Mirror, Mirror (Part I)

If you're a regular follower of mine, you know most of my work these days is in the COPD world. (Also, thank you for being a regular follower!) Back in the day, we used to look at COPD as pretty much "pink puffers" and "blue bloaters," and we had a pretty simple view of what the disease meant. Bad air can't get out, so good air can't get in, and you get short of breath. You might have some phlegm to cough up, and you'll probably need oxygen at some point. These days, as research has progressed, we've seen that COPD is more accurately described as something like a dozen different disease states, united by certain symptoms, but not necessarily etiology or even treatment.

Respiratory care seems to be in a similar boat these days. We are individuals united by a title, but not always by credential, or education, or even motivation. We tend to take an "us vs. them" approach on many things, which is rarely productive. Unfortunately, this also applies to our view of our professional organization, the American Association for Respiratory Care. Despite literally being composed of other respiratory therapists, and it's still often viewed as the evil Them. "Why aren't THEY doing something?" "When will THEY fix things?"

We're at a point now where this professional apartheid is no longer sustainable. As I've said over the last few weeks, moving into our future requires an all-hands-on-deck approach. The AARC is not a perfect entity by any stretch, but they're the only group that has the infrastructure to guide the changes we all want to see. This will require some adaptation on their part (which we'll talk about next week), but we need to be ready to compromise and set realistic expectations as well. This means we're going to have to give up some of our longstanding and common "demands" for what we consider progress. For example (all taken from RT social media over the last few months):

• National licensure: A great idea! So great, in fact, nurses have been trying to accomplish it for close to two decades. In that time, 25 states have joined the Nurse License Compact. You read that right; almost twenty years, and only half the country has reciprocal licensure. Physicians, even with their powerful lobbies, have license reciprocity in a whopping 18 states. Yet people seem to expect the AARC to accomplish nationwide reciprocity for a barely-recognized occupation virtually overnight. This cannot be a fair standard.
• Patient ratios: Again, an excellent idea. Many people rightly state that the level of care usually goes down the more treatments you have to give or (particularly) the more ventilators you have to manage. As a matter of fact, those people are so right that the AARC agrees with them, and has long had white papers describing the need for staffing analysis and productivity benchmarking, and has called for any patient harm related directly to insufficient staffing to be reported to the proper bodies. That's honestly the extent of their ability in this area. Again, if we look at nurses, while over a dozen states have some kind of nurse staffing laws on the books, only one (California) has a law that contains actual numbers. (Massachusetts technically does as well, but it only covers ICU nurses.) The rest delegate the responsibility to hospital committees, or merely require the reporting of staffing ratios. We can be mad at state bodies for not taking action, but again, we cannot fairly hold this against the AARC.
• Higher wages: Really? What do you expect a national body to do, other than say, "You should pay RTs more?"
• A national union: Another great idea! Unfortunately, union membership has been dropping steadily for decades, would take almost unprecedented coordination, and would still require you to join a national body to speak with one voice. You can actually do that now...by joining the AARC.

These are all very valid concerns, to be sure. But we have to be realistic about what we actually expect our various governing bodies to be able to accomplish. We also have to remember that the AARC is NOT "Them." It's US. If we see them as the enemy, we have to realize we're looking at ourselves.