As a respiratory department manager, you have many daily demanding tasks. Today is no exception, but, as you look toward your office doorway, you see your newly hired respiratory therapist waiting eagerly for your guidance and direction. She has completed the required human resources training and now wants to get to work. Your department is shorthanded and very busy, and you really need her on the floors doing therapy with patients. You know she is a licensed therapist; however, you do not know her competency level delivering therapy or with your specific types of equipment. You remember that during the last hospital accreditation survey, you learned that a staff member cannot provide therapy to patients until their competency had been verified for that therapy or equipment. So you do the right thing by ensuring her competency with therapies and the equipment your department uses.
Sound familiar? This scenario occurs each day throughout the United States in respiratory therapy departments. It can be very challenging to manage the day to day operations of a department, large or small. Properly developing and managing a competency program is not just an accreditation requirement, it is the right and ethical thing to do. "It's the only assurance that safe care can be provided to patients."1 Additionally, the American Association for Respiratory Care (AARC) has developed the AARC Statement of Ethics and Professional Conduct (2009), which directs respiratory therapists to "Actively maintain and continually improve their professional competence. … Perform only those procedures or functions in which they are individually competent. …"2
When respiratory care practitioners graduate from a respiratory therapy program accredited by the Commission on Accreditation for Respiratory Care (CoARC), they graduate with the basic knowledge and skills needed to work in their chosen profession. Once they reach your door, however, you, as a manager, must make sure they can perform the job and have all the right elements to be successful under all conditions. When speaking of the importance of competencies, O'Shaughnessy states, "The scope of competency extends far beyond its usual definition as an annual test of the ability of a therapist to perform various procedures. … competency 'can be defined as a combination of the knowledge, skills and attitude required for acceptable performance under a specific set of condition.'"1
The American Association for Respiratory Care (2008) published a Position Statement requiring clinicians providing respiratory care to have "formal training and demonstrate initial competence prior to assuming those duties."3 Competency assessments can be conducted in various ways depending on available time, department policy, and availability of competent staff to perform such testing. If the competency assessment is little more than "a paper-based whitewash that no one really puts any stock in …,"4 the department will lose credibility among other health care professionals and a patient care neglect lawsuit may result.
Even after your department has developed a competency program, the work cannot stop. With new technology, updated equipment, changes in therapy or medications, and growing job responsibilities, the competency assessment program must be routinely updated. Here is where continuing education comes into play. Developing a meaningful, timely, and interactive continuing education program requires an understanding of adult education.
To gain this understanding, one needs to ask, what motivates adults to learn? Long5 questions where the motivation comes from: "intrinsic or extrinsic? … do adults learn because of some innate characteristic or because of external circumstances?" Perretta6 cites previous research that identifies six motivational factors, two of which pertain to clinical continuing education: job requirement to attend and professional advancement. As respiratory department education coordinators or instructors, it would be nice for us to know why those attending our training were there. Wlodkowski7 suggests that there are two strategic attitudes for the teacher to employ to help encourage positive adult motivation for learning. He encourages educators to "[t]reat learners with a normal positive expectation that they will learn … [and] … make the learning worthy of the adult learners' choice." Present the material in a positive way, explaining the benefits of the material and the steps that will be taken to ensure successful completion by all participates. This also may help to increase the attendance and success of your educational program.
There are many barriers that can hinder the development of a continuing education program, among them cost, time, and other resources, but there are important reasons why a continuing education program should be started and maintained, one of which is patient safety. Additionally, many methods are available to help develop or improve your continuing education program.
Perretta6 gives a number of training suggestions, such as self-paced format, simulation, skills labs, discussion groups, and interactive case studies. Herdrich8 discusses a unique method that is "a reflective learning process called 'action learning,'" which brings experienced and less experienced clinical staff together to discuss ideas and case studies, and work through issues. This method is wrapped around the idea that continuing education and clinical work should be considered a lifelong learning process.
Bunch9 mentions a program called "Learning Institute" that the AARC is developing. Once completed, the program will provide long distance learning opportunities to respiratory therapists worldwide. Long distance training programs were researched by Hopper and Johns10 and were found to be needed, successful for experienced therapists, and very important for rural small departments with limited resources.
Competency assessments and continuing education programs are important and vital to the success of any clinical department. Department managers should adhere to their professional organization standards related to ethics and professionalism when developing these individual programs. Bottom line, it is the right thing to do for patient safety.
David Blakeman, RRT, MTD, is the director of the respiratory therapy program at Idaho State University in Pocatello. For further information, contact .