A progressive staff brings excellence to Jackson-Madison County General Hospital—a small-town, rural hospital in Tennessee.

By Laura L. Gater

Teamwork and cooperation are keys to providing excellent respiratory care at Jackson-Madison County General Hospital, the flagship of West Tennessee Healthcare (WTH) in Jackson.

“People come to Jackson, Tenn, thinking they are going to see an ‘old timey’ hospital system and are very surprised to see how progressive and advanced this organization is to be in a small town and rural setting,” says Joan Nowell, RRT, director of respiratory care services. “We are highly progressive in the health care we provide. We have five cardiac catheter labs and a PET scanner, and we were the first hospital in Tennessee to have a mobile intensive care ambulance unit and the sixth in the nation with a mobile ICU.”

Jackson-Madison County General Hospital is a 662-bed facility. The hospital owns five small rural hospitals, which comprise WTH. Jim Moss, CEO, is on the board of the American Hospital Association. Two of the hospital’s vice presidents have respiratory therapy backgrounds.


Jackson-Madison County General Hospital recently received the Quality Recognition Award from the American Association for Respiratory Care. Its respiratory therapy department was one of the first in the state to perform noninvasive ventilation.

“We have been doing therapist-driven protocols since the mid 1990s, something very aggressive at that time for the South,” says Nowell.

The department hits its target benchmark every 2 weeks, and has done so for more than 2 years, placing it in the top 25% in the nation. It also places in the 90th percentile ranking among hospitals across the country with comparable size and services, in the Press-Ganey customer satisfaction survey program.

“Our department is the clinical rotation site for our local community college respiratory care program,” states Nowell. “This year we have 15 students and we provide the clinical instructors from within our department.”

Commitment to Success

The 80 RT staff members work well together and are thought of highly throughout the rest of the WTH organization, according to Ron Hill, vice president of hospital services. “Their positive, caring atmosphere makes a difference in the quality of patient care that they provide,” he says.

Teamwork is a vital aspect of the department. Staff members help each other and care for each other. “One of our salesmen noticed our teamwork and said that if he ever returned to respiratory therapy he would want to work here because of it,” Nowell says.

Hill believes that the respiratory therapy department’s commitment to excellent patient care and patient satisfaction is accomplished by the leadership of the department, surveying patients to find out what needs improvement, keeping up with the latest technology, and providing staff training opportunities.

“Technology and training are paramount to excellence,” states Hill. “You have to have the right tools and know how to use them.”

The department is committed to exceed customer expectations, through the Press-Ganey survey and the department’s own patient survey. All staff members want to know what they can do better.

“The department’s commitment is to two of our hospital goals: high-quality health care and compassionate customer service,” explains Lyn Tisdale, RRT, manager of respiratory care. “Patients expect us to have high-tech equipment. We also provide common courtesy toward the patient.”

Herb Owrey, RRT, RN, RPFT, assistant respiratory therapy director, believes that the department’s primary commitments are to provide high-quality patient care and meet the needs of both patients and colleagues. The department is often a resource for nursing and other areas. These commitments are accomplished by staff members’ flexibility, which is accomplished through cross-training and rotation. “We treat probably more than 60% of hospital patients, from premature infants to geriatrics,” he says.

Day and Night

Jackson-Madison County General Hospital respiratory staff use nonmandatory protocols with utilization around 40% to 50% hospital-wide, with higher utilization for oxygen; respond to all CPRs; intubate; draw blood for arterial blood gas testing and analyze results; provide treatments and professional interdisciplinary patient care in all areas, including emergency; and ride the ambulances and mobile intensive care unit to help care for respiratory-compromised patients.

Every day, workloads are shifted according to patient volume. The department takes pride in its dedication to provide one-on-one care, not multiple treatments at one time. The hospital is the referral base for 14 counties, and the city of Jackson has a population of 50,000, so they never know what to expect each day.

The summer day shift averages 100 to 150 breathing treatments a day, while in winter that number may reach 300 a day. There may be 16 to 35 mechanical ventilator patients at any given time. Today, one floor may have enough respiratory patients to keep one RT busy, and another day that person may have three floors of patients.


Owrey has developed the therapy-driven protocols, which enable staff members to be decision-makers rather than task managers. The doctors know what protocols the RT staff is following, and have confidence and trust in them.

“For example, if we have to increase a patient’s oxygen, by protocol, we have to notify the doctor. This can key them into a patient’s situation before it gets worse. The same with weaning a patient off oxygen. We don’t have to call the doctor to let him know, as long as the patient is doing okay,” explains Nowell. “I think that demonstrates the level of confidence that physicians have in our therapists.”

RT department protocols were first developed in 1996. As technology progresses, the department updates them. One recent protocol addresses ventilator-associated pneumonia. Staff members had read about concerns with this type of pneumonia and decided to be proactive and develop protocols to address the situation. Instead of changing the disposable circuits on ventilators weekly, they are now changed on an as-needed basis.

The department has two medical directors, each of whom is affiliated with a different clinic. The medical directors review the protocols first and also do protocol trials before approving them.

Two 12-hour weekend shifts were also added. These team members get paid for 40 hours’ work. These new positions help meet staff needs and provided a good opportunity to get consistency in staffing on weekends and meet employee needs a little better, according to Nowell.


The culture of the WTH organization is its greatest strength, according to Hill. The caring and sharing among RTs and for their patients are evidenced throughout the entire organization, and so is the commitment to patient satisfaction. “I think the respiratory care department is one of the leaders in caring in the [WTH] organization,” he says. “Respiratory care is vital to the health care team.”

Department strengths also come from being a part of a larger health network, which provides more opportunities. “Our whole outlook is based on our organization’s philosophy,” explains Tisdale. “We emphasize teamwork and love and respect for each other. There’s a high level of teamwork between us and the nursing department, for example.”

Jackson and surrounding areas were in the news lately when two tornadoes touched down there on May 5. RT staff members’ dedication to their jobs was impressive, according to Nowell. “We were called in that night for a disaster,” recalls Nowell. “No one refused or couldn’t make it in, with several living far away, as much as 60 miles. And many had to come back for their regular shift the next morning. We provided oxygen and treatments to pulmonary patients who lost electricity. We had therapists who lived many miles away who had to leave 2 hours early to get to work since their normal route was disrupted due to the damage. All employees took ownership of the situation, realizing the need to make it in to work. I was, and still continue to be, so very proud of our department staff.”

Future Challenges

Tisdale acknowledges that a big challenge for their department is keeping up with technology. “I always tell our students, ‘You’re really just starting to learn.’ We are learning our jobs every year to keep up with technological changes. We have excellent doctors to back us up and we have to keep open to changing times,” he explains.

Another challenge, according to Owrey, is continuing to meet patient needs, since hospitalized patients’ conditions are often more acute today and thus require more intense care than in the past. “We want to continue being the best that we can be,” states Nowell.

“We just have the attitude that we’re good, but we realize we can always be better—that is our driving force,” Tisdale adds.


Laura L. Gater is a contributing writer to RT.