RTSOleadership

#RTSO Leadership Summit 2018

Thank you Respiratory Therapy Society of Ontario (RTSO) for the 2018 Leadership Summit. What a great collection of motivated attendees, working together to create positive change.

#RTSO gives voice to RTs in Ontario. To support this organization I have volunteered on the board of directors for the past few months. It is an honour working along side this driven and passionate group of volunteers. Do you know an RT in Ontario who has not joined RTSO yet? See this link for more details: https://www.rtso.ca/rtso-membership-benefits/

Tony Kajnar

Mr. Tony Kajnar is a senior therapist at the Sault Area Hospital.  His work experience extends from diagnostic testing to the anesthesia assistant (AA) role.  Beyond his main responsibilities at work, he has assisted with the expansion of the AA role at his hospital, co-chairs the Canadian Pulmonary Function Testing Symposium, leads the Pulmonary Diagnostic Committee with Respiratory Therapy Society of Ontario (RTSO), and assists RTs and PFT labs with adhering to the latest and best guidelines.  Tony and I crossed paths as we both actively look for clarity in the pulmonary diagnostic field.  His extensive knowledge, drive to improve the filed, and willingness to help others has positioned him to be a mentor to many including RTs.   He was kind enough to take time out of his busy schedule to answer my questions.

 

To begin, let me ask two of my favourite questions to ask RTs: When did you first hear about the respiratory therapy field? What made you decide to become an RT?

After my first years of college I realized I did not enjoy my choices and attempted to reevaluate my career options, I ultimately completed aptitude and interest testing to get career ideas.  I took a Myers-Briggs test and completed a book entitled “What Color is your Parachute”, these lead to several healthcare career suggestions.

At the top of the list was Respiratory Therapy, which I had never heard of.  I came up with a list of questions and contacted my local hospital RT department who were kind enough to provide a tour and answered my questions.  I was impressed with the freedom and variety that their daily role provided and then began working toward enrolment.

 

 

Since  graduating from the RT program you have had various roles, what are some of your memorable roles so far?

Like so many, I began as a staff therapist in a hospital.  The market was quite competitive so I worked part time for nine years.  I had obtained my CPR, ACLS and PALS instructor’s certificates and enjoyed providing continuing education as my schedule allowed.  During my instructor work I got involved with simulation education and simulation teaching, which I am pleased to see in concurrent education these days.

Over these years I also worked part time in my hospital’s pulmonary function lab.  When I first started it was a requirement to obtain certification as a cardiopulmonary technologist and so obtained my CACPT(P).  I certainly enjoy diagnostics

The most challenging role to date was as an anesthesia assistant.

 

 

 

What made you decide to study and pursue AA?

Previous exposure to OR/anesthesia rotations in the RT program and our staff anesthesia department were quite positive for me.  Our hospital was part of the MOHLTC pilot into anesthesia care teams, our site was designated for an intra-op RRT/AA component and a post-op pain management with an RNEC.  This pilot was externally funded for two years but has since become part of our hospital program.

 

 

How has your experience working as an AA been? What are some areas of satisfaction and challenges working as an AA?

This role forever changed my perspective and bolstered my interest in health care.  The role was a great opportunity with so many difficult challenges to navigate.  A mantra from the Michener’s AA programs was “you don’t know what you don’t know” and that truly was reflected in the things that we were exposed to.  The more you learn the greater the engagement.

Our hospital did not have an RT role in the OR prior to the AA pilot, this created a very challenging environment in addition to the significant time investment in completing the basic and advanced AA programs.  Travelling to the Michener for our practicums and the late hours completing weekly assignments were both difficult and awesome. 

 

 

Any comments or advice for RTs who may want to consider becoming an AA?

This is an excellent opportunity for anyone truly interested in a role related to anesthesia.  There is a lot of competition and the path is extremely challenging.  Exposure to this role could help provide a better idea if the commitment is the right fit for you.  The role will vary from site to site which may influence your decision, so it is best to learn what you can from those practicing in your area.

 

 

How has the field changed over the years and has it been due to change in technology/equipment? Pharmacology? Protocols/practices? How do you see the role of an AA and the field of AA in the future?

My AA involvement was during phase one of the MOHLTC’s anesthesia care team model.   This initiative involved the CAS, their engagement and support is extremely important.  An RRT background may provide an edge for the clinical components of the AA profession but my greatest learning challenges were with the pharmacology and physiology involved with the anesthesia role. 

Anesthesia offers a departure from the acute care RRT role.  I was surprised to learn how the AA role was present for many years in Toronto, this was highlighted by the great faculty of the Michener Institute’s AA programs.  Some of my classmates were Quebec-trained RRT’s and I was impressed to learn how much the Quebec RRT program’s entry to practice competencies focus on anesthesia, not acute care.

The AA role is young and will no doubt change in ways that we cannot foresee.  It is important that we continue to have RT involvement in this exciting role.

 

 

How did you get involved with working and managing a PFT lab?

Have always had exposure to the PFT lab through the different hospital postings I have held.  It was a role I rotated through initially then had more permanent assignment in.  This eventually led to my current senior role in our hospital based PFT lab.

It is a great blend between technology, instrumentation and patient care for me.  There are plenty of opportunities for direct patient feedback, which is a great source of satisfaction.

 

 

Any comments or advice for those who may want to work in a PFT lab?

Our entry to practice competencies provides an introduction to pulmonary diagnostics but there is a lot consider with providing a formal diagnosis of lung disease and how our findings support treatment.  The ATS, ERS, CPSO and CTS practice and quality assurance guidelines are a good place to start in understanding the technical requirements related to this area of practice.  Understand the contraindications to testing you are involved with and actively screen for them prior to testing.  The quality based procedures and certified educator roles are also important to review and understand as they apply to the continuum of care.

Knowledge and understanding of the published practice guidelines is also important.  As standards change we need to be aware how this affects both diagnosis and treatment for lung disease.

 

 

How can the field of PFT improve to better serve the population?

There are many quality assurance standards to consider with lung function testing which are essential in categorization of lung disease and treatment.  We can all appreciate that objective lung testing is required to establish lung disease but only 50% of asthmatics and even less COPD patients have had such testing.  We must appreciate that there is a care gap; we need to support more accurate diagnosis and follow up to guide appropriate treatment in any lung condition.  Many patients being treated for lung disease have not had appropriate lung function tests to confirm or rule out their diagnosis. 

 

 

For some RTs and HCPs working in the acute care settings, the only exposure they have to COPD and Asthma patients is during the exacerbations.  As someone who helps COPD and asthma patients during all stages of their disorder or disease, what advice you have to share with RTs?

We need to advocate for documenting accurate lung function, screening for post bronchodilator reversibility and ongoing follow-up testing in patients.  Many patients with COPD and Asthma are not optimized and follow-up testing or assessments may not be considered after symptoms have been controlled.  Testing can help support titration of their inhaled medications.   Careful review of treatment, effectiveness of treatment and accurate categorization is also important in an effort to prevent future exacerbations.  Many patients may not be aware of their diagnosis and some may not understand their treatment options and delivery devices.  There are many opportunities to help patients gain better control.

 

 

With a sudden burst of various puffers coming to the market over the last 3 years, what is important to keep in mind? How can RTs better assist their patients with their puffers?

The new treatment options require us to continually review and update our knowledge in order to maintain consistency for the patient.  The medications and their role in respiratory guidelines are part of our best practices.  Being familiar with these medications, their delivery devices, mechanisms of action, interactions and precautions is all part of our professional responsibility.

 

 

I am going to ask few questions about the leadership side of your career.   In Sault Area Hospital you have been involved in many projects which not only improved the quality of patient care, but also expanded the role of RTs and AAs.   How did you get involved with or initiate changes in your hospital?

Some experiences were the result of job postings; other initiatives came from interest or certifications I worked towards. 

Policy and procedure updates have always been a challenge for me.  Sometimes the need to change has been a result of ongoing best practice and clinical guideline updates.  Other times it was from staffing or operational changes that brought new duties or refined them.  Developing effective communication with administrators and clinical leaders to outline policy and training required to accomplish appropriate changes is an area where our profession could benefit from additional resources, groups and references. 

 

 

Any recommendations for those who want to initiate positive change in their work environment?

Get involved in areas you are passionate about, this makes the work you put into the role much more enjoyable.  There are many opportunities with your professional associations, get involved where you can as there is always need for our profession to support future growth with our ever-changing health care system.

 

 

You have been active in improving the quality and standards of diagnostic testing including PFT.  How did you get involved with the Canadian Pulmonary Function Symposium?   What have been your goals?   How could RTs benefit from this annual symposium?

Several clinical practice issues lead to a search for clinical resources in order to address them.  

I attended the Medgraphics Cardiorespiratory Diagnostics Seminar in 2014 and was shocked to learn that it has been offered every year since 1994.  

I got involved with the Canadian Pulmonary Function Symposium after it ran in 2015.  I attended and offered to get involved with my fellow co-chairs, Laura Seed and Murray Beaton.  The Canadian PFT symposium is intended to be a resource for any clinician interested in pulmonary diagnostics.  Speakers and topics reflect current topics in addition to reviewing best practices and quality assurance requirements for pulmonary diagnostics. 

This experience has provided opportunities to meet several individuals, researchers and manufacturers who have helped answer clinical questions and motivated my ongoing involvement in supporting pulmonary diagnostics advocacy.

 

 

On a path to clarify and improve guidelines and protocols, you have been active in asking questions, surveying practices across the country, and vocalizing important concerns that need attention.  In your opinion, what are some areas that need more attention?  What are some of the obstacles?  How can RTs get involved?

I believe communication and knowledge transfer is an obstacle for our profession given our relative numbers to other professional groups.  It is easy to get lost in our health care system. 

My hope is to have a supportive clinical practice network that includes respiratory therapists.  There are many clinical practice areas that would benefit from formal study and publication involving the RRT role across all practice settings.  Research is an area I hope to see more RRT’s getting involved in for benefit of patients, the profession and our health care system. 

 

 

Looking at the RT profession, what do you see as the next big growth area?

Don’t think I can accurately predict the next area of growth but I certainly hope that we will see the development of an advanced practice respiratory practitioner, similar to the nurse practitioner role.  Such a role could support patients with lung disease in ways that go beyond our current authorized acts.  This role could also support our profession through advocacy and research as well as providing a goal for other colleagues to work toward.

 

 

As we get close to the end of this interview, do you have any final words or comments for the readers?

Certainly hope to see more RT’s get involved in promoting health care, advocating health care reform and research.  Hope to see RT’s support others for the benefit of patient care and best practices.

 

 

Thank you, Tony, for taking the time to answer my questions.  Also, thank you for your ongoing contributions in the respiratory therapy field!

 

If you would like more information about the upcoming PFT Symposium check out http://www.cacpt.ca/PFT-Symposium-2018-Details.pdf  .  This year’s event is taking place in Calgary, AB, from September 21st to 22nd (2018).

[End]

International Women’s Day

My blog would not be where it is today without the contributions of great RTs out there. Check out these blog posts profiling some of the amazing women in our industry!


RT Social

I began my respiratory therapy program as a mature student, after few years of working after completing my undergraduate studies. It took me a full month to get my brain back to the speed at which it was absorbing information during my undergrad years. The RT program was intense but was made possible due to my amazing classmates. The challenges brought us closer and created quality friendships. As we got jobs with various schedules, finding a time to meet up became challenging. It would take our group around a month and half to organize a meet up. Maintaining friendship is as important as making new friendships. To support the RT community, to bringing RTs closer, meet new friends, and to nurture the existing friendships, I will begin to organize social events in Toronto for Greater Toronto Area (GTA) RTs. The first social event is happening on March 10th from 8 pm to 2 am at Jack Astor’s located and Yonge and Bloor. Check out the details of this event in Facebook. Join. Share the word and event. https://www.facebook.com/events/322816551562100/

Christina Dolgowicz

I always enjoy attending Canadian Society of Respiratory Therapists (CSRT) conferences, as there are variety of speakers, topics and streams. In May 2107 at the CSRT Conference in Halifax, I attended a talk, titled ‘Creating a Regionalized Lung Health Program’, by Christina Dolgowicz and Michelle Maynard. While I enjoyed the talk, I was more blown away by the dedication and hard work of the speakers.

As I slowly become more involved with the RT community, read articles and speak to healthcare providers, I hear more about Christina’s work. Some of her current and past roles include Chair of Champlain LHIN Lung Health Network, Lung Health Coordinator, Certified Respiratory Educator, RRT at The Ottawa Hospital, member at Quality Ontario and many other RT roles. Her contributions in the respiratory field vary from direct patient care and education, advisory to policy making, to establishing and promoting community-based pulmonary rehabilitation program.

Christina is highly respected among her colleagues and in the RT community, so I was delighted when she agreed to answer few questions about her journey, thoughts and views.

When did you first hear about the respiratory therapy field? What made you decide to become an RT?

I was completing my 3rd year of University and didn’t know what I wanted to do but knew I had to find a job when it was all done! I wanted also to come back to Eastern Ontario and thought I could go to school in Ottawa and started looking into college courses. My criteria for a program:

1. I wanted to go into healthcare

2. I didn’t want to be a nurse

So I looked into the courses that Algonquin College offered and it was between Respiratory Therapy and Diagnostic imaging… I met with the Anita Gallant (course coordinator at the time) to find out what being an RT was all about. To be honest, the only thing that stuck with me was: I got to wear scrubs and hold a pager – that sounded like being a doctor and looking like they do on the TV show ER – so I applied – and got in! It was during that first week that I found out what RTs do –like an ABG! (up until that point I did NOT do well with blood) so I almost dropped out… but thankfully I met some awesome classmates and stuck it out.

With various roles and years of experience, what are some of your memorable roles so far?

To be honest, I have been lucky to enjoy all of the roles I have worked thus far. I started originally at the Ottawa Hospital (2004) and despite working full time in the community now, I still work casual at the hospital. The hospital allows you to react quickly to critical situations and work as part of an interdisciplinary team – RNs, PTs, MDs and other RRTs. It’s professionally and personally rewarding – you get some great experience and make lifelong friends along the way.

Currently – my role as coordinator of the Lanark Renfrew Lung Health Program – is my most exciting role so far. I work with an awesome group of RRTs who are passionate about lung health in primary care (education, early screening, management, rehab) and their passion and wanting to make a change (and willing to say yes to opportunities that come our way) is what makes my job so much fun.

What is your passion that drives you each day working as an RT?

My passion is seeing the difference our program makes in peoples lives. In my current role, unfortunately I have less contact with clients, but I hear the stories through the rest of the team I work with. Occasionally I get to work out in the rehab program and it’s a humbling experience to see the daily struggles that people with chronic lung conditions live with. I also hear about frustrations from clients in regards to the lack of services that are available – and this also drives me to work harder in creating partnerships with other organizations to increase access to lung health services in primary care.

How did you get involved with promotion, initiations, implementations and operation of community lung health education and community-based pulmonary rehab programs?

I originally started working in primary care in 2006 at the North Lanark Community Health Centre and gained so much experience from my supervisor, Karen Jones. She worked very hard and advocated for RTs in primary care and she grew the program from 3 sites with 1 RRT to more than 10 sites and 4 RTs. With working at the hospital and in the community, I got a good sense of where I wanted to spend the majority of my career. I was frustrated at the hospitals with the amount of time it took to make a simple change – only because big tertiary centers are so large and changing policies/procedures takes a looonnnggg time. Making simples changes in primary care was much easier and there is such a need for RTs in primary care, so it was a perfect fit for me to remain working in primary care. Because of Karen’s guidance and mentorship and the success of the lung health program – I was able to continue her work and advocate for services that spread further than the sites we were currently working out of. I’m also someone who can’t sit still and need to continue to push forward for improving care for clients with lung disease. This may be a downfall, but I say yes to many opportunities that come our way because who knows what may come out of it!

What have been some of the challenges along the way?

Some of the challenges that are lack of funding and lack of communication amongst health care organizations. We are all working to improve the health care system experience, but sometimes it feels like we are all doing it alone. By working together, advocating for change, utilizing existing resources – it can really make a difference.

How can other leaders, communities, and health programs learn from your experience?

Just reach out! We are all working to continuously improve the client experience, ensure that we are meeting their needs and goals. By sharing our experiences together, we can share what we’ve learnt so far (and I will get some ideas from you as well!).

Can you share some thoughts about the role of community based pulmonary rehab programs?

A community pulmonary rehab program plays such an important role– it connects people and creates a peer support group, care can be provided close to home and out of hospitals/tertiary care centres. By keeping it in the community and out of hospital, it decreases participants risk of getting sick, participants can be connected to local programs to exercise with after the program is done, it saves the participant cost/time of travelling to a large organization and paying for parking and finally, because our staff work in the community – they may already be connected to many of the primary care providers who send us clients and it makes connecting and consulting that much easier. It is also less expensive to run a community program than a hospital program.

How can RTs be more involved with such initiatives (planning, decision making and operations)?

Look to your supervisors/managers and share your ideas with them! It always helps if those ideas i) align with the goals of where you work ii) improve the client experience iii) improves outcomes/quality of care and iv) saves the organization money! And don’t get discouraged – sometimes these things take time – but when the ideas come to life – it’s all worth it.

Any advice on how new RT’s can build up their leadership experience?

Get involved in your provincial and national associations – even if you’re fresh out of school! You can learn so much from RTs across Canada and you never know when those friendships produce an opportunity. I was on the CSRT Board of Directors in 2007 – 3 years after I graduated – and to this day I still meet up with the friends I made while I was on the board and that experience of serving on a national board really opened up my eyes as to how the profession worked.

Can you tell us a little bit about your experience working as Quality Standards Committee for COPD, part of Health Quality Ontario?

Health Quality Ontario – COPD Quality Standards Committee was a great opportunity for me. I was able to be a part of a provincial group, bringing together top players and lived-experience advisors to talk about COPD in primary care – something I am very passionate about! It was great to ‘dream big’ and produce quality standards of care that people should receive if they are diagnosed with COPD. They will be officially released in Spring/Summer of 2018 and it will be great to see how practices are changed based on these quality standards.

What is the next big growth area that you see for the RT profession?

I believe that the trend now is to have more RTs working in primary care. Traditionally we have been a tertiary care discipline – and the majority of our training is focused around working in critical care areas. We are seeing more and more RTs taking on a role of a case manager in primary care, managing chronic ventilated patients in the community, running rehab programs, delving into the management of cardiac conditions – it is so exciting! Primary care wants RTs to work with them. Not once have I heard a primary care team say: we don’t need an RT. They are calling asking: can you send us an RT? J I encourage RTs who are interested in working in the community to take the certified respiratory educator course and look for opportunities in primary care. It may start as spirometry screening and grow into a pulmonary rehab program – you never know!

How can RTs be more involved with decision making and planning in the hospitals, communities and ministry levels?

As mentioned above, start by getting involved with your professional associations (many of them are working at the ministry level), local lung association or find a task force/working group or committee at your hospital to get involved with. Maybe there isn’t one? If you have an idea and some support – create one!

Any advice on how RTs can expand their framework to support each other in a uniform and national way?

Join your professional and national association! Your regulatory college is there to protect the public – your professional associations are there to promote RTs and work for you! The worst thing I hear is people complaining about their lack of pay, their lack of respect amongst other health care providers, the lack of change in their job – want something to change? Get involved! There are some amazing, engaged RTs in Canada who are facing the same struggles that you may be facing – and by working together, we can make a difference.

Thank you Christina for allowing me to share your perspective and views with others. Also, thanks for your great contributions to the field of Respiratory Therapy!
Farzad ‘Raffi’ Refahi

Feb 01, 2018