The Journey Back To Acute Care

Perhaps you are a new Graduate RT or you have been practicing in the Pulmonary Function Testing lab, Homecare or Patient Education side of respiratory therapy for some time and are looking to get back to the acute care setting.   The last acute care experience dates to when you were a student.  The process carries a sense of excitement and anxiety. You keep your certificates up to date, and try to attend networking sessions.   Despite submitting multiple applications, you have not received a single call for an interview. There is a sense of frustration and doubt that we all have experienced at some point.  Major Canadian cities are saturated with recent graduates and new RTs compete for casual positions which tend to offer limited shifts per week but expected an open availability.  More part-time and full-time positions are available in rural hospitals but fewer postings show up.  Should you move to a rural hospital to get the experience?  Should you change provinces? Is this the right career for me?  Before you head into a downward spiral or make any serious decisions, take a moment, step back and breathe.  Just like any career or job, there is a high level of competition.  The journey back to acute care is not easy but it is possible. Recently, I sat down with a colleague who successfully made this transition.

Viral Patel Image Mr. Viral Patel is an RRT in the Greater Toronto Area.  His experience includes acute care, pulmonary function testing at various laboratories, and sleep apnea education.  Over the past few months he has found his way back to acute care.   I asked him few questions to find out more about his experience, challenges and thoughts.


Question 1.  What were your challenges applying for an acute care position without a prior/recent acute care experience?

Acute care is field that requires constant practice to maintain skills that are learned overtime. As you move away from acute care practise these skills begin to fade and our mind loses the “routine-ness” of working in a hospital. That in its self presents a very massive challenge in applying for acute care position.  Furthermore as you move away from acute care the more knowledge you tend to lose. Acronyms that you were so used to in clinical such as “TVR, ECMO or CHF” you have to think about what they are and how they affect our practise. As such, most places prefer someone who has had recent acute care experience. Can you blame them? Absolutely not, their first priority is to get the best possible candidate for the job and patients.


Question 2a. What were some areas that you had to improve to increase your chances of getting an interview (i.e. skills/knowledge/networking etc.)?

If you don’t work in acute care for an extended period time you begin to lose the clinical skills that are required to be an effective part any respiratory team.  Maintaining certifications such as BCLS, NRP and ACLS are very important to keep your mind asking the right questions when presented with real scenarios.  I had to sharpen up on mechanical ventilation (paeds vs. neo vs. adults), ABG interpretations (what is realistic when dealing normal values comparing to what is taught at school vs. real practise).  Review different types of procedures which are part of our scope of practise: arterial lines, intubations, extubation and smaller procedures such as sputum indications. Brushing up on how they are done really helped.  Keeping an eye open for positions is also key, establishing good relationship with clinical managers and building a rapport to show commitment to the respective hospital.


Question 2b. What resources/recommendations would you share with RTs who are trying to get back to acute care setting?

Class notes, evidence based journal articles, go to your local hospital and get an outline of policies and procedure of common RT related procedures, ACLS/NRP books and of course practice leaders! Even if you don’t work for a hospital if you are a certified SRT/GRT/RRT what harm is there to approach a practice leader to shadow a regular RT for a day just to feel it out?


Question 3. What are some of your challenges now that you are working? 

Definitely getting back in routine of things, knowing where to find appropriate supplies and organizing myself during procedure so that I am not caught unprepared.  Speeding is also something I am working on as acute care can be highly volatile in terms of work load therefore quick safe and efficient work management is key.  Some procedures/equipment maybe only used under special circumstances so taking the time to understand specialty equipment so in the event that I ever do need use them I am prepared.


Question 4. what resources/recommendations you have for those who are now working in Acute Care (after a hiatus)? 

The key resource is definitely policies and procedure that every hospital implements.  They highlight and guide us in implementing our scope of practice such as ventilation of patient groups, arterial line insertions, intubations, extubation, flolan/Milrinone, bronchoscopy and code blue teams.  Clinical practice leaders are an excellent resource for all kinds of information such how to better yourself at specific skills, odd requests from RN’s or patients that you may not have seen in practice so far, or even when dealing with a really stressful day and you need someone to debrief with.  RN’s are your best friends, they know their patient just about better than anyone! If there are specific test results you need or a clarification on patient history you can bet they know the answer.  Lastly RT’s are truly a team driven department and therefore your fellow RT’s are also an amazing resource.  I have been very lucky to be surrounded by a great team who are willing to help each other out above and beyond the call.


Question 5. Any last thoughts?

Don’t be discouraged if you are just out of school and without a job and don’t be discouraged if you need to go out of the province to practice.  Follow up with HR after applying, build a good rapport and always have a positive attitude.  Always be eager to learn and adapt to changing circumstances.  A few of my colleagues jokingly remind me that I am not a student and I don’t have to do everything everyone says but I tell them all the time I am building experience. The way I see it the more you see and do the more comfortable you become.


Thank you Viral for taking time out of your busy schedule to answer my questions.

To view a list of his qualifications, education and experience, visit his LinkedIn profile at .

Farzad ‘Raffi’ Refahi


Influential People In Respiratory Therapy: Dr. Mika Nonoyama

There are many people contributing to the field of respiratory therapy. In my journey to learn more about this field, I have reached out to few individuals to discover more about their experiences and the types of activities there are currently involved in. Today’s post is about Dr. Mika Nonoyama.

Mika Headshot

Dr. Nonoyama is a Respiratory Therapist, Health Clinician Scientist, Associate Professor, Advocate, Scientist and Researcher.  I have read her articles and posts in variety of platforms and mediums. I wanted to learn more about Mika, her ongoing contributions to our field.  She was kind enough to take time from her busy schedule to answer my questions:


Question 1: What attracted you to the research side of respiratory therapy?

A few reasons. I loved the idea of coming up with a question and going through the process of answering it. Especially once all the data has been collected and it sits in front of you – it’s almost like an exciting mystery where the results could go any which way despite the hypotheses. The other main reason is because of my mentors, in particular my PhD supervisor Dina Brooks who is a fantastic leader and doing such amazing research.

Question 2. What does a typical day look like for you?

In theory my job is 40% research, 40% teaching and 20% service (volunteering). But depending on the time of year it will change…every day is different. During the teaching term much of my time is devoted to the preparation and ongoing upkeep of the courses (at UOIT). I spend once a week at SickKids doing research with the front-line RTs and collaboratively with other researchers. I also do other research that brings me into the community setting. I have many students (undergraduate, graduate and RT) who help with the initial parts of the research projects while I oversee the processes. My service involves volunteering at various places like the Lung Association and within my University. I love this aspect of my job also because I am able to network and learn about the work these organizations do. I have to mention my day also involves being a wife and a mother of school aged children!


Question 3. Who do you collaborate with on daily basis?

My three research themes are 1) paediatric respiratory therapy; 2) long-term mechanical ventilation; and 3) rehabilitation and chronic respiratory disease. For each of these themes I have different collaborations. The first are my collaborations with SickKids, but I also have connections with folks at CHEO. I collaborate with a large group across the country of health professionals for long-term mechanical ventilation – we call ourselves CANuVENT. My main mentor there is Louise Rose. For the rehab and chronic lung disease I also have various contacts but much of my collaboration is with Dina Brooks.


Question 4. What are some of the sources of gratification/satisfaction and challenge working in this area?

Gratification – seeing the end result of your research projects – usually publication. Though this can be a challenge because it takes time and patience to write and have a paper accepted. I also love to see the look of recognition and understanding on students’ faces when I teach them. My goal is usually to help them experience so they can apply it when they enter the work force…would be nice to see them once they are in the work force! The main challenge for me is finding the time to do it all…


Question 5. What were some areas/knowledge/skill sets that you had to work on to improve in this role?

There is the usual education but more importantly is the desire to learn and do things outside the box. Trying something that interest you and makes you somewhat uncomfortable can lead to wonderful things. I also believe that volunteering your time is essential. I found my success came once I figured out what interested me and what I wanted to do (seems simplistic I know). Once I had that vision I put things in place to make it happen. Having great mentorship to help along the way is key too.


Question 6. Any interesting projects you are working on right now?

One of the most interesting (and challenging) is trying to streamline various respiratory therapies in the paediatric ICU at SickKids. As you know there are many aspects to RT – intubation, weaning, extubation and everything in between. We are working step-by-step on this, extubation readiness being the first. It’s interesting because the research questions come from patient care, involve the care practitioners and are applied back to patient care. Since I don’t practice anymore it’s wonderful to be a part of the practice side of things.

Question 7. Where do you see the future of Respiratory Therapy?

I do hope RT becomes a degree-entry-to-practice. Since most students have a degree already it seems to make sense. It would also help get RTs more within the University system so they are able to interact with the peers they would practice with e.g. nursing, PT, OT, MDs. It would be great also if many RTs would seek graduate degrees and step into the primary investigator role within their institutions.


Question 8 – Any recommendations/thoughts/suggestions for students and RRT who are interested in getting involved in the research side? What are the steps involved?

Though generic my answer for question 5 really is the advice I would give. Figure out what area you would want to research and find who is involved. Get in touch with them to see if you can start the collaboration. I am always happy to hear from anyone to chat about things also.


Question 9- Any final thoughts?

I do love what I do and feel very lucky I am able to do it.


Thank you Mika for sharing your experience, perspective, and giving us a better understanding of the research side of the respiratory therapy field!

To see a full list of Dr. Nonoyama’s educational background and research collaborations, please visit

Mika Nonoyama image

Image source: Google Scholar


Farzad ‘Raffi’ Refahi

July 16, 2017

Resources for Bronchiectasis

At the beginning of my career I was more focused on few respiratory conditions and diseases such as Asthma, COPD, Cystic Fibrosis and Acute Respiratory Distress Syndrome.  With more experience, I am more exposed to variety of conditions that directly and indirectly impact the respiratory system.  In my journey I have realized that bronchiectasis is a common condition which I did not pay much attention to as I viewed it a “secondary consequence” or complication.  This condition involves abnormal widening of airways.  In my attempt to better understand this condition, I searched the web; Here is a list of great resources that will help you review this condition:


The Lung Association:

British Lung Foundation:

European Respiratory Society: