From the Editor by Jan Morgan
From the President by Jeff Gonzalez
House of Delegates Meeting
Nebraska Can Reach the Summit
Legislative Adjenda
Nebraska Society to Hosts International Fellow
NSRC Video Tape Library
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As we prepare this newsletter, it’s hard to believe another eventful year is behind us. As many of you are thinking about
your personal and professional goals for 2002, take a moment to read the articles in this final edition of the Inspiration.
Some interesting legislative issues will be brought to your attention, some of which may have a direct role in your future as a
LRCP. Your elected NSRC officials spend many hours keeping track of legislative issues that directly or indirectly affect
the practice of respiratory care with the intent to protect and serve citizens of Nebraska. As always, it is our goal as NSRC
board members and committee chairs to hopefully raise more interest in the society and increase our voice in healthcare
issues as they arise. I hope you all have a wonderful holiday season and can look forward to a happy and healthy 2002!
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I hope this newsletter finds every therapist in the State of Nebraska healthy and enjoying the holiday season. The NSRC has been very busy this year. A commendable state educational meeting was held in Kearney this past spring with many quality speakers present. Politically the society has drafted legislation to address the issues of sleep and the practice of respiratory care. The society has also worked on addressing many of the issues that will affect those practicing Respiratory Care in the state of Nebraska. Of particular interest is the issue of paramedics being allowed to practice their profession in acute care hospitals and clinics. Also, the practice of unlicensed caregivers providing care in many areas in which they may or may not be adequately supervised or trained. All of us need to be aware of these issues and understand how they affect the patients that we treat. .
As I left San Antonio I left with the feeling that our friends and piers of our profession in other states are facing many of the same issues as we are in Nebraska. They reiterate the need for unity and participation of all therapists. I again commend those practitioners that have been there for the society when the NSRC has asked and I challenge each and every one of you to step forward when called upon. I also encourage everyone to attempt to recruit a new member(s). This very act will strengthen not only the NSRC but the AARC also. A strong voice and participation are essential for success. .
All active members should be aware of the upcoming Board of Directors election. Ballots will be mailed very soon with candidates willing and able to represent Nebraska therapists. Please take the time to vote and become a part of the process. If you do not get a ballot please contact me so as that I might verify your status. Remember you must be an ACTIVE member and on the Nebraska Society for Respiratory Care’s official roster that is provided by the AARC. .
In closing I have witnessed many therapists willing to help other practitioners fulfill their goals whether it is through education or providing information in order to facilitate an individuals practice. The BOD is also committed to assist in whatever reasonable means possible to do this. Please remember that we are here to serve the membership. If you have a question, concern, or comment please provide me with factual information so that I can address the issue in a timely manner. Remember, this information must be factual and I request that you contact me directly so that I may use you as a resource. .
Once again may the New Year be fruitful to everyone and rewards many to each and every professional. Take care of not
only your patients, but also yourself and your profession.
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The House of Delegates met November 28 and 29, 2001 in San Antonio, Texas.
The NBRC made the following reports: At its April meeting the Board of Trustees voted to reconsider its previous decision not to award a trademark acronym to denote the Perinatal/Pediatric Respiratory Care Specialty credential. The Board will likely hear the final recommendations at the April 2002 meeting.
The NBRC has proposed the development of a “Respiratory Care Hall of Fame” that would be sponsored by the AARC< the NBRC and CoARC. The purpose would be to create a permanent recognition for individuals who have made significant historic contribution to the field of Respiratory Care, provide a documented history of respiratory care and inform the public about the contributions of respiratory care to the nation’s healthcare system..
The NBRC has changed the admission policy to require a minimum of an associate’s degree of all students entering an accredited program as of January 1, 2002. As of December 31, 2005, all examination candidates must have an associate’s degree to take the exam. The NBRC has been asked to eliminate the 90-day waiting period between attempts for all NBRC exams. The 60-day waiting period was eliminated in early 2000 with a positive result..
The computer based testing has been a very positive change. The NBRC reported that 98% of those taking the exam rated their experience as “excellent” of “satisfactory”. The pass rate has stayed consistent with past years..
The AARC’s Director of Government Affairs reported that President Bush signed a proclamation proclaiming October as COPD Awareness Month. Twenty-seven states, including Nebraska followed with their own state proclamations..
The AARC continues lobbying efforts to have respiratory therapists recognized under the Medicare home health services benefit. All therapist are encourage to write their congressman about his issue. The AARC is also working to get pulmonary rehab recognized and paid for under Medicare..
The House of Delegates considered and passed several resolutions that were presented by the state affiliates. The first resolution asked that a feasibility study be done via Performa, that the State of Hawaii be considered as a future site of the international congress or s summer forum meeting. The second resolution asked that the AARC Executive Office notify the State Affiliate of any communication with the State Licensing Board. The third resolution asked that the AARC publicize that fact that a member can select a State Affiliate that they want to join by designing a space on the application and renewal form for this purpose. The fourth asked the AARC to consider Dallas, Texas as a site for the international congress and/or summer forum meeting and include Dallas in their rotation of meeting sites. The fifth resolution asked that the AARC set up a credit card billing process that would offer member the ability to pay their dues over a three-month period, with the transaction cost passed on to the member. All of the above resolutions were referred to the Executive Office for their consideration. The following resolution was accepted for information only: The AARC was asked to provide to the State Affiliates and membership the specific financial information explaining the need for any future dues increase and how that increase will be utilized prior to proposing any future dues increases. .
Several State Affiliates contributed money to the Emergency Fund. Over $12,000 was donated..
The AARC’s 2002 budget was approved. It contains $316,876 for revenue sharing among the State Affiliates, One million in grants for research, $266,000 for Public Relations, and money to assist affiliates with delegate travel if they meet the financial requirements. They are budgeting for a 5% increase in membership. This is an increase of about 1,600 members. Member recruitment stays as a top goal for the AARC. The membership currently stands at about 31,000 members. This represents about 37% of the practicing Therapists..
The new AARC President outlined her goals for 2002. They can be found on the AARC website at www.aarc.org. .
The House elected new officers for 2002. They are: Treasurer Barb Fedak, Colorado, Secretary Michelle Porter, Utah, Election Committee Chair Al Moss, Michigan, Speaker-elect LaDawn Leary, Kentucky, By-law committee co-chairs Rich Lundy, Montana and Laura Lucas, South Carolina. The Speaker of the House of Delegates for 2002 is Ruth Krueger, South Dakota. .
The next meeting of the House of Delegates will be June, 2002 in Vail, Colorado.
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Every year during Respiratory Care week, and various times throughout the year, respiratory therapists in Nebraska participate in activities that demonstrate and vocalize the important work we the “lung experts” perform. .
The AARC has a “Summit Award” that is bestowed to various state societies confirming the great work therapists in a state have done. We must continue to champion our cause. If we don’t let the public know who we are and what we do, most will never know. A quiet hero is a wonderful thing. But a quiet hero may not get the funding they should. How will state and federal legislators know the lung experts are on the job and deserve reimbursement, unless they are aware? .
Our president and past presidents have informed me that the NSRC could have had some great national exposure the last couple years, except no one sounded the horn. The “Summit Award” requires information on the activities our members have participated in throughout the year. When we meet with the State Legislature, or put on simple spirometry lung screenings, or have the news media cover a story about therapists or therapy, these events can be recorded for use on the “Summit Award”.
The goal is to get the word out to the public about our importance. We are not nurses or physical therapists, though some do not understand the difference. In talking with therapists from across the state, I can tell that we are working hard to get the public relations exposure we need.
Help your NSRC win a Summit Award by sending us the details of the activities you or your hospital have participated in this year. Please send us the brief summary of any media coverage you may have had, i.e. newspaper clipping, date, time, station and subject of broadcast coverage, etc. Send in the date, time, and location of any lung screenings you were involved with. We can also include any educational events our members have participated in. Please include activities you are planning this spring. We can include all activities happening before June 1, 2002..
Send all information about Public Relations, Legislative, or Educational activities to: Frank Freihaut RRT, President Elect NSRC, 14717 Boyd Street, Omaha Nebraska 68116. You can also e-mail me at ffreihaut@nhsnet.org. Please include a contact person and how they can be reached. .
Let us get the word to the AARC that Nebraska is doing great things for Respiratory Care. .
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The tragic events of September 11th highlighted the fantastic, important and vital role our Emergency Medical Technicians and Paramedics perform daily. I’m grateful for the education and training they receive. Our hospital recently participated in caring for victims of the Seward High School Band bus accident. The professional, prompt and coordinated efforts of the various emergency personnel was quite impressive. Equally impressive were the efforts of our Respiratory Staff. Each therapist on that shift checked with each other to free up staff for the prompt delivery of stat services to our emergency room. Though we only received a couple intubated patients, the therapists were prepared to handle several. I’m also grateful for the education and training Respiratory Care Practitioners receive..
Paramedics and Respiratory Care Practitioners (RCPs) have important vital roles, though they are not interchangeable. Paramedics and RCPs have specific training for specific jobs. You may be aware that some groups in the state of Nebraska would like to help ease the burden of our nursing and allied health personnel shortage by having paramedics work under a nurse and function inside of hospitals. The feeling is that a paramedic will be able to do anything that is contained in their curriculum. The paramedic curriculum includes aerosol therapy, oxygen therapy, intubation, IV insertion, chest needle aspiration, mechanical ventilation, basic pharmacology, and more. These procedures and information are rightfully taught to help alleviate an emergent situation while getting the patient to an acute care facility. Unfortunately, the limited time spent in training for these procedures and emphasis on the short term immediate clinical response is not the detail or long term disease management, patient education, and science of therapy delivery that an RCP must learn. .
Citizens of Nebraska have a current expectation of health care delivery when they or their loved one are admitted to an acute care facility. Citizens admitted to hospitals in Nebraska are protected by the laws of Nebraska. The current laws require RCPs and nurses to have a minimum education background via successful completion of their respective registry / national boards..
We have fought hard to be recognized as professional care givers who have the background education necessary to not just follow orders but to interact with the physician and nursing staff to optimize each patient’s care. We have seen in studies like the Muse Report, (www.aarc.org/professional_resources/muse/), that when respiratory treatments are delivered by a RCP, the patients have better outcomes, fewer re-admissions, and shorter length of stays. The Indiana University Center for Survey Research study, (www.aarc.org/advocacy/resources/indiana_study.html), demonstrated that though nurses may have respiratory treatments in their curriculum, the amount of time and emphasis is marginal at best. This study found that not only was the didactic instruction on respiratory care procedures very limited but also most nursing schools surveyed could not quantify any clinical practice time spent on these procedures. Without the needed education and the demonstrated ability to perform, should a nurse really be supervising respiratory care procedures? .
It has been many years, at most hospitals, since therapists simply ran around giving as many neb treatments per hour as they could. Most administrators know that the current revenue system requires that we do the right things right. To simply deliver therapy, we could train aides. But the public deserves and finances require that we evaluate what our therapy is doing to the patient. We must play an integral role with the physician, in directing care for our patients..
Yes, paramedics are taught and often give medication nebulizer treatments. Their entire curriculum is accomplished in about 9 months. How much time is spent on respiratory care treatment modalities and how much time is spent on disease management is not clear in their curriculum. But with only 9 months to digest their entire curriculum, no one subject can be covered with same depth as an RCP program. An RCP will have completed, at minimum, a two year degree program and have successfully completed a standardized national board exam..
The question is not who can give respiratory care, but who should. We must look at the current standard of care in Nebraska and the United States. Currently the standard of care for patients within acute care hospitals is to have qualified RCPs deliver respiratory care. Patients and their families expect to have a higher level of care when they get admitted to a hospital. I have a strong concern that we will be lowering the standard of care if the Nebraska legislature decides that the mechanical ability to give a treatment is an ok substitution for the patient assessment, disease management, patient education and integrated health management that is the current standard..
The legislation that is being discussed would have each individual facility set the standards for insuring the paramedics in their facility would be qualified to perform whatever duties the facility wants. I know my hospital has high standards and I would like to believe all of Nebraska’s hospitals have high standards. This, however, would circumvent the current accepted practice of being able to compare healthcare providers. Currently we can compare each other to the State laws for Respiratory Care. Every hospital utilizing RCPs must ensure their staff is duly licensed by the state and that requires the proper educational background. If each hospital was free to set their own guidelines for what a qualified staff member would be, then we could have very different care being given in one hospital versus another. Sooner or later a hospital administrator will see that it looks cheaper on the payroll, to have a few paramedics and one or two nurses to “watch” them, than to have a couple RCPs with the nurses. This would be bad for patient care and as seen in the Muse report, bad for patient outcomes and length of stay. .
We must pay close attention to this coming year's legislative agenda. I would love to see Nebraska paramedics get licensed. I would love to see creative ideas for getting and keeping nurses and RCPs in our rural hospitals. I am afraid though that many may see a short-term answer of changing where a paramedic can practice, form outside the hospital to anywhere, as a reasonable fix. We must help our legislators and the public recognize the current minimum standard of care we have, that they will not accept a drop in this standard..
In some areas of our state it must be difficult for a paramedic to get enough response calls to stay competent. I would support allowing the paramedic to help staff emergency departments. They spend time training in emergency departments. The E.D. is the same “stabilization and transport” environment that they are trained for. But I feel we ultimately hurt both the paramedic and the patients of Nebraska hospitals if we expand the paramedics work area to the general hospital. We hurt the paramedic by forcing them to do more than they have been educated and trained to do. We would hurt the patients by reducing the standard of care that is currently practiced in acute care facilities today. We would potentially weaken the trust of the public in Nebraska hospitals, due to the wide variety of standards that would evolve due to each facility setting up it’s own system of standards for paramedics working with nurses..
The NSRC will keep, as always, it’s eyes and ears open, on the changing health care environment. We as a profession must be strong patient advocates. Vocal enough to be herd and understood by the public and thus our state and federal legislators. Respiratory Therapists are not required to belong to their professional organization. In Georgia, I am told, the dentists must belong to the Georgia Dental Association to practice in that state. Would not that be great, to have 100% participation of every RCP in the state. The NSRC does not have that luxury but we need the voices of all RCPs across our state. As we hear of specific issues effecting RCPs and patients in Nebraska we will be asking you to help. We will need letters written to legislators, and RCPs to stand up at town hall meetings to ask the important questions that often the public may not realize need asking until it is too late. The RCPs before us fought hard for national standards like the NBRC testing, and for state licensure. These issues have benefited every RCP and have benefited the patients we serve. It is our turn to not let these standards slip away. Thank you for being a member of the NSRC. Please be ready to act when we see an issue that threatens patient care or the standards of Respiratory Care. Please ask your co-workers and friends that are RCPs if they belong to the NSRC. If they don’t, take a moment to explain the importance of their voice in our organization. .
The NSRC was selected to host one of the AARC’s 2001 International Fellows. The International Fellowship Program is sponsored by the American Respiratory Care Foundation (ARCF). The program founded in 1990 has hosted 88 professionals from more than 41 countries. Fellowships in Respiratory Care are awarded to health care professionals to promote the development of Respiratory Care globally. Fellows apply to the AARC and are selected based on qualifications which demonstrate a commitment to the enhancement of Respiratory Care. The NSRC has hosted two fellows previously; one from Malaysia in 1993 and one from China in 1998. .
Dr. Lee is a professor of Anesthesiology, Seoul National University College of Medicine. He is the chief anesthesiologist in liver transplantation as well as the chief in the experimental medicine in clinical research institute. He is a member of the teaching staff of the medical college, training medical students in postoperative respiratory disease related to anesthesia and cardiopulmonary resuscitation. Dr. Lee had previously trained in the United States where he was trained in ECMO (Extrcorporeal Membrane Oxygenation) He is the only professional who has performed successful ECMO in South Korea. His application expressed a desire to benchmark educational programs, to assist in establishing a Respiratory Care program in Seoul. .
Before arriving in Omaha. Dr. Lee visited Seattle to see Respiratory Care in Washington. In Nebraska, Kook (Dr. Lee) visited Nebraska Health System. Nebraska Methodist Hospital, Nebraska Methodist College, Select Specialty Hospital, Saint Joseph Hospital in Omaha and in Lincoln Bryan LGH Medical Center East and West, Saint Elizabeth’s Regional Medical Center, South East Community College, Madonna Rehabilitation Hospital and AHP-MHR Home Care. Jane Wilwerding Matsui was the “city host’ or AARC/NSRC liaison. .
Dr. Lee’s visit was enhanced by professionals willing to share their knowledge and expertise. At NHS, Sandy McGranaghan in Pulmonary Lab, Carie Smith in Sleep, Dr Tom Poulton an anesthesiologist and pediatric intensivist, provided Dr. Lee his introduction to Respiratory Care in Nebraska. Pat Haynes and Dr. Walter O’Donahue showcased Saint Joseph’s. Dr. O’Donahue took Dr. Lee on rounds with Pulmonary Medicine. Greg LaHood from Select Specialty Hospital provided insight into rehabilitation. Chris Hamilton included Dr. Lee in one of the classes she was teaching at Nebraska Methodist College. Jan Morgan and Patty Bauer shared an informative and interesting visit at Methodist Hospital. .
Jeff Gonzalez coordinated Dr. Lee’s visit to Lincoln. Art Ortiz and Jeff shared with Dr. Lee Respiratory Care at Bryan LGH Medical Center West. Marcy Wyrens and Lil O’Neill from Bryan LGH East facilitated Dr. Lee at their institution. At Saint Elizabeth’s Regional Medical Center Jay Snyder, Pam Kelly and Jane McReynolds shared their skills, with Dr. Lee. At Madonna Rehabilitation Hospital Jim Pelton and Nancy Nathenson discussed and demonstrated pulmonary rehabilitation. J.D. Nutter discussed home care with Dr. Lee at AHP-MHR. .
A dinner and presentation by Dr. Lee on “Respiratory Care in South Korea” was held November 29th ,the final evening of Dr. Lee’s visit to Nebraska. The NSRC hosted the dinner, John May and Nebraska Health System provided the location and service, AHP-MHR Home Care furnished appetizers. Attendees included those who facilitated Dr. Lee’s visit, members of the state licensing board; and committee chairman and officers of the NSRC. .
Dr. Lee discussed healthcare in South Korea. He explained that his hospital is a 1500 bed facility, not the largest in Seoul (Seoul is a city of ten million). Health care in South Korea is funded by the government at much lower levels than health care here. The hospital that Dr. Lee practices at is a liver transplant center. His comments revealed some differences; the majority of the liver transplant patients are living related patients. The use of cadaver organs is not as common as locally. Respiratory care is provided by the physicians and nurses. Only physicians make ventilator changes. The primary interest in sleep medicine is by psychiatrists and pulmonary rehabilitation is not available in Seoul. .
After Dr. Lee’s presentation, Jeff Gonzalez, NSRC president presented Dr Lee with some reminders of his trip to Nebraska. His favorite was a Nebraska Sweatshirt. Dr. Lee expressed his gratitude for the hospitality, his admiration for Nebraska Respiratory Care professionals and a very positive impression of the value Respiratory Care provides. .
Dr. Lee went from Nebraska to the AARC meeting in San Antonio. There he joined the other fellows in sharing expenses, learning even more of the diversity of Respiratory Care and enjoying the exhibits. At the reception honoring the international fellows, Dr. Lee again complimented his Nebraska hosts on their professionalism, abilities and hospitality. .
The NSRC has purchased several quality educational materials and applied for the associated CEU's for licensed respiratory practitioners in the state of Nebraska. These CEU's are only available to members of the NSRC. .
These tapes are 55 to 60 minutes in length, and deal with a clinically oriented topic. Practitioners desiring to view the videotapes, as a department activity or as an individual, will need to adhere to the following guidelines in order to receive CEU's: .
1. Designate an In-house educational contact person who will assume responsibility for the videotapes.
2. The In-house contact person shall:.
a. Provide a list of those NSRC members who are requesting to view the videotape..
b. Request one tape at a time..
c. Request the tape in writing 2-3 weeks in advance of when needed. Every effort will be made to provide the tape on
a timely basis..
d. Submit $3.00 per tape. Please make checks payable to the NSRC..
e. Verify attendance making sure all attending sign in. Sign-in list must be legible and ready to submit to the State
Licensure Board..
f. Return videotapes within 7 days of receipt so that they may be available to other practitioners. A late charge of
$1.00 per day will be assessed to tapes kept longer than 7 days..
3. Videotapes shall be sent in mailing envelopes that contain pre-addressed labels for return to the NSRC committee
person..
4. CEU's will be mailed on a monthly basis to the In-house contact person for distribution to all participants..
5. These videotapes will be made available only to members of the Nebraska Society of Respiratory Care and shall
remain the property of the NSRC. .
Titles available:.
1. Assessing the Respiratory Patient.
2. New Developments in Respiratory Drugs, Medications and Delivery Devices.
3. Emergency Respiratory Care: The Respiratory Care Practitioner's Role.
4. Noninvasive Mechanical Ventilation: Its Role in Acute and Chronic Respiratory Failure.
5. Asthma: Managing the Disease.
6. Managing the Work of Breathing During Mechanical Ventilation .
7. Tissue Oxygen Delivery.
8. The Hospitalized COPD Patient- 10 Commandments for the Clinician.
9. ARDS Review.
10. New Approaches in Smoking Cessation.
11. Nutrition and Respiratory Care.
12. Sleep Disorders.
13. Drainage of the Pleural Space.
14. Pulmonary Rehabilitation.
.
Please keep in mind: 20 CEU's are required every two years. .
The NSRC does not view this as a money making project. Rental is for outbound postage and mailing supplies. Return postage is the responsibility of the In-house contact person/institution. Any money accumulated in excess postage will be utilized to offset the cost of purchasing new tapes. For more information or questions, please contact Bruce Anderson, RRT at (402) 435-0974, e-mail job60@ix.netcom.com. TOP OF PAGE