Respiratory Intern PRN Night Shift

*Job Requirements * I. General Summary Under general supervision of the education and clinical supervisors, LIPs, and guest lecturers, the respiratory intern will observe in the classroom setting and in precepted clinical orientation a variety of routine technical procedures. This orientation period will allow time to gain knowledge of effective evaluation and treatment of individuals with cardiopulmonary functions threatened or impaired by developmental defects, the aging process, physical injury, or disease. The intern period is to serve as a means to provide effective respiratory care department orientation, while ascertaining the overall competency of the new graduate. II. Principal Responsibilities and Tasks Under general supervision of the Respiratory Care education supervisor coordinator the respiratory intern will observe the following work being performed by staff assigned to the respiratory care practitioner job classifications.

• A variety of respiratory care treatments given to specific patient populations (adult, pediatric, or neonatal).
• Explanation of treatments to patient and/or family before performing. 
• Observes physical signs and symptoms, general behavior, general physical response to respiratory care procedures. Collaboration of therapists with physicians regarding therapeutic treatment plans to determine whether initiation, modification, or discontinuation of the treatment regimen is warranted.
• Termination of patient treatment upon notice of patient discomfort, troubled medical status, or inability to accept treatment.
• Observation of Cardiopulmonary Resuscitation (CPR) procedures, including, airway management, manual ventilation, and cardiac compressions as needed.
• Observes the therapist as they administer therapeutic and diagnostic gases (exclusive of general anesthesia), bronchodilator treatments, and chest physiotherapy, aerosolized medication treatments in accordance with departmental procedures, as directed by a physician. Additionally, they will observe the therapist delivering oxygen and humidified air through a variety of devises to reverse and prevent tissue hypoxia, treat arterial hypoxemia, decrease the work of breathing and decrease myocardial work.
• Observes therapist physician interaction as they assist the physician with non-surgical insertion, maintenance and removal of artificial airways, as requested.
• Watches the technique of suctioning of the patients artificial and nasal/oral airways with the use of a sterile disposable catheter inserted into the airway.
• Learns age-specific version(s) of respiratory techniques when working with adult/pediatric/neonatal population.
• Observation of mechanical ventilation and continuous positive airway pressure (CPAP) to critical care patients, witnessing while the therapist adjusts ventilation and CPAP under the direct supervision of a physician.

• Observes the effectiveness of mechanical ventilation and other therapeutic interventions in the critically ill patient by learning the interpretation of chest x-rays, and blood gas results. Observation of the therapist as they observe the patients appearance, respiration rate and oxygen saturation, and notifying doctor as required. The following skills are performed in the classroom setting only.

• Calibration and maintenance of ventilators (life support systems), pulse oximeters, nebulizers, Metered Dose Inhaler (MDI), oxygen and humidity equipment in accordance with departmental procedures and standard operating procedures.  Completes Mechanical Ventilation Competency

• Ensures correct ventilator alarms and settings. 

• Given a mock scenario, makes an adjustment to ventilator parameters and settings as outlined by the Education Coordinator.
• Applies cleaning/sterile techniques or ensures decontamination of equipment essential for optimal operation of the respiratory therapy equipment. Follows protocols and guidelines regarding the disinfecting of equipment.
• Reviews how to initiate and perform maintenance rounds on all types of oxygen and humidity equipment used through the hospital.
• Reviews procedure on how to assure all equipment in need of service is labeled appropriately and sent for repair to biomedical engineering, in accordance with departmental procedures.
• Reviews and practices in a mock computer environment, respiratory care documentation and reporting of information on activities related to patient care in accordance with departmental procedures. 
• Reviews the collection of data, such as, Arterial Blood Gas (ABG) readings, Electrocardiogram (ECG), Hemodynamics, laboratory values and patient history to fully understand reason for adjusting patient's life support equipment.
• Given a mock scenario, the Respiratory Intern will practice preliminary interpretation of arterial blood gas results and related information detailing how they would report the results to the attending physician.
• Reviews quality improvement information such as inappropriate ventilator change, incident sheets, and equipment failures.
• Demonstrates knowledge and skills to provide care appropriate to the age of the patients served on the assigned unit. Demonstrates knowledge of the principles of growth and development over the life span and possesses the ability to assess data reflective of the patient's requirements relative to his or her age-specific needs, and provides the care needed as described in the unit/area/department policies and procedures.
• Attends and participates in in-service training and various educational programs for professional growth and development. 

• Strives to continually maintain the highest personal and professional standards as defined by the state license, medical system policy, and the American Association of Respiratory Care code of ethics. III. Education and Experience 

• Graduation from an accredited respiratory care education program.

• Pending credentialing as a CRT or RRT by the National Board of Respiratory Care in Respiratory Therapy is required. Hired interns may be onboarded and start the classroom portion of orientation. 
• Progression to the clinical phase of orientation requires licensure by The Maryland Board for Physician Quality Assurance. Failure to attain a Maryland State license will required alternate work as an equipment technician until a license is issued. Once a license is issued, the RCP will be converted to either a CRT or RRT Job Description.
• A minimum of six months to one year performing didactic and clinical Respiratory care procedures is preferred.
• General knowledge of anatomy and physiology of the respiratory system, biology, microbiology, technical mathematics, and pharmacology are required. Knowledge of medical terminology, and moderate level of proficiency in operation of equipment, such as, various types of ventilators, nebulizers, aerosol masks, nasal cannulas, mist tents, oxyhoods and other oxygen delivery devices.

Post Orientation the Respiratory Intern shall

• Possess the ability to determine the quality of patient performance, judge degree of patient discomfort or failing medical status, and the inability of patient to perform during treatment process.
• Possess the ability to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served on the assigned unit. The individual must demonstrate knowledge of the principles of growth and development over the life span. They must also possess the ability to assess data reflective of the patient's requirements relative to his or her age-specific needs. Additionally they should provide the care needed as described in the unit/area/department policies and procedures.
• Possess the ability to work with patients possessing potentially infectious diseases using the appropriate "Universal Precautions" and other safety procedures.

• Possess effective verbal and written communication skills are necessary in communicating with patients, doctors, other respiratory staff and nursing staff throughout the medical system, and in maintaining accurate and complete documentation of testing procedures. IV. Working Conditions

• Work is performed in the classroom environment, but may be performed in an office setting.

• Work requires pushing and pulling of equipment weighing up to approximately 300 lbs. (with assistance), up to 10% of the time; requires walking and standing approximately 40% of the time; sitting approximately 50% of the time.

• During some patient observations, there is potential for exposure to patients possessing infectious disease, requiring observance of "Universal Precautions" by wearing protective clothing, such as, gowns, masks and gloves following safe work practices. V. Patient Safety The Respiratory Technician ensures patient safety in the performance of job functions and through participation in hospital, department or unit patient safety initiatives. No Direct patient care is provided by the Respiratory Intern and all work in the patient care environment is purely observational.

• Takes action to correct observed risks to patient safety.

• Reports adverse events and near misses to appropriate management authority.
• Implement policies, procedure, and standards consistently in the performance of assigned duties.
• Develops effective working relationships and maintains good communication with other team members.
• Identifies possible risks in processes, procedures, devices and communicates the same to those in charge.

*Work Experience * Education and Experience

• A Certificate from an AMA approved program by the National Board of Respiratory Care in Respiratory Therapy is preferred.
• A minimum of six months to one year performing didactic and clinical Respiratory care procedures is preferred.
• General knowledge of anatomy and physiology of the respiratory system, biology, microbiology, technical mathematics, and pharmacology are required. Knowledge of medical terminology, and moderate level of proficiency in operation of equipment, such as, various types of ventilators, nebulizers, aerosol masks, nasal cannulas, mist tents, oxyhoods and other oxygen delivery devices.
• CPR is required
• Associates Degree in respiratory or related field is preferred.