King Faisal Specialist Hospital and Research Centre
provides RTs opportunities worth their weight in gold.
What hospital offers respiratory
therapists some of the greatest professional and educational
opportunities, not to mention personal perks such as high
salaries and long vacations? Many would find it hard to
believe that one of the best hospitals for therapists is
actually located in Saudi Arabia. For 25 years, King Faisal
Specialist Hospital in Riyadh, Saudi Arabia, has been offering
respiratory therapists one of the best professional
opportunities around. In addition to high, tax-free salaries
and 6-week average annual vacations, King Faisal gives its
75-plus therapists an unusually high level of autonomy to make
decisions and perform tasks that are not typically permitted
in United States and Canadian hospitals.
A Global Melting Pot
for RTs
Former Faisal staff therapist and manager
Mike Masters, RRT—who currently lives and works in Park City,
Utah—believes strongly that a King Faisal stint for therapists
provides a rich background that generally boosts one’s career
and also serves as an excellent way to meet therapists from
all over the United States, Canada, and other countries. “The
therapists have so much autonomy at King Faisal, and my
experience was the best I’ve ever had professionally,
financially, and personally,” says Masters, who, in addition
to having worked in Saudi Arabia, has worked in 10 different
hospitals in three US states. “It’s the only place in the
world that has a melting pot of RTs—you meet therapists and
medical professionals from all over the world, which means
you’re constantly exposed to new methods of patient
care.”
Masters, who met his wife (a
nurse from Scotland) at King Faisal, enjoyed his experience so
much that after a 5-year assignment 10 years ago, he returned
in January 1999 for a 6-month job as a staff therapist. He
adds that he and his wife frequently discuss the possibility
of returning to King Faisal. “I’ve recruited eight people to
work over there, and I continue to actively recruit others
because I want to educate therapists about what they are
missing,” Masters says.
A respiratory therapist
assists a patient in the pulmonary function
department.
Most of King Faisal’s RTs are
Americans and Canadians, but some were also trained in Saudi
Arabia, the Philippines, Sudan, and North Yemen. Currently,
40% of the therapists are Americans and 50% are Canadian.
“Working at King Faisal gives therapists a multi-cultural
exposure to the practice of respiratory therapy,” explains
Wrae Hill, RRT, director of respiratory care at the hospital.
“By having medical professionals from around the world working
here, we have a truly international focus, which is unusual in
North America,” says Hill, a Canadian and 4-year veteran of
King Faisal.
This global focus on health
care is what Masters particularly liked about his job. He
cites one occasion when he assisted a physician with a
percutaneous tracheotomy, a procedure performed frequently in
Europe. “Since coming back to the States, I’ve talked to
pulmonologists and therapists who have said they know very
little about this procedure,” Masters says. “It’s very
interesting being exposed to all these different international
procedures, and you begin to realize that sometimes there are
better ways of doing things.”
Respiratory Care in
the Hospital City
King Faisal, more commonly
called “Hospital City,” was created in 1975 as a referral
institution to provide specialized medical care for Saudi
citizens, eliminating the need for treatment abroad. It has
more than 6,000 employees from more than 50 countries. Based
on the North American model, the hospital’s respiratory care
department is the largest full-service facility existing
outside of North America. Therapists provide care to patients
with cardiopulmonary, neurologic, or metabolic disorders who
require diagnostic pulmonary function testing, administration
of therapeutic medical gases or aerosols, ventilatory life
support systems, cardiopulmonary resuscitation,
bronchopulmonary hygiene, or maintenance of natural or
artificial airways. In some ways, King Faisal’s respiratory
department is even more advanced than many teaching hospitals
in North America and Europe.
No expense has been spared in
equipping the department with the latest and most expensive
equipment. A wide array of modern equipment to provide ongoing
diagnostic and ventilatory life support is available
throughout the department. Monitoring devices include pulse
oximetry, end-tidal CO2 monitors, neonatal volume monitors,
and airway pressure monitors.
Primary adult ventilatory
support is provided using the latest ventilators and bi-level
positive airway pressure systems. High-frequency oscillatory
ventilation is offered as well as inhaled nitric oxide, using
an in-house design that features analyzers and accessories to
treat pulmonary hypertensive states in high-risk infants and
cardiac surgical patients. Clinical strategies and techniques
are currently under development for the most effective
treatment of adult respiratory distress syndrome (ARDS) with
inhaled nitrous oxide.
Wrae Hill, respiratory care
director (left), and Bob Goodsell, RRT, discuss ventilation
strategies.
The blood gas laboratories
feature the most advanced analyzers and cooximeters and
interface with the hospital-wide information system. The
pulmonary diagnostics laboratory offers complete respiratory
mechanics and performance testing including spirometry with
flow-volume loops, helium dilution and body plethysmography
lung volumes, single breath and steady state lung diffusion
measurements, plus treadmill and bicycle cardiopulmonary
exercise testing. For the most part, therapists draw and run
all arterial blood gases in one of seven different
laboratories located in each intensive care unit (ICU),
emergency department, and pulmonary function area.
The professional opportunities
that exist in such an advanced respiratory care department are
why so many therapists from around the world are interested in
working at King Faisal. At the same time, because of the
demands of the job, only the most experienced and
well-educated therapists are hired to work at the hospital.
All RTs must be certified in advanced cardiac life support
(ACLS), pediatric advanced life support (PALS), or neonatal
resuscitation program (NRP). “In all the general care areas
and many of the ICUs, RTs are the first-line intubators,” Hill
notes.
The department’s medical
director, Mohammed Zeitouni, MD, FCCP, is a US board-certified
intensivist and pulmonologist, who has done fellowships in
Cleveland. “He is a dedicated RT advocate and provides us with
excellent clinical and medical direction,” Hill says.
Job
Requirements
King Faisal requires all therapists
to have an associate degree in respiratory therapy or
equivalent, current registration by the National Board of
Respiratory Care (NBRC) of the United States, or the Canadian
Society of Respiratory Therapists (CSRT), and a minimum of 2
years of postregistry work experience. According to Hill, the
average experience level of staff therapists is approximately
11.6 years, while the management team averages just over 18.5
years of experience.
In addition to Hill’s position
as department head, the remaining respiratory staff at King
Faisal includes an assistant head, 50 RRTs (North
American-trained), 10 RTs (Philippine-trained), two pulmonary
function technologists, five blood gas technologists, and two
respiratory care assistants. Currently, the hospital is short
about 15 RRTs. Hill points out that although the department is
budgeted for 79 employees, it actually needs 85. “We’re
currently putting in about 2,000 hours of overtime per month
due to recent service expansions,” Hill says. King Faisal has
also recently opened a 250-bed tertiary care hospital in
Jeddah, which has 30 job openings. The same scope of services
will be offered in Jeddah with more emphasis placed on private
sector patients.
One staffing change that is
new at King Faisal is that there are no more supervisors. In
June 1999, the department threw out its top-heavy supervisory
structure (six supervisors/65 RRTs) for a charge RRT structure
in which charge RRTs are selected by their peers. These
therapists carry a 60% to 80% clinical load and have some
administrative duties as well. “This has resulted in more
effective use of our excellent clinical staff, with 88% of the
staff providing direct patient care,” Hill says. “Most of the
staff are happy with this new arrangement since it encourages
strong communication with peers,” he adds. This restructuring
has also created a high level of intrinsic accountability,
which makes work more rewarding.
The department has six charge
therapists who work day or night 12-hour shifts and cover
codes in the coronary care unit and emergency department, and
handle sick calls and overtime duties. These therapists
balance their workload in seven different intensive care
units. In addition, there is a core group of specialized
therapists who work in the cardiac surgical ICU, the
medical/surgical ICU, pediatric ICU, the newborn ICU, the East
Wing (ICU and general patient floors), children’s cancer
center, and Jeddah Hospital. According to Hill, most
therapists choose to specialize in one of these areas within 6
months of working at Faisal.
Therapists working in the
fast-paced cardiac surgical ICU see a high volume of very
complicated pediatric congenital heart disease patients, as
well as adults with complicated coronary artery bypass graft
or valves. In the medical/surgical ICU, there is a high volume
of challenging pediatric and adult ARDS cases, not to mention
surgical/metabolic and septic patients. The pediatric ICU has
a number of clinically challenging patients, including those
with complicated metabolic and heart and lung problems who
require surfactant therapy. Therapists assigned to the
neonatal ICU attend all high-risk deliveries and cesarean
sections. The eight-bed ICU in the Children’s Care Center
relies on therapists who provide all therapeutic and
diagnostic functions: oxygen and bronchodilator therapy,
primary intubator at codes, spirometry, arterial blood gases,
and ventilator management.
One interesting aspect for
King Faisal’s respiratory therapists is that they work with
many health care professionals from other countries who are
not familiar with RTs. Regardless of this fact, Masters points
out that once these staff members start working closely with
the therapists they immediately start to value their work.
“Whether it’s a nurse or anesthesiologist who is used to
making vent changes or looking at the patient’s blood gases,
they end up appreciating that it’s one less thing they are
required to do,” he says.
Hill agrees that most non-North
American nurses and physicians are sold on RTs within a few
weeks of working with them. “We do great work, which is
recognized and appreciated by our colleagues from centers
outside of North America,” Hill says.
Personal
Rewards
Former Faisal therapist John Wolfe, RRT,
currently based in Denver, agrees that there are enormous
rewards in working in Saudi Arabia. He spent 4 years at King
Faisal starting in 1991, after he and his wife sold their
house and cars and moved their two young children to Riyadh.
Wolfe originally signed a 2-year contract to work at the
hospital but then he and his wife, who worked as a nurse in
the same hospital, decided to stay another 2 years. “In
addition to getting used to good, tax-free salaries with lots
of paid vacation, our two children were getting an excellent
education at the Saudi Arabian International School in
Riyadh,” Wolfe says. “We both felt that the best professional
and personal decision we could make was to stay another couple
of years in Saudi Arabia,” he says.
Wolfe points out that
recruiters are very careful when hiring foreigners to work in
Saudi Arabia. In addition to assessing the applicants’
attitudes about living far away from home in such a
dramatically different culture, recruiters also pay close
attention to their professional experience to ensure that they
would be a good match. Wolfe prepared for this type of
scrutiny by becoming registered and even worked an additional
stint at Denver General Hospital to brush up on his bedside
skills. “When I had originally wanted to take this assignment
in Riyadh, a recruiter advised me to do this, since I had been
working the past couple of years in home care and that wasn’t
viewed as favorably as working in an acute care facility,”
Wolfe says.
Wolfe looks back fondly at his
years working in Riyadh. “It was clearly an opportunity of a
lifetime,” he stresses. “I had far greater experience at the
bedside than I had had in Colorado and was exposed to a great
number of challenging cases.”
Aside from excellent career
opportunities, Wolfe and his family also experienced some
unbelievable vacations and even some once-in-a-life
adventures. For example, on one occasion, Wolfe was called to
visit the king’s mother-in-law at home, since she had an
oxygen concentrator for her respiratory problems, even though
no one had ever explained to her or her staff how to use it.
“I was sent because of my home care experience,” Wolfe
remarks. “Her staff picked me up at my apartment and then
drove me to her incredible mansion. Here I was an American in
a bedroom of a member of the royal family, surrounded by
servants. I’ll never forget that moment for as long as I
live.”
Therapists such as Masters and
Wolfe also stress that you cannot find a better social life
than with the King Faisal extended employee family. “Because
you’re not distracted by outside forms of entertainment or
other activities, you focus on socializing,” Masters says. “I
formed some of my best friendships with people during my years
at King Faisal.” In addition, since the majority of therapists
are Americans or Canadians, staff frequently runs into
therapists whom they had known previously back
home.
The hospital’s Employee Social
Club offers many recreational opportunities, including
exercise areas, lighted tennis and squash courts, a bowling
alley, golf courses, and an Olympic-sized swimming pool. A
wide range of activities are scheduled daily and weekly
including swimming and aerobics classes, team sports,
marathons and triathlons, horseback riding, and special
classes for crafts, hobbies, and cooking.
Sightseeing excursions are
held frequently, which makes sense since some employees have
up to 10 weeks of vacation. Some of the most popular
destinations are trips to the desert and diving in the Red
Sea—one of the most beautiful underwater destinations in the
world.
Orientation for New
Hires
Because the transition to living and working
in Saudi Arabia is substantial, an extensive training program
is offered for new RTs. The recruiting organizations in the
United States (Nashville-based HCA International) and Canada
(Toronto-based Helen Ziegler & Associates) both offer
formal orientation programs for therapists prior to their
arriving in Saudi Arabia. Once they arrive at King Faisal,
they participate in a 7-week clinical orientation. According
to Hill, the orientation provides a number of tools, including
prereading assignments, Competency Based Assessments (CBAs),
and knowledge reviews. The knowledge reviews are designed to
reinforce the reading that is assigned to new therapists prior
to their ICU and general care rotations. A charge therapist is
assigned to each new hire and is available to guide them
through their early weeks.
RTs are required to earn 20
CEU credits per year and must maintain current basic cardiac
life support, ACLS, and NRP certifications. The department
offers ample clinical education opportunities to satisfy these
requirements, including life support training using American
Hospital Association or American Academy of Pediatrics
standards. Hill also notes that a new employee review system
is being widely received by the staff. “These new
peer-reviewed performance appraisals encourage better
communication and accountability among peers at the bedside,”
Hill says.
An Opportunity Worth
Repeating
With so many opportunities for
therapists working at King Faisal, it is easy to see why so
many return to the hospital for repeat or permanent
assignments down the road. Most therapists sign 1- or 2-year
contracts that are renewable. The department is also piloting
two staffing projects: a part-time program for therapists
wishing to work 23 to 40 hours a week and a 6-month,
short-term assignment for full-time employees.
Although the majority of
therapists work for 2 to 4 years at a time, some like Masters
can not seem to get enough. “I would definitely like to return
some day,” he notes.
“It’s always an incredible
experience when you’re given so much autonomy and respect and
are also able to work with some of the world’s best
RTs.”
Carol Daus is a
contributing writer for RT
Magazine.