Professional (Mistaken) Identity

Posted on by Carole Hamp

While working as a staff RT a number of years ago, a ward clerk referred to me as ‘support staff’. I think she was joking – at least I hope she was – but I was still offended. “I’m not support staff,” I countered. “I’m a health care professional!” We laughed about it at the time, but it also apparently stuck with me.

Most RTs know how hard it is to explain what we do, especially to patients who ask if we’re a “special kind of nurse”. Once, after hearing “RT to room…” numerous times on the overhead pager, a patient’s family member asked me, “Who is this Archie fellow they keep calling?” Then, after doing my very best to summarize our profession he commented that: “it sounds like a job that is better suited for a man”. (Sigh).

It’s also often difficult for other health care professionals to wrap their heads around the RT’s role. Most of us have had the experience of being mistaken as the nurse or the physician – the latter particularly if standing at the head of the bed, which RTs often are. I have been asked several times to do a chest x-ray, assess patients whose problems were decidedly not cardiorespiratory-related (psychosis, groin pain, maggots), and was once called in from home in the middle of night to clean a gastroscope. Some facilities have tried to solve the mistaken identity issue by coding their professions in different coloured scrubs – which is helpful, but does little to clarify our role or speak to the immense value that RT services contribute to patient care outcomes.

We are – and likely always will be – a relatively small and newer profession, in comparison. Things have certainly gotten better over the years, but it seems that we continue to struggle with how others perceive our role. So my question is – who owns that? Who is responsible for ensuring that all the people that RTs interact with know not only what we do, but also its importance? Undoubtedly, both the CRTO and RT education programs have an important part to play in informing other professions and the general public about the RT role. However, I truly believe that the greatest impression can be made by the individual RT at the bedside (or in their particular practice environment). Ultimately, each RT has the power to raise the profession’s profile and showcase our unique body of knowledge/skills in their daily practice and interactions.

So, if we are ‘health care professionals’ (as I firmly declared I was), then it’s up to us to own that. Professionals rely on their knowledge to make decisions and also accept responsibility for those decisions (not just falling back on, “I did it because the doctor ordered it”). Professionals take pride in their work, conduct themselves in a respectful manner and take every opportunity to share what they know with those around them (like patiently answering questions – even somewhat insulting ones!).

It comes down to the individual RT enlightening one patient, family member, other health care professional, and yes – one support staff member – at a time about all that RTs do every day to enhance the lives of their patients and the entire health care system.

The Practice of Empathy

Posted on by Carole Hamp

A health care professional working in a large hospital in the U.S. was fired last year for reposting a picture on Instagram® of an empty trauma room. The photo, which was taken by a colleague, included the caption “man vs. 6 train” and depicted a room recently used to treat a patient who had been struck by a subway train. The health professional was not fired for breaching any privacy laws or hospital policy because the picture didn’t reveal any patients or staff members. Instead, she was told she was fired “…for being insensitive”. 1

The news coverage of this event mostly focused on the relative merits of posting work-related photos online, which certainly is an important consideration for anyone working in the health care field. Most employers have policies around this type of activity, and there is legislation specifically aimed at protecting patient’s privacy when accessing health care services. However, I am not aware of any legal definitions for things like sensitivity, compassion or empathy. I find this interesting because, as health care professionals, we frequently deal with individuals experiencing the worst moment of their lives. As a result, we often struggle to do our jobs professionally and efficiently while at the same time acknowledging – on a very human and personal level – how the situation impacts our patients and their families.

Although respiratory therapy practice has evolved into many diverse clinical roles, we have retained a strong foundation in technology, with specialized knowledge and skills that provide patients and the health care team with what they need, in that moment. The downside is that we are sometimes more likely to allow a dedicated focus on things like ventilators and monitors to distance us from the person they are attached to.  And this risk grows as health care becomes an increasingly “technology dense” environment.

For me, a way to avoid acting in a manner that appears insensitive or lacking compassion is to practise empathy – put yourself in the patient’s (or family’s) shoes. Certainly some of us are more naturally inclined towards empathy, while for others it takes a conscious effort. We may find some patients easier to empathize with than others, depending upon their background and circumstances. We also have to be careful to not let our emotional involvement get in the way of providing our patients with the best possible level of care. However, if we can maintain the perspective that “this could be me or my family member”, I think we are more likely to carefully consider our actions, how they may be perceived and/or their potential impact.

1. Neporent, L. (2014, Jul 8). Nurse firing highlights hazards of social media in hospitals. Good morning America [Television broadcast]. Retrieved from http://abcnews.go.com/Health/nurse-firing-highlights-hazards-social-media-hospitals/story?id=24454611

 

We are all in this together

Posted on by Carole Hamp

If you are like me, the events that took place in Paris the other week have left you shocked, angered, and – ultimately – deeply saddened by the senselessness of it all. I don’t profess to understand the many complex factors that result in one group of people attacking another, and that isn’t even really what worries me the most. What concerns me is that such attacks only serve to deepen the cultural divides that already exist in our society and exacerbates the “them and us” mentality. At a time when our world is getting smaller and we should be moving towards greater understanding and unity, aggression has only pushed us further apart.


One of the unique things about health care is that it stands somewhat apart from the rest of society in this regard (or at least it should), because in health care there is only really an “us”. Regardless of cultural backgrounds, our patients want the same thing as we do – to be as healthy as possible so they can get on with their lives. I’m not saying it is always easy. There are often significant variations in cultural perceptions and beliefs between members of the health care team and their patients, and these differences can create serious ethical and logistical challenges. Culture is dynamic and diversity often exists within any single culture, so there are simple no “one size fits all” solutions to the dilemmas we face. The ongoing journey towards a health care system that equally supports all cultures is a difficult process, and we are certainly not there yet. But I do believe we are headed in the right direction.


In a small way, the health care system serves as an example of how people of all backgrounds can work together for the benefit of all. And maybe when we strive to recognize and respect differences, we push back just a little against the larger forces that seek to divide us. What is clear to me is that the more we understand and appreciate what distinguishes our patients’ cultural values, beliefs and practices from our own, the better care we can provide.

Giving Back & Paying Forward

Posted on by Carole Hamp

It’s often very challenging for any of us to find the time or energy to do much more than what simply needs to be done in a given day. There seems to be more and more demands being placed on all of us, with so many competing priorities clamouring for our attention. Yet we know that when we do manage to go that extra mile and do what we (or others) didn’t think –possible, it feels amazing. We are invigorated and proud when we’re able to exceed all of our expectations (and others’) – and this is not just true not in our personal lives either. When we go above and beyond as RTs, the effect is two-fold because it not only enriches us as individuals, but also elevates our entire profession.

Sometimes the greatest achievements begin with people refusing to listen to their own voices, or those of others, saying there is not enough time or money and that it will simply never happen. Nelson Mandela said, “It always seems impossible until it’s done”. This phrase reminds me of the Respiratory Therapists Without Borders (RTWB) initiative, which is a project that began as one RT’s idea – Eric Cheng. With the perfect combination of skill and passion, Eric’s vision has grown into a very successful and sustainable program allowing many RTs to share their specialized knowledge with the wider world. In the words of a couple RTs who have given their time to RTW

« Having been a student for what feels like a lifetime, I have had my share of great mentors and learning experiences. Perhaps one of my most humbling and enriching experiences came during my time as a RT student where I had the opportunity to do a placement in one of the oldest and busiest hospitals in Nepal. As this organization is one of the only government run hospitals; it offers free treatment to those who are underprivileged and poverty-stricken. Seeing how the doctors made every possible effort to ensure that each patient received the best treatment possible, despite their lack of funding and medical equipment, gave me new perspective on the meaning of altruism. Now that I am a practicing RRT, I too have been given the opportunity to provide high quality, patient-centered care and to rise to the challenge of giving back and having a positive impact on my profession; and that, is what I intend to do. »
~ Clement Hui RRT

“When I got the opportunity to teach the doctors and nurses of Patan Hospital how to use CPAP and a few months later, BIPAP to treat ailments that often patients died of until this time, the feeling was incredible. I was so humbled by the difference in my world compared to theirs and this experience has opened my eyes to the need for our help around the world to places less privileged than ours. It has also motivated me to continue to help at RTWB however I am able because I truly believe they are doing an incredible amount of good!”
~ Annika Janssens RRT

RTWB is just one of the infinite ways (think RTSO, CSRT, Lung Association, etc.) that we can give back to our profession and pay it forward to those who need our help. What we offer does not have to be a grand gesture or an enormous sacrifice; simply giving our best effort while teaching a student RT is a tremendous gift to that student and to all the patients they will encounter down the road. We all have the opportunity- no matter how busy we are – to go beyond what is merely expected of us and fulfill a very real need in the world. To quote another famous and learned individual (Dr. Seuss)… “Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not”.

All the best for a safe and meaningful holiday.

Avoiding “Alert Fatigue”

Posted on by Carole Hamp

Advances in computerized technology provide health care professionals with enhanced capability to monitor a wide variety of patient conditions and, hopefully, prevent adverse events.  However, with that comes a multitude of alerts, alarms and – in the case of ventilators and cardiac monitors – a cacophony of noise and flashing lights.  This has led to a phenomenon known as “alert fatigue”, which is becoming increasingly common among health care professionals – sometimes with disastrous consequences.

There was a recent news story about two British Columbia pharmacists who were found to have deliberately turned off certain “compatibility warnings” on their pharmacy’s computer system[1].  These warnings are intended to alert the dispensing pharmacist to any potential adverse drug interactions, but can result in a number of “false alarms” for harmless interactions.  In this particular situation, however, a patient was given two different medications that were incompatible to one another and she subsequently died from a severe bacterial infection resulting in complete respiratory failure.

In our technology dependant health care system, “alert fatigue” among practitioners is a well-documented and increasingly concerning problem.  Between 2005 and 2008, the Food and Drug Administration in the U.S. reported 566 alarm-related deaths[2].  Alerts are meant to warn care providers that something is wrong and that action needs to be taken, but frequently the cause of the alarm is not clinically relevant to the patient.  This can all too often make an alarm seem to be nothing more than an annoyance and a distraction that disrupts workflow.  The danger in of this, of course, is that practitioners will miss or ignore a potentially critical alert – or even intentionally change an alarm parameter to reduce the likelihood that it will activate.

It can be very challenging for RTs to remain vigilant so that they can attend to what is truly important among all the ringing, chirping, beeping and flashing.  The first step to preventing “alert fatigue” is to acknowledge that it is a very real problem and to watch for signs that you may be falling victim to it. The next step is to engage your organization’s support in combating this threat to patient safely by developing specific policies and procedures on alarm settings, delay ranges and customizing alarms based on the patient’s needs[3].  In addition, careful consideration of the alarm capabilities of equipment at the time of purchase has been shown to go a long way to mitigate “alert fatigue”.

 

[1] Tomlinson, K. (2014, October 6). PT Pharmacists’ failure to check drug risks leads to ‘horrible’ death

B.C. woman’s demise exposes dangers of ‘alert fatigue’ among pharmacists. Canadian Broadcasting Corporation. Retrieved from http://www.cbc.ca/news/canada/british-columbia/pharmacists-failure-to-check-drug-risks-leads-to-horrible-death-1.2787185

 

[2] Rodak, S. (2012, February 15). Sounding the Alarm: 6 Strategies to Reduce, Prevent Alarm Fatigue. Becker’s Infection Control & Clinical Quality. Retrieved from http://www.beckersasc.com/asc-quality-infection-control/sounding-the-alarm-6-strategies-to-reduce-prevent-alarm-fatigue.html

 

[3] Cvach, M. (2012). Monitor alarm fatigue: an integrative review. Biomedical Instrumentation & Technology, 46(4),   268-277.

“There is nothing more I need to learn.”

Posted on by Carole Hamp

Someone told me the other day that: “There is no point in me taking any extra courses or paying for a conference. I know all I need to in order to do my job. There is nothing more I need to learn.”  I didn’t really know how to respond to that statement.  Personally, I can’t think of a single aspect of my life where I know “all I need to know” (with the possible exception of the Kardashians – I know almost nothing about them and yet it’s already way more than I ever needed to know).  

In all other areas though, I find that learning never seems to end – especially when it comes to my job.  Everything in health care changes so quickly, and we need to keep up no matter where we work as an RT.  This doesn’t mean taking courses or attending conferences every day – most of us learn on the job and on the fly, usually unaware of the new knowledge we are gaining.  But sometimes it’s important for all of us to step outside of our little world and take in the bigger picture.

Maybe you’ve been working in a particular area of practice for a long time and feel that you know quite a bit (although I still don’t think it could possibly be “everything”).  But what about those external forces outside your practice setting that impact what you do?  No matter where you work, you are affected either directly or indirectly by things like the Ontario Ministry of Health and Long-Term Care, RT education programs, the National Competency Profile, and the health care labour market.  You may not feel that you or your practice changes all that much, but these external influences and factors are undergoing a dramatic evolution at this very moment.  And these changes affect all of us– whether we are conscious of it or not. 

For example, at one time I didn’t think the provincial government had much to do with our little hospital-based Asthma Education Centre – until of course it was closed because of the Ministry of Health’s move towards shifting more out-patient care into the community.  I also didn’t appreciate the degree to which the National Competency Profile dictates how and what RT students are taught, and that the reason some of our students struggled with neonatal ventilation was because it’s often challenging for schools to find specialized clinical placements.  I didn’t even know there is a National Alliance of Respiratory Therapy Regulatory Bodies, which is involved in making decisions about important RT practice issues like entry-to-practice requirements, interprovincial labour mobility, and providing credentials to internationally educated health care professionals.

To paraphrase Conestoga College’s marketing slogan:  what happens out there…matters to you!  The knowledge that  you have gained from you specific experience and practice are important, but there are also many ways to learn more about the big-picture factors affecting you as an RT.  Professional development and continuing education provide an opportunity to keep your skills and knowledge current, relevant and reflective of today’s patient needs. 

Consider the domains of GROW, and events such as the upcoming INSPIREvolution 2014 Conference in Toronto (November 21 & 22), hosted by both the CRTO and the RTSO, that brings together speakers from every organization that shapes and defines the profession.  Please come and join us for this special conference exclusively created about RTs and for RTs.  Whether you’re a rookie or a veteran RT (like me), there is always more we need to learn.

When care and values collide…

Posted on by Carole Hamp

Earlier this summer there were several stories that appeared in the news about physicians who allegedly refused to provide certain non-emergency treatments (e.g., artificial contraception) on religious or moral grounds[1].  Consequently, the College of Physicians and Surgeons of Ontario (CPSO) undertook a review of its Physicians and the Ontario Human Rights Code policy and invited the general public to weigh-in on whether doctors should be permitted to deny patients specific treatments or procedures if they conflict with the doctors’ beliefs. The Ontario Human Rights Commissioner also expressed a keen interest in this matter, as it potentially means that patients may be unable to access care because of race, age, ethnicity, gender, sexual orientation, or disability. 

This issue of providing patient care or not when it conflicts with our own personal values is not as pressing a concern in RT practice, as we are generally not the health care professionals proposing plans of care.  However, I suspect many of us have been in situations where we were asked to do something that was contrary to our belief system.  For example, it may have been a circumstance where we felt a terminally-ill patient should be withdrawn from life support, while the family insisted that all possible medical interventions be continued.  Although we may believe it’s cruel to subject a patient to painful, invasive procedures when there is – in our opinion – little chance of recovery, the family may believe life to be so sacred that it must be preserved at all cost.  Values collide – but there is still a patient that requires care.

Even beyond objecting to the treatment itself, our belief system can cause us to make judgments about what “type” of people are worthy of the care that we provide.  I recall being involved with managing ventilation on an alcoholic individual recovering from the most recent of several liver transplants, and I questioned why he deserved another chance if he could not stop drinking. I felt it was wrong to “waste” an organ when there is such a shortage and so many other people in need. Did it change the way I provided his care? I don’t think so. I hope not.  

Some of the people expressing opinions on the physicians’ issue have stated that doctors must leave their personal beliefs at home, as they have no place in medical practice. Yet I question whether this is possible for any health care professional?  What we believe and what we consider to be most important in life are the things that make us who we are, and we just can’t park that at the door of the patient’s room.  It isn’t as simple as saying “it’s not about you”, because you and what you believe are an integral part of the patient-health care professional relationship.  The best any of us can do is to recognize that our core values and beliefs are constantly at play, and they have the potential to shift our focus inward and away from the patient who needs and deserves our full attention.  

The CRTO’s Commitment to Ethical Practice document offers some insight into how our belief system impacts us both personally and professionally, as well as guidance on the integration of our values with our obligations as health care professionals.    

 

[1] Grant, Kelly. (2014, July 2). Policy allowing doctors to deny treatment on moral or religious grounds under review. Globe and Mail. Retrieved from http://www.theglobeandmail.com/life/health-and-fitness/health/policy-allowing-doctors-to-refuse-treatment-on-moral-or-religious-grounds-under-review/article19434118/

 

“But I could lose my license!”

Posted on by Carole Hamp

It seems like with every day that passes, RTs are having new responsibilities added to their roles.   While most – including the CRTO – view this evolution of the profession as a positive thing, RTs sometimes express concerns about what could happen if they embark on a new endeavour and something goes wrong.  One comment we hear most often in these circumstances is, “but I could lose my license!” I think this is an important concern to address because  an RT’s practice should be based first and foremost on their personal scope of practice and the best interest of their patients – not on fear.

It is true that all health regulatory College’s Discipline Committees have the option to revoke a Member’s certificate of registration.  However, it’s important to note that this is only likely to occur in situations where it is determined to be the best means of safeguarding patient care.  In fact, no RT in Ontario has had their certificate of registration revoked since the CRTO’s inception in 1994.  This is because the issues that have arisen regarding RTs thus far have been most appropriately dealt with through remediation or other measures aimed at ensuring the Member provides safe, competent and ethical patient care. 

As an example, in the 2013-2014 fiscal year, there were four (4) complaints, 17 reports (Registrar reports, employer reports and Members’ self-reports) lodged about Ontario RTs.  In the case of one complaint, the Inquiry, Complaints and Reports Committee (ICRC) recommended that the Member revise his practice to ensure he is complying with the CRTO Standards of Practice, including the Professional Practice Guideline on Conflict of Interest. Further, in two of the mandatory employer reports, it was the decision of the ICRC to require the Members to complete specified continuing education or remediation programs (SCERPs).  In only one case was it the decision of the ICRC to refer the matter to the Discipline Committee for a hearing, which is to be held later in 2014.

It’s also important to mention that a discipline hearing is required to revoke a Member’s certificate of registration – and the bar for referring allegations to a hearing is fairly high.  This means that the nature of the concerns has to be quite serious, or there’s a pattern of behaviour that remediation has not been able to address.  Additionally, there must be sufficient evidence to support the allegations (i.e., witnesses, documentation, etc.).  The interest of patients in Ontario is usually best served by the CRTO focusing its resources on ensuring Members receive the education and remediation support they need in order to meet the highest possible practice standards.

Losing one’s licence is always a possibility; however it should not be the reason that an RT decides to decline taking on new roles and responsibilities.  The most relevant concerns when presented with an opportunity to expand one’s professional practice are:

  1. Is it clinically appropriate, i.e., in the best interest of the patient?
  2. Is it within the scope of practice of Respiratory Therapy?
  3. Is it within my individual scope of practice, i.e., do I have the requisite competencies (knowledge, skills & abilities) to undertake the activity?

These and other considerations are provided in the CRTO’s position statement on Scope of Practice & Maintenance of Competency.

The RT role in Enhancing Patient Safety

Posted on by Carole Hamp

At the recent CSRT conference, I had the pleasure of listening to Brent Kitchen an RRT from Saskatchewan speak about “Using Mistake Proofing to Prevent Harm”.  In his presentation, he referenced the Canadian Adverse Events Study, which found that approximately 7.5% of adult hospital admissions involve an adverse event “resulting in death, disability or prolonged hospital stay”[i].  The actual percentage is likely much higher because the study did not involve all provinces and did not include paediatric patients or adult patients in long-term care facilities.  The World Health Organization (WHO) puts the risk of being harmed in the healthcare system at 1 in 300, significantly greater than the risk of being hurt flying in a plane (1 in 1,000,000)[ii].  The WHO’s statistics are impacted by the number of incidences that occur in the healthcare systems of developing countries, which may be higher than in Canada.  Nevertheless, it is estimated that adverse events in this country result in approximately 2 – 4 needless deaths per day.

Many adverse events result from preventable medication and surgical errors caused by poor communication (both verbal and written) and inadequate infection control practices.  Research conducted in Canada and the U.S. indicates that the financial and human cost associated with these incidents can be alleviated through careful application of evidence-based medicine.  For example, healthcare-associated infections – such as catheter-associated bloodstream infections (CABSI) and ventilator- associated pneumonias (VAP) – are a major source of adverse events[iii].  Fortunately, numerous studies demonstrate that well over half of infections like CABSI and VAP can be avoided through evidence-based infection prevention and control practices.

That being said, there is sometimes a tendency to think that safety is someone else’s job; that managers and infection control practitioners (some of whom are Respiratory Therapists), should establish and ensure compliance with current best-practices. However, all Respiratory Therapists play a very important role in reducing the frequency and severity of adverse events.  Our specialized knowledge and perspective offers a unique opportunity to identify situations when the appropriate level of evidence-based care is not being provided (e.g., improper use of PPE).  We are often the ideal profession to take the lead in collaborative initiatives, aimed at reducing preventable adverse events and improving patient care outcomes.



[i] Baker, G. N., Baker, G. R., Norton, P. G., Flintoft, V., Blais, R., Brown, A., . . . Tamblyn, R. (2004). The Canadian adverse events study: The incidence of adverse events among hospital patients in Canada. Canadian Medical Association Journal, 170(11), 1678-1686.  doi: 10.1503/cmaj.1040498

[ii] Boinot, P. (2009, October 19). Preventable adverse events in healthcare: Issues and solutions [Blog post]. Retrieved from http://www.hinnovic.org/preventable-adverse-events-in-healthcare-issues-and-solutions/

[iii] Umscheid, C. A., Mitchell, M. D., Doshi, J. A., Rajender, A., Williams, K., & Brennan, P. J. (2011). Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infection Control and Hospital Epidemiology, 32(2), 101-114. doi: 10.1086/657912

Providing Culturally Competent Care

Posted on by Carole Hamp

In the healthcare setting, cultural competence refers to the ability to provide appropriate and effective medical care to members of various cultural groups. RTs provide care to patients/clients with diverse values, beliefs and behaviours. A practitioner therefore must become competent in providing equitable care though the process of gaining a congruent set of behaviours and attitudes.  This progression begins with an awareness of the how diversity manifests itself and what impact it has on the provision of healthcare. Providing culturally competent care will allow the RT to provide optimal care for all patients/clients and maintain compliance with laws and recommendations.