Vol. 16 •Issue 24 • Page 13
RT Education Is ACLS Enough?
In a recent editorial, Vern Enge discussed a JAMA study that suggested nursing education levels had a direct impact on the quality of care delivered in hospitals. RCPs are no strangers to such arguments. We have wrestled with the CRT vs. RRT issue for more than 20 years now and not resolved it.
Interestingly though, we are now seeing the rise of a new breed of specialists—respiratory nurses. They are organized, focused and making some interesting progress.
The Respiratory Nursing Society (RNS) began as a specialty nursing organization in 1990. It is growing rapidly. So much so, in fact, the organization has issued position papers on long-term oxygen therapy and the development of non-chlorofluocarbon metered dose inhalers. The RNS has patient brochures available and currently is developing the first edition of its Respiratory Nursing Society CORE Curriculum for Respiratory Nursing.
The curriculum has more than 40 authors and is a comprehensive, peer-reviewed resource intended to serve as:
• A clinical resource for direct and indirect care of respiratory patients,
• An orientation guide for clinicians who are novices to providing care for respiratory patients in multiple clinical settings and throughout the course of their illness,
• A resource for developing competency assessment tools, and
• Preparation for respiratory nursing certification. Let me say that again. Preparation for respiratory nursing certification. Did ya’ll hear that? A certified respiratory nurse!
Let’s step back just a minute. What drives a hospital, long-term care facility or any other organization to hire a practitioner? For the most part, the driving forces are regulations and licensure laws. As RCPs, we have varying laws to follow and various levels of care we can provide. We also have five states that do not require licensure of RCPs at all.
By contrast, nurses have basically one credential that enjoys reciprocity and is equally recognized across the country. Nursing is about to have a certified respiratory nurse who will be recognized nationwide as well. Respiratory nurses will have their own staff education and competency programs and will be in compliance with training programs for caregivers, as required by federal and state regulations.
What are we doing as RCPs to enhance and document our competency against the RNS? Continuing education requirements vary from state to state and are defined by a jumble of state laws. As things currently stand, organizations like JCAHO usually define competency.
The National Board for Respiratory Care has developed a continuing education program with the intent of defining competency. The NBRC’s Continuing Com.petency Program (CCP) is designed “to enhance and/or contribute to the continuing competency of credentialed respiratory therapists and pulmonary function technologists, demonstrate concern for patient safety and be consistent with similar programs offered in other health professions.”
The NBRC program affects all credentials issued July 1, 2002, and later. Those of us credentialed before then are not affected, but we may voluntarily elect to participate in the CCP. Our original credentials remain in effect if we do not participate in the program, however.
If we do decide to participate, we have three ways of doing so. Our first option is to complete a minimum of 30 hours of Category I continuing education (CE) units directly related to respiratory therapy or pulmonary function technology. If, like me, you are a Neonatal Pediatric Specialist, you must complete a certain number of pediatric-related education units as well as adult units for your base line credential of RRT. (In my case 15 pediatric and 15 adult = 30).
CPFTs and RPFTs also have requirements to maintain their credentials. For many of us, Advanced Cardiac Life Support (ACLS) or neonatal resuscitation fulfill some of our state CEU requirements. Will this be the case for the NBRC? Nothing has been put in writing or disseminated.
Our second choice is to retake the respective examination(s) for the credential being renewed and achieve a passing score. If we fail the exam, we have two years to retake it and be reinstated. Can we practice in the interim between failing and retaking? Are we at increased liability?
Our third option is to take and pass an NBRC credentialing examination not previously completed. I could take the CPFT exam and be good to go for a while.
What will happen in the long term to those who do not participate? Will that somehow be noted? Could we be listed as active vs. inactive or current vs. non-current practitioners at some point in time? Is there now or is there likely to be an increased legal liability to anyone who does not participate? How will this all affect state licensure? These questions have yet to be answered.
Those who were awarded a credential on July 1, 2002, or later are already subject to a five-year expiration date. There is no choice. One year prior to the expiration date of your credential, the NBRC will send you a reminder notice. Six months prior to the expiration date, a follow-up notice will be sent. A final reminder notice will be sent 90 days prior to the expiration date. The NBRC is very clear there will be no “grace” period for expired credentials.
At that point, you will have will have two years to reapply for testing and pass the examination. After two years, you will be considered a brand new candidate and have to qualify for the exam all over again.
Again there are questions. What happens if you meet your state’s licensure requirement and maintain state CEUs but your NBRC credential expires? Are there liabilities?
NBRC program changes will not affect anyone until July 2007, so we do have time to sort these things out.
But let’s go back to why facilities hire practitioners in the first place. The answer: To fulfill regulatory and licensure requirements. I believe RCPs need continuing education units and must be able to document competency. Our field is growing exponentially.
But is it in our best interest to muddy our licensure laws even further? Are we now creating more documentation headaches for employers? And more specifically, are we making ourselves attractive to employers?
Perhaps we need to be careful and recognize there potentially is a competing credential on the horizon in the form of a nationally recognized RN license with almost universal reciprocity backed by a well-organized national association.
For the record, I started out as an RCP and got my RN later. I am not a member of the Respiratory Nursing Society. I wish them no ill. In fact, I applaud any organization that is founded on principles of improved quality of care and patient safety. I have been a long time member of the AARC and I am credentialed by the NBRC.
In fairness to these respiratory care-specific organizations, they may have addressed or be addressing the questions raised above. But if they are, they are not communicating this to the average RCP on the unit.
I also recognize that while we are fighting among ourselves and trying to sort out all these issues, we could well lose sight of the forest for the trees. In other words, if we don’t come together as RCPs, we may be replaced.
The same-old same-old of renewing your ACLS still is important as is getting certified in things like external defibrillator use; but in the long run, it may not be enough for us as a profession to stay competitive.
Margaret Clark is a Georgia practitioner.