I have heard this question many times and in various forms.
Who is a respiratory therapist? What do respiratory therapists do? Where do respiratory therapists work?
With the current COVID-19 situation, respiratory therapists have been mentioned frequently. This blog post is meant to be a very quick overview. If you have any questions feel free to contact me and get in touch with your respiratory therapy organizations. I usually write for clinicians, but this post is meant for everyone as everybody is impacted by COVID-19.
Who are respiratory therapists?
“Respiratory Therapists are health care professionals who monitor, assess and treat individuals who have difficulty breathing”
How and why was the profession of respiratory therapy initiated?
The origin of this profession is from the second world war. It began as a technician role to reduce the workload of physicians and nurses. With a focus on the cardio-respiratory system, the role has evolved into a therapist and now includes various responsibilities.
What are the roles and responsibilities of respiratory therapists?
To keep things simple, I am going to give you a few different scenarios. They are not referring to any specific patient or organization. The teams are made of many amazing and dedicated clinicians who will be omitted in these scenarios so we can focus on the RT role!
Here are three scenarios to put things in perspective:
Case One: Asthma Exacerbation
Mary, and her parents, had felt that her asthma was not fully controlled for a few days and the recent cold has made her breathing much more difficult. Today her mother took her to an emergency department (ER) due to the severity. In the ER, a respiratory therapist is called to initiate the nebulized Salbutamol and to re-assess the patient. Despite various interventions, Mary continues to deteriorate and the decision is made to assist Mary’s breathing with the use of a ventilator. An RT places a breathing tubing in the trachea and attaches it to a unit that breathes for the patient (i.e. a ventilator). The RT continues to monitor and adjust the ventilator to optimize Mary’s breathing. When Mary’s condition improves, assistance from the ventilator is discontinued and the breathing tube is removed. Mary is now able to breathe on her own. Part of the discharge process, an RT sits down with Mary and her parents to discuss self-assessment and monitoring, and proper inhaler techniques. A follow-up appointment, in a couple of weeks, is scheduled for Mary at the Asthma Clinic. In the Asthma clinics RTs perform a breathing test, called Spirometry, and provide patient education which includes understanding the disease, management, prevention and optimization in case things don’t feel like the norm.
Case Two: COPD Exacerbation
Michael ignores the worsening of his cough, chest tightness and difficulty breathing with even short distance walks. Today he finally decides to consult his family doctor. A decision is made for him to visit an ER. In the emergency department, various tests and treatments are done, and an RT is called to start supporting Micahel’s breathing (using a mask and a supportive unit called BiPAP). Michael’s breathing is optimized over the next day. He is transferred to the general ward for monitoring. Before discharge, an RT meets with Micahel for a smoking cessation conversation. The RT also provides education about the need for ongoing oxygen. A follow-up Pulmonary Function Testing and respirologist/pulmonolgist consult are scheduled. An RT with a Home Oxygen Company/team would visit Michael to set up the equipment, perform assessments, and provide further education. During Pulmonary Function Testing, an RT walks Michael through various breathing tests. At the respirology/pulmonology visit, an RT may sit down with Michael to review the proper inhaler technique. Same RT may also provide a smoking cessation consult. A follow-up PFT and respirology/pulmonology visit are scheduled.
Case Three: Mona and Baby Lisa – Labour and Delivery
Based on the assessments and monitoring of Mona, a difficult delivery is suspected. The team, including a respiratory therapist, is present in the delivery or operating room. Immediately after birth, RT and nurses perform the routine assessments and provide the required care. In this example, the RT puts a small “mask” on Baby Lisa’s nose to deliver a small amount of airflow or pressure. This will help to keep the lungs open slightly longer, and in turn, make breathing easier for Baby Lisa. The RT, part of the team, transfers Baby Lisa to the intensive care unit for further monitoring. Baby Lisa’s breathing is optimized by adjusting the CPAP unit as required. Use of CPAP will be weaned off as Baby Lisa starts feeling better. If Baby Lisa requires even more support, the RT can use a breathing tube to establish a better pathway, and a ventilator to deliver a more controlled breathing support.
There is more…
Respiratory therapists are involved with other roles such as managers, researchers, teachers, inventor, remote support using the phone/video-chat, transport team, consultant, policymaker, in-hospital code blue/pink resuscitation teams, operating rooms, sleep labs, CPAP educators, and others.
What can an RT do for someone with COVID-19?
Respiratory therapists can be part of the team who does the initial assessment. By applying nasal prongs or a mask, an RT can improve the body’s oxygen levels. When needed and indicated, inhalers can be given to optimize breathing. Assistance in breathing can be provided using non-invasive, such as CPAP and BiPAP, and invasive measures (Ventilators).
How to become a respiratory therapist?
Most clinicians in Canada complete their undergraduate studies and then apply for one of the many respiratory therapy programs in Canada. For the list of available programs in Canada, I will refer you to the website of the Canadian Society of Respiratory Therapists: https://www.csrt.com/rt-profession/#education. The training usually involves two years of academic and simulation learning, and a final year of clinical placements.
How much do respiratory therapists get paid?
Based on Payscale.com, the median hourly rate is $31.80 in Canadian dollars ( as of March 22, 2020, https://www.payscale.com/research/CA/Job=Respiratory_Therapist/Hourly_Rate ). As you can guess, the pay is higher with more years of experience, and with roles that entail more responsibilities and that in the acute care settings.
Where can I get more information about respiratory care and respiratory therapists?
On the national side, visit the Canadian Society of Respiratory Therapists: www.CSRT.com.
On the provincial side visit the College of Respiratory Therapists of Ontario: www.CRTO.on.ca, and Respiratory Therapy Society of Ontario: www.RTSO.com.
On a personal RT perspective, there is my website: www.Respiratory.Blog . In my interviews with different respiratory therapists, I try to share different perspectives and insights. Here is one example: Mieke Fraser’s post at http://respiratory.blog/mieke/ (published on October 25, 2017).
Thanks for your interest in respiratory care and respiratory therapists! Share this with others who may find it helpful!
Stay safe. Frequently wash your hands. Practice social isolation.
Here is a PDF version of this post for ease of sharing:
Today is March 20th, 2020. The first day of spring. Happy Nowruz to all those who celebrate the new year. Iranians, among few other nations, have the first day of spring as their new year.
While new year celebrations involve visiting others and sharing delicious food, this year will be quiet. I hope it is quiet. Let’s continue the social isolation. Let’s continue to practice proper hand hygiene. Let’s self-isolate if you are feeling unwell. Let’s think about the vulnerable population and the elder members of the family.
My blog posts are usually meant for clinicians. This time, I am writing to every one, since dealing with COVID-19 is beyond the work of clinicians and healthcare system.
While you monitor your physical health, please don’t forget about your mental health. There are various electronic and video communication options that allow you to connect with others. Call the elderly to check-up on them. If you know someone in isolation, ask if they require groceries (being dropped behind their door).
Those who experienced SARS in 2003 may experience higher levels of anxiety around this time (especially clinicians). Make sure you connect with proper resources, support and intervention if required.
Give yourself mental breaks. Find a few trusted sources for news and COVID-19, and only review those. Constantly reading about it may induce increased anxiety. ( www.RTSO.ca is one of my trusted sources.)
Find appropriate stretches and exercises that can be safely done at home. Stay hydrated. Use this opportunity to stop smoking. Pick up that book that you always intended to read!
Don’t forget about the positive. Give gratitude for the good in your life. There are many great people who are doing their best to help out. A quick shout out to respiratory therapists and clinicians who continue to work to keep us healthy. Fatima Foster is creating a supportive online community for clinicians who are experiencing some anxiety around this time. John Meloche from Melotel Inc. is using the resources in his company to support communities and organizations who have non-for-profit COVID-19 support groups. There are many more examples if you look for them!
The other day I received a Pulmonary Function Testing question that I had not dealt with lately. I provided a short answer but did mention that I will connect with a trusted expert. Here is a quick shoutout to Dan Pinard from Novus Medical Inc. Thank you for the quick and comprehensive answer!
If you have read any of my annual Thank You posts, that I write during RT Week, Novus Medical Inc. is a recurrent name. Once again, they are supporting the PFT Symposium in Canada. This year, 2020, the symposium is on September 18th and 19th and takes place at Radisson Vancouver Airport Hotel.
From my understanding, more information will become available as soon as speakers have confirmed their invitations. For more information, you can visit https://www.cacpt.ca/conference/ . Also, to learn more about the great team at Novus Medical Inc. visit: https://www.novusmedical.ca/about-us .
I will let you know as I find out more about the event!
There are various ways that you can get involved with your respiratory therapy organizations in Canada. Some take a minute to do, some five minutes, and some requiring a few hours a week on an ongoing basis. You can make a difference, and you should not take that lightly or for granted.
Fast and Easy Involvement
Takes a minute to find your respiratory therapy organizations on social media platforms. Follow them. It helps you stay up to date, and by sharing the relevant and important posts, you help with spreading the word, advocating and promoting the profession.
Takes a Few Minutes but You Will Help Shape Things On a Larger Scale
Our national organization, Canadian Society of Respiratory Therapists, is filling a few spots on the board of directors. Put aside 5 minutes to read the biographies and letters of intent. The voting process takes just a minute. Have your say, and help shape the future of our profession on the national level. Go to www.CSRT.com and vote! The deadline is tomorrow!
Have Some Time To Volunteer On An Ongoing Basis?
Have a desire to help and support your provincial organization? RTSO is recruiting for various position and roles. Visit www.RTSO.ca for more details. I have been volunteering with RTSO for more than 2 years, and have assisted with various projects. I have learned from many amazing volunteers over this time.
Together, We Are Stronger!
We can make a difference. Renew your national and provincial RT memberships!
I first heard of Mr. Gino De Pinto through other Respiratory Therapists (RTs) and indirectly through social media interactions. At the 2018 Vancouver Canadian Society of Respiratory Therapists (CSRT) conference, I had the opportunity to meet him in person. During the 2018 Respiratory Therapy Society of Ontario’s (RTSO) Leadership Summit, and through my discussions with him, I recognized his genuine care and passion for our field. When I spoke to one of his past students, he appreciated Gino’s evident care for students. His past and current students have commented on Gino’s direct and open communication, and his wiliness to stand by and for students in our field. I personally got to witness and appreciate his character as a fellow RTSO volunteer. He has brought enthusiasm to our board of directors and has re-energized our student engagement committee. I am happy to share my interview with Gino below.
Gino, thank you for taking the time to answer my questions. Let’s go to the beginning. How did you get involved with the field of respiratory therapy?
With the respiratory therapy profession having a low profile on television and in the media compared to the nursing, physician and paramedic fields, finding out about the profession was by accident. Going back to high school I enjoyed taking science courses and I was always fascinated with the cardio-respiratory system. My title for my final presentation for OAC Biology was “Exploring the World of the Blue Bloater and Pink Puffer”. A strong interest in science led me to the University of Waterloo where I received my Honours Degree in Science. During my final year at Waterloo, like many other RRTs I came to the realization that I needed to further my education if I wanted a career. Having both a brother and sister working in healthcare I started exploring opportunities. I applied to both the Medical Radiation Technology program and the Respiratory Therapy program at Fanshawe College. I was accepted into both programs. After going back and forth on a decision that would affect the rest of my life. I reached out to a family friend that was working as a RRT at the Timmins and District Hospital and I made arrangements to spend the day with a RRT to help with my decision. I spent the day with Susan Boisvert who showed me all the roles of the profession from PFTs to managing a patient on a ventilator. That was all I needed to make my decision and later that day I accepted my offer to Fanshawe College in the fall of 2000.
The graduating class of 2003 all faced the same challenge of entering a profession with much uncertainty. A few months from graduating, healthcare in Canada was dealing with the SARS crisis. As RRTs we were front line workers dealing with an infectious respiratory disease that people knew little about. Infection Control practices changed immensely since 2003. My students can testify how much emphasis I put on infection control practices during competency testing and I can trace that influence back to working in the aftermath of SARS. Since they were limiting visitors to hospitals during that time, I was offered a telephone interview for a temporary full-time job at Grand River Hospital. I was not able to set foot in the hospital but accepted the offer of employment as I thought it was a tremendous opportunity. During my time at Grand River Hospital I had some great mentors like Deb Bester and Jocelyn Hurst who helped mold my career. They set a high standard for patient care and for being accountable. Within a couple of years, I was able to take on a role as Resource Respiratory Therapist where I was able to learn how to create and maintain Policies and Procedures. I was a member of ICU council where I was able to use my voice as a RT to help with VAP protocols, help establish the RRTs role with the Critical Care Response Team and give my input into the design of the new ICU. This is where I could really see the importance of the interprofessional model that is so important with the patient-centered approach to medicine. After 16 years I continue to work at Grand River Hospital as a casual RRT. I have far less influence on the department as a casual but the position allows me to keep current with practice.
Thank you to Susan for introducing Gino to our field! Since graduation you have been involved with various roles, activities, and volunteering positions. Can you share with the readers some of your memorable roles so far?
I also had an opportunity to work at St. Mary’s General hospital on a
part-time basis for 4 years. Working at a cardiovascular hospital gave me a new
perspective on the profession. Working with great mentors like Danny Veniott
and Rob McGivern exposed me to how a great work ethic and positive attitude can
dramatically change a culture of a department. With their leadership the role
of the RT grew dramatically. Inserting of arterial lines became the norm, establishing
an Anesthesia Assistant program and a Weaning centre of excellence were just a
few highlights that I witnessed firsthand that influenced my career. Never
satisfied with the status quo of the profession are lessons that I learned from
my time at St. Mary’s. This is where I first met Lori Peppler-Beechey whose professionalism,
positive attitude and leadership skills were evident early. After working with
her for a years she resigned from St. Mary’s to start a new RT program at
Conestoga College. On one of her last shifts I told her if she ever needed
anyone to teach part-time to give me a ring. I thoroughly enjoyed being a
Preceptor for students at the bedside and thought this would be a great
opportunity. The phone rang a few months later and an opportunity to teach in
the lab presented itself.
Teaching part-time for the first 2 years of the program was stressful and
exhilarating. Going back to the textbook to refresh on content to ensure I was
teaching concepts appropriately was nerve racking but rewarding. Students came
with a tremendous passion to learn about respiratory therapy which made the
stress all worth while. After teaching part-time for 2 years there was an opportunity
to teach on a full-time basis with the focus of teaching and facilitating the
clinical year of the program. After finally having a regular full-time job at
St. Mary’s another difficult decision crossed my path. Do I leave a stable
full-time job for another full-time job at a College with a program that was
yet to be accredited? With the support of my wife, I made the decision to take
the job. The decision was made a bit easier knowing that I would be working
with great people like Lori Peppler-Beechey, Tim LePage, Kelly Hassal and Karl
Weiss. With this great team we were able to attain full program accreditation
from CoARTE.
During my first years of teaching at Conestoga College I am most proud of
the relationships formed with our clinical partners. Ensuring all stakeholders
had a voice in the education of RTs from Conestoga College positioned our
students for success and eventual employment. Helping establish and integrating
clinically immersive simulation into the program was another career highlight.
Working with a mentor like Karl Weiss on the design and implementation of
simulation into our curriculum was stressful and gratifying. Then being able to
present our findings at the 2013 CSRT conference in Niagara Falls allowed us to
showcase all our hard work. Another highlight was working with Karl Weiss on
developing our pediatric/neonatal hybrid rotation. With a bottleneck of
pediatric rotations shared with other college programs. We had to create a
clinical immersive simulation in combination with a traditional hospital
rotation to best prepare our students to meet those neonatal/pediatric competencies.
At that time, I was able to work with amazing subject matter experts like Gary
Tang, Ernie Matchett, Cathy Trocchi, Tami Tesseyman, Catherine Burke-Trembley and
Pam Hall. Collaboration was the key to success and their input and expertise
made for a great learning environment for the students and faculty.
Four years ago I transitioned from a full-time professor responsible for
the clinical year to a more traditional teaching position in the classroom.
During that time the program said good-bye to Lori Peppler-Beechey as she took
on new roles in leadership. Currently I have the pleasure of working with Pam
Hall who is now the program coordinator. Seeing the passion she has for
teaching her students is infectious. She is a tremendous leader, passionate for
the profession and a hard worker that has inspired me to be a better teacher in
the classroom.
In the context of a clinical setting, which area did you enjoy the most? Also, how can RTs be better clinicians?
I enjoy working in Critical Care the most. Learning about and applying new ventilator strategies is what makes our profession unique. Being at the bedside and looking back at the past 16 years of optimizing the patient while on the ventilator, I can look back and reflect on the trends. I have worked with mostly adults and seeing the adoption and implementation of ARDSnet, the use of APRV, HFO, prone ventilation, tracheal gas insufflation and the use of inhaled prostaglandin are just few examples of different strategies used to help patient’s breath. Being a patient advocate in my opinion is the best quality an RT can have. Being able to speak up and provide suggestions to help our patients is key. Recognizing that patients don’t all fit in the same box is the first step in ensuring your patient will receive the best possible care. Looking at waveforms, interpreting blood gases, looking at chest x-rays and providing evidence informed literature are all keys to making appropriate suggestions at the bedside. If you continue to advocate and look for solutions, you can sleep better at night knowing you tried all possible treatments to help your patient with their specific disease process.
Seems like the decision to become an instructor was not at random. Can you expand on that? Also, any advice for RTs who may want to get involved with this role?
As I mentioned earlier, I always enjoyed being a Preceptor to a student.
Being able to showcase your expertise and help students apply theory to patient
care was always rewarding. For those of you who are interested in teaching I
recommend that you respect the learner, this will ultimately create a positive
learning environment. Look for teaching opportunities within your organization
like becoming a BCLS or NRP instructor. Build your resume by going to
conferences and participate in webinars. When meeting educators express an
interest in teaching, gather their contact information and send them your
resume. When an opportunity presents itself be flexible and accountable. This
will help ensure you do not miss on future teaching opportunities.
What advice do you have for RTs and
preceptors to better assist students in their growth? What advice do you
have for students to maximize their learning and growth?
Having students can present challenges. Listening and reframing your
question will better assist a student with their growth as a professional. Do
your best to be patient and try to remember what is was like when you were a
student. Students come to the hospital or home care setting wanting to do their
best. If a student is struggling with a certain topic try to remember what
stage of the clinical rotation they are at. Is it their first day or have they
been in the rotation for a couple of weeks? Knowing this will help you determine
how to best guide your student. Do they need to see a procedure for the first
time or an additional time? Do they need to review pharmacology or
pathophysiology so they can best understand treatment modalities? Once you have the answers to these questions
you can determine the appropriate feedback that will stimulate connections to
theory and help them grow as a learner.
Advice I give to students to maximize their learning is to be flexible.
Having multiple Preceptors can add stress to a student’s learning and growth as
a practitioner. At this point in your educational journey you would have had
multiple teachers with different teaching philosophies and styles. Not all the
teachers would have resonated with your learning. The same can be said about
Preceptors, but as a student if you respect what they want to teach you and
appreciate the time they are taking to demonstrate a practical skill will help foster
a relationship. By building relationships and trust, preceptors are more likely
to invest in your learning. If a preceptor invests in your learning you will
maximize all learning opportunities that present themselves.
Your contributions to the field include
holding few past and present volunteering roles. Can you expand on that? Also, this is a good time for me to ask about
your involvement with RTSO.
When I was a student at Fanshawe College I had great teachers who all volunteered their time outside the classroom. Paul Williams, Dennis Hunter and Sandy Annett led by example and all were volunteering with different aspects of the profession. For myself, helping establish a new respiratory therapy program for the first 8 years of my teaching career was very busy. Now that the program successfully navigated through two accreditations and has graduated over 10 classes, I am able to find time to give back. Our program had developed great relations with CRTO and CSRT. The next step was to build a strong relationship with RTSO. I had the pleasure of meeting Dilshad Moosa at the CSRT conference in Vancouver a couple of years ago. This meeting led to an opportunity to gain a position as a Co-chair of the student affairs committee. Once in that role I was able to see the importance and need of connecting the Ontario Respiratory Therapy programs with the RTSO. The RTSO plays an important role providing a voice to the profession. Being able to connect with great leaders like Sue Jones, Sue Martin and Nancy Garvey have given me a great perspective on the profession and where it is going. Once in this position I was approached to be on the Board and was happy to take on this new role. Since taking on this role I have had the pleasure to work with the Ontario colleges to increase student membership and provide contributions to the RTSO Airwaves. At this point I am more than happy to give a shout out to Shawna MacDonald editor of RTSO Airwaves who continues to provide excellent resources for the RT community and remember if you are an RRT in Ontario #MembershipMatters. Being able to model leadership traits in the profession to my students will hopefully encourage them to be great leaders when they graduate.
It is interesting how we are positively influenced by the
great work of others. I was a student
when RTSO held an educational day at The Michener Institute. I volunteered and was very impressed by the
leadership and professionalism of its president at the time, Mr. Jeff
Dionne. I also enjoyed and looked
forward to Airwaves (thank you Shawna!).
The decision to join RTSO and volunteer with the organization was an
easy one. As I mentioned in the
introduction, I am impressed and appreciative of all of your contributions to
our organization!
I am going to take a step back to talk about the bigger image of our field. How do you see our field changing over the next few years? Also, what changes do you hope to see?
The role of the community RT has changed dramatically over the past
decade. More patients are at home needing support with their oxygen needs,
tracheostomy care and home ventilation. The government has funding to support
theses new initiatives so hopefully we will see continued support from leaders
in our profession to take advantage of these opportunities and promote our
profession. I am hoping we can learn from our Paramedic friends who are now
offering their services to patients in the community. Community Paramedicine
(CP) programs provide opportunities for Paramedics to apply their training and
skills in the community outside of their traditional 911 emergency response
role. CP programs promote Paramedics to
work in collaboration with other health care professionals and community
agencies to connect patients with needed health and community services. These
connections assist patients to participate in their care, maintain independence
and promote involvement in their communities. I see a real opportunity for RTs
to take on a similar role in the community and I hope to see initiatives like
this trickle down into our profession.
Outside of work and volunteering, what do you enjoy doing?
I love spending time with my family.
I have a wonderful and supportive wife named Judit and 3 beautiful children who
keep me busy. I love basketball and I am a die-hard Raptors fan. From watching
Alvin Robertson drain the first points in franchise history at Skydome to
watching this magical run of the Raptors hoisting the Larry OB has been a dream
come true. Now I patiently wait for the release of the next season of Stranger
Things.
Before we end this interview, do you have any final words to
share with the readers?
Farzad, it has been a pleasure knowing and working with you
over the past couple of years. I am hoping the passion and dedication that you
have for the profession spreads through our wonderful community. I appreciate
your inclusiveness while advocating for the profession. Keep doing what you are
doing.
Thanks Gino. The credit really goes to all the wonderful RTs out there, like yourself, who perform quality work and push to raise the bar despite all the obstacles along the way. I have simply been lucky enough to share my journey of learning and discovery with my followers.
Once again, thank you Gino for sharing your insights with me and the followers. Also, thank you to the followers of this blog for taking the time to read this interview. Hope you enjoyed this interview as much as I did.
This post is put together by Farzad ‘Raffi’ Refahi and made available online by the support of John Meloche of the Melotel company.