Editor’s note: This text-based course is an edited transcript of the webinar, Professional Organizations Within Respiratory Care: What You Need to Know, presented by Jessica Fino, EdD, RRT.
After this course, participants will be able to:
- Describe the roles of the various professional organization
- Identify professional requirements within each organization
- Recognize the benefits of maintaining an active membership as a Respiratory Therapist
Who Are They?
- The National Board for Respiratory Care (NBRC)
- The Commission on Accreditation for Respiratory Care (CoARC)
- American Association for Respiratory Care
- State-Level Societies and Organizations
Many practicing therapists and students have different opinions and interpretations of our professional organizations. I thought this would be an interesting topic to clarify some of those questions and bring out some ideas and concepts that perhaps you were not aware of. Who are our professional organizations and boards? What are these names and entities you hear passed around in the profession? We have the National Board for Respiratory Care (NBRC), the Commission on Accreditation for Respiratory Care (CoARC), the American Association for Respiratory Care (AARC), and the State-Level Societies and Organizations that I will talk about in this presentation.
The National Board for Respiratory Care (NBRC)
- Establishing Competency Standards
- Defining Excellence in Respiratory Care
- Credentialing Exams
- Credentialing Maintenance
Starting with the National Board for Respiratory Care (NBRC), we will review a few essential things. Off the top of your head, if I were to ask you what does the NBRC does, you would probably tell me, "Oh, they write our credentialing exams, they are the ones responsible for the exams that we have to take so we can get a license." However, there is much more to what they do and their services. We look at establishing competency standards. When we look at competency, we are looking at the concept of ensuring that those working alongside us have the knowledge to be in the same field. Previously, when respiratory first started, you had on-the-job training. You had individuals who learned the skills on the job, which was expected, however no longer the case. You are expected to have at least an associate's degree or a bachelor's degree to enter the field. The NBRC comes into play because they help establish that minimum competency.
What are the expectations of this individual coming into the field of respiratory care? What should they know? What should they be able to do? "Defining excellence in respiratory care," excellence is not only that we are knowledgeable in the field, but we are also capable. The field has evolved from on-the-job training, competencies have evolved, the things we knew 20 years ago have evolved, and things we now know are different today. We have that continual evolution of what those competency standards should be, and it helps us maintain excellence by making sure that we stay up-to-date and that we are expecting a knowledge level that is equivalent to the times that we are experiencing today. Some of you are like, "Well, I am already a therapist, why does this apply to me?" The NBRC is also responsible for credentialing maintenance. This area may be confusing for some of us because there have been several changes in recent years and even in the last few years.
Who Makes Up the NBRC?
The NBRC is a not-for-profit organization that is comprised of representatives:
- AARC – American Association for Respiratory Care
- CHEST – American College of Chest Physicians
- ASA – American Society of Anesthesiologists
- ATS – American Thoracic Society
Backing up, who is the NBRC? Who are they made up of? The NBRC is a non-profit organization comprised of representatives from these four organizations 1) AARC, 2) the American College of Chest Physicians, 3) the American Society of Anesthesiologists, and 4) the American Thoracic Society. From all these individual organizations, you can see that we get input from various outlets in several different areas to make sure that it is not all one-sided. That respiratory therapists are not the bureaucracy or only respiratory therapists decide what respiratory therapists should know. We have several physician groups that likewise add their input.
- CRT – Certified Respiratory Therapist
- RRT – Registered Respiratory Therapist ▪ RRT-NPS – Neonatal/Pediatric Specialist
- CRT-SDS or RRT-SDS – Sleep Disorders Specialist
- RRT-ACCS – Adult Critical Care Specialist
- CPFT – Certified Pulmonary Function Technologist
- RPFT – Registered Pulmonary Function Technologist
Looking at the NBRC credentialing exams, there are seven of them currently. We have the Certified Respiratory Therapist (CRT), the entry-level, minimum expectation passing for the therapist multiple-choice exam. The CRT has also evolved in recent years. It used to be you just took the CRT exam first, then you the RRT exam, and as you passed them, you could claim your credentials. Nowadays, one exam determines if you are an RRT or a CRT, based on your passing level and whether you can sit for the Clinical Simulation Exam (CSE). The CRT or RRT is our basic minimum credential to enter the field. We also have specialty credentials in 1) Neonatal/Pediatric Specialist, 2) Sleep Disorder Specialist, 3) Adult Critical Care Specialist, 4) Certified Pulmonary Function Technologist at the certified and registered level.
According to the NBRC, more than 265,000 professionals have obtained at least one or more of these credentials. Specialty credentials signify that your skills and knowledge are highly specialized in one or more areas. For example, I know that there are children's hospitals and things that require their therapists to have the NPS or prefer their ICU therapists have the ACCS exam, that is one of those where It is like you are attaching this label to yourself that, "Hey, I have taken the extra steps and I have studied this even further, and I want you to know that I am specialized in this area."
Does that mean that someone with just an RRT is not skilled enough to work with neonates or not skilled enough to work in the ICU? It is a way of showing that you took the extra step and specialized in those areas. On the NBRC website, one of their services is that they offer detailed content for these exams. The NBRC offers an outline of the detailed content, identifying what you would be expected to know. NBRC also free practice exams if you are interested in taking one. If you are a member of the AARC, there is a one-time discount code where you get $40 off for being an AARC member.
- Annual Fees - $25/ year or $125/ every 5 years
- CEU’s vs. CMP vs. Quarterly assessments - Anyone who was credentialed after July 2002 must participate in the credentialing maintenance program
- Earn a new NBRC credential
- Take quarterly assessments and/or document up to 30 continuing education credits (in 5 years)
- Pass the same NBRC examination again
The credentialing maintenance is presumably the most confusing aspect regarding the NBRC. I am a member of several social media accounts or networking accounts where there are various respiratory therapists from different states, hospitals, and organizations. What does this mean? Why do I have to get continuing education units (CEUs)? If you are a therapist who obtained your credentialing exam or received your credentials before July 2002, you do not have the continuing education unit requirement from the NBRC. Those individuals are what we call grandfathered into credentialing maintenance.
If you obtained any of your credentials after July 2002, you are automatically a member of the Credentialing Maintenance Program, and you have to submit a minimum of 30 continuing education units every five years. Recently that has changed as well that there are different ways that you can obtain and meet the Credentialing Maintenance Program. You have the annual fees of $25 a year or $125 every five years. If you graduated before 2002, it does not mean that you cannot be a member of the NBRC. However, it is highly encouraged. Now, if you graduated after 2002, it is a requirement. You have to pay your annual fees at least every year or every five years as part of the credentialing maintenance.
In addition to paying your fee, you have to satisfy one of the three areas for your credential to remain active. The Credentialing Maintenance Program has three different ways to meet the requirements. First, you can earn a new NBRC credential. For example, I have an RRT, if I take the Neonatal/Pediatric Specialty (NPS) and pass my NPS, it resets all of my credentialing, and I am good to go for at least the next five years. I could also pass the same NBRC exam again. If I want to retake my RRT, I can and if I pass that exam, it resets for the next five years, and I am good to go.
Now, this newest option is the quarterly assessments. They have this new program where they have a series of questions. I have done a few of them, like the board exams, but It is not an internal exam. It is somewhere between 5-10 questions. The amount that you pass determines your zone. If you do well, you will be in the green zone. If you get some of them right, some of the wrong, you may be in the yellow zone. If you get a large majority of them wrong, you will be in the red zone. You take those quarterly, and the better you perform, the fewer continuing education units you have to submit. It is not that you do not get your continuing education units or do not need your continuing education units. It is that you are passing these quarterly assessments. On the NBRC website, when you log into your account and review your credentials, it has a meter to show you what meter you are in. If you are in the green zone or the yellow zone, it reduces the number of continuing education units you have to upload. If you are in the red zone, then I am sure you would have to upload the 30 continuing education units.
Alternatively, if you do not want to mess with the quarterly assessments or miss some of them, that is fine, you can upload 30 continuing education units into the NBRC website. To recap, those are the three ways that you can do it 1) pass a new exam, pass the same exam 2) participate in the quarterly assessments 3) upload continuing education units or participate in the quarterly assessments, and reach a level that you no longer have to submit continuing education units because your knowledge and your pass rate is high enough.
Why is Membership Important?
- You help maintain credentialing
- Fund research related to these programs
- Advocate for your patients and the RT’s who provide their care
You may be asking, Why is that important? Why does it matter if I graduated before 2002? Why did they start doing this to us? It is a way to maintain the criteria and the minimum expectation of practicing in the field if you think about it. For example, let's say I went to respiratory school and I graduated in the early 90s, I practiced for five or six years, the economy started coming up, and I decided, "You know what, I think I can make more money as a financial advisor." I become a financial advisor, which I have done for the last 15 years.
Suddenly, I notice they are making more money in respiratory. Everybody is looking for a respiratory therapist. My credential is still active. All I would have to do is reactivate my license with whatever state I am working in, go back to work, and work in the hospital because my credential is still active. Not to say that those individuals do not know anything, but if you were able to choose the therapist that has been working with 20 years of experience in the hospital setting vs. someone who has not worked in the hospital setting, touched a ventilator or a patient in 20 years, you could see why that knowledge in credentialing maintenance is essential. We want to make sure that those individuals are knowledgeable and up-to-date on current practice because things are evolving and changing all the time.
Why is membership important? Beyond the requirement of ensuring that your knowledge level is where it should be and that you have the minimum expectations in your current practices, it is vital because it helps maintain credentialing not only for you but also for the individuals coming after you, the new therapists that are entering the field. It helps us maintain and ensure that new grads and new testers have the knowledge needed to come and work alongside you. It also helps fund research related to these programs and helps advocate for your patients and the respiratory therapists who provide their care. When we look at funding research, it funds research in determining the credentialing process and the exams. Are they working? Are they effective? Are they meeting the needs of the profession right now?
The Commission on Accreditation for Respiratory Care (CoARC)
- The Commission on Accreditation for Respiratory Care (CoARC) accredits entry into Professional Practice respiratory care programs at the Associate, Baccalaureate, and Master’s degree levels, as well as post-professional Degree Advancement respiratory care programs at the Baccalaureate and Master’s degree levels and Advanced Practice respiratory care programs at the graduate level (CoARC 2021)
The Commission on Accreditation for Respiratory Care (CoARC) accredit entry into professional practice respiratory care programs at the associate, baccalaureate, and master's degree levels. Additionally, CoARC accredits post-professional degree advancement respiratory care programs at the baccalaureate and master's degree levels and advanced practice respiratory care programs at the graduate level. Why is this important to me? This is important because CoARC is the accrediting body for respiratory care programs at any level. It is a voluntary process that the schools themselves submit and go through. It is a highly regarded achievement to achieve CoARC accreditation and why this is important to you is because it is a requirement for NBRC Exams.
It is not the only requirement, as there are additional ways to sit for an exam if you previously went to a program that was not accredited. However, it is the easiest way, and it is the up-to-date, current, most appropriate way to qualify for sitting for an NBRC Exam by graduating from an accredited university program. Beyond that, it protects you, the consumer, ensuring that I am going to a school that will prepare me for entry into practice. It will prepare me for my exams, and it is going to prepare me for working in the field.
Why Is This Important To Me?
- Requirement for NRBC Exams
- Protects the consumer (you)
- Ensures the quality of the respiratory programs
- Advances the profession
Why does this matter to me? I am already a practicing therapist. It matters because it helps ensure the high quality of educational programs and make sure that those coming in will have the exact expectations and knowledge that you are required to have. It also helps ensure the quality of existing programs advance the practice and the profession. Much talk has been about the advanced practice respiratory therapist (APRT). We would like to see it come to fruition; however, it is not widespread. We are not quite there yet, but let's say it does eventually take off, and we have an advanced practice profession. You want to make sure it is also a CoARC-accredited degree. We want to maintain this level of excellence, so we are not moving backward in a sense. If we are going to create these advanced positions, advanced credentials, pursue master's and advanced level degrees, you want to make sure that you are looking into CoARC-accredited programs. The best part is that you do not pay for a CoARC accreditation as the consumer.
- Fees associated with accreditation are the responsibility of the school and/or program
- Accreditation improves the quality of respiratory education
- CoARC accreditation comes from the program itself, all the fees associated with that are paid by the school or the program themselves and the accreditation improves the quality of respiratory education. , quality not only requires that the program meet expectations as far as teaching the right material but they are also evaluated on how well the students from those programs perform
Currently, we are going through this in my program, and it is a very rigorous, detail-oriented process. We are evaluated on all sorts of things. I do not want to speak negatively towards anything, but there are programs, even on the CoARC's website, that refer to them as "degree mills" where you can get a degree, and it says it is a degree in respiratory care. However, if it is not an accredited program, who knows what they taught you in a sense? They are not responsible for reporting their content, outcomes, or job placement to any other entity. We are responsible for showing what we teach, how we teach it, and its associated outcomes. How well are our students performing? What's our job placement look like? What are our attendance levels? Do students come to this program, stay through the program, and graduate? This is what the CoARC does.
American Association for Respiratory Care (AARC)
- AARC- the national association for respiratory care professionals
- Education - AARC Congress, meetings, and educational courses providing CRCE credits Advocacy - interacts with local, state, and federal government on public policies that affect our patients and our members
- Publications - publishes a peer-reviewed journal RESPIRATORY CARE
- International Respiratory - maintains an international connection by an annual International Fellowship Program (AARC 2021)
The American Association for Respiratory Care, referred to as the AARC, is our national association. There are several aspects and areas that the AARC focuses on, crucial to what we do as therapists.
For education, the AARC is responsible for our national meeting every year, referred to as AARC Congress. They are also responsible for several additional meetings and have educational courses that provide our continuing education credits. They organize, maintain, and offer several continuing education unit (CEU) opportunities. They interact with the local state and federal government on several public policies that affect our patients and members when it comes to advocacy. When looking at advocacy, state and national laws come into play that may directly affect what we do as respiratory therapists in our practice related to providing respiratory therapy to our patients. They have legal resources, individuals who specialize in this, and they will come and help us understand these laws. AARC will help us advocate for ourselves and ensure that we are aware of things going on at the government level and how those would potentially impact us.
Additionally, they have resources on current procedural terminology (CPT) codes and billing and coding for our procedures. We all know the bottom line is that the hospital wants to bill for our services, earn money, and prove our worth. AARC is very knowledgeable has resources on coding, billable services, how to bill, when to bill or not to bill. A helpful aspect of things they offer. They are also associated with marketing and the respiratory therapy roles outside the hospital setting. If we look at the other healthcare counterparts and our other co-workers, there is not a whole lot currently for respiratory to do outside of the hospital or clinic setting., Looking at telehealth home care services, I am sure we would love to see respiratory branch out into those types of settings and environments. This goes along with that advocacy. If we can get billable services moving into that arena, I think that is where we will truly see those types of positions begin to develop and areas of respiratory therapy come into play. It is an important role and how they support us in that area.
As far as publications, the AARC is also responsible for publishing our peer-reviewed journal, Respiratory Care. There is also a specialty, Respiratory Care Education Annual, that they publish and a few other newsletters. Our major peer-reviewed journal, the AARC, is the overseeing company and organization that produces it. If you are looking for up-to-date information, best practices, or something you want to know more about, this is your resource. There are allied health journals, but anything specific to respiratory care, this is your spot, this is where you go. Something I learned in developing this presentation that I was not as familiar with is that they also have international respiratory connections. The International Fellowship Program allows healthcare professionals from outside the United States to visit and observe respiratory care practices in the United States, helping respiratory therapy in other countries. Here at my university, we have several international students from other countries that come here, and it is one of those eye-opening experiences to learn about the need for respiratory in other countries, the lack of respiratory care, or how they approach it differently. This is an exciting concept for me as far as linking up with our international partners and ensuring the quality of respiratory across the world.
- Clinical - Clinical Practice Guidelines, safety checklists, disaster planning, ventilator management, and protocols
- Publications - Respiratory Care Journal, Respiratory Care Education Annual, Press Releases
- Professional Documents, Coding and Billing
- Career - postings, networking, awareness, APRT
- Students - Learning modules, exam prep, job searches
- Programs - Awards, Grants, Conferences, Certificates, Competitions, Staffing Tools
Let's say you are working in a hospital, and you have been put in charge of developing a protocol for ventilator management. You think to yourself, "I feel like I am in a world on my own. This is one of the few places I have worked at, and everything I have encountered kind of approaches it in the same way. What else can I do? Where else can I go?" The AARC is an excellent resource for that. Suppose you are developing protocols and looking for strategies, wondering what goes on outside the island of your hospital. If you do not have a lot of therapists or contact with many individuals from other hospitals or you have got doctors that cross over to the same hospitals, you want to see what a different perspective on this is? What is a different way of doing this? What are they doing in this area? How are they approaching this concept over here? That is where the AARC comes into play because they already have existing things out there that could be great resources if you are developing new protocols or safety checklists. There are clinical resources our practice guidelines that detail how to practice in the field. I am sure we have all experienced during COVID times, wanting to know what are respiratory therapists or what is their role? How are they dealing with these major issues? Do press releases come from our national organization? The Respiratory Care journal, Respiratory Care Education Annual are endless resources here. If you need a document for coding and billing or approaching different governmental organizations, those are there, and there are many resources. I cannot stress enough how many resources the AARC provides, not to say that they encompass everything you would need, but it is pretty close. Other resources that you can find at the AARC are career-related job postings. There is a job board to post job postings throughout the various sections. When you become an AARC member, you are not only a member of the general AARC but there are also networking opportunities specialty sections to join. For example, I am a member of the Education Specialty Section. There are special sections in management, leadership, adult critical care to name a few.
There are different sections that you can voluntarily join and network with therapists with similar interests. Let's say that you work at a long-term acute care hospital, and you would like to pose a question to the Adult Critical Care or Education Section about working with this particular type of ventilator. We have seen all types of questions, and it has become a considerable resource when COVID-19 hit. Questions posted, how are your students continuing to do clinical? The hospitals are not allowing students in right now. How are we going to get these students graduated? What opportunities are you finding for students to complete their degree and maintain the right track to meet the need? What resources or opportunities should we be taking to meet the need and increase the demand for respiratory therapists? How are we going to find new students? What recruiting opportunities should we do? It lets you network not only with therapists in your immediate area but therapists throughout the entire United States. Everyone who is a member of the AARC can join those different specialty sections. It brings awareness to the profession and the opportunities out there.
For example, if an individual has developed a home therapy position and it is taking off, they can share their opportunities, "This is how I went about this, how I created this, how this came to be." That is where we will see much success with the APRT role. How did you do it? How did you get this program started? How did you get your medical board on gear with it? What did you have to do to get the doctors on board? How did you get it approved by the hospital? What type of services are you reimbursed for? There are many opportunities for us to work together to build each other up. Furthermore, the AARC gives us that platform to work together to advance the profession in this way. As far as students go, there are learning modules, exam prep, and job searches within the AARC. Students can join at a discounted rate and have access to these types of things. I know that in their big national meetings every year at the Congress, there is usually a student section where students get to interact and network with students from other schools. Several programs, awards, grants, conferences, certificates, competitions, and staffing tools. Believe it or not, there are staffing protocols out there for respiratory therapists as a resource from the AARC.
- Career Services
- News and Information
- Professional Development
Membership offers you all these opportunities, career services, education. It keeps you up-to-date with current news and information. It allows you to network with those other professionals and allows for the opportunity to gain professional development through the different courses and things they offer. It simply creates a respiratory community, a community where we can come together and have a common goal. As respiratory therapists, we get stuck in our area, "This is how things have to be done. This is what we do. This is how we do it here." It brings you into a community that opens your eyes and allows you to work and learn about how things are done in different areas. One enormous benefit of being an AARC member is that if you are an AARC member, all you have to do is enter your number into the NBRC website, and any continuing education unit you have acquired from the AARC or that was awarded from an AARC approved service will automatically come over into your NBRC transcript. For example, all I have to do is whenever I log into my account, I enter my AARC number, I click a button that says "import" bringing over all my continuing education units for the last five years. I do not have to keep up with any pieces of paper. I do not have to manually enter them all in and then determine what amount of continuing education units they were worth or keep track of the continuing education units for whichever category.
- License to Practice ensures you meet the local requirements
- Regulates practice within the state
- Public Safety
- Background checks
State licensure is another area that applies to the majority of therapists. State licensure is crucial because it helps ensure that we are licensed to practice and meet the local requirements for the state you are working in. There are only 49 states that practice regulatory licensure in the United States. State licensure has the authority to make changes to our practice, and the NBRC gives you the credentials. Most of the time, a requirement for your state licensure is that you have a credential from the NBRC. The state you work in is where you apply for a license to practice, allowing you to go in and physically begin working with patients. State licensing has the authority to make changes to practice through rules and regulations that often are based on need. State licensure has a lot to do with safety, background checks, making sure that these individuals have not previously committed Medicare fraud, have significant misdemeanors, felonies, or assault charges. As healthcare providers, we are held to a different or higher standard than non-clinical professionals or individuals who are not working in healthcare. We want to make sure that we have a certain ethical and moral background and code to take care of other individuals in this way. Background checks, fingerprinting, and some state licensures require that the therapists take ethics courses for their renewal. Your state licensure is responsible for those types of things.
- 49 States Participate in Regulatory Licensure
- Requirements may vary across states as well as renewal intervals
- Compact Licensure
- Sunset Law
Forty-nine states participate in regulatory licensure and these requirements. Unfortunately, there is no "across the board," like the NBRC is; everybody in the United States is coming to sit for a board exam, all the rules will apply to you equally. When it comes to state licensure, every single state is different. Every state has different requirements and intervals in which you must renew. For example, some renew every two years, three years, or every other year. It is up to the state you are in. One of the most frequently asked questions regarding state licensure is compact licensure because it exists in nursing. One thing with COVID many people have asked about. If we could develop a compact licensure within respiratory, you could work in this state or this state without getting a license in every state. Unfortunately, that is not the case yet. When we look at different state requirements, the continuing education unit requirements are also different. When I said continuing education unit requirements did not apply whenever we were talking about NBRC, this is another reason why that is confusing- continuing education unit requirements may not be required by those individuals who obtained their credential before 2002, but that does not excuse them from state licensure requirements. Every state has continuing education unit requirements. For example, Connecticut has ten continuing education units required yearly. I am in Texas, and we have 24 continuing education units required every two years, on average 12 CEUs a year. Two of those have to come from an ethics section or have a topic on ethics.
New Jersey has a requirement of 30 continuing education units every other year. One hour has to be in infection control, one hour in patient safety, and one hour in ethics. There is quite a bit of variation across the states. When we look at compact licensure, it is a topic of much discussion, but it is not active yet, anywhere that I am aware of, but I do know that it is something that the AARC is looking into. Again another service or a role of the AARC is they are out there, and they did a survey asking the different state organizations and state societies to evaluate if compact licensure is something we need and if compact licensure is something that would benefit our profession. About 55% said they would be open to compact licensure, but only 33% of the state societies responded thought it was needed. This is where we go back and forth. If you ask a therapist out there working right now, I do not know that anybody would be upset about the idea of compact licensure allowing them to cross state lines and continue working. However, we have the different organizations and things that have said, "I think it would be beneficial, but I do not really think It is needed." We contradict ourselves there. It is one of those things we have to research. We have to come together as an organization and determine if this is something we will do? How are we going to pursue this? What states are going to participate? What compact states would make sense to join together? Examples of how all these different organizations come together and work together.
Sunset Laws were not a term that I knew of until it applied. Once I got into education and started explaining these different roles to my students, I started to think, "I am glad our professional organizations and our state societies do this for us." A Sunset Law is a statute that includes automatic termination of a government program agency at the end of a specified time. For example, in Texas, for licensure regulation, which applies in other states as well, it was a regulation that went into a place where everybody entering the field of respiratory care had to have a license. You had to go through the Department of Health to apply for your license. You had to get a license to work in the state of Texas. Well, this law came into the sunset timeframe. In about 2014- 2015, it was going to expire automatically. Sometimes they are automatically renewed. Government agencies do not bat an eye at it, they renew it, and we keep going. Usually, these are associated with budget cuts and reducing workloads of state agencies. In 2014, they decided, "Let's do away with the regulatory practices of respiratory care." You are thinking, "Okay, sweet. Another fee I do not have to pay for every two years to continue working."
However, let's put this into perspective. Remember, the state licensure was responsible for background checks, ensuring that we were ethical and current on our continuing education units, especially for those individuals who do not have to do it for any other reason. A lot goes into licensure other than the fact that it is not just something that you pay into, but it helps hold the profession and your role in your state with certain regard that what you are doing is important. Where this came into play is our state society. Texas Society for Respiratory Care and our national organization, the AARC, joined together. The AARC has tons of resources on Sunset Laws to help if that happed to your state. They had a whole web page on licensure in helping with this. l We had several therapists who wrote to our capitol, attended executive meetings, and met with legislators saying to them, "Hey, you cannot deregulate us, you cannot put us in the same concept or the same group as these other professions." The other professions included massage therapists or nail technicians. This means, we will regulate who does our manicures, but not who manages our ventilators? It is not intended to speak negatively of any of those other professions. They were removing the importance of our profession at the state level. Our state societies lobbied, met with these individuals, and ultimately moved us from the Department of Health to the Texas Medical Board. Now in the state of Texas, we are with the Texas Medical Board, and we effectively did not have all of our regulatory practices in the state removed.
- CSRS summarizes it best
- The California Society for Respiratory Care recognizes the purpose of respiratory care regulation is to safeguard the public’s health, safety, and welfare by establishing minimum qualifications and creating exclusive titles corresponding to the level of qualifications for individuals who wish to offer respiratory care services to the public (CSRC 2014)
An example from the California Society of Respiratory Care summarized reasonably well that the purpose of respiratory care regulation is not just to safeguard the public's health, safety, and welfare. However, it helps establish a minimum qualification, and it creates exclusive titles corresponding to the level of qualifications for individuals who wish to offer respiratory care services to the public. State licensure and state representation are necessary because therapists met with legislators whenever the sunset law started happening in respiratory, and the legislators asked, "Okay, how many people do you represent?" There are about 16,000 respiratory therapists in the state of Texas, and you want to say, "Yeah, I represent all of those." They will ask, "How many are members of your society? How many of them are members of your organization?" That is where you look at the AARC membership and state membership. We are not even at 3,000 memberships of the 16,000 respiratory therapists in the state of Texas. There is room for improvement.
- Serves as a liaison between national and local organizations
- Represents RT’s at the state level
- Roles and operations can be similar to those at the national level
Our state organizations are similar to the AARC. Your state organizations serve as a liaison between the national and local organizations. When the Sunset Laws occurred, the Texas Society of Respiratory Care reached out to the AARC. The AARC and the TSRC worked together to help tackle issues such as approaching legislators and hiring a lobbyist, someone to act on our behalf in that type of environment. The state organization is a liaison for your local therapists and therapists at the national level.
- Joint/ AARC
- Representation is KEY!!
Many of our state organizations are joint membership of the AARC. I become a member of the AARC. I tell them what state I am associated with, and now I have a joint membership from the AARC and TSRC. They work together. It used to be that you had to join separately. Currently, It is a collaborative process that your membership to the national organization also contributes to your state society. Again there are also educational opportunities many times from your state. Every year our state society puts on a meeting, a big convention for just therapists. Again, they are also very knowledgeable on resources needed to help in the legal arena. If we have new laws coming into play, they let us know. Take a look at reimbursement, almost everything has to do with reimbursement, and Medicare is a tremendous player. No one knows what the future holds. There are thoughts to stop reimbursing for procedures that directly impact respiratory therapists. You want to have these individuals and these organizations who are well-versed in this area, knowledgeable, who have the right resources, and who have studied these particular areas to be the ones who will bat for you and represent you. I cannot stress this enough.
Another reason representation is so important is that becoming a member equals representation. , when these organizations have to go out there, and they have to meet with these legislators, they have to go and meet with these boards and do these types of things, you want to know how many people are you representing, Well, there is 100s of 1000s of us, but only 1/8 of that are members of our professional organizations. I have to say the more of you that there are members in these different organizations, the more representation we will have, and the better chance we have of having our voices heard. We can say, "There is a whole group of us here, and we are all approaching you for the exact cause, the same purpose."
Most Asked Questions
I wanted to go over the most commonly asked questions about these professional organizations because I know it all links together and can easily get jumbled up. I went through a couple of the networking platforms and social media accounts that I am associated with specifically for respiratory therapists, and I found the most commonly asked questions associated with this topic.
What Happens If My NBRC Credential Expires?
- If you are within 6 months - submit your CEU’s and pay $250 late/reinstatement fee
- Within 2 years - reapply for testing
- After 2 years - apply as a new applicant subject to those regulations
If you take any credentialing exam after 2002, it will affect all your credentials. Let's say you got your RRT in 2000, but you decided you would work for a children's hospital, and you took your NPS in 2006. It is now retroactive, where all of your credentials are subject to the renewal process. You do not have to get continuing education units (CEU) for every specialty exam, like 30 CEUs per specialty. Only 30 is the max required, divided across all your credentialing areas. For example, if you have an NPS, ACCS, and RRT, it would divide the 30 CEUs through those three areas, targeting your NPS, ACCS, and general continuing education in respiratory care that would apply for your RRT. Let's say you missed your deadline, and you did not submit your continuing education units. If you are within six months of expiration, all you have to do is pay $250 to reinstate and submit your continuing education units, and you are good to go. If your credential has been expired for two years, you can reapply for testing. You will have to retake your exam and pass the exam. If it is longer than two years, you have to apply as a new applicant, and you are subject to whatever the regulations are at that time. The NBRC is not saying they would not let you test, but you have to meet the criteria that any new applicant would have to meet at that time.
Do I Have To Be A Member Of The AARC To Track My CEU’s For The NBRC?
- They are separate entities, however, an active AARC membership automatically tracks and imports your CEU’s into the NBRC.
These are separate entities, AARC and NBRC, but if you are a member of the AARC, it automatically brings in your CEU transcript. It is a massive plus because I know whenever I was practicing at the bedside, keeping up with those pieces of paper all the time was a nightmare.
If I Have A Criminal Background Will I Be Able To Get/ Renew My License?
This is a state level regulation. It may vary across states, however any new charges or failure to disclose information may result in removal of your state license.
Criminal charges do not remove your credential, and it has nothing to do with NBRC. Criminal charges apply to state-level regulations. Remember, criminal charges and criminal backgrounds have to do with your licensed practice. It occurs at the state level, and it may vary across states. However, any new charge or failure to disclose this information may result in removing your state license. As an educator, I had helped several students with minimal charges that they had prior, something that occurred when they were 16 years old before entering college. The Texas Medical Board is specific about disclosing all that information. Does this not mean that you will not get a license? No, they want to know everything you have ever done in a sense, and disclosure of it is all they require. I cannot speak to higher charges or different things to that extent, but I know that new charges and failure to disclose are highly frowned upon in all states, and it may subject you to losing your license.
What Type Of CEU’s Does The NBRC Accept?
- Lecture – A discourse given for instruction before an audience or through teleconference
- Panel – A presentation of multiple views by several professionals on a given subject with none of the views considered a final solution
- Workshop – A series of meetings for intensive, hands-on study or discussion in a specific area of interest
- Seminar – An advanced study or discussion in a specific field of interest
- Symposium – A conference of more than a single session organized for discussing a specific subject from various viewpoints and by various presenters
- Distance Education – Includes materials such as text, Internet or CD, provided the proponent has included an independently scored test as part of the learning package
The NBRC is not specific as some state societies. There are different CEU requirements from the state and different continuing education units.
There are many different opportunities and ways to get CEUs, including lectures, teleconferences, panels where you sit with a group of professionals in front of you with a topic of discussion, workshops, seminars, symposiums, distance education. State licensure is more precise about submitting and limits the types of CEUs completed. Those limits include specific hours in self-study versus a certain amount achieved through a traditional live in-person or online course.
Do I Have To Get New / Different Ceu’s For The NBRC And My State Licensure?
- The NBRC requires 30 CEU’s every 5 years, most states require fewer but on a more frequent schedule. (Ex. 24 / 2 years)
The NBRC requires 30 continuing education units every five years. Most of the time, the states will require fewer than 30 CEUs on a more frequent schedule. For example, if your state requires 24 every two years, it will far exceed the 30 that the NBRC requires within five years. That does not mean I have to go and get 54 continuing education units, as long as I have 24 CEUs for my state every two years. Please keep track of those or become an AARC member, and it tracks it for you. Those 30 continuing education units will also apply for the NBRC.
My Role as a Respiratory Therapist
- Membership - supports initiatives but more importantly adds representation within the local and national government
- Leadership - advocate for change and support within the various levels
- Education - current practices, reliable resources, and collaboration among fellow RT’s
There are all sorts of stories that the AARC, the NBRC, want money from us, which is not the case. I often think horror stories from members spawn from a misunderstanding of what their role was. Membership supports initiatives, but more importantly, it adds representation within our local government and our national government. Membership gets us resources that we otherwise would not have. It maintains people who have designated their entire job and work to ensure that our profession gets the correct representation and the proper advocacy. It helps support our leadership, and it helps advocate for change.
If you want change to occur if you want better representation within your state at the national level, you have to take that step and be that change. Maybe you are not someone who is going to go and rally at the capitol for a specific law, but you can become a member, you can pay your membership fees, and you can allow those other people who that is what they want to do, that is what they have studied for to go and do that for you because your membership helps support them. There are tons of educational opportunities throughout the different platforms that help us maintain current practices, help us know that we have a reliable resource to go to and help collaborate among fellow respiratory therapists. We have that wonderful networking community, and I encourage you to look at these websites and visit these different organizations to confirm that you have the right resources. Make sure you have the correct understanding of what is required of you. Ensure that you are an ally for your profession and advocate for respiratory therapists.
AARC (2021). American Association for Respiratory Care. Retrieved from https://www.aarc.org/aarc-membership/
Commission on Accreditation for Respiratory Programs (2021). Program resources. Retrieved from https://coarc.com/
CSRC (2014). Basis and purpose of respiratory care regulation. Retrieved from CSRC White Paper (csrs.org)
National Board for Respiratory Care (2021). Credential maintenance program. Retrieved from https://www.nbrc.org/credentialedpractitioners/#credential-maintenance
Fino, J. (2021). Professional organizations within respiratory care: what you need to know. Continued.com - Respiratory Therapy, Article 134. Available at www.continued.com/respiratory-therapy