubt suggested to them that to “get ahead” in the field they really needed to seek out a managerial position.
While that is the right move for some people, many others have simply said, “thanks, but no thanks.” They can’t imagine leaving the bedside for a seat behind a desk.
What keeps these therapists working one-on-one with patients? We turned to some of our Specialty Section email lists to find out. Here are some “sound bites” from their replies—
I really enjoy patient education, so I take every chance I get during the day to educate my patients on their respiratory therapy. In the emergency department, that could be talking about avoiding asthma triggers or instructing proper MDI technique. Or, in the ICU setting, it could be educating a family member on what the spontaneous breathing trial will be like or what PEEP actually means. Whenever I see the light bulb illuminate above a patient or family member’s head, I am reminded of why I am here. — Holly Reed, BS, RRT-ACCS, WellStar Kennestone Regional Medical Center, Marietta, GA
I like very much working in pulmonary rehab because seeing patients with chronic lung disease improve in practical, functional ways for activities of daily living is very rewarding. Working with patients is a good fit for my temperament and personality. I would recommend that those considering management positions be certain that management operations is a proper fit for them individually. There are lots of stressors we all have to deal with; getting into management will have no less challenges than doing clinical health care work. — Jim Fayle, BA, RRT, Saint Agnes Medical Center, Fresno, CA
I enjoy the challenge patients present, and getting to show that there are still compassionate people in this world. Honestly, I love being a “worker bee” and interacting with patients. Not all patients will be nice, but strive to make them realize you care and will help as much as possible — hopefully leaving them with a smile. The benefits of the nice far outweigh the occasional ill-tempered patient. — Debbie Ayscue, RRT, RPFT, Raleigh Pulmonary & Allergy Consultants, Raleigh, NC
About 20 years ago, I wondered if I should stay in the direct patient care area or not. I chose to do advanced studies towards research writing, health education, and public health, where I learned about collaboration with many allied health fields. My favorite areas to work in just happened to be towards palliative care, cardiac surgery, and airway clearance devices. I also find that I like to work in environments where I am on my feet rather than at a desk. For recent graduates, I would give the following advice: approximately 90% of the work is routine and 10% is challenging, either in the amount of physical activity that is needed or in your critical thinking skills. — MaryAnn Couture, MS, RRT-ACCS, Hartford Hospital, Hartford, CT
Patient care is the area where we have the greatest impact and the greatest learning opportunities afforded us. My greatest satisfaction at the end of the day is the positive feedback I receive from my patients and the incredible interactions experienced with them. It is win/win situation. Although management is important and has been offered to me in the past, I believe you lose touch with what “goes on in the trenches” and you get too involved with the politics of the hospital. Patients come first and the best way to accomplish that is to work directly with them and learn what works and what doesn’t. — Beth Guadagnoli, CRT, CPFT, Northwest Hospital and Medical Center, Seattle, WA
I like getting to know my patients; the rehab patients become like family. I would really miss seeing the patients, and I also think my clinical skills would suffer working in a management setting. While everyone has a different emphasis about the job/career, respiratory care is all about the patient, and what we can learn from them. — Anne M. Hamilton, BS, RRT, McLaren-Bay Region, Bay City, MI
When I was first “forced” into the DME respiratory industry by the Medicare DRG implementation and subsequent layoffs, I fell in love with the work, as I could spend time with only the patients who needed it, and could spend whatever resources and time I wanted. The regulatory environment was also less intrusive, so we had more freedom to do really helpful work. Over the years, due to those benefits not being recognized, reimbursement reductions have decreased resources. But so far I still can see patients on a schedule that allows for very involved patient care when needed. For the last 11 years, I have owned a DME company in a 50% partnership. This has allowed me to focus on patient care with my own agenda, while leaving the more business-oriented functions to the partner. If given a choice, I will always choose direct patient care. — Steve Gavras, CRT, LVN, New West Medical, Redding, CA
I absolutely love working directly with the patients because of the interaction. I feel that in this capacity you can make a bigger impact because you are right there with them. You have a chance to hear their stories, meet their families, make a way for them to understand their respiratory issues, and fully explain what the mode of treatment is doing for them. As far as management positions, I don’t think about them right now. I like the impact made at the level of direct patient contact. I think there are those of us who do this job because our desire is to take care of our patients on a personal level. Always take time to go the extra mile, you never know just how much of an impact that you can have. — Paul S. Myler, RRT, Shawnee Mission Health, Peculiar, MO
I am “middle management, supervisor status.” My job title splits patient care 70%, supervisory 30%. I took the coordinator position to help develop and grow the pulmonary rehab program 26 years ago. Fortunately, I only have four direct staff to supervise! I have no desire to seek higher management positions. I enjoy learning about patients’ experiences and educating them about disease management. I’ve done disease management with my patients since graduating my RT program. I’m always the “last man down” to department because I spend time with my patients. They have enriched my life in return. — Karen Lane, RRT, AE-C, St. Luke’s Hospital, Chesterfield, MO
I love directly improving patients’ quality of life, and the satisfaction I get is far more than what I give to them. Disease management is the way to go. We need to move from task oriented to patient centric care. Patients don’t need just exacerbation management but lifetime management of their pulmonary issues. It can be thankless at times, but the personal satisfaction is awesome, and when we do get recognized the thanks are boundless! — Elyse Carroll, BS, RRT, AE-C, Hospital for Special Care, New Britain, CT
Ten years ago I did a PFT on my husband and subsequently diagnosed him as Alpha 1 Antitrypsin, which changed the course of my career. I became part of the Alpha 1 community as a support group leader and mentor to coworkers and physicians about Alpha 1. Working with and living with a COPD patient is completely different and it changed my perspective of the patient; I can understand what they live by watching it at home. As part of my growth, I helped start a pulmonary rehab program in our hospital and I LOVE it! I have a unique opportunity to help on a much deeper level. I cannot save everyone, but I sure can try and that is my reward. I have had the most motivated patients and I love that they teach me. I love changing their lives for the better. — Sarah Volk, BS, RRT, CPFT, Community Hospital, Munster, IN
I work setting up and running pulmonary rehab programs in nursing homes, on their rehab floors. I do a lot of teaching at adult day programs and centers. I love to see them get stronger, and go back to their own lives. If they are nursing home residents, the reward is to see them comfortable and able to interact with their families. I have been in management, and feel happier here at bedside. — Christine Dube, RRT, LPN, Genesis Health Care, Methuen, MA
I recently retired after working in the field for over 42 years — though one of the local community colleges needs an instructor, so I am looking into that. I found that working in a very acute hospital setting with multiple medical and surgical units, where one could independently make adjustments in care delivery, to be very satisfying. The number of positive patient outcomes resulted in greater trust from the critical care intensivists. Further, because of the level of experience on my part, I found myself to be teaching ventilator care to physicians, as well as new therapists and nursing staff. For the last 14 years I worked on the nightshift and found the collaborative approach of the health care team to be more pronounced. I find it ironic that I started as an OJT on the nightshift and have now finished my hospital career on nights, as well! — Michael S. Feldman, RRT, Boston, MA