There are no doubt many respiratory therapists who work with kids with asthma who have thought how nice it would be to go into their schools and implement some programs that would help those kids stay in the classroom and out of the emergency department or hospital.
Diane Rhodes, BBA, RRT, AE-C, had those thoughts too. But instead of just thinking them, she went out and made it happen. In the following interview, she explains how she went from traditional RT to her current position as program director of asthma for the 66,000+ student North East Independent School District (NEISD) serving San Antonio, TX, and surrounding communities.
When and why did you decide to become a respiratory therapist and where did you get your RT degree?
I was in the hospital — again — due to a severe asthma episode. This admission was during my sophomore year of high school. Yet, it was the first time a respiratory therapist took the time — during an IPPB treatment — to explain my disease and what was occurring in my lungs. At that point, I wanted to know everything about the profession. I would guess that conversation, and hospital admission, changed the trajectory of my life.
Right after high school, I attended St. Philips College in San Antonio and earned my certificate of completion leading to the CRTT. I begin working as a respiratory therapist after the completion of my first semester at St. Philips College. I then moved to Dallas, TX, and completed the associate’s degree RRT program at El Centro Community College.
How long did you work as a traditional RT and what did you most like about that role?
I worked in the acute care setting for about five years. I enjoyed working all facets of the position, but I really enjoyed the opportunity to educate others — patients about their disease as well as mentoring new RTs. If I had to add another facet, I enjoyed working the post-op cardiac floor and working with patients to get them back to a normal quality of life.
I worked double shifts on the weekends in acute care facilities while pursuing my bachelor’s in business administration degree at Texas Tech University. After completion of my BBA, I became a clinical/lab instructor at my alma mater — St. Philips. I really enjoyed the aspect of teaching and the opportunity to shape the lives of future RTs as professionals.
Where were you working when you got the opportunity to join the NEISD? How did the opportunity come about?
After working as a clinical instructor for four years, I worked in home care for 15 years. The combination of my RT background and BBA placed me in a unique position to lead several durable medical equipment companies through the Joint Commission accreditation processes alongside my respiratory therapy duties.
I met the superintendent of schools for NEISD while volunteering at a school function for the school my children attended. During a conversation, I asked him if he had ever researched how asthma affected school attendance and student performance.
This caught his attention. I continued to share my personal history of missing an incredible amount of days of school when I was a child attending NEISD schools — 3-5 consecutive days at a time, several times during each school year. I also mentioned that my son, despite having moderate persistent asthma, rarely missed, simply because he had an RT mother who advocated for his school environment, adhered to controller meds, etc. I gave him some personal examples of when I advocated for my son’s environment in NEISD schools.
He asked, “How many kids have asthma?” I stated, “About 10% of your student population.” You could see the wheels spinning in his head as he did the math. He then stated, “Do you realize that a 1% increase in average daily attendance generated $3.4 million of state funding for NEISD?”
I said, “No, but may I suggest you assess your district to determine the impact asthma may play in absenteeism?”
He stated that NEISD has RNs on every campus. I praised their involvement in my son’s life, and thanked him for his belief that the health of all children was so important that he staffed a nurse on every campus. I suggested he follow up with the nurses to see how much “uncontrolled asthma” takes up their day. He did. The rest is history.
On a side note — I made him a bold goal value proposition. I told him I would help him raise his attendance by 1% — and he would not have to pay me $3.4 million.
How did your background as a bedside respiratory therapist help you get the job?
I believe all of my previous positions and work experience provided me an insight to my current position. My position attempts to close the health care gaps and meet the needs of our 8000 students with asthma so they can live a normal quality of life and achieve their full academic potential. It requires insight into our current health care system — what works, what does not. My experience in acute care, clinical teaching, and home care allowed me to see the barriers and disconnect from hospital to home. My experience in teaching and Joint Commission accreditation allows me to problem solve, evaluate processes, create policies, and communicate goals. Start with the end in mind is a phrase from Stephen Covey that really resonates when you are creating a program from scratch.
What preparation other than your RT education did you need to get the job?
Since this was a brand new position, I am not sure if it was my BBA or my work experience and passion that made me stand out from other applicants. Although a minimum of a bachelor’s degree is required for most certified positions in a school district, I think it was more my personal and work history that allowed me to communicate the barriers and gaps in our health care system, as well as the district not meeting the needs of those with asthma. Disease management is crucial and has a huge impact on the academic success of students with a chronic disease like asthma. A school district cannot ignore that fact; they need to work with the health care system, not as separate silos.
Tell me a little about the position and what it entails.
The positon is a program manager overseeing disease management of 8000+ students with asthma. We use a four-component approach — Awareness, Medication, Education, and Environment — designed to engage every stakeholder — student, family, nurses, teachers, facilities, campus administrators, and district leadership — to create asthma-friendly, healthy learning environments for students with asthma in NEISD so they can have normal lives and achieve their full academic potential.
What are the biggest challenges you face in this position, and what are the biggest rewards?
The biggest challenge is trying to find resources for families who fall through the health care funding gaps. I have established relationships with amazing asthma specialists who will see these students, but the costs of controller meds are an ongoing challenge.
Internally, the biggest challenge is, each year we always find a couple of instances where someone smuggled in an “air freshener.” The “independent consultant” pyramid schemes sometimes overshadow good judgement. It is quickly resolved, but it is an ongoing challenge, as that outside influence has an aggressive marketing campaign.
The biggest reward is when the challenges I mentioned are resolved. An example is when I know the culture at a campus has changed because they embrace the program. Meaning, the right terminology — i.e. symptom threshold — is used and asthma friendly best practices become the norm. It is campus driven and reinforced by others who are not directly associated with the program.
Take the air freshener, for example — a campus administrator or other teacher identified the air freshener as a trigger, and removed it — I did not have to get involved. This culture improved the lives of all the children with asthma on that campus, and may have created an environment where a student can safely step-down from an expensive combination controller medication to a less expensive ICS. Sustainability comes when asthma friendly practices occur and I was not involved in that process!
Do you think there is career potential in school districts for other RTs? Why or why not? If you do see potential, what advice do you have for your fellow therapists who might like to go after such a position?
I do, as it serves an unmet need. Despite the NHLBI guidelines, we still have too many pediatric asthma patients who do not have a normal quality of life, limit their life due to asthma, and miss numerous days of school, all of which lead to impairing their full academic potential.
My advice would be to create a value proposition for the decision-makers of a large urban school district. Depending on who that person is in a particular ISD you would address the financial, academic, and quality of life impact asthma has on a school district.
School districts in states where average daily attendance is part of the calculation of state funding are losing out financially when asthma control is lacking. The health of a child with a chronic disease should be included as school leaders and state legislators address school funding shortfalls and academic inequity.
However, we need to market ourselves as an adjunct to school nurses. We have the educational background and clinical expertise on asthma medications, delivery techniques, and devices. We also have the educational background to grasp indoor air quality.
For instance, the physics and principals we learned for ventilator mechanics allow us to understand the basic principles behind plumbing and HVAC systems. The gas laws apply across these technical fields. As RTs we are very familiar with particle size and deposition in the lungs in regards to medication. With indoor air quality you shift your thinking to potentially harmful particles, size, and where they deposit in the airway. We are well equipped to be asthma management advocates in the preK-12 school setting as part of a district’s mission to educate all students.