The RCP as a Multiskilled Health Care Provider

A Position Paper Prepared for the National Conference on Multiskilling and the Allied Health Workforce

The RCP as a Multiskilled Health Care Provider

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
Medical Directors
52.8%
Hospital Administrators
69.6%
RC Department Managers
73.8%

 

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
Respiratory Care
Physical Therapy
Radiology
Occupational Therapy
Speech Therapy
Other
Medical Directors
59.9%
16.0
17.4
1.4
1.8
3.5
Hospital Administrators
50.0%
30.3
10.3
1.7
1.4
6.3

 

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
Bronchoscopy
Cardiac Rehabilitation
Electrocardiograms (ECG)
Electroencephalography (EEG)
ECMO
Hyperbaric Oxygenation
Invasive Cardiac Testing
Noninvasive Cardiac Testing
Sleep Lab Studies
45%
19
57
41
6
8
15
48
23

 

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.

  • RCPs are on the premises seven days a week, 24 hours a day. They are one of the few allied health professionals who care for and evaluate patients around the clock, allowing them to efficiently respond to a patient’s changing needs and to be on hand at all times to conduct other duties.
  • RCPs are already used as multi-skilled providers in many hospitals. They have been identified as one of the best candidates for cross-training among allied health care providers because they can administer prescription drugs, they possess technical expertise, and they have a large skills inventory.
  • Certification of RCPs requires education in physics, biology, pharmacology, anatomy, and other laboratory sciences. They have an aptitude for laboratory sciences that prepares them to quickly learn new clinical procedures, thereby increasing opportunities for cross-training.
  • RCPs have a skill base of more than 100 clinical interventions. They possess the most diverse capabilities of any allied health professional. Their broad skills inventory allows RCPs to meet changing job demands, giving them the flexibility to learn new skills through cross-training and continuing education programs. It takes few resources to add to and update an RCP’s clinical skills than it does for professionals who have mastered fewer skills.
  • RCPs are trained to use complex, high-technology medical equipment. Respiratory care procedures often call for the use of complex medical equipment such as mechanical ventilators, which requires special training. No other allied health provider is formally trained to use this technology. RCPs have a predisposition toward understanding and operating technologically advanced equipment, upon which the medical industry will increasingly depend.
  • RCPs maintain ongoing patient interaction, education, and assessment. Future health care will be dominated by a focus on wellness. Because of the rehabilitative aspects of respiratory care, Rcps often spend time educating patients about their illnesses, treatments, and preventive strategies. With their unique combination of high-touch and high-tech skills, RCPs make excellent community educators on a range of topics, including nicotine intervention, asthma, and pulmonary wellness.
  • RCPs currently provide services in settings covering the full continuum of care. Many RCPs are engaged in managed care initiatives, providing care in settings such as skilled nursing facilities, doctors’ offices, patients’ homes, and rehabilitation centers. This experience in a seamless health care system provides them with skills and competencies needed in today’s health care workforce.

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.

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  1. The Impact of Prospective Payment on the Respiratory Care Profession. American Association for Respiratory Care, 1986
  2. Vaughan, D.G., Fottler, M.D., Bamberg, R. & Blayney, K.D. (1991). Utilization and management of multi-skilled health practitioners in U.S. hospitals. Hospital and Health Services Administration, 36(3), 397-419
  3. A Study of Respiratory Care Practice. Arthur Andersen and the American Association for Respiratory Care. 1992.
  4. Year 2001: Delineating the Educational Direction for the Future Respiratory Care Practitioner. American Association for Respiratory Care. 1992
  5. Year 2001: An Action Agenda. American Association for Respiratory Care. 1993