These are the questions you asked in the membership survey sent last year. The board felt each comment needed a valid, thoughtful response. Please contact us if you have follow up questions. Additional questions and responses will be posted next month.
- Membership Survey Responses
- 1. “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.
- 2. “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!!
- 3. "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!
- 4. “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.
- 5. "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
- 6. “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.
- 7. “I would like to see your average therapist be asked to come to D.C. and experience the legislative process and see what really happens behind the scenes so that they could share their experience with other therapists and hopefully more people can get involved in the process. Many therapists feel only the NJSRC hierarchy members are allowed to attend meetings in D.C and many feel neglected they can't be part of the team.”
Response by Bob Guardabasco, President Elect
First let me thank you for your comment. Every year the board is asked for volunteers to spend three days in Washington D.C. Although we would like to have a member from each of the 13 congressional districts, unfortunately, there are financial restraints to the number of attendees. Over the past three meetings, we’ve had at least 3 first-time therapists in Washington. The commitment begins in January with calls to congressional offices and to set up meetings in Washington.
There are a number of ways therapists can contribute and be part of the team. Become a member of the Government Affairs Committee, and if you are interested in attending a future "Hill Day" and are willing to make the commitment, please contact us. If you are unable to make the time commitment, help us by setting up meetings with your representative or write letters your legislators requesting their support for the respiratory care profession.
- 8. "More communication, more frequent short emails of happenings, sometimes notifications are given out too late, making it difficult to adjust work schedule to attend and more communication more visible interaction"
Response by Jill Guide, Chairperson Communications and Public Relations
As the survey results were coming in and then fully tallied, I was pleased by the ratings and comments specific to the communications questions. Our hard work is paying off! The overwhelming majority of participants found the frequency of communications either just right or not frequent enough, with the comments reflecting similarly.
Since 2014, the Public Relations committee has resurrected Scope, added over 100 new followers to our social media sites and launched two new websites. The point being, we have multiple methods for the dissemination of information, but we sometimes lack the content. The NJSRC is a family - in this ever changing profession, it is important we stick together. Scope is a resource you can utilize to share your success stories with your family, gain insight into industry related best practice, put a spotlight on a valued employee deserving of recognition or simply brag about your department’s accomplishments. I can say, posts that are specific to department activities (RCWeek, clinical studies, membership spotlight) get the highest amount of visits on the NJSRC site.
Make no mistake about it. Your colleagues really are interested in what your department has going on!
Our goal is to distribute Scope monthly. The committee utilizes several resources including AARC, its affiliate websites and Google alerts. But most importantly, we turn to our members who share the same passion for our profession as we do and want to make that passion known throughout the state. There are plenty of ways to contribute. Why not submit an article as a guest author? Or when your department participates in a health fair, develops a new community or facility-based program, or anything you may want to share, simply send us an email.
Lastly, working with our education committee, notifications for conferences will go out much farther in advance. This year, the NJSRC will offer a Spring Conference at the NJ Sharing Network, on May 12 and it will be our third year there. The NJSN is more centrally located than our Northern Region Director’s Dinner and Conference and the Annual Atlantic City Shore Conference. The Northern Region Dinner and Conference will be held at Portofino Restaurant on June 5. More information to follow. Stay tuned into our communications for the latest updates!
- 9. "Align with other professions to give us more clout"
Response by Lori-Ann Ligon, President
As the tapestry of healthcare changes in the United States, we must change with it. Many other healthcare professions have transformed themselves to meet the needs of the patient, but, the respiratory care profession has been lacking in its promotion of who we are and what we do. Most of our fellow healthcare partners have made great strides in raising the bar for entry level education... for example, to become a physical therapist, you must now possess a Doctorate in Physical Therapy. Pharmacists are required to achieve a doctorate as well. There are not very many three year nursing schools left as the nursing profession has moved to an entry level bachelor's. Respiratory care has just begun the process of eliminating the CRT credential, making the RRT entry level. More needs to be done to develop true bachelor’s degree programs in respiratory care if our profession is to remain current and ensure alignment with other allied health professions. We as a professional group need to be more visible to the public. We need to participate in health fairs in the community, guest speak at service organization events, become and maintain membership in the AARC and get involved in activities through the state society.