The novel coronavirus pandemic is testing the limits of health care systems while also stretching thin the ranks of respiratory therapists, skilled professionals who were in short supply already. At Rush University Medical Center, a handful of student volunteers who are finishing their master’s degrees in respiratory care are helping out.
Weeks before the novel coronavirus arrived in Chicago, Rush University Medical Center rapidly expanded its capacity to treat COVID-19 patients, whose symptoms can range from mild to severe and even life-threatening. It added critical care beds and equipment and organized COVID clinical teams.
Rush’s 75 respiratory therapists are crucial to the critical care teams, but they are needed across the medical center, in neurosciences, pediatric and neonatal intensive care units and in treating patients with chronic respiratory conditions, said Steven Mosakowski, RRT, director of respiratory care services. He began resourcing additional therapists, because, he said, “There are always far more patients than therapists.”
At the same time, David Vines, PhD, MHS, RRT, director of the Rush College of Health Sciences respiratory care master’s degree program, thought his second-year students might be able to help and may want to volunteer. The students already had completed three clinical rotations, including both adult and pediatric critical care, and are competent in a number of key skills.
Rush University students are very active volunteers in the West Side community, but they have not been asked to volunteer for clinical work during the pandemic. An exception was made for the respiratory care program because of the extraordinary need and the students’ advanced learning.
Since March 31, five second-year master’s students have been helping the respiratory therapists across the medical center.
“They are very well-prepared and about ready to step out into the world as respiratory therapists,” Mosakowski said.
Nevertheless, the students do not work alone and have continuous oversight.
The students assess how the patient is responding to the ventilators’ flow of air, and monitor the smallest, minute-by-minute details, reporting any notable changes. They also routinely reposition patients, suction away excess saliva and otherwise ensure the patients are attended to fully.
“They are working side by side with the therapists. The students are focused on the patient, how the patient is doing, and they have a good understanding of how the patients who are on ventilators should be interacting with the equipment. They can interpret the data and can tell if the numbers are trending in the wrong direction and alert the therapist,” Mosakowski said.
The students act as an extension of the respiratory staff, allowing the therapists to attend to the most acutely ill COVID patients. “The COVID critical care patients’ condition can change from stable to unstable very quickly, much more quickly than other patients,” he said.
Laurel Stewart has volunteered for 12-hour shifts, three days a week, while continuing her studies. Because her courses are being offered online to support social distancing, she has found the work manageable, and she is very happy to be volunteering.
“I know this is the focus, the pandemic, and it is the best learning experience I’ll ever have,” she said. “Every morning we meet with the physician teams who tells us what they expect from the day and what changes in condition they want to see, patient by patient – because all of the patients are so different!”
She’s volunteered in non-COVID units some days and more often in COVID units, which is a different challenge than she experienced in her clinical training.
“In clinical rotations, we would learn about how to treat each of the different diseases, and we would follow a plan. We’d learn this is right or wrong, the answers were yes or no, as we assessed each patient,” she said.
The extraordinary challenge with COVID0-19 is because it is so new, the answers change, and the patients’ conditions may change rapidly.
“I never thought I’d do this kind of care as a student or work so closely with the respiratory staff,” she said.
Only a few years ago, she didn’t know what respiratory therapists did, and now, the pandemic has put respiratory care in the spotlight.
“Respiratory therapy already was well-respected at Rush, and the job is becoming more and more valued everywhere,” she said. “We aren’t people who wheel in vents and walk away. We use the vent to give the patient exactly what respiratory support they need, no more and no less. It is very precise.”
Stewart earned a bachelor’s degree in microbiology from the University of Wisconsin – Madison, where she studied infectious disease and immunology. Her volunteer work during the pandemic has reignited her interest in infectious disease research, particularly in SARS-CoV-2, the virus that causes COVID-19. She expects to help one of her professors with a research project.
“I’m wondering what the immune responses are to the virus, how it behaves,” she said. “We know so little now.”
Already at Rush, researchers are studying the virus, conducting clinical trials and developing diagnostic and serological (antibody) tests. A clinical trial led by one of the respiratory care faculty, Jie Li, PhD, RRT, is studying the early use of prone positioning with high-flow nasal cannula for COVID-19 patients who are in acute respiratory distress. Proning, in which the patient is placed face-down on the bed, is a method used to increase the patient’s oxygen levels and reduce the need for intubation.
“We learned in classes that proning could really work for some people with severe lung symptoms,” Stewart said. She saw it used once before in her training, and now she is seeing it in use at the medical center regularly. The Rush respiratory care division is sharing its expertise with other professionals in an educational video created at the Rush Center for Clinical Skills and Simulation – one example of the collaborative response to the novel coronavirus by health care professionals around the world.
“The students are seeing firsthand how a crisis like this can and should be handled,” said respiratory therapist J. Brady Scott, MSc, RRT. “They are working shoulder-to-shoulder with amazing respiratory therapists each day, and they are seeing firsthand how hospital departments might need to seek novel approaches to staffing, equipment utilization and daily operations. They are not reading about it in books—they are living it.”
Stewart and the other second-year students will finish their master of science degrees with the completion of the summer term. After they pass a credentialing test, they will be licensed respiratory therapists in Illinois.
“They are hugely helpful,” Vines said. “Can you imagine the experience they are getting? The management and decision-making skills as well as the respiratory care work itself. It is an experience of a lifetime in a matter of weeks.”
The students have offered such crucial and capable support during the COVID-19 surge that if they are needed, some of the first-year respiratory care students may be able to help perform basic duties, such as cleaning and preparing equipment under direct supervision. But Vines is looking into whether the students could be employed as respiratory technicians, new roles for which both first- and second-year students would be well-qualified.
The master’s degree program currently has 23 students, and Vines said, with the current attention to the vital role respiratory care plays, he already is seeing more interest from prospective students.