Respiratory Therapist - Adult Critical Care

It takes a lot of very smart, hard-working and talented people to provide the level of care that we give to our patients. Tufts Medical Center is an internationally respected academic medical center and we pride ourselves not only on the sophistication of the care we deliver, but the compassionate way in which we provide it. And that starts with our employees.

This position is responsible for respiratory care for patients of all age groups, who are diagnosed with cardio-pulmonary dysfunction.  Services are provided throughout the Tufts Medical Center are complex. This includes the ICUs, in-patient rooms, the Emergency Room, and outpatient clinics.  A request for service originates from the medical staff of Tufts Medical Center.  It may be written or verbal and can be communicated to the therapist by direct telephone conversation and/or beeper page.  The patient’s nurse or unit secretary conveys the order. 

All patients are assessed for their needs initially and on an on-going basis until no longer required.   Documentation of services provided is recorded in the Respiratory Therapy Progress Notes section located on the department flow sheet.  A copy of this document is filed in the patient Medical Record. 

A list of the specific practices available by this department is noted below.  A Respiratory Therapist is under the direction of the Director and Assistant Director of Respiratory Care.  Patient services are available 24 hours/day, 365 days/year.  Services are provided in accordance to policies and procedures agreed upon by the Medical Directors of the department. Clinical Practice Guidelines have and continue to evolve as the framework of clinical respiratory care practice.  These practices are well referenced and sponsored by the American Association for Respiratory Care.  

Opportunities for growth and career expansion include:  

PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS: 

• Neonatal and pediatric training 

• Advanced certifications: ACLS, NRP, PALS 

• Incentive career ladder supporting expanded skillsets 

• Participation in neonatal and pediatric transport program  

• Extracorporeal Membrane Oxygenation (ECMO) training 

• Participation in orientation of new employees, primary preceptor opportunities 

• Quality and Safety initiatives: participating in composing and maintaining clinical practice guidelines and protocols 

• Participation in various departmental and critical care research opportunities  

• Initiates patients on invasive and non-invasive mechanical ventilation; routinely checks and maintains proper function of ventilator in conjunction with the physician order.  

• Abides with infection control guideline for invasive and non-invasive equipment per departmental policy.  Changes and adjusts ventilator parameters based on clinical assessment and blood gas analysis in accordance with physician orders.  

• Weans patients from mechanical ventilation and other therapies through patient assessment and adjusting parameters within prescribed protocols. 

• Administer inhaled medications in accordance with institutional guidelines derived from the department of respiratory care and pharmacy. 

• Administers oxygen using low flow, high flow, open and closed circuits. 

• Embodies patient and family centered care. Explains procedures to patients and family.  

• Provides services to analyze blood specimens for blood gases, glucose and electrolytes in neonatal and pediatric intensive care units. 

• Administers Positive Pressure Breathing, (e.g. CPAP or BiPAP), which consists of the application of positive pressure to the upper airway to promote better lung inflation and aerosol distribution.  

• Routinely assists in the transport of patients requiring life-support to and from referral hospitals.   

• Provides in-house transport of mechanically ventilated and other high-risk patients.  

• Provides non-traditional therapies, e.g. Nitric Oxide gas administration, as ordered. 

• Provides resuscitation and support services at all high-risk deliveries. 

• Monitors effectiveness of therapy using non-invasive techniques such as pulse oximetry, end tidal CO2 and transcutaneous PO2/PCO2, in addition to invasive techniques such as arterial blood gas sampling. 

• Analyzes inspired oxygen concentration using various oxygen analyzers.  

• Calibrates monitors and maintains Transcutaneous Oxygen Monitors, End Tidal CO2 and pulse Oximetry monitors.   

• Assists in Cardio-Pulmonary Resuscitation as part of Code Team primarily providing airway management and manual resuscitation.   Commonly administers drugs via the endotracheal tube during cardiopulmonary rescue e.g. Lidocaine, Atropine Sulfate and Epinephrine. 

• Documents therapy, patient assessment, and interventions performed and test results in the progress notes of the medical record in a concise, accurate, and thorough manner.  

• Transcribe a detailed shift note for all patient’s cared for during the shift.  

• Responsible for acknowledging the proper assembly of all respiratory therapy equipment prior to and during patient use. 

• Performs daily rounds and fairly bills patients for services rendered.  

• Attend rounds daily with the intensive care unit critical care team and is an active participant in the patient’s care. 

• Assists with development of  in-service programs for departmental personnel. 

• Assists the Associate Director with the orientation of new employees; acts as a preceptor for new employees and is utilized as a clinical instructor for students enrolled in local universities. 

• Administers therapeutic agents such as Heliox, Surfactant, Tobramycin, Ribavirin and Pentamidine in accordance with established Departmental procedure. 

• Provides services for new clinical programs as research protocols are developed. 

JOB KNOWLEDGE AND SKILLS: 

• Ability to walk and stand for approximately 90% of the time. 

• Ability to transport respiratory therapy equipment (up to 100 lbs.) using carts or wheels on the equipment to and from patient areas.  

• One needs to demonstrate the ability to communicate with and assess the patient needs of different age populations to provide the necessary care.  This will be demonstrated by supervisory review of Daily Shift Notes documented in all areas of clinical practice. Skills will be rated as part of your Performance Appraisal. 

• Ability to perform all required duties under emergency and extreme stress situations. 

• When cross-trained to perform neonatal and pediatric services, one is expected to acquire and maintain NRP and PALS certification. 

• Demonstration of competency is required on an annual basis.  This will include computer based training and evaluation in adult, pediatric and neonatal mechanical ventilators. 

 EDUCATION: 

• Bachelor’s degree level in health profession, science or equivalent is preferred.  

• Associates degree in Respiratory Therapy is required.   

• Must possess the RRT credential.   

• Knowledge of medical terminology, physiology of the cardiopulmonary system and respiratory therapy science. 

EXPERIENCE: 

• One to two years on the job experience in acute and critical care. 

• An equivalent combination of education and experience which provides proficiency in the areas of responsibility listed above may be substituted for the above education and experience requirements 

LICENSES, ETC: 

• Must be currently licensed and in good standing with the Licensure Board of Registration of Massachusetts. 

• Must be a Registered Respiratory Therapist, be issued Registration from the National Board of Respiratory Care. 

AGE SPECIFIC COMPETENCIES: 

Possesses and applies the skills and knowledge necessary to provide care to patients throughout the life span, with consideration of aging processes, human development stages and cultural patterns in each step of the care process. This includes: 

• Knowledge of growth and development 

• Ability to interpret age specific data and response to care 

• Provide age specific communication 

WORKING CONDITIONS/PHYSICAL DEMANDS: 

• Most work is performed on patient floors, emergency room, outpatient clinics, and respiratory therapy workrooms.  

• Exposure to infectious patients, blood products, and contaminated equipment.  

• Works with high-pressure gas systems and uses gas mixtures which support combustion.  

• Exposed to potentially toxic aerosols such as RibavirinÒ and PentamidineÒ and poisonous gases e.g. nitric oxide & nitrogen dioxide. 

• Frequent contact with patients and their families, medical and nursing staff, unit secretary and other employees.