Seeking Some Advice

So here's the deal...

I've decided that after five years at one hospital as a CNA, it is time for me to try somewhere new. There are several reasons for this, but the biggest being:

1. Pay. The pay is decent, but below average for what CNAs make in the area. Even with an annual merit raises, I'm still not making what I should.

2. Hours. I'm PRN at this hospital and am technically only required to work 16 hours every four weeks. Obviously, in order to support myself and my daughter through school, I need to work quite a bit more hours than this. I was working pretty close to full time hours (about 72 hours bi-weekly), but lately that has drastically changed, to where I'm hardly able to get any hours.

3. Staffing. I realize staffing is a problem in health care and most likely always will be, but at this particular hospital, the staffing is dangerous and somewhat scary. We're talking one CNA to about 40 patients, most of which are total care (living dead) patients. To some of who are or have been CNAs, I know this may not be considered terrible-- this sort of assignment is normal for a nursing home, but keep in mind these are acute care patients.

All that being said, it is time for a change. The hospital across town is a level II trauma center and has openings for CNA in their per diem (pool) staff. Which brings me to the part where I need your help:

This particular hospital has a base pay that is higher than what I currently make with 5 years experience. However, I've known them to pay several nurse aides with as much experience as myself $13-15/hour. I believe that with my relevant experience and the set of skills I possess, I should make at least $13/hr (right now I'm barely pushing $10.)

So, how do you handle this situation? On the application, there is a spot that says, "Desired salary ____." I'm always careful to not put something I feel may be viewed as too much so that my application isn't thrown in the pile of people they'd never consider hiring, but I never want to put an amount too small because I fear they may give to me. I've heard writing "Negotiable" is an option, but I also hear that most employers will throw at an application with this written because it shows that an applicant is incapable of making decisions.

Salary always come up during a job interview. Sometimes I've felt it really makes or breaks the interview and your chances of being hired.

What do you do?

My First Time

The ICU at Trauma Hospital is always busy, as I've heard, and this particular day was no exception. Alarms were blaring in the background, post-op open hearts and GSWs were rolling in from ER and surgery 90 miles a minute. Nurses, doctors, and respiratory therapists were always present and on their toes. Every second that you had to sit, you find yourself practically waiting for something to happen. Experience, and even only six hours spent in this unit as a student, will tell you that much.

I finally had a chance to sit down and catch up on some charting. And since the RT and I had a few minutes to spare, I decided this was as good of a time as any to give report.

"Room 401 received their treatment, DuoNeb, at 0741. Sats were 98% on room air, heart rate 76 before and 81 after, breath sounds were diminished bilaterally, respirations--"

Suddenly, I'm cut off by a nurse who runs up to us rather frantically.

"Do you have bed 23?!"

"We do. Why?" I'm instantly visualizing the chart in my mind, thinking about what I have or haven't done.

"The doc wants to tube him. He's declining. Long periods of apnea and mental status has changed, we need you in there NOW."

I look to the RT and he looks back at me. We shrug our shoulders and make way to the room.

"Never a dull moment around here," the RT says, laughing a bit.

It's insane how things can change in an instant. That's what I love about intensive care rotation. One minute, your patient is sitting up on 40% BiPAP in no apparent distress, and the next minute you walk in to find a room full of people crowded around your patient and the monitor, with someone at the head of the bed squeezing an ambu bag the intubation supplies set out on the patient's bedside table.

It sounds sick. But it really isn't. Nothing validates your knowledge or assessment skills like a crashing patient, and your ability to act fast and play a part in their team of health professionals, well, their life basically hangs on that. And that is the best and worst feeling in the world.
Think, TJ, think...

A quick glance at the monitor reveals sats are 88 with bagging, HR is in the low to mid-50s, and B/P is plummeting. Even increasing the FIO2 on the BiPAP to 80% didn't help. All the signs and symptoms this patient was showing indicated intubation...and fast.

I make my way through the crowd of people, to my place at the head of the bed next to the intensive care doc. I'm noting the time, what size blade he is using, the size of the ET tube laying next to the patient's head, and many other things. I reach over and grab the ambu bag from the nurse, giving it a tight squeeze and releasing slowly. And again...about every five seconds.

The pulmonologist looks over at me, the laryngoscope with a size 4 Macintosh blade in his right hand.

Wait...right hand? What the hell? Everyone knows blade in the left, tube in the right...

I'd never have seen this coming, but he handed me the blade.

I'm sure I looked very confused at this point. I mean, I know I'm able to intubate. I got the checkoff in lab, but didn't see this coming.

"Go for it, kid," he gave me a nudge.

Okay. I can so do this. I positioned the patient's head, placing a towel under his shoulders. I open his airway, using the "cross-finger" technique. I squat down just a little, and slide in the laryngoscope blade.
Vallecula. Epiglottis. Vocal chords. I'm surprised at how clear it looks. It feels like I've been down there forever, but it's only been about four seconds at this point.

Keeping a close eye on my landmarks, I reach for the size 8.5 sitting beside the patient, stylet in place. With the ETT still most of the way inside the package, I give it a slight crook at the end.

I apply a small amount of water-soluble lubricant to the tip of the tube, grasping it firmly in my right hand. I'm not really breathing at this point, because someone once told me if you hold your breath while the patient is without oxygen during intubation, you'll get an idea of how long it takes you to do it and be certain to keep it under 30 seconds from start to finish.

Before I knew it, someone was bagging my patient again. Visible chest rise. 23 centimeters at the teeth. Positive breath sounds in all lobes/bases. I advanced the tube just about a centimeter after the chest xray.

Sats returned to normal, HR increased, and the pt was doing well last time I left.

Having successfully intubated my first patient, I guess you can say I'm no longer a virgin. What was your first time like? I'm curious.

How RIM/BlackBerry Helps Me Survive RT School

I'm back!
For all of you faithful readers, I apologize for my leave of absence. A lot has went on in the past few months, but for the sake of time, I blame my lack of posts on my BlackBerry Bold from AT&T.

But wait, you don't have an iPhone? Nope, don't want one.

Let me tell you a bit about the specs on this baby:

• Half VGA resolution 480 x 320 pixel color display
• Backlighting, with a light sensing screen
• Trackball
• QWERTY keyboard with backlighting (by far my favorite feature!)
• Bluetooth v 2.0
• Supported video formats: DivX 4, DivX 5/6 partially supported, XviD partially supported, H.263, H.264, WMV3
• Supported audio formats: .3gp, MP3, WMA9 (.wma/.asf), WMA9 Pro/WMA 10, MIDI, AMR-NB, Professional AAC/AAC+/eAAC+
• 2.0 megapixel still camera with flash and 3x zoom (also has video capabilities)
• Battery life: Standby -- 13.5 days, Talk time: 4.5 hours
• 4.48" x 2.6" x 0.59"
• Weight 4.8 oz (nice!)

None of that means much to most of you. So let's get down to how I use this phone in school, seeing as this blog is focused around RT School--

The good thing about a smartphone is that if you know what you are doing, it will run your entire life for you.

As respiratory therapy students, we are pretty busy. Between class, school, and clinicals, the calendar application that comes installed on all BlackBerry phones is most excellent.



Who needs pen and paper anymore? You will receive an alert directly on your phone, and you can set reminders at different intervals (1 day before the event, 1 hour before, etc.). There's also a snooze option-- which I don't recommend. If you're really good with techy things, I believe there is even a way to set it up where the phone will switch to silent during your meetings and classes scheduled in the calendar.

Other programs I find most useful that come installed on the BlackBerry Bold-- at least AT&T's version-- include voice notes (just as it sounds-- the phone doubles as a voice recorder for lectures), Word To Go, Sheet To Go, and Slideshow To Go.

(I find the ToGo software suite most useful in clinicals, when you need to look over your class notes, drug spreadsheets, or review a short PowerPoint presentation to refresh your knowledge over a topic).

Heck, even the web browser isn't that bad:



Okay, enough with what comes installed on the phone. Today it is all about apps, apps, and more apps. There are millions out there, but the ones I use for school are as follows:

-Google Sync All of us know how pesky it is once you get a new phone to set up all of your contacts. And if you know your schedule for months, or even weeks, in advance, well, it would take hours to add it to your phone. That's where this app comes in. You can add contacts to your Google (GMail) address book and update your calendar online (much faster!), then simply sync it all to your BlackBerry smartphone. This is by far my favorite productivity app.

-Epocrates Rx for BlackBerry The makers claim this application has been shown to, "Improve patient care and safety, save time, and enable confident clinical decisions." Need I say more? I realize there aren't many drugs we handle as respiratory therapist (students) but, every now and then, you get that drug you covered in Pharmacology and have never seen again. Plus, Epocrates is useful when making recommendations to the physician or checking for drug interactions.

-gCalc Since a lot of what we do as students and practitioners involves equations and most of that involves converting units (inches to centimeters, etc), this app is as good as gold!

-Google Maps I know that most of you aren't nearly as directionally challenged as I am, but throughout the duration of our program we visit several outlying "rural" hospitals, some of which are an hour drive or longer. When you wake up at 0430 to leave for your affiliate site, it's nice to know that you don't have to worry with trying to decipher a paper map. This one has saved me from being late more times than I can count.


I really am back this time. Stick around, because coming up tomorrow: A more detailed review of the BlackBerry (from a user's perspective, not a student perspective) and a few of my most favorite apps that I use for fun.

Test Post

Testing CellSpin for BlackBerry app -- www.cellspin.net

Does this ever happen to you?

You sit down to right what you feel will be an amazing post. You assume that it will be riveting, emotional, and thought-provoking. Hell, maybe you even feel that it will cause people to take a second look at their life and realize that there is a lot to be thankful for. You figure that said post will draw a lot of comments, attention, and most of all, will do a great service to the anonymous patients involved by sharing their story.

Then, somewhere in the middle of about the 15th paragraph, you realize that you can't write it. You can't publish it, because things that were said to you by the anonymous patients should be kept between you and them? Ever actually end up feeling that by publishing this post, you will be doing a disservice to one man, woman, and child? What about starting to feel as if you should just let this man rest in peace and not share his tale?

Well, that's happened to me.

Just know that somewhere out there, a man and women who were very in love a long time ago parted ways and were rejoined in the same unfortunate car accident. The man died, the woman lived. The woman was coherent enough to recognize this man as the person she had thought about for the past several years.

Oh, and did I mention the woman's kid is alive because this man made the decision to be an organ donor? Yep.

The kid would have died due to internal injuries sustained to his organs. This woman now knows that the love of her life, the one she lost, has saved the life of her son.

That, my friends, is amazing.