Adrenalin Junkies Need Not Apply

If you’re the kind of RT who lives for Code Blues or the next stat page to the ED, then pulmonary rehabilitation probably isn’t for you.

But if you find yourself looking for excuses to spend just a few more minutes with an elderly COPD patient, or getting tears in your eyes when you see a family struggling to cope with a loved one being sent home on oxygen, then this relatively more laid back practice setting might be just what you’re looking for to fulfill your career goals.

Debbie Koehl, MS, RRT, FAARC, a long-time coordinator of the pulmonary rehabilitation and patient education program at Indiana University Health Methodist Hospital in Indianapolis, IN, knows about working in pulmonary rehabilitation. In this interview with the AARC she explains what it takes to work with patients in this setting.

Working in pulmonary rehabilitation doesn’t offer the same adrenalin rush as, say, working in the ICU or ED. What kind of person is best suited to this area of respiratory care and why?

Debbie Koehl: Although working in pulmonary rehabilitation (PR) does not have that adrenalin rush, there is a great feeling of satisfaction working with our patients. Often times our students and some of our supplemental staff remark about how great it is to see patients improve and get better. I think that someone who has patience, enjoys working with patients one-on-one or in a group, likes to do patient education and training, and has great communication skills is ideal for PR. PR is not acute care, but many of the skills we learn in the acute care setting are put to use, especially our critical thinking skills.

Not all, but certainly most PR programs are dedicated to helping older people maximize their health despite their chronic lung disease. What do RTs need to know about working with this patient population before applying for a job?

Debbie Koehl: Dealing with patients with chronic lung disease can be very challenging. They often present with more than one co-morbidity as well as stress and depression. I would say that patience, an understanding ear, and the ability to educate are all traits that are extremely important. I always tell students PR is not for everyone, it takes a special person. Chronic care is not acute care. If a PR job has opened up and you want to apply, I would shadow the area and make sure it is something you want to do. Even though it is not fast paced like critical care, it can be just as taxing when dealing with multiple patients and their disease states and issues.

Is there any additional education or training that could benefit the therapist who would like to work in a pulmonary rehab program? If so, what is it and where can people obtain it?

Debbie Koehl: Although there are no specific training courses for PR at the moment, I think there are some additional training programs that can help. Both the AARC Asthma and COPD educator courses offer a lot of need-to-know information. Not only will they give you great reviews of the disease processes but they will also help with skills in patient education. Attending the educational sessions related to pulmonary rehabilitation and patient education at the AARC’s International Respiratory Convention & Exhibition is always good too. And joining the Continuing Care/Rehabilitation Specialty Section and discussion list is a great way of gleaning information and making professional contacts.

Reimbursement has been a big issue for PR programs, persisting even after the pulmonary rehab benefit became law under Medicare. What should prospective job candidates know about these reimbursement challenges before taking the plunge?

Debbie Koehl: Reimbursement is a challenge. Most of us knew or know nothing about billing and reimbursement until getting involved in PR. The AARC, along with many of our sister organizations (AACVPR, ATS, ACCP, NAMDRC) has put together a Pulmonary Rehabilitation Program Toolkit that can help make sure you are paid for your services — and being paid for what you do is extremely important. Make friends with your billing department. Know what your charge master looks like. As a PR professional it is important to know the billing and coding aspects of your program.

As a long-time PR coordinator, what would you say are the biggest challenges and rewards of working in this area?

Debbie Koehl: The biggest challenge I see is making sure people know about pulmonary rehabilitation and what it can do for them. Our patients do our best marketing, both with their friends and their physicians. So many patients tell me, “I wish I would have done this or known about PR earlier.” My biggest rewards are seeing patients improve and seeing them do things they did not believe they could do.

What’s your fondest memory of working in PR and why?

Debbie Koehl: I have many, but one of my favorites involves a patient we had who was 80 years old. She was so spunky and never minced her words. She was a fighter and was a strong woman. When new people would start, she was our informal instructor. She would correct them if they did something wrong, she would put them in their place if they misspoke, and she would always tell them the importance of pulmonary rehabilitation and what it did for her. She was our biggest advocate and everyone knew and loved her. We miss her dearly!

Here are four things Debbie Koehl believes therapists should keep in mind before seeking a position in a pulmonary rehabilitation program:

  1. Be ready for patients who challenge you. They will want answers and will always ask you why they have to do something or what is the purpose of doing something. Be ready to answer and back it up. You cannot use the old, “I told you so/to” explanation you heard as a kid.
  2. Have patience . . . and then have more patience.
  3. You have to have good patient and communication skills. You need to be flexible; each patient is different and will learn and listen differently.
  4. You also need good critical thinking, problem solving, and assessment skills. You need to be able not only to interpret the objective information but also the subjective information you learn about your patients.