Nature of the Work
Most respiratory therapists work with hospital patients in three distinct phases of care: Diagnosis, treatment, and patient management In the area of diagnosis, therapists test the capacity of the lungs and analyze the oxygen and carbon dioxide concentration and potential of hydrogen (pH), a measure of the acidity or alkalinity level of the blood. To measure lung capacity, the therapist has the patient breathe into a tube connected to an instrument that measures the volume and flow of air during inhalation and exhalation. By comparing the reading with the norm for the patient's age, height, weight, and sex, the respiratory therapist can determine whether lung deficiencies exist.
To analyze oxygen, carbon dioxide, and pH levels, therapists need an arterial blood sample, which they generally draw themselves. The procedure for drawing arterial blood requires more skill than is the case for routine tests, where blood is drawn from a vein. Inserting a needle into a patient's artery and drawing blood must be done with great care; any slip can damage the artery and interrupt the flow of oxygen-rich blood to the tissues. The respiratory therapist places the sample in a blood gas analyzer, and the results are relayed to the physician.
Treatment of patients, be they premature infants whose lungs arc not fully developed or elderly people whose lungs are diseased, is another important job duty. Treatment may range from giving temporary relief to patients with chronic asthma or emphysema to emergency care for heart failure, stroke, drowning, or shock. The three most common treatments are oxygen or oxygen mixtures, chest physiotherapy, and aerosol medications.
Respiratory therapists use various kinds of equipment to administer oxygen and oxygen mixtures. In one case, a patient may need an increased concentration of oxygen. The therapist simply places an oxygen delivery device, such as a mask or a nasal cannula, on the patient, and sets the oxygen flow at the level prescribed by the physician. In the case of patients who cannot breathe on their own - someone who has undergone heart surgery, for example - the therapist would connect the patient to a ventilator, a machine which delivers pressurized air into the lungs. The therapist inserts a tube into the patient's trachea, or windpipe; connects the tube to the ventilator; and sets the rate, volume, and oxygen concentration of the air entering the patient's lungs.
Chest physiotherapy is performed on patients who need help with removing mucus from their lungs. For example, during surgery, anesthesia depresses respiration, so this treatment may be prescribed to help get the patient's lungs back to their level of function before surgery and prevent the lungs from becoming congested. Chest physiotherapy also is used on patients suffering from lung diseases, such as cystic fibrosis, that cause increased amounts of sticky mucus to collect in the lungs.
Chest physiotherapy helps remove the mucus, making it easier for the patient to breathe. In chest physiotherapy, the patient is placed in a position to help drain mucus from the lungs. The therapist thumps and vibrates the patient's rib cage, after which the patient is instructed to cough. This procedure not only stimulates the lungs to expand, but also helps clear lungs of congestion. This process helps prevent respiratory illnesses which could complicate recovery.
Respiratory therapists also administer aerosols, generally liquid medications suspended in a gas that forms a mist which is inhaled. Therapists may either administer the medicine themselves or teach patients how to do so. In either case, the therapist must instruct the patient in how to inhale the aerosol properly. If the medicine is improperly inhaled, it will be ineffective.
Monitoring patients who are using oxygen and ventilators occupies a good portion of the therapist's day. Patients and equipment must be checked regularly. If the patient appears to be having difficulty or if the oxygen, carbon dioxide, or pH level of the blood is abnormal, the ventilator setting must be changed. The therapist alerts the doctor and adjusts the ventilator according to the physician's order. In addition, therapists continually check equipment to ensure that there are no mechanical complications and that the equipment is in working condition.
Providing respiratory care at home is a rapidly expanding area of practice. Respiratory therapists have long administered oxygen to patients in their homes. Increasingly, however, mechanical ventilators and other sophisticated life support systems are being used in the home. Therapists teach patients and their families how to use the equipment. Many of the people who receive home respiratory care will need it for the rest of their lives. They are taught how to operate complex equipment themselves, with several visits a month from respiratory therapists to inspect or clean the equipment and ensure its proper use. Therapists also serve as troubleshooters, making emergency visits if equipment problems arise.
Respiratory care is moving into new areas. A growing number of respiratory therapists are being trained to assist in the specialized treatment and rehabilitation of cardiopulmonary patients. Others are acquiring additional skills in order to specialize in respiratory care for newborn and premature infants.
Other duties include keeping records of the cost of materials and charges to patients, and maintaining and making minor repairs to equipment.Some therapists teach or supervise other respiratory therapy personnel.
Working Conditions:
Respiratory therapists generally work a 40-hour week. As hospitals operate around the clock, therapists may be required to work evenings, nights, or weekends. Respiratory therapists spend long periods standing and walking between patients' rooms. In an emergency, they work under a great deal of stress. Gases used by respiratory therapists are potentially hazardous because they are used and stored under pressure. However, adherence to safety precautions and regular maintenance and testing of equipment minimize the risk of injury. As with many health occupations, respiratory therapists who per-form blood gas analysis run a risk of catching an infectious disease, such as AIDS, from accidental pricking of a needle. Careful adherence to proper procedures minimizes the risk.
Employment:
An overwhelmingly majority of respiratory therapists held jobs in hospitals in departments of respiratory care, anesthesiology, or pulmonary medicine. Durable medical equipment rental companies, home health agencies, and nursing homes accounted for most of the remaining jobs.
Training, Other Qualifications, and Advancement:
Formal training is necessary for entry to this field. Training for a career in respiratory care is offered at the postsecondary level by hospitals, medical schools, colleges and universities, trade schools, vocational-technical institutes, and the Armed Forces. Some programs prepare graduates for jobs as respiratory therapists; other, shorter programs lead to jobs as respiratory therapy technicians. Many programs for respiratory therapists are accredited by the Committee on Allied Health Education and Accreditation (CAHEA) of the American Medical Association.
Formal training programs vary in length and in the credential or degree awarded. Most of the CAHEA-accredited therapist programs last 2 years and lead to an associate degree. Some, however, are 4-year programs that lead to a bachelor's degree. Technician programs last about 1 year, and graduates are awarded certificates. Areas of study for respiratory therapist programs include human anatomy and physiology, chemistry, physics, microbiology, and mathematics. Technical courses deal with procedures, equipment, and clinical tests.
People who want to enter this field should enjoy working with people and should be sensitive to patients' physical and psychological needs. Respiratory care workers must pay attention to detail, follow instructions, and work as part of a team. Operating complicated respiratory therapy equipment requires mechanical ability and manual dexterity.
High school students interested in a career in respiratory care are encouraged to take courses in health, biology, mathematics, chemistry, and physics. A working knowledge of science and mathematics is essential. Respiratory care involves basic mathematical problem-solving - an ability to use percentages, fractions, logarithms, exponents, and algebraic equations, and a knowledge of the English and metric systems of measuring. Calculus is not required but is helpful. An understanding of chemical and physical principles such as general gas laws, the states of matter, chemical reactions at the atomic level, and the periodic table is also important. Computing medication dosages and calculating gas concentrations are just two examples of the need for knowledge of science and mathematics.
Licensure, certification, and registration are methods used to assure the skill and competence of health personnel. Licensure refers to the process by which a government agency authorizes individuals to engage in a given occupation or use one particular job title.
Certification and registration are voluntary processes in which a nongovernmental organization - in this instance, the National Board for Respiratory Care - attests that an individual's clinical skills and knowledge of the field meet professional standards. Two credentials are awarded to respiratory care practitioners who satisfy the requirements: Certified Respiratory Therapy Technician (CRTT) and Registered Respiratory Therapist (RRT).
A distinctive feature of the credentialing process in respiratory care is the fact that everyone who aspires to an entry level job starts out by becoming a CRTT. Graduates of 2-year and 4-year programs in respiratory therapy, as well as graduates of 1-year technician programs, begin by taking the CRTT examination. Regardless of the type of program, it must have CAHEA accreditation. A separate examination, open only to CRTT's, who meet the education and experience requirements, leads to the award of the RRT.
Most employers require that applicants for entry level or generalist positions hold the CRTT or be CRTT-eligible, that is, eligible to take the certification examination. Positions in intensive care specialties, and those that involve supervisory duties, almost always require the RRT or RRT eligibility.
Respiratory therapists advance in clinical practice by moving from care of general to critical patients. Additional knowledge and skills are needed to provide respiratory care for patients with significant problems in other organ systems such as the heart or kidneys.
Sometimes such specialization means a new job title. Respiratory therapists may fill positions as cardiopulmonary technologists after gaining experience in arterial blood pressure monitoring, electrocardiograph (EKG), and related procedures.
Therapists may also advance to supervisory or managerial positions. With additional education or experience, promotion to the position of director of the respiratory therapy department is a possibility. Respiratory therapists in home care and equipment rental firms may become branch managers.
The field of education also offers opportunities for career development. Jobs for hospital in-service educators are available for therapists with teaching skills. Many therapists have found careers as instructors in respiratory therapy education programs; with additional academic preparation, they are eligible to advance to the position of professor or program director. Other therapists leave the field to work as sales representatives or as equipment designers for equipment manufacturers.
Job Outlook:
Employment of respiratory therapists is expected to increase much faster than the average for all occupations because of substantial growth of the middle-aged and elderly population, a development that is virtually certain to heighten the incidence of cardiopulmonary disease.
The elderly are the most common sufferers from respiratory ailments and cardiopulmonary diseases such as pneumonia, chronic bronchitis, emphysema, and heart disease. As their numbers increase, the need for respiratory therapists to care for them will increase as well. In addition, advances in treating victims of heart attacks, accident victims, and premature infants, many of whom may be dependent on a ventilator during part of their treatment, will require the services of respiratory care practitioners. Projected rapid growth in the number of patients with AIDS will also boost demand for respiratory care since lung disease so often accompanies AIDS.
Developments within the profession will affect the kinds of skills in greatest demand. Neonatal care and cardiopulmonary care have already emerged as distinct specialties, and opportunities appear to be highly favorable for respiratory therapists with the requisite skills. In academic medical centers and other hospitals that provide advanced specialty care, occupations such as critical care therapist are beginning to emerge.
The outlook for respiratory therapists will also be affected by reimbursement policy, that is, by the rules that Medicare, Medicaid, insurance companies, and other third-party payers use to determine what services they will pay for. A tightening of the rules governing payment for respiratory care would probably mean less rapid job growth than currently anticipated, while an easing of the rules would mean faster growth. The likelihood of either change is hard to predict.
Home health care is a bright spot on the horizon due to technological advances that permit complex care to be administered at home. Opportunities in respiratory care should be favorable in home health agencies, equipment rental companies, and firms that provide respiratory care on a contract basis. Hospital-based home health programs will provide excellent job prospects, too. Because of reimbursement policies, especially strong growth is expected in durable medical equipment (DME) firms which rent respiratory equipment However, it is important to bear in mind that the very rapidly growing field of home health care accounts for a relatively small share of respiratory therapy jobs. As in other occupations, most job openings will result from the need to replace workers who transfer to other jobs or slop working altogether.
Related Occupations:
Respiratory therapy workers, under the supervision of a physician, administer respiratory care and life support to patients with heart and lung difficulties. Other workers who care for, treat, or train people to improve their physical condition include dialysis technicians, registered nurses, occupational therapists, physical therapists, and radiation therapy technologists.
