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ADVANCE Perspective: Respiratory Views

Is it Time for a New Respiratory Care Profession?

Published November 9, 2011 12:02 AM by Sharlene George

Respiratory care needs another rung on the career ladder, and there is no better time than now for respiratory care practitioners to start the climb, according Deniese S. LeBlanc, RRT, director of respiratory care at Stony Brook University Medical Center, N.Y.

LeBlanc gave a late afternoon lecture Monday at the AARC Congress 2011 in Tampa titled "An Advanced RCP With Prescriptive Rights ... The Journey Begins" that received an overwhelmingly enthusiastic response from attendees.

Few opportunities currently exist for vertical advancement in respiratory care, LeBlanc said, and the field is "losing its best and brightest to other disciplines." When talented RTs look five years down the road and can't see a clinical path to professional growth, they often detour toward other careers as nurse practitioners and physician assistants, or they leave direct patient care altogether for the sales and marketing arena.

But what if a new direction -  in fact a new profession - was available for RTs who want to elevate their skills and become a physician extender specifically trained in cardiopulmonary science?

In the hospital, let's say, this new physician extender position could allow RTs to optimize ventilation protocols, deliver conscious sedation with bronchoscopy, and perform central line insertions. In the outpatient setting, they could educate asthma and COPD patients, be authorized to write prescriptions and order pulmonary function tests, and perform necessary follow-ups. LeBlanc offered a long list of other responsibilities that could fall under an advanced RCP's scope of practice based on their extra education and experience.

The respiratory care program at Stony Brook University has taken the first steps toward creating this new profession. A rigorous master's of science degree curriculum with an emphasis on advanced clinical practice is in development. And plans are under way to present the concept of an advanced RCP with prescriptive rights for respiratory services to the New York State Department of Education's licensure board.

LeBlanc conducted a survey of 2,500 RTs in New York showed that out of 355 responders, 71 percent feel there are limited advancement opportunities in the respiratory care profession, and 56 percent expressed interest in attending an advanced clinical practice master's program.

She also identified other stakeholders within her hospital's community and gauged possible resistance from colleagues such as NPs and PAs. "The feeling out there is that we're all so busy, and so much work needs to be done in health care," LeBlanc said. "We can offer a niche market that doesn't step on others' toes ... There is room for all of us, and the time to move is now."

LeBlanc encouraged the audience to go back to their own programs and institutions and explore the feasibility of creating a new professional role of an advanced respiratory care practitioner with prescriptive rights.

The eagerness in the room was palpable. "This is the most exciting thing since NIV," said one audience member, who was followed by others who called it a, "brilliant idea," and "absolutely wonderful initiative."

If you're looking for a place to go in the respiratory care profession, will you jump on the bandwagon?

21 comments

Bottom Line.. RRT's need to become a "Billable" code for our profession.  As a certified WBE RRT homecare company, we can't bill insurance for RRT's.

RN's, PT assistants, CNA's etc are a billable insurance codes. I helped push for NYS Licensure when I was 18,but  I was unaware of some of the repercussions that I would face as a RRT homecare owner . This is especially true on a state and federal level. Now is time for change especially for our RRT future!

Janet, , President 02 Solutions December 27, 2015 12:02 PM
Clifton Park NY

Of course the whole nation knows how respiratory therapists are treated in Kentucky due to nationwide articles on taking some of the RRTs out of ERs, but there is still a high need for RTs here. As for the future of elevating a program for RTs in ky, it would not happen here. We are completely nursing driven and have very little respect and even less from new rns. My guess is the nursing associations and education programs that teach them we are replaceable and underneath their respect. Our state association is weak and Do not look to put us in the spotlight to educate the average person on what we do. The problem here in this comment section is apparent. Many people are trying to explain the lack of respect our profession has and how that has gone downhill as a whole. People are chastising these people and trying to lay blame on the individual. Wrong. We should be trying to find solutions as to why this is happening. I myself am pursuing a degree as a PA since I have no other upward opportunity in respiratory. It is a problem that needs to be addressed and we don't need to be complacent as healthcare will pass us by.

Rebecca, RRT-BS December 27, 2015 11:14 AM
Louisville KY

As a respiratory therapist for over 25 years I have had the opportunity to witness many postitive as well as negative things happen in our field. I love the field and am constantly learning and growing. I regret the fact that the vicinity trade schools pump out the students by the droves and I believe this is where our problem starts. The education that these student receive is not optimum in my opinion and that sets us up for a dilution in the quality perception that nursing, administration and the medical staff has of RT. My leadership team and myself have made the effort to contact these programs and share with them that we feel their students are ill prepared to work in the field and until they improve the quality of students they graduate we will not hire them. On a positive note I also think that the rest of us working in the field must do more to educate ourselfs on current practice and stay motivated to provide the best care possible utilizing evidence based literature. This is not easy and requires work on everyones part. I agree that it is a battle for recognition and I have been fighting for 25years. I have not given up the fight but am also tired of the battle. The only way I have learned to make progress is to "show what you know" which is more than anyone who is not an RT (that includes RN and MD). We are the specialists in our field and that will never change !! Be Proud.............Remember we are only 50 years old, nursing is over 300.  

Andrea MacDonald, Respiratory therapy - Supervisor, Holy Cross Hospital November 21, 2011 9:54 AM
Fort Lauderdale FL

I have been a respiratory therapist for 28 years and for the most part I have enjoyed my profession, until I landed in north Florida. There is no respect for respiratory therapists here and nurses treat us like nursing assistants ordering neb treatments just because they hear a wheeze, when in most of the cases is the wet sounds of CHF or pulmonary edema, or simple like ask the patient to cough and voila! No more sounds! That is the reason I went back to school and I am pursuing a bachelors in Public Health, my goal is to become a pediatric asthma educator and complete a master’s degree in Maternal Child Care. I have met a young RT that is looking forward to go on as an anesthesia assistant or a perfusionist, and he has been in the field for only six months. Nursing is experiencing the same issue, they cannot retain personnel  for years like is used to be, people are getting burn out because hospitals care only  about making money and looking good in the community without caring for their employees. Right now is an employer’s market, when you complain; they just say “if you are not happy, leave, there are a bunch of people looking for a job”. So I did, and now I was blessed to find a job away from hospitals and continuing to practice my beloved profession and feeling very good about it.

Wanda, , RRT Hospital November 20, 2011 9:45 AM
FL

Perry there is already such a profession that exists. Anesthesiologist Assistants are master's trained anesthetists, who similarly to PAs work under the supervision of a physician. However AA licensure/practice is limited to less than half of the states in the U.S.

Jordan Sheldon, Retired RCP November 19, 2011 9:06 PM
Dallas

Guess I got moderatd off after 5 failed posts...Joel, if this goes through, let's work together to remedy your situation.

Scott

Scott Hubbell November 18, 2011 7:22 PM

Respiratory is positioned well for a opportunity like this.  I have always said RT should have a CRNA program as we have the vent knowledge and experience.  With the nursing shortage its time for Respiratory to make a move and take the profession to another level.  

Perry Sanford, Sleep Medicine - CEO November 18, 2011 6:13 PM
Pflugerville TX

Creating another niche "mid-level" (look at anesthesiologist assistants and radiologist assistants) will only pigeon-hole RCPs even further. Isn't the complain of most RCPs the lack of advancement? Some of this is surely attributed to a specialized skill-set. Why not simply pursue more established professions, such as the PA profession? Instead of being limited to pulmonary care, a PA is trained for all fields of medicine. Attending NP school requires completing an additional RN program.

Jordan, Retired RCP November 18, 2011 3:27 AM
Dallas TX

Scott....Where did I say I hate Resp???...where did I call you a name.  In fact I loved Resp up until several years ago when economy crunch hit.  The point of my comment was that Resp has changed over the years.  We get less & less respect from management on down as a whole.  I receive respect as I earned it over the years.  This is not a field I would choose again.  RN week the hosp gives them gifts & a dinner...PT week the same...RT week we have to bring in a pot luck dinner...last years was cancelled due to poor staffing.  THIS is what I dislike about Resp...the lack of respect.  I'm in New England & this is what its about....You may be better off in your part of the country.  

Joel Price November 17, 2011 4:17 AM

Joel,

No one stated anyone was a better therapist than the next.  I am responding to your very negative posts.  Obviously you have not had good experiences being an RT.  No one has forced you to work where you are, under the conditions you proclaim. The comments you made only add to the perception you projected.  I therefore say that you have represented this view of our profession, in your workplace, by your attitude.  Our profession will not progress without the backing of its workforce and visionaries.  Calling me names really only inforces my stance.  For all I know, you may be the best RT in the world, you are just a lousy advocate.  It befuddles me why you would work 37 years in a profession you hate?  You gave up the fight, I get it.  So you want to discourage progress for the future?  I don't get that.

Scott November 16, 2011 8:09 PM

Excuse me Scott.....You have no business writing about me.  You do not know what I do...I am a excellent therapist but overworked & understaffed in a very busy heart surgery ICU.  I take care of 20 patients per day...majority on vents, bipaps or about to be placed on either one.  Yes I am burned out.  I used to love Resp.  I was employed by management who thinks the bottom line is more important than patient care.  Where RN's are taught they are the boss & resp are stupid neb jockeys.  Your work place might be much better than mine...You have no right to judge based on your experiences & I doubt very much if you could keep up the pace I do every day...I survived 37 years in the field because of my expertise & I know when my patient care is suffering due to the workload.  Just because you are cocky does not make you a better therapist....

Joel Price November 16, 2011 12:59 PM

Joel,

I am looking forward to your retirement as well.  I hope it is very soon.  Too bad it took you 37 years to realize you chose the wrong profession.

Scott, RT - Program Director, NWKTC November 16, 2011 9:46 AM
Goodland KS

I welcome the changes and opportunity for advancement in the Respiratory Field.  Yes. often physicians see respiratory therapists as "button pushers" but you career is what you make of it.  If you can prove your clinical skills by thinking "outside the box" of vent checks and nebulizer treaments, your clinical peers will see your worth.  However, this degree won't come soon enough for me and I plan on returning to school to become a NP but I will keep my RRT degree because I am proud to be a respiratory therapist.  

Dawn November 16, 2011 9:07 AM
NY

California's Respiratory Care Practitioners (RCP) work almost exclusively in hospital acute care settings.  However, there's no reason why RCPs could not venture into clinics, just as RNs have.  Microcircuitry allows extreme portability and robust technology which could go to the community, instead of the patients coming to us when they are most ill and we are least effective.  Prevention is key to health care reform, as costs have undergone double-digit inflation for forty years.  Practitioners who ignore these costs do so at the peril of loss of the entire health care system.  More academic degrees do not improve our lot.  RNs from two year community colleges who have a sound foundation in the sciences and who continue professional development can perform in many health care venues; why not Respiratory Care Practitioners?

MICHAEL MONASKY, RCP, RRT-NPS November 16, 2011 12:43 AM
Sacramento CA

Although I love Respiratory Care I quickly became frustrated with the lack of opportunity for advancement within the field that would not result in taking me away from patient care. After weighing the options of PA vs MD vs NP, I choose to head back to school with the goal of becoming an NP.

I am currently enrolled in an accelerated BSN-MSN program and although I am excited to eventually have a job that I know I will enjoy, I miss being a RT.......none of my co-nursing students quite understand why I get so frustrated when I hear "patients with COPD should never be on more than 2 lpm O2" etc.

I think this type of advanced degree is a much needed option for the field of respiratory care. The new generation of respiratory therapists are not content to stay in a lateral position for the remainder of their careers. I personally know several young therapists who are planning on leaving the field of respiratory care to pursue PA or NP, this could be what is needed to keep more talent in the field of respiratory care.

Bev, RRT November 15, 2011 9:27 PM
IA

Pete in Louisianna...I understand.....as the "humerous online video says"    RT is the hospital Bi**h.  These other people are not in the real world of Resp...Its work till you drop....no staffing....no excuses for missed Rx...Sweat shop mentality here in NH

Joel Price November 15, 2011 3:59 PM

I have been in the field for almost 30 years, and have watched it grow...but here in Louisiana, there is no room for growth, due to backward physican thinking " I am God".  Instead of embracing Respiratory Protocols, most doctors here shun it, there is no market for Respiratory therapists because the schools continue to spit out 20 or so graduates a year...and that keeps the wages low, which is what the hospitals want.  Most departments now are managed by Nurses, so how can you expect this to fly....So I cannot see a Advanced Care RT Practice happening here... I wish it would however, because I hate to have the profession go down the tubes esp. like it has here....

Peter LeCompte, Cardiopulondary Care - Respiratory Therapist November 15, 2011 3:50 PM
Houma LA

I would embrace the new opportunity for advancement. I have been weighing options of PA/MD versus MS in Health, but either way it takes me a way from the respiratory career that I have loved for over 30 years. Doctors in the midwest have been communicating with RT's for determining appropriate therapy for several years, however not all md's are on board with this thinking. Maybe an advanced degree would help with their confidence of respiratory care and alleviate some of their workload as well.  Sign me up!!

Dave, RRT-NPS November 15, 2011 12:42 PM
NE

I was a respiratory therapist first but, in order to advance, I went to nursing school. I have always thought that our profession does not sell itself properly.  I did not think that physicians would support Physician's Assistants but that field had proved itself and P.A.'s have an  important place in  patient care.  I am delighted that  Stoney Brook University is looking into this advancement for Respiratory Care Practitioners.

Gloria Simons, , RN,RRT retired November 15, 2011 8:55 AM
MA

Although I hope it never happens to me, I could see that after 37 years how your enthusiasm for respiratory has gone.  You've seen many changes over the years and this is one more positive change that the younger respiratory generation can bring about--those with energy and enthusiasm for all things respiratory. In my hospital small though it is, respiratory is highly respected. I myself am on the Emergency Management Committee, spearheading the Joint Commission Hand Washing initiative and organize patient safety surveys and contests. Respiratory is what you make of it. The younger generation is not content to be "button pushers and knob turners" and I intend to support them in every way!

sheryl, respiratory - clinical supervisor November 15, 2011 8:27 AM
FL

I do not know any Dr. that would give up their control and no hospital that would think RT were worth any more money if this responsibility is given to them.  AARC is having "pipe dreams" if they think this will fly...as the saying goes "We're ONLY Resp"   button pushers & knob turners to the management & nursing of many hospitals.  I've given up the battle...I'm just looking forward to retirement after 37 years in the field.  BTW I do not want some new grad barely able to handle a floor assignment running my vent because the dept was short staffed that night.  

Joel November 15, 2011 7:58 AM

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