Building Craftsmanship in Respiratory Care
Mentoring, education, and communication make RTs “master craftsmen.”

Working in a community academic medical center can offer the best of two worlds to respiratory care professionals. While community hospitals have a small town touch that makes a difference in relating to the community, most lack the latest technologies and may be unaware of current trends in state-of-the-art medical practice. Academic medical centers, on the other hand, rely largely on research-study granting to forward medical research and find the best strategies to meet patient needs. Many of their RTs are left out of the mix. In a third scenario, the best of each is combined. Changes are accomplished through mentoring, and the result are hybrid respiratory care practitioners—master craftsmen, as I like to describe the therapists at Lehigh Valley Hospital-Muhlenberg, Bethlehem, Pa. They hold RRT credentials, utilize the latest technologies, involve themselves in evidence-based practice, and study their outcomes—this creates respiratory care craftsmanship. Craftsmanship changes respiratory therapy from “just” a job to a career.

Building craftsmanship in respiratory care does not happen overnight. It takes time and patience. It means making mistakes along the way, and it means learning. Being able to recognize the culture of care in which one practices is the first step. In critical care, one needs to know how the unit is medically managed. Is it open or closed to admitting physicians? RTs need to know the technical knowledge base of these physicians and how they can bridge any gaps. To enhance patient care, therapists must develop the ability to communicate with physicians who may not be familiar or comfortable using the technology. This communication is essential for positive relationships. RTs also need to be part of respiratory journal clubs—another opportunity to communicate with each other and to increase their knowledge of the science, thus enhancing patient care. When new programs arise, the therapist needs to be proactive in collaborative care. For example, open heart surgery in a small community hospital presents challenges that can result in failures. That is why, when we started such a program at Lehigh-Muhlenberg, it was essential for our team to be involved from the beginning. Some administrators asked why. The answer? In 1 year’s time with a dedicated experienced surgeon, we were able to produce the best length-of-stay numbers in the state

of Pennsylvania. Studies have shown that extubation times directly correspond to better outcomes following open heart surgery. We are there to deliver the goods. By being part of collaborative teams, the therapists better understand the other team members’ roles in patient care and can communicate what their roles are directly to the patient. What better advocacy than to communicate with the patient in front of a group. This collaboration must be consistent 24 hours a day.

Critical care therapists need to recognize the patient’s condition and signs and symptoms of organ functioning to manipulate the ventilator setting with confidence. No dial and stick here. Therapists need to be educated on the latest ventilator guidelines and modalities to meet the challenges of today. When they call the doctor for a conference about the patient’s condition, they need to explain the alternatives for delivery of ventilator care.

Other opportunities for the therapist to develop their craftsmanship are in the areas of ARDSnet ventilator settings, APRV, pressure control ventilation, high frequency percussive ventilation, oscillatory ventilation, prone positioning, inhaled nitric oxide administration, heliox gas administration, and a bronchial hygiene protocol. Developing craftsmanship is not for the meek and mild—the therapist here has the duty to be the advocate for the patient and deliver [solutions] to the physician. This is where our future lies. Sure, sometimes it is a tough sell to the stodgiest of physicians, but, over time, the rewards are great. Building craftsmanship is where art meets the science of respiratory care, and the therapist makes a difference. The department must more than just function—it must demonstrate craftsmanship. This is high tech, high touch.

Rob Lichtstein, BSRT, RRT-NPS, is clinical educator for respiratory care services at Lehigh Valley Hospital-Muhlenberg, Bethlehem, Pa.