A Position Paper Prepared for the National Conference on Multiskilling and the Allied Health Workforce
The American Association for Respiratory Care (AARC) advocates the use of multi-skilled or cross-trained respiratory care practitioners (RCPs) and has encouraged the assimilation of new competencies and skills by its members.When cross-training in health care first emerged as a major topic of discussion in the early 1980’s the AARC was already considering ways in which RCPs could assume responsibilities for tasks not traditionally within their scope of practice as a means of controlling costs and utilization patterns in health care.
Shortly after the implementation of prospective payment as a cost control mechanism in the Medicare program, the AARC took a long look at how prospective payment would impact health care and this profession. A Task Force on Professional Direction was convened and did extensive surveying of the respiratory care management community, medical directors and educators of respiratory care services, and hospital administrators in facilities where respiratory care services were offered. The results were published in a 1986 report.(1)
At that time, 79.1% of respiratory care departments indicated that they were providing clinical procedures other than the traditional tasks of intermittent respiratory therapy, therapeutic gas administration, chest physiotherapy, diagnostic pulmonary tests, and ventilator support. These non-respiratory related services were primarily in invasive and non-invasive cardiac diagnostics, extra corporeal membrane oxygenation (ECMO), and health education.
Furthermore, hospital administrators and medical directors supported this move and believed that RCPs were prepared and ready to take on additional responsibilities. A question regarding the trend toward cross-utilization was posed to medical directors, hospital administrators, and respiratory care department managers; a majority of all groups believed that the trend would continue and indicated that they expected to see an increase in the scope of services provided by RCPs as follows:
|Expect to See an Increase in Cross-Utilization of Respiratory Care Practitioners|
|RC Department Managers
When asked to identify the department best prepared for dealing with the changes wrought by prospective payment and the need for cross-trained health care providers, the respiratory care department was most often named by medical directors and hospital administrators.
|Department Best Prepared for the Future|
Other studies that have looked at the need for and benefits of cross-training have also identified respiratory care practitioners as good candidates for multiple skills. The University of Alabama at Birmingham study,(2) which looked at skill combinations for various health professions, named respiratory care in several multiple skill areas.
While prospective payment nudged the health care system into looking at multi-skilled health care providers, it is the current climate of health care restructuring and managed care that is catapulting the concept into reality. Once again, the AARC has been looking at ways of creating a respiratory health care provider who fits in with the needs of the health care system.
A 1992 Respiratory Care Practice Survey of hospitals nationwide done by Arthur Andersen and the AARC showed that respiratory care departments are expanding into other areas of practice.(3)
|Respiratory Care Departments Providing Non-Traditional Services|
Invasive Cardiac Testing
Noninvasive Cardiac Testing
Sleep Lab Studies
This enhancement of the skill base of RCPs has established the profession a tradition of flexibility and a reputation for adaptation to change. RCPs bring to the workplace a unique and discrete set of specialized skills. Additionally, the attributes and characteristics of RCPs make them excellent candidates for cross-training.
While these established characteristics of RCPs are being widely developed, it was through two Educational Consensus Conferences, which were convened in 1992 and 1993 to evaluate the needs of the health care system of the future, that mechanisms were identified to ensure that the Rcp is educated to meet those needs. It was well-established by the group of individuals who met at the first Consensus Conference in October 1992 that the RCP of the future would need to have multiple skills and the critical-thinking abilities and flexibility to be able to asimilate new tasks.(4)
The second Educational Consensus Conference detailed an orderly plan for the implementation of multiskilling.(5) Beginning with identification of requisite skills, an appropriate modular curriculum could be developed. The fact that this education must be provided post entry-level was emphasized by the conferees. The source of this skill building was identified as a formal educational process. The rationale behind this position is based on the need for standardization of educational outcomes and quality assurance for the employer.
In summary, the AARC endorses and actively promotes the concept of multiskilling, provided that the practitioner is qualified through formal education and adequate skills assessment. Today’s RCP has, in many cases, already assimilated such diverse skills as EEG, ECG, phlebotomy, ECMO, endotrachaeal intubation, sleep laboratory studies, and drug administration via routes other than aerosol. Through the formal educational process, tomorrow’s RCP will be well prepared to meet the need of the health care system for multiskilled providers.