So You Want to Be a Long-Term Care Therapist?
Hospitalized patients who aren’t well enough to go home are often transferred to a long-term care facility such as a nursing home or a long-term acute care hospital. Respiratory therapists who work in these facilities provide a full range of care. They also find themselves acting as patient advocates and patient and family cheerleaders as well.
In the following interview, AARC member Connie Dills, MBA, RRT, RPFT, clinical educator at the Hospital for Special Care in New Britain, CT, explains why she ventured into the area and what it means to her to participate in the care of this special patient population —
How long have you worked in long-term care and what sparked your interest in the area?
I have worked in long-term care for 13 years. I never thought I’d be interested in working in long-term, since I had always worked in acute care during the prior 18 years. But having transferred from another state, I decided to take a chance. Particularly since the position was for a respiratory educator, which was what I was looking for.
What does that position entail and what do you like most about it?
My position as clinical educator for respiratory care services here at the Hospital for Special Care includes coordinating, facilitating, and participating in the mandatory and regulatory educational requirements for the RTs, as well as training on new equipment and treatment modalities. I also manage the ABG lab and provide training for those RTs who analyze blood gases. Additionally, I perform all the annual re-validations for competency of the respiratory therapy staff.
Orientation of new RTs also falls under my job description, which involves introducing them to respiratory practice in general here at the hospital — lay of the land, so to speak — and then coordinating their orientation schedules and assigning their preceptors as they progress through each unit. Since I work in a multidisciplinary education department, I also provide respiratory education to newly hired nurses. We have an interdisciplinary preceptor forum between respiratory therapy and nursing. I, along with a nursing peer, hold monthly meetings with preceptors from both disciplines where we discuss a variety of topics related to adult learning.
My favorite job-related activity is conducting the validation fairs. I really enjoy being able to connect with each and every RT on staff. We have 100, so there’s not a lot of opportunity to talk with them and hear what they have to say on a daily basis, particularly when they are off shift. I always learn so much from them and gain a lot of insight on what they encounter and have to deal with.
What are some of the biggest differences between working in a long-term care setting and delivering care in the ICU or on the floors in an acute care hospital?
The biggest difference is that you can deal with or work around just about anything in acute care for a few days, since their stays are quite brief these days. Here, there are no “work-arounds.” You really have to be creative, think out of the box, and find real working solutions to patient-related challenges as they present themselves. These people are here for weeks, months, and in some cases years.
Another somewhat related difference that presents its share of challenges is that since this is “home” for many of our patients for a prolonged period of time, we all have to be mindful that they are just like us. They want to do the same things we enjoy, like go out to dinner, go to a movie, go shopping or to an important family function. The big difference is that it’s a lot more challenging, but we have a great team here and we get it done.
Many of your patients face major health challenges. What are some of the personal characteristics that you believe are essential for therapists to possess before working with this patient population?
Therapists who work in the long-term care setting first and foremost must be patient. Nothing happens fast, and since the patients are not so acutely ill, they require a lot of coaching and support. Another important attribute is to be as sympathetic and empathetic as possible, because that could be you or your family member in that bed.
What kind of educational background, credentialing, and/or experience is necessary to make the move from general respiratory therapy to working in long-term care?
Contrary to what one might think, the best RT for this type of care is an RRT with a strong critical care background. Our hospital has approximately 100 ventilators running every day, and being able to manage a wide range of patients with varying pulmonary pathology requires great skill.
What are job opportunities like for RTs in long-term care these days, and how do you think they may be changing as a result of the Affordable Care Act and other factors?
My personal opinion regarding the future demand for RTs practicing in long-term care is that it will most assuredly increase. Patients are discharged from acute care facilities very quickly due to reimbursement and are sent to long-term acute care facilities at increasing rates. And they are much sicker.
Do you have an especially interesting or heartwarming story to tell about your work with a long-term care patient?
Recently, we had two of our patients who had become close, get married. We had a full scale wedding and reception outside in the park area of our grounds. The entire staff was involved. There was not a department in the hospital that didn’t contribute to their happy day. It was very meaningful for the staff as well.
If you had to give therapists who want to work in long-term care 2 or 3 bits of advice, what would they be?
If I had to give advice to an RT considering working in long-term care it would be, I would say be ready to utilize all your critical thinking skills, be ready to use all your clinical skills and then some, and be ready to find personal fulfillment.
