“More in-depth information on issues in the field, state”
Response by Jorge Nogueira, Director-at-Large
We welcome you to regularly visit the NJSRC website at www.njsrc.org. The website will bring more interaction with instant social network postings to our Twitter (@NJSocRespCare) and Facebook page (@NJSRC), which means when we post a new article or event, you will see it on the website and our social network feeds.
We will also be regularly updating our content with news articles in the Scope Newsletter section of the Website.
At conferences and symposia we will consider adding a short “field / state update” session to the agendas.
“We need some new blood, same old people.”
Response by Jorge Nogueira, Director-at-Large
The best way for me to answer this is to recount my own experience….
5 years ago, someone asked me what I thought of the NJSRC. My response was, “It’s the same group of people…We need new blood”. I realized that my observation was a problem that I helped create. Of course it’s the same group of people….no “new blood” is volunteering to get involved. So that is what I did…. I started attending meetings, contributing to the discussions, and soon thereafter becoming a board member.
The board DOES need “new blood”… Get involved, get your fellow RTs involved, nominate, and most importantly…VOTE. You have a voice and the power to change the “status quo”….Use it!!
“I don’t know what goes on at the state society level or any other level.”
Response by Fernando Echeverria, Director-at-Large
You are not alone! I’ve been in our professions for almost 20 years, and it wasn’t until a few years ago that I began to understand how our state society helps us. We are the first to admit that we need to improve our efforts in communicating with the professionals in our state. Part of this effort is our newly redesigned webpage and social media accounts. Going forward, we hope to engage in more discussions like this with our fellow therapists throughout the state.
The NJSRC is a nonprofit, state affiliate of the AARC. There is much misunderstanding about what our state society does, and how we do it. For example, one of the most common misconceptions is that the state society board of directors and committee members are compensated for our roles. Whenever I am asked how much we get paid, I can’t help but laugh inside (sometimes outside). We volunteer for these positions not only because we are passionate about our profession, but because we know that the profession needs organized representation. Without this representation, we as a profession would not be able to react to potential changes that would affect not only the profession, but all of the individual respiratory therapists in our state. Our goal is not only to represent the profession in government issues, but to also promote the profession to the public. We promote the advancement of respiratory therapy through increasing awareness, occasionally partnering with other groups to do the same. For example, we have worked closely with the COPD Foundation to promote awareness of not only the disease, but also our roles in helping those that suffer from it improve their quality of life.
These kinds of activities provide a platform for us to raise awareness of the vital role respiratory therapists play in our healthcare system. Recently, there was a report published in the Chronic Obstructive Pulmonary Diseases: Journal of The COPD Foundation, which recognized respiratory therapists as key providers to this patient population. http://www.aarc.org/new-copd-care-report/
As I said, we have worked to improve our communication with our members and in doing so, we hope to encourage more members, like you, to ask questions and participate in discussions. There is no better way to gain an understanding of something then to be a part of it. There is strength in numbers, and the more support we have, the stronger our professional voice will be. When we have something to say, in promotion or support of our profession, we need the voice of the thousands of respiratory therapists in our state. Only then, can we be heard!
“Advance the APRT licensure”
Response by Joseph Goss, Delegate
In the survey sent out late last year, a comment was received about the Advanced Practice Respiratory Therapist (APRT) license. Introducing the APRT is easier said than done but it’s a very worthy effort nonetheless. It involves three, but I would argue four groups: Commission on Accreditation for Respiratory Care (CoARC): the National Board for Respiratory Care (NBRC): the American Association for Respiratory Care (AARC) and my fourth, us, the state society (NJSRC).
Where are we today?
Currently, the CoARC has completed the development of the accreditation standards for advanced practice. These standards were approved at their November 2016 meeting. The standards identify the primary role, description, and eligibility for an APRT education program. As listed on the CoARC website, the standards are divided into five sections: (A) Program Administration and Sponsorship; (B) Institutional and Personnel Resources; (C) Program Goals, Outcomes, and Assessment; (D) Curriculum; and (E) Fair Practices and Recordkeeping.
The NBRC has appointed representatives to serve on an ad hoc committee. One committee goal is examining issues related to the credentialing of the APRT. Additionally, in anticipation of an eventual credentialing examination for these therapists, the NBRC is working with trademark counsel to protect, through intent to use, the titles APRT and RRT AP.
Just a few weeks ago, the AARC published a request for proposals inviting qualified organizations to submit a bid for conducting a national needs assessment related to the APRT. In part, the needs assessment helps o determine future employment predictions of an APRT. This is the second most difficult part of the process.
The final part involves us, the NJSRC. We, along with other societies, must lobby state legislatures to obtain licensure. Without the ability to practice, the efforts of the CoARC, NBRC, and AARC would all be in vain. This will be the most difficult part to accomplish, as obstacles and resistance may arise from other organizations.
What can you do to help with these processes?
Respond to our requests for help by writing letters or sending emails. We need to let legislators know that our membership supports moving the profession forward.
“A definitive limit to the number of ventilated patients being cared for by any one therapist”
Response by Joseph Goss, Delegate
Thank you for your comment on setting a definitive number of respiratory therapists providing care to ventilated patients. Chapter 43G subchapter 31.5 (N.J.A.C. 8:43G-31.5) of the NJ Hospital Licensing Standards states “[t]here shall be at least one licensed respiratory care practitioner assigned primarily to patients in licensed critical care units. Assignments shall be based on the acuity level of patient illness assessed each shift.” Therefore, all hospitals should have this acuity system in place for intensive care units. But the law does not provide for a set ratio for therapists to ventilated patients. It only identifies the department has a system in place to address a ratio.
California is the only state we are aware that has a set patient to therapist ratios. “In critical care units, burn units, labor and delivery, post anesthesia units, and any other specialty units, one respiratory therapist per four patients who are receiving respiratory care as ordered by a physician.” There is no acuity requirement for the ratio. This is the opposite of New Jersey’s approach of permitting the department to better judge staffing needs.
The CA law’s ratio approach might sound great on paper but what if acuity changes? Should there be more or less therapists during a given shift? How does this affect budgeting? Would a hospital take services away from respiratory care and reassign them to another department?
The problem is the lack of evidence to support a patient to therapist ratio. A study out of Johns Hopkins University published in 2013 noted “a multi-component intervention, including an increase in RT/patient ratio, improved RT orientation, and the establishment of a core staffing model was associated with increased respiratory resource utilization.”1 The article alluded to a ratio of 1 to 9 as being ideal but that did not account for acuity. It also did not identify whether this was for all patient care areas or just ICUs.
An unpublished report by Robert Chatburn noted “[t]here are neither official AARC Guidelines nor benchmark data suggesting appropriate staffing levels in hospital ICUs.” “This leads to a continual situation of either over- or under-staffing, resulting in either inefficiency or poor staff morale / reduced patient care standards.”2 Once again, research is unclear on the approach to staffing based on ratios.
The best solution to utilizing therapist time is for department directors to use an objective acuity system in planning shift staffing.
- Parker, Ann M; Xinggang Liu; Anthony D Harris; Carl B Shanholtz; Robin L Smith; Dean R Hess; Marty Reynolds and Giora Netzer; Respiratory Therapy Organizational Changes Are Associated With Increased Respiratory Care Utilization. Respiratory Care March 2013, 58 (3) 438-449; DOI: https://doi.org/10.4187/respcare.01562
- Chatburn, Robert L. Report: Staffing of Respiratory Care Practitioners in the ICU. Report Date: 3/2/16
“Form a Best Practice Folder on Our Site”
Response by Joseph Goss, Delegate
Thank you for your comment about a best practices area on our website. It was something discussed when the new site was built, and while it could be implemented we chose against it. Two significant reasons were highlighted in the discussion, maintenance and AARC Connect.
There are methods to provide for a secure, members only area that could host best practice material but maintenance was not practical. The member database would need to be updated almost weekly as members join and leave the AARC. And if a member would join specifically to access the content, it could be several days before the database was updated. We were concerned this could discourage a member from returning to the site.
Second, we choose to promote the AARC Connect for this purpose. Written about in the January eScope, AARC Connect is the repository of all best practices, policies, procedures, articles, etc. Not only New Jersey members – another limitation to our website’s member-only area – but members around the county contribute to AARC Connect. This increases the possibility of finding the information you seek.
If this was not your idea of a best practice area, please contact us so we can discuss further. Perhaps there is something we had not thought about implementing.
We appreciate all comments and ask all our members to continue submitting ideas.
