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RT staffing

Census driven for nursing service. But RT has to be Acuity driven. This means that adminstrators don't care about patients that only need medication therapy. They only care about how many Ventilators and/or Bipaps are in use in order to staff accordingly.

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Permalink Reply by Ray on January 4, 2009 at 5:44pm
You right on with your comment. I just wish the AARC could help us more with this problem.
Permalink Reply by Tony on January 6, 2009 at 11:58pm
You all bring up very good and valid points. I think what we are all forgetting is that there is power in numbers. It doesn't really matter what the AARC standpoint is at this point, nor does it matter what each administration does. What really matters is what we as a society and organization do. Our numbers are few, and we are not organized as a single unit. We also do not have a powerful union like the nurses have to drive our point home to the organizations that matter. One of our biggest hurdles is that we are not well known, and medicare will not reimburse for us in the home. This leaves us very vulnerable as a profession. This keeps our wages lower than other professionals with the same education, and makes us look more like a CNA than a nurse in the eyes of insurance companies. This lowers the perception of value to those who give us jobs.
Permalink Reply by Brett Oetting on January 8, 2009 at 8:48pm
Safety in numbers certainly a major driving force, but the general perception of RT departments as a cost center rather than a revenue generator is another major concern. This shift in concept occurred in our area around the time of Medicare Reform in 1998. As a result, all the hospitals in our area had to do some creative accounting to recoup operational costs. A perfect example is how oxygen and associated equipment (cannula, humidifier, mask, etc.) was rolled into a slightly inflated room charge. Every hospital I've worked for justifies it's productivity via procedure/therapy billing. Not billing for oxygen immediately crippled the strength of all RT departments in our area. Adding insult to injury is the fact that all medical gas is commonly paid from the RT budget, which can be a pretty penny when you consider how much gas they use in anesthesia.

I appreciate what the AARC is doing and JACHO seems to be getting on track with their guidelines, but the essential problem with the AARC is that they are not a governing or legislative body that can write laws. The general perception of RT departments as cost centers doesn't help. The only direct influence AARC/JACHO has is the threat of denial of accreditation, which hospitals need to bill for service. No accreditation, no enforceable payment. If the AARC/JACHO continues to stand firm, concurrent therapy will end and realistic workloads will hover around 30 procedures per 12 hour shift; however, this will only happen one hospital at a time as they are surveyed by JACHO.

I guess good things come to those who wait, but I hate the waiting game!
Permalink Reply by Mike Gordon on January 12, 2009 at 3:03am
You want to put a stop to the way we get staffed. Read "The Respiratory Therapist's Legal Handbook" by Anthony L. DeWitt. He does a very good job describing how staffing is currently done. Then look at CMS guideline: § 482.57 Condition of participation: Respiratory care services and the interpretive guidelines in the state manuel. Then call CMS. They only care about patient safety. Put them in a shaker. Case law on Public Health Law helps too!
This is what you have to do.
It has to be a staffing issue and a patient saftey, not workload issue. The whitepaper from the AARC on stacking would help as well.
I finally got CMS to investigate. It has to be worded in such a way as to get their attention using thier own verbage. They will tell you they don't investigate staffing. Then show them the state manual.
Joint Commission will not do anything about staffing. How good are your policies and procedures?
Unless therapists start complining in mass, they hospitals will never change.
http://biotech.law.lsu.edu/map/index.htm This is how the legal system sees the medical world.
Learn your rights. Fight for the right to work.
Permalink Reply by Ray on January 12, 2009 at 5:07am
Thank you for your insight into this issue that effects all of us.
Permalink Reply by Garry W. Kauffman on January 14, 2009 at 4:32am
Ray
Good point. Actually, the AARC's Uniform Reporting Manual is the standard that we can use to calculate what's reasonable (e.g. time standards). What I would like to see is for Medicare and commercial insurers to adopt the URM as the standard for what's an appropriate workload.
In Pennsylvania, we are beginning talks with the licensing board for this very proposition. Nurses in several states have mandated patient-nurse ratios and this seems to be a reasonable approach, even though it doesn't address every aspect of providing quality care, to making a stand for patient quality.

Garry
Permalink Reply by Joe on January 14, 2009 at 9:14pm
I ask the staff to document in the computer everything that they do. The numbers go, "upstairs" monthly. Being busy with work not related to vents and bipap is very real but the burdon is on the staff to document document document. The people upstairs understand numbers. If you have time to sit in the break room and whine then you have time to increase your documentation.
Permalink Reply by ric mandanas on January 15, 2009 at 8:52am
joe you are absolutely right. documentation, documentation, documentation. But its our documentation that they usually measure proving that we have done a lot. These is where i got the nurse's soft spot. (as they do more documentation than ours) is it true also to some of you there? Here in our hospital a patient being admitted averagely got 40 pages of documentation that needs to be filled up by the nurse admitting the patient. I would just pour my sympathy on them then you get their heart. Well as I always advice to most of my colleague here, if you want your shift to be smooth, be friend with the nurse (of course with limitations) and really it works most of the time.

this thread really helped me a lot and i already got the key. its from mike. Patient focus.
Permalink Reply by Chuck on January 19, 2009 at 1:22am
Couple of comments:
We, and everybody else involved with inpatient care, became cost centers in the mid 1980's when DRG's were first introduced, well before Brett suggested.
While I am certainly not in favor of stacking treatments just to get your work done quickly, there are patients who do not need me in the room for the duration of their routine neb treatment. My time might be better spent reviewing charts, tracking down doctors, etc., etc. Part of the no stacking argument has been that one should always stay with the patient. Some patients need that, many do not.
I worry about what mandatory staffing laws will do to hospitals. There is obviously a nursing shortage. There is also a staffing shortage in other areas, including RT. This will drive up wages-good for us, but tough for hospitals already struggling. Even hospitals that can afford the wages may still struggle to find the staff. Without the required staff level, what happens? Transfer patients to better staffed hospitals? More OT? Agency staff? All will have an impact on the bottom line. Like it or not, our current system requires hospitals to make money to survive.
A blanket statement that administrators don't care about patients is unfair. I know administrators who worked in patient care before moving up. 30 miles south of where I live the hospital CEO is an RRT. 25 miles to the west is a hospital with an RRT in a senior VP position. Our new CEO is an RN. These people do strive to do the best they can for all of the patients. My VP came up through radiology, and has a PASSION for patients. He accepted the job because he thought he could do more for patients as a VP than as a manager. But in order to care for our patients someone also has to keep an eye on the finances. Maybe the coming reform will change that, but I seriously doubt it.
Permalink Reply by christian on January 19, 2009 at 5:58pm
you are absolutely right ric, patient focus, but how do you do that? I mean, there are times where you cannot avoid "concurrent therapy".I for an instance, cannot stay in one bed and wait to finish my patient's neb, my 8 hours shift is not enough to handle a 1 RT : 12bed ICU,not mentioning the procedures like going to CTs, MRI, etc with an occasional call from the wards. Sometimes you feel like you've only done a 30% patient care and 70% documentation.(don't know where assessment and management will fit in this) I really do think that this should stop but we don't have enough staffing resources, we're not that popular yet. Nobody see or listen to the grievances of being understaffed, since you try your best to do all the things in your shift and avoid any reports, how will you show that you cannot do it altogether, when documentation and statistic shows you had managed your shift properly. They don't see you physically and mentally exhausted.
Permalink Reply by ric mandanas on January 20, 2009 at 8:22am
we are practically on the same boat. what a dilemma is there such a place? LOL.
Well Christian, I perfectly know what you mean and I am glad we have this forum to air out sentiments. it is like some kind of an relief valve (or something like that) to release the dangerous pressures
I hope you get my humor here.

But when Mike discussed some legal thing that they got in the U.S. (do we have that here or in KSA? i wonder). he mentioned about admin. would only care about patient safety, something click (like a lighted bulb).
Who would listen to our legitimate grievances. It could be unending and depressing, yet a simple tap at the back would ease up a little if not totally resolved.

Well I realize that if during the usual meeting (i hope two way talk) we focus on patient safety.
Can you imagine the danger of not properly evaluating each patient, not properly given time for the medication to work. not properly staying with patient when needed. and imagine all not properly done procedure for the reason of lack of time doing it or staff performing it. If they will not listen that you are exhausted physically, then they definitely would listen if patient's safety is at stake, in the end this the truth. That is what I mean.
Rey even suggested that we should have this "Patient priority policy", but Ray who would make the policy?


This thread really helped us a lot at least. I just hope they don't read and based this for our (you know what...)
That's why most of us just work without complaining. But up to when?... (Have noticed some uncompleted documentation, -- could be a way to get noticed? to fail? who knows)

One humorous comment that i notice in what Chuck contributed in his reply. I hope you wouldn't mind.
The whole comment is right and workable. You even defended some people we worked with being right person doing the right job. Then sum things up I think you mentioned about the coming reform, then you said I doubt it. I just smiled. As if we started from the beginning.
But definitely most of us were enlightened not to prejudge.
Permalink Reply by Ray on January 21, 2009 at 3:11am
Tirage your care. Quality care should come first.These rest of the work might not be completed if not given proper help. If you try and do it all then management expects you to do that much work, plus more the next time. This type of mentally of just not saying anything and trying to it all has to stop for our profession. The worst patients should get quality care from us.

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