Maintaining Your Health Care Competencies

Maintaining Your Health Care Competencies

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Individual Skills Reflect on Entire Departments

By Kathleen A. O’Shaughnessy

Competency assessments are not solely about the quality of an individual respiratory therapist’s skills. They mirror the quality and value of the respiratory therapist overall.

“It’s the only assurance that safe care can be provided to patients,” said Bill Dubbs, RRT, associate executive director of the American Association for Respiratory Care. Such assurance further serves as a safeguard against lawsuits.

Competency assessments are not a unique phenomenon to an individual hospital. They are a requirement for hospitals and other health care facilities, often dictated by state regulations. The Joint Commission on Accreditation of Healthcare Organizations mandates them as part of its accreditation requirements. RTs are not alone in this regard.

Because of its importance, the scope of competency extends far beyond its usual definition as an annual test of the ability of a therapist to perform various procedures. An assessment can have repercussions that reach beyond the therapist reviewed.

For an RT or any other health care professional, competency “can be defined as a combination of the knowledge, skills and attitude required for acceptable performance under a specific set of conditions,” according to Scott Bartow, RRT, vice-president of Ventilatory Care Management, Milwaukee.

All three elements should be part of a proper competency assessment, he said, since they are all integral to providing not just good respiratory procedures, but good respiratory therapy.


Psychomotor skills, of course, are extremely important as the basis for all respiratory therapy procedures, from administering a nebulizer treatment to performing an intubation. These skills require constant honing.

As with any abilities, some people are naturally more skilled in specific areas than others. Naturally, the therapist with a special ability in intubating pediatric patients, for example, will be called in whenever possible during an emergency. But that RT will not always be available, so all other therapists must be able to step in and accomplish the task.

Once skills are learned in schools, they must be reviewed. We cannot assume RTs have skills just because they have specific training or a medical background, explained Bartow. As a Wisconsin-registered therapist, with training and experience in intensive care, he can legally perform procedures, such as drawing an arterial blood gas, in that state.

On the other hand, he hasn’t done an ABG in 10 years. “I wouldn’t be competent to do it,” he said. Continually working therapists, however, who perform ABGs on a regular basis, do not always see a need to prove their capabilities each year in an assessment.

Although each facility makes its own decisions as to what skills it believes it is necessary to assess annually, Dubbs pointed out, generally competency tests fall into two categories.

The first involves procedures not routinely performed, for example, CPR. “It’s not done frequently, but when you’re called on, you have to do it right the first time,” he said. The second is high-risk procedures “There’s a high probability that something could go wrong” he added. “It’s important that the therapist’s competence has been documented recently.”


In addition to possessing skills required for the physical functions of respiratory therapy, RTs need good medical knowledge of the respiratory system to provide competent care. Good patient assessment is, likewise, part of an RT’s competency package.

“If therapy is done correctly, the therapist should thoroughly assess the patient prior to treatment and make recommendations about changes [needed] in therapy. That’s part of competency too,” said Dubbs.

Equally important is a good attitude. Competent, effective care involves focusing on the patient, with coaching and encouragement as needed. “You can’t just administer a therapy while standing there looking around or reading the newspaper,” Dubbs said. “You have to pay attention to the patient to really provide care.”

Dubbs believes continued assessment is also key. In order to assess all aspects of competence, the ideal situation would be to observe therapists in real-life situations, preferably without them being aware they are being assessed, both men agreed. The supervisor should use an objective checklist, ensuring that policies and procedures of the department and hospital are being followed. Simultaneously the evaluator could make some subjective evaluations of the RT’s general effectiveness in meeting the patient’s needs.

Such assessments figure prominently as an obvious measure of therapist qualifications. But they go far beyond that. Poor competency assessments could cost some therapists their jobs. But they could also threaten the jobs of others in the department. A big issue in respiratory therapy care today “is the idea that substitutes, people who are not as well-trained as respiratory therapists, can be used to deliver respiratory procedures,” said Dubbs.


Current research, including the recently released AARC Muse Study, indicates otherwise. The most recent study shows there is a 42 percent lower mortality rate among patients who had an RT providing respiratory services, Bartow noted.

Nevertheless, outsiders who see therapists merely going through the motions, performing therapy by rote without care and attention, easily develop a perception that untrained, non-professionals could do the same task.

By contrast, showing competency proportional to responsibility can help respiratory therapists and respiratory departments move to higher levels.

Consistently positive competency assessments also “make a big difference in determining whether a department will be allowed to implement therapist-driven protocols,” said Dubbs. *

Kathleen A. O’Shaughnessy is an ADVANCE editorial assistant.

Recredentialing Exams for Continued Competency

The National Board for Respiratory Care evaluates the requisite competencies for RCPs through the content of credentialing exams. It also supports the ongoing process of maintaining competency through its voluntary recredentialing program, said Gary A. Smith, RRT, associate executive director of the NBRC and the chair of the National Commission for Certifying Agencies (NCCA).

“The board does a new job analysis [to determine common abilities and knowledge required of professionals] every five years and updates the content of the national credentialing examinations. Every three years or whenever that content changes, an individual can take the test to become recredentialed,” explained Smith.

This program is eligible for CE credits through the AARC and in many states satisfies some or all of the requirements for license renewel. The recredentialing program helps the NBRC meet its ongoing competency program requirement for the NCCA. The NBRC is the only agency to continually maintain its accreditation status since the NCCA began accrediting agencies in 1977.

There are not, Smith admits, many volunteers for the recredentialing program. Of approximately 180,000 credentialed RTs, only 50 to 100 of them choose to re-take the examination in any given year.

NBRC officials hope for a wider appeal for its newest venture into competency assessments. Through its subsidiary, Applied Measurement Professionals Inc., the board is publishing the Respiratory Care Competency Assessment Program (CAP). That program, based on research from the national job analyses, will aid departments in determining what and how to assess competency for five different groups of practitioners.

–By Kathleen O’Shaughnessy

Competency Tests Help Profession Maintain Standards

As an assistant professor of respiratory care and the director of clinical education at Ohio State University, Phillip Hoberty, EdD, RRT, describes assessments to his students as “continued opportunities to show their competence.”

“[Respiratory therapy education] is not about learning it now and then doing it any old way you want in the future,” he said. “There is a certain standard that needs to be maintained throughout a working career.”

Hoberty believes a good educational background, particularly in the clinical setting, is the best preparation for meeting the requirements of providing overall competent, effective care.

Once students move from the classroom into the clinical setting, they can develop patient skills, such as putting them at ease with a procedure. These are difficult to learn from a textbook. Developing good working relationships with patients is part of the total education process necessary for truly competent respiratory therapist, he said.

Competence involves more than the ability to do a procedure or make an assessment, said Hoberty. “It also involves having the confidence to go ahead and do those things.”

Again, clinical education is key, since the best way to develop this confidence level is through using good clinical precepts, creating a comfortable learning environment for students.

-Kathleen A. O’Shaughnessy