Finding Your Niche: How Michael O’Brien Became a Pediatric Home Ventilator Program Coordinator

Michael O’Brien wanted to be a priest. He became an RT instead and hasn’t looked back.

When Michael O’Brien, MSc, RRT, RRT-ACCS, RRT-NPS, RRT-SDS, RPFT, AE-C, decided to use some education awards he got from a couple of Americorps service tours to apply to nursing school about ten years ago, it wasn’t because he saw himself having a lifelong career in nursing.

When he didn’t get into nursing school and learned about respiratory care from the RT program director at the same college and decided to apply there instead, the same was true.

“I entered health care as a means to becoming be a Catholic priest,” said O’Brien. “Between 2011 to 2012 I was discerning with the Trappist’s, a monastic order that organizes their life around regular prayer and lives off the goods it produces. After spending Christmas week in retreat at an abbey with the monks, I wanted to apply to their novitiate. But in order to apply, I needed to be free of any debt.”

O’Brien had tens of thousands of dollars of student loans from his undergraduate work to pay back before he could even think about the priesthood, and working low paying jobs to do it seemed impossible. Getting a degree in a higher paying health care field sounded like a good option.

“I didn’t know what a respiratory therapist was, but I applied and was accepted,” he said. “After finding myself in health care, my desire to become a Catholic priest gradually quieted. In hospitals and emergency medical services, I was surrounded by people who were studying to become proficient in a discipline to satisfy the mission of caring for people. I eventually realized that my motivation for becoming a priest was to love other people and that I didn’t need to be a priest to do that.”

Drawn to work with kids in RT school

The children he cares for as coordinator of the Pediatric Home Ventilator Program at the University of Virginia (UVA) Children’s Hospital in Charlottesville are definitely benefiting from that decision.

“During respiratory school I was drawn to work with children partly because I saw that the entire spectrum of respiratory therapies could be exercised in children,” said O’Brien. “I was also drawn to work with children because I saw that it required a particular bedside manner to engage with both the child and their family.”

After working as a staff therapist at UVA Children’s for three years, the Pediatric Home Ventilator coordinator position opened up and he decided to apply.

“The role was created as an experiment to aid pulmonologists in the management of tracheostomy- and ventilator-dependent children in the outpatient setting,” said O’Brien. “Pulmonologists wanted the assistance of a respiratory therapist to manage the exacting detail of technology-delivered therapy — ventilators, mechanical in/ex-sufflators, and continuous oxygen therapy, for example.”

One of O’Brien’s colleagues in the department initially took on the role of coordinator and revised and standardized the tracheostomy education for caregivers, but after about six months decided to step down to focus more attention on her own son.

O’Brien had just completed a master’s of science in clinical research at UVA and the program had a lot of overlap with public health. It also emphasized program evaluation, process improvement, clinical research design, and data management.

“I applied to the role because I wanted a role that allowed me to form longer care relationships with patients and their families,” said O’Brien. He also saw an opportunity to use his new degree.

“In my interview for the role, I proposed an analysis of program efficacy around the new tracheostomy education and outpatient follow-up. The analysis was well-received, but I can’t say that I was offered the job because of it. I was the only respiratory therapist in the department that applied to the job.”

Three main responsibilities

O’Brien says his three main responsibilities as coordinator are to train caregivers in the management of technology-driven therapies and transitioning home, contribute to care plan management in the outpatient realm, and create continuity between inpatient and outpatient management in the event the child must be readmitted.

Training caregivers involves making sure they know how to perform routine care and intervene in emergency situations. The program takes them from scenarios with a single root problem, where they identify the nature of the problem, select an intervention, and then evaluate its effectiveness, to complex emergency scenarios with multiple root causes.

On the care management front, O’Brien advises licensed independent providers on respiratory therapy management strategies. “The clinic in which I have the biggest presence is the complex care clinic, a multidisciplinary space with numerous specialties and allied health professionals — cardiology, pulmonology, complex pediatrics, speech therapy, nutrition, and of course respiratory therapy,” he said. “I collaborate with pulmonologists on adjusting ventilation therapy, weaning of support, and progression toward decannulation.”

He creates continuity of care between the inpatient and outpatient settings by sharing information about the patient’s current technology-delivered therapies and their settings, their DME company, and their goals of care.

“Though our pulmonologists and otolaryngologists of course document basic information about ventilators and tracheostomy tubes, there currently is no other central record in our EMR that serves as a multidisciplinary reference with comprehensive details about a patient’s respiratory support,” he said.

Since his role is firmly planted in both the inpatient and outpatient areas, he also serves as another reference for teams on the patient’s history.

Advocacy part of the job

O’Brien is actively involved in advocating for the needs of these children and families as well. He’s been particularly involved in efforts to improve reimbursement for pediatric durable medical equipment and home health care providers in his state.

“In Virginia, reimbursement for pediatric respiratory DME is below the cost of provision,” he explains. “This endangers the solvency of Virginia DME companies.”

Company mergers and consolidations are rampant, and some have even closed their doors, creating an even greater strain on the providers that remain.

Virginia also does not mandate private duty home nursing for technology-dependent children, and even though every child who goes home on technology qualifies for it, few actually receive it due to a lack of qualified nurses and geographic disparities.

“Fighting for Virginia DME companies is essential because I can’t do my job of discharging children to their home if there is no DME company to provide supplies or no home nursing to relieve families,” he said. “If our DME companies continue to fail, then discharge of technology-dependent children from Virginia hospitals would be threatened. A vicious cycle of delayed discharge and no inpatient vacancy would affect all children in Virginia who require acute care.”

Career shaping position

O’Brien says these factors constitute the biggest challenges he faces in his job. “Sadly, most of this burden falls on the shoulders of caregivers,” he said.

His complex care clinic employs two nurse clinic coordinators who work by his side to help deliver information to providers and satisfy requests from third-party agents involved with the provision of supplies. “But even with these experienced and mission-driven colleagues, our efforts are barely enough to meet the needs of our patients,” he said. “The obstacles to receiving continuity of care are systemic and complicated.”

The rewards of working with technology-dependent children, though, are vast. O’Brien loves being able to watch his young patients grow and develop, and the gratitude he receives from their caregivers is priceless.

“Through this unique role I have been given an opportunity to create special provider-patient relationships,” he said. “These relationships have shown me how I have contributed to a child’s well-being and a family’s journey through disease management as a respiratory therapist.”

The feedback has been crucial in shaping how he understands himself as a health care provider and has reaffirmed his dedication to the respiratory care profession.

“I used to think that I could not fulfill serious patient needs as a respiratory therapist because I did not have the opportunity to take on such great responsibilities,” he said. “For a short while, I seriously contemplated applying to medical school.”

Becoming the Pediatric Home Ventilator Program coordinator quelled those doubts and also gave him a better picture of the fractured nature of the U.S. health care system today and the importance of the RT in it.

“Speaking candidly, the delivery of high-quality health care in the U.S. is a team sport,” said O’Brien. “And for patients with chronic respiratory disease, they are best served by a team with a respiratory therapist.”

Good advice

Michael O’Brien has this advice for any RT who might be contemplating a niche role in the profession, whether it’s working with technology-dependent kids or some other underserved group —

  • Identify areas of care where an RT can add value as a member of a multidisciplinary team.
  • Before you begin work, agree upon relevant measures of work with stakeholders and create a plan for collecting data.
  • Make evidence-based guesses. You might not find literature very similar to the work you want to do. Find the closest thing, extrapolate interventions and outcomes to your circumstance, and write about the outcomes.

By Debbie Bunch

Heading to the New Era

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