my job

By Laura French • jobslink@startribune.com

There are almost as many letters after Bruce Estrem's name as there are in it: BA/RCP/LRT/NPS. His first certification was Respiratory Care Practitioner (RCP). He graduated from St. Paul College (then St. Paul Technical College) in 1984. His RCP certification enabled him to earn licensure as a respiratory care therapist (RCP). Then he went back to college and got a bachelor's degree in personal communication from Concordia College in St. Paul. He was one of the first six employees hired by Pediatric Home Service, where he became a neonatal pediatric specialist (NPS).

In the beginning, Estrem said, "I knew nobody in respiratory therapy. It just looked like an interesting field." The more Estrem learned, the more intriguing it became. "It's a very broad field, with many career avenues. You can go into research, clinical care, rehabilitation work, extended care, home care, manufacturing of medical equipment or sales and marketing. It can also be a good gateway to academics."

Estrem remembered going to his first CPR event, in the early days during his clinical rotations. "Respiratory therapy was very involved, and the patient actually survived," he recalled. His first job was in a rural hospital. "In that environment I really got to experience working independently. I don't need someone looking over my shoulder."

Knowing his preference for working independently, he was intrigued by home care and got a job in the adult home care market, then moved into pediatric care. "We found a niche — very fragile pediatric patients weren't getting what they needed," he said. From a company with six employees and no customers, the company has grown to "well over 400 employees and 3,500 patients," Estrem said.

Who are your patients?

We work with children with significant cardiac issues, children born with lung damage as preterm infants. We have patients with tracheal malasia and very complex syndromes like spinal muscular atrophy and spina bifida. What services do you provide?

What we do is provide medical equipment and supplies, training, and support. Often we're training nonmedical patients to run this high-tech equipment. We're preparing the home, training parents and paid medical staff who may not know how to run respiratory and infusion therapy equipment. In the hospital you have a button to push. In the home, you make a phone call.

The clinical education role kind of just evolved. We had nursing agencies call asking for training. I said "I'm available today." That has morphed into a full-time position. I train families and nurses. It's beyond just our employees. We may provide equipment and a different nursing agency provides the staff. Is it difficult to work with very fragile children?

There's nothing that makes me happier than when a patient no longer needs our services. Some have gotten better and gotten married and had children. Others will never be able to leave home. Both are equally rewarding. I know that I make a difference in a patient's life and a family's life. The numbers tell themselves: It's $5,800 per day for a ventilator patient in a hospital. It's less than $800 in the home per day. The level of care these children are getting at home is no different from in the hospital, and they would much prefer to be with their families. That's where health care is going. □