Nurturing patients and students in a fast-paced profession

The Report: April / May 2003 vol.24 num.2

by NADENE REHNBY

ts hard to keep pace with Colya Kaminiarz. As a respiratory therapist and clinical instructor at BCs largest hospital, Kaminiarz is always on the move.

-Its what I like best about my job," he said, heading out of Emergency, stopping at the bronchoscopy unit, and into Intensive Care to check on his students. -Its very fast-paced."

Respiratory therapy is itself a complex and multifaceted profession. With a core role assisting in the diagnosis and treatment of lung disorders, RTs work with medical professionals in just about every area: maintaining open airways for trauma or surgery patients, assisting in resuscitation, or providing life support for patients who cant breathe on their own. Aside from acute care, RTs provide a range of care related to lung functioning — from managing childhood asthma to providing in-home oxygen for seniors.

Kaminiarz has worked at Vancouver General Hospital for eight years. Here, there are normally a dozen or more RTs on duty: several in the pulmonary function department, where lung disorders are diagnosed and treated non-invasively; and the others scattered across the site in Emergency, the ICU, operating rooms and on the wards, as well as in specialized areas such as the spinal cord unit. Wherever RTs work, Kaminiarzs students are always close at hand.

Opportunities like working in VGHs Emergency department are a boon to his students, he said. -You never know whats going to come through the door. You can apply so many skills in a day. And its a great area for teamwork."

Being part of a team is central to an RTs work. For example, Kaminiarz sees anesthesia ... surgery ... as another significant learning environment. -You work closely with physicians and get an opportunity to perform procedures you wouldnt elsewhere," he said.

Even more interdisciplinary is the ICU environment, where RTs work with a team of health professionals that includes the pharmacist, unit social worker, and the bedside nurse, as well as resident and attending physicians.

Being a clinical instructor to a dozen students also keeps Kaminiarz on the move. Students come to VGH for an eight- to 16-week rotation, part of the three-year RT diploma program at University College of the Cariboo, which is one of Canadas most respected programs and the only one offered in BC.

Kaminiarz is kept busy with a host of duties, from orienting new students, to lesson-planning and lecturing, to marking exams and conducting assessments. But clearly most satisfying is his one-on-one with students. He is enthusiastic while supervising procedures, working on competencies, or coordinating student teams as they prepare for an in-service for other health professionals.

Kaminiarz is always on the watch for students having difficulties. -Its incredibly challenging ... both the workload and the emotional impact," he said, noting that nearly 40 per cent of RTs in training do not stay in the program. -We try to identify problems as soon as possible and work out a strategy to help them work through it."

Student Samantha Robertson appreciates Kaminiarzs teaching style. -He doesnt get stressed," she said, noting his easy manner in what can be an intimidating environment. -This morning he helped me with an extubation, and just asked me a lot of questions to help get me through it. He didnt hover."

According to Kaminiarz, effort put into students is well rewarded. -Students are a big demand at first," he said, -but as they get up to speed they are able to take on more of a load." He also sees them as critical to the advancement of the profession. -After all, these are our future co-workers."

At 32, Kaminiarz is young for a teaching role. Born in Germany and raised on Bowen Island, he studied sciences at UBC and worked in the Canadian Forces Medical Reserves before being put on to RT by paramedics, a profession he was considering. -I had no idea respiratory therapy existed," he said. But after tours at VGH and St. Pauls, he was hooked. He applied to UCC in 1993, and landed at VGH when he graduated two years later. -I was looking at teaching maybe another four or five years down the road," he said. But when the position came up, he jumped at it.

-Because medicine is always changing, you have to make sure that what youre teaching is going to be relevant," he said. So he stays on top of current research, serves on the board of the Canadian Society of Respiratory Therapists, and is also an active member of its US counterpart.

Things are moving quickly in the profession. An RT shortage has been further hampered by provincial cuts to student spaces (now reversed), tuition increases, and the recent wage settlements that saw RTs receive much less than other high-demand health professions. -It will make a difference in recruitment down the road," he said of RTs five-per-cent increase. -It was very demoralizing to staff."

As a union activist, Kaminiarz is already looking to the next round of bargaining. -HSA is a collection of members," he points out. -If we are not happy, we have a responsibility to become involved."

Health care funding is a more immediate concern. -Patients are now sicker when theyre admitted, and the workload is heavier," he said. -Were still providing optimal care, but I dont know how much longer we can keep things up."

As an occupational health and safety steward, hes concerned about the pressure this puts on members. -Its important for us to speak up now about the impact on patients ... and us."

Next year, BC will join other provinces in turning the three-year Respiratory Therapy diploma into a four-year degree program. Kaminiarz is looking forward to the advancement this will bring to his students at VGH, and to the profession. The hospital will hire 15 to 20 RTs this year, but must compete with other jurisdictions experiencing similar staff shortages: for example, Albertas health facilities are actively recruiting respiratory therapists and other health science professionals.

Kaminiarz is happy to stay right where he is. -The next logical step for me, professionally, would be administration," he says -but thats too far from clinic practice." Eventually he would like to fold his clinical and teaching experience into research, which he sees as a natural fit.

-I keep a folder of potential research projects," he said with a smile. But, given the demands of his job, -this will have to wait another day."