Adult Critical Care Certification

“Never stop learning,” is a credo Pier Mangieri, RRT, RRT-NPS, RRT-ACCS, RRT-NPS, RRT-ACCS, lives by. The last credential following his name is proof of the motto – the respiratory therapist became one of the first in the nation to earn the new adult critical care specialty certification offered by the National Board for Respiratory Care (NBRC). He’s etched himself into history books at Indian River Medical Center, as well, by being the first on staff with the designation.

“It’s a tough examination,” said Mangieri, a cardio pulmonary clinical specialist at the Vero Beach, Fla., facility where he has worked for 18 years. He studied roughly six to eight hours a day for three consecutive months to prepare for the exam, while taking practice tests along the way to assess his readiness.

“Usually you can do Kettering exam reviews based on previous tests to prepare. But since there was no previous test, there was nothing available. So I tried to study everything under the sun,” said Mangieri. He noted that the four-hour test encompassed “hemodynamics, drugs, the latest and newest modalities of ventilation, ARDS protocols . It was quite broad. There was so much literature to cover; I studied like a maniac.”

Despite a substantial investment in time, effort, and out-of-pocket expenses, Mangieri said it was well worth it to him and delivered a great sense of personal and professional gratification.

“Physicians depend on me to do what’s best for their patients. They put trust in me,” he said. “So I have to be on board with the latest knowledge. Different patients, different disease states require different treatments. I need to be on my A-game.”

A Long Time in the Making
It is precisely that sense of expanding capability that was at the heart of the new credential as it was crafted into reality across seven years of NBRC-directed efforts. Lori M. Tinkler, MBA, NBRC’s associate executive director and chief operating officer, described the lengthy process to develop the new credential.

“The American Association for Respiratory Care (AARC), one of our four sponsoring organizations, requested we look at developing a specialty examination for respiratory therapists working in the adult critical care setting. So we began a five-step process in mid-2005, which finally ended with the new examination and credential being offered in 2012,” said Tinkler.

She explained that the process began with a viability study (a focus group got together to discuss if the idea was even warranted), which affirmatively led to a feasibility study (to determine if there was indeed a need for the credential), a personnel survey (to ensure there is a population to support such a program on an ongoing basis), a job analysis (to examine the functions or tasks someone in this critical care role performs.) “The job analysis really drives the blueprint for the test and determines the content on which credential candidates are tested,” said Tinkler, noting that prospective examinees can see a detailed content outline on the NBRC website — .

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Once it was determined which tasks are being performed on the job and how important those tasks are to the adult critical care specialty, the test development process began. “We facilitated an item-writing workshop that resulted in about 100-150 people participating in the process,” said Tinkler. “They helped write items for the exam. Then the examination committee reviewed, refined and revised the questions, and made sure they matched the content outline. We had to make sure they were appropriate for testing purposes, and written at the correct cognitive level. And we had to ensure that we were not writing an exam that would be so difficult that no one would be able to pass it.”

Ultimately the new examination – which Tinkler declared “a very good test” — was launched in July of 2012. Not only does it offer RTs a conduit to sharpen their skills through review and examination, it serves a larger purpose.

A Conduit to Opportunity
“This provides another opportunity in the career ladder of an RT,” said Tinkler. “This is an achievement examination. It says, ‘I’ve gone above and beyond and have knowledge and experience in this specialized area.’ The person who earns this credential may not be doing general care but may be working in a LTC facility, or a critical care physician practice. Someone with this credential can work outside the traditional role of a respiratory therapist. It helps propel the assertion of RTs as a key member of a healthcare team.”

To date, about 250 people have taken the exam, “. and 85% passed,” said Tinkler. “When we put out a new exam, we typically get the cream of the crop — those waiting with bated breath to take it – at the start.”

Mangieri is indeed one of those professional go-getters, and he aspires to help others along a similarly ascendant career path. “I know I’ve inspired at least one other therapist at Indian River. I’m working with her right now to prepare for the exam and to get through the study process,” he said, adding, “I feel very proud of this undertaking. Physicians around the hospital congratulate me and some tease, ‘Oh here comes the expert.’ We’re having a good time with it. As for me, I hope to keep moving on with my learning. Never stop learning.”

Valerie Neff Newitt is on staff at ADVANCE. Contact: [email protected].

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