A Career Option for Respiratory Therapists
If you were the kid who was always asking “why” and trying to figure out the cause of every effect you encountered, then pulmonary diagnostics might be the right career path for you. In this interview, Katrina M. Hynes, RRT, CPFT, assistant supervisor in the Special Pulmonary Evaluation Laboratory at the Mayo Clinic in Rochester, MN, explains how she got into the area and what it takes to succeed —
Why did you decide to become an RT and what led to your interest in pulmonary diagnostics?
The respiratory care profession literally fell into my lap by chance. Out of the blue, Faith Zimmerman, who was the health sciences program director at the University of Minnesota at that time, contacted me at my work. She had seen that I had put in an inquiry regarding the cardiovascular invasive specialist associate’s degree program. She encouraged me to consider pursuing the bachelor’s degree respiratory care program instead, considering I already had two years of college education at a previous academic institution. She requested to meet with me to discuss what the respiratory care program at the University of Minnesota/Mayo School of Health Sciences had to offer me.
To this day, I can recall my first day of clinical. We were reviewing a patient case prior to entering the patient’s room. During our roundtable discussion, the program director at the time, Jeff Ward, was talking about CHF and wanted to know what we knew about it. All I could think was, “please do not call on me,” and “oh my goodness, I’m in over my head.” Prior to entering into the program I was pursuing a double major in international business and the Spanish language. I had zero health care knowledge or experience. Determined to succeed, I put my head down and studied hard.
The program curriculum required students to specialize in two respiratory disciplines. I chose pediatrics/neonatal care and pulmonary diagnostics. I enjoyed the atmosphere and the patient population of the pulmonary function lab. After completion of my junior year, I was fortunate to obtain an internship in the pulmonary function laboratory at the Mayo Clinic as well as a respiratory therapist assistant II internship at Methodist Hospital. I’m so fortunate to have had both experiences, for it was then that I solidified my passion for diagnostics.
What are some of the biggest differences between working in a pulmonary function lab and delivering care in the ICU or on the floors?
Based on my experiences having worked in both environments, albeit my time outside of the lab was short term, both require a high level of knowledge and skill, attention to detail, and the ability to troubleshoot equipment. The difference that is most prominent to me is the level of communication requirements needed in a pulmonary function laboratory versus the ICU. ICU patients were often heavily sedated and unable to communicate with the health care providers. My interactions with the patient’s family and friends were minimal in that environment; oftentimes that communication occurred between the assigned nurse and the physician care team managing them.
In the pulmonary function laboratory our patients are walking, talking, and interacting with us throughout the entire encounter. Clear, concise communication is imperative. Our patients must understand what we’re asking them to do to produce a good test. Oftentimes we must use demonstration, or the teach-back method, to confirm their understanding of the procedure they’re about to perform. Frequently, we see patients who require the use of an interpreter or the language line to translate between ourselves and the patient so that we can communicate effectively with the patient. In this situation a systematic approach with clearly defined roles and communication guidelines is crucial. You must establish the expectations and format of how the communication will occur during the test. In doing this, you will ensure patient safety, establish trust, effectively communicate, and provide the patient the greatest opportunity to give their maximal effort and produce the best results.
Diagnostics requires attention to detail to ensure quality test results. What are some of the personal characteristics you believe are essential for therapists to possess before seeking a place in a PFT lab?
First off, it’s vital that any PFT lab has a formal training program that includes the completion of competencies within the first six months of employment and annual competencies thereafter, due to the level of specialized care and the complexity and diversity of testing methodologies. A sound understanding of pulmonary pathophysiology is needed to provide comprehensive care and patient education. In addition, therapists working in the PFT lab should be actively involved in the laboratory’s quality assurance program. This might include understanding equipment maintenance nuances, tracking equipment performance by conducting basic tests on yourself (biologic QC), or being part of a quality review process. If all these checks and balances are in place, with a little hard work, good communication skills, a positive attitude, a team oriented mindset, and the ability to think on your feet, you will succeed in a pulmonary function laboratory.
What kind of educational background, credentialing, and/or experience are necessary to make the move from general RT to working in a diagnostic lab?
To move from general RT to a pulmonary function lab, you must complete an orientation program — comprehensive training that includes competency and demonstration of the different testing modalities. I strongly encourage respiratory therapists who work in the lab to obtain their CPFT and/or RPFT credential as well. These additional credentials demonstrate your understanding of the specialty and they are also beneficial in honing your diagnostic skills and understanding of the procedures performed.
What are job opportunities like in the pulmonary diagnostics field these days, and how do you think they may be changing as a result of the ACA and other factors?
The paradigm shift in health care towards preventive medicine will open up a plethora of diagnostic opportunities for respiratory therapists. Government programs are penalizing hospitals for increased hospital length of stay and readmission rates. Respiratory therapists are key stakeholders in the success of these programs through the provision of appropriate and timely patient education, rehabilitation, and specialized diagnostic testing, as well as in-home health care. With reimbursement cuts on the rise and bundled payments at our front door, we’re being asked to do more, with less, and at a better quality than ever before. As a result, we’re challenged to think innovatively to provide care in a more efficient and cost effective manner.
Do you have an especially interesting experience from your work in the PFT lab that you can share with us?
A service that we provide in the Mayo Clinic pulmonary function laboratory is the cardiopulmonary exercise test (CPET) with video laryngoscopy. The procedure is performed to characterize the upper airway architecture in individualized patients who present with inspiratory stridor during exercise. In the infancy of the new service line we saw a middle-aged female who presented with shortness of breath with exertion. She’d been seeking medical attention for over a decade, visiting some of the most prestigious medical institutions in the country, with no resolution of her symptoms. She was being treated for asthma at the time, but further evaluation in our pulmonary function laboratory revealed she did not have asthma. In fact, her repeat PFT revealed normal lung function and no signs of airway inflammation with FeNO testing.
We performed a CPET with video laryngoscopy and found that the patient had bilateral arytenoid collapse with paradoxical vocal fold motion. I remember the fear in her eyes as she continued to pedal while her airway occluded with each breath in. By communicating with her throughout the test she understood how important it was for us to document these findings via video. With our team’s support and reassurance she persevered. When the required video footage was captured and a proper diagnosis was evident the patient immediately broke out into tears, stating, “I knew I wasn’t crazy.” Her journey was now over; she had the answers she’d been seeking for nearly a decade. She was going to have surgery and finally move on with her life.
If you had to give therapists who want to work in a PFT lab 2-3 bits of advice, what would they be?
- Ask to spend a day or two in the laboratory to see if the work is a right fit for you.
- Once you’ve worked in the laboratory and feel comfortable with the procedures, study for and obtain the CPFT and/or RPFT credential.
- Always keep the interests and safety of the patient as your first priority. The laboratory can be very equipment-focused, but you need to make sure to pay attention to the patient as you work through the various procedures. The Mayo Clinic’s primary value states “the needs of the patient come first” and this clearly needs to be our focus regardless of the area we work in.
