The nation’s first APRT master’s program at Ohio State University recently graduated its first group of licensed advanced practice respiratory therapists.
By Phyllis Hanlon
Image: The first graduating class from OSU’s Advanced Practice Respiratory Therapist program: (L-R) Back row: Scott Hazelwood, Courtney Thompson, Mindy Conklin, Andrew Shonk. Front row: Nicole Letcher, Tiffany Shook, Punam Shingala. Image courtesy Ohio State University.
When Courtney Thompson enrolled in her first year of college, she planned to become a teacher. However, fate would intervene and steer her in another direction. One of Thompson’s grandmothers had COPD and the other, lung cancer. She witnessed first-hand the struggles these women endured but was inspired by a respiratory therapist who helped her grandmothers successfully manage their breathing difficulties.
That experience convinced her that helping people exactly the way the therapist had was the path she needed to follow.
Pursuing that path, Thompson graduated from Marshall University through St Mary’s Center for Education with a bachelor’s degree in respiratory therapy in 2015. She landed a job as a registered respiratory therapist (RRT) at the Ohio State Wexner Medical Center. Although she found the work satisfying, in time she felt that she wanted to do much more for the respiratory community and the profession. At the time, her only options were to enter a nurse practitioner or physician assistant program.
Fortunately, her timing was good, as the first advanced practice respiratory therapy (APRT) program had just launched at Ohio State University—College of Medicine, School of Health and Rehabilitation Sciences.
Determining a Need for Advanced Practice Respiratory Therapists
Program director Georgianna Sergakis, PhD, RRT, RCP, FAARC, reported that conversations around creating an advanced practice respiratory therapy program began in 2007. Physicians and other medical specialists, including pulmonologists, critical care physicians, sleep specialists and managers from a range of departments, provided input. Having encountered motivated students who sought clinical autonomy but with no advancement opportunities currently in the field, they unanimously agreed that additional educational opportunities for registered respiratory therapists (RRTs) were needed.
The committee conducted a needs assessment in Ohio in 2012 and also polled graduates from the baccalaureate program to gauge their interest in an advanced program. The results confirmed that there were good reasons to create such a program. The committee drafted a degree proposal, which was filed in 2014 and published in Respiratory Care Annual. “The Ohio needs assessment was important for our program,” said Sarah M. Varekojis, PhD, RRT, RRT-ACCS, FAARC, Associate Professor and Director of Clinical Education, Respiratory Therapy, OSU–College of Medicine, School of Health and Rehabilitation Sciences. “We had to show that our program was meeting a need in Ohio.”
Additionally, the American Association for Respiratory Care (AARC) served as a third-party sponsor for a national needs assessment, the results of which were published in Respiratory Care in 2019. Another educational national publication also published the needs assessment results. “Both of these assessments served an important role,” Varekojis said.
Advanced Practice Respiratory Therapist Program Requirements
When designing the program, the committee had to comply with educational standards set by the Commission on Accreditation for Respiratory Care (CoARC). Varekojis pointed out that CoARC mandates certain requirements although individual programs can issue their own specific conditions. First, the student has to be a graduate of a CoARC approved institution. “You have to have a bachelor’s degree or you could also have a baccalaureate,” she said. “Our program at OSU is a master’s level program.” The student also has to have at least one year of work experience as an RRT and be licensed to practice in the state where the program is located.
CoARC initially adopted the standards for OSU’s APRT program in 2015; they were also endorsed by the AARC, the American College of Chest Physicians, the American Thoracic Society and are supported by the American Society of Anesthesiologists.
The APRT curriculum comprises 47 credit hours in a five-course semester. Students begin studies in the fall and graduate in the spring, according to Varekojis. During the first year, students take foundational courses that include advanced health assessment, pathophysiology of altered health states, advanced pharmacology in nursing, ethical issues in advanced practice and advanced practice in respiratory care. The students also take evidence-based practice courses with the physical therapy department. Varekojis pointed out that the APRT students take some courses with nurse practitioner students as well.
In addition to the didactic component, students are required to complete 1,000 hours of supervised practice by a licensed physician in a clinical specialty, which might take place in adult critical/emergent care, pediatric or neonatal critical care, pediatrics, primary respiratory care, neuromuscular respiratory care and sleep disorders.
Advanced courses are applied in both inpatient and outpatient settings and reenforce the principles of the foundational courses. “At the time of admission to the program, the student indicates their interest in a specific area of practice,” Varekojis said. “OSU has everything a large urban hospital has: multiple inpatient care areas, an outpatient clinic, specialty clinics, a sleep clinic and general pulmonary. There are a lot of different clinical opportunities for students.”
Students who decide to focus on sleep medicine can explore this discipline in the sleep clinic where they learn more about a variety of sleep disorders. Those interested in pediatrics have clinical opportunities at Nationwide Children’s Hospital, which is affiliated with the OSU College of Medicine. Physicians comprise the faculty and students are exposed to the same opportunities that are available in the adult setting; these might include rotations in the ICU and NICU.
Jessica Schweller, APRN, CNP, sleep nurse practitioner in the Ohio State Sleep Disorders Clinic, began her medical career as an RRT. After she graduated from the RT program in 2004, she wanted to expand her scope of practice. At the time, such opportunities did not exist for RTs so she entered a nurse practitioner (NP) program. She currently works as a sleep NP in the internal medicine department at OSU but now has the opportunity to work with APRT students during their sleep medicine rotation. “I help students get to my level of practice. In a clinical environment they are one-on-one, right there seeing patients individually, reporting back what they find, creating a plan and determining a diagnosis,” she said.
Schweller added, “Students have an opportunity to see what I do and it helps the decision as to where they want to work. They do some procedures while being supervised and will have more autonomy in decision-making,”
Students also work with other clinical professionals, including pharmacists, ICU nurses and others who can help guide their decisions regarding their future. Students observe first-hand what these clinical professionals can do and are encouraged to think about what they can do for a variety of departments in a clinical setting, Schweller said.
Advanced Practice Respiratory Therapist Capstone Projects
Students begin thinking about a topic for their capstone project, which is performed in a clinical setting at an academic medical center affiliated with OSU, in their first year and finalize it at the beginning of their second year, according to Sergakis. “They identify a clinical problem, do a systematic review of the literature, write and synthesize the information and finally create an implementation plan for an evidence-based synthesis. [These projects] highlight the value-added of an APRT,” she said.
As an example, one student examined the value of non-invasive mechanical ventilation for a subgroup of patients as a bridge after intubation to prevent reintubation. The student created an algorithm after reviewing the literature and creating a clinical practice.
Currently, several students are investigating how best to diagnose in the management and prevention of readmission or transitioning to other health care settings, Sergakis added.
Expanding the Role of the RT
OSU graduated its first class of seven students in May 2021. Following graduation, the students are actively pursuing clinical advancement for APRTs while continuing to work as RRTs, according to Varekojis. “They are having discussions with their employers. Once legislation passes they can become licensed,” she said. “Legislative language has been presented and a legislative draft has been created. Lobbyists are seeking legislator sponsors to introduce the bill.”
Varekojis emphasized that an advanced degree in respiratory therapy differs significantly from the one an RRT obtains. “This new profession is completely separate in scope of practice. They are focused on patient management, diagnostic management and therapeutic management,” she said. The difference between the role of the RRT and the APRT can be compared to the scope of practice between an RN and an NP.
“The RRT provides bedside treatment and intervention to treat a problem. There is a lot they can do: intubate, ECMO, etcetera,” said Varekojis. “The APRT can do decision-making, assessment, determine a diagnosis, write a plan for the RRT who might implement it. They have a goal to play an expanded role in the care of patients.”
Schweller explained the difference between the two roles by noting that the RRT “delivers the treatment he or she is told to do,” while the APRT does “assessment, managing and prescribing.” She noted that making this distinction has made students more aware of the purpose and goals of the program.
Ideal Career Advancement Vehicle
The launch of the APRT program provided a reason to remain in the profession and offered Courtney Thompson a new professional avenue. She entered the program in the fall of 2019 with high expectations and was not disappointed.
According to Thompson, the APRT program at OSU is the leading career advancement vehicle that respiratory therapists have been waiting for. “I have seen so many amazing RTs go into another type of advanced practice provider [discipline], but to do that they must leave respiratory therapy. This [program] will keep that from happening and will allow amazing RTs to advance and use the skills we have but more in a cardiopulmonary way like the APRT program,” she said.
Thompson found that building relationships with other respiratory care professionals, particularly the pulmonary physicians, was a very important and useful aspect of the program. “We did our clinicals with attendings and I honestly learned so much from them,” she said. “Since graduating, that learning has not stopped because now, as an RT still at the bedside, they are still aware of what I went to school for and do not hesitate to still create a learning environment for me.”
Thompson added that during the program the students took classes with nurse practitioner students, which was mutually beneficial as it helped to build a bond between the two groups. “[That experience] let them see us as a profession since we will ultimately be working with them when we get into jobs,” she said.
As she continues to work at OSU’s Wexner Medical Center, Thompson is unsure of which respiratory discipline she will pursue. During her clinical practice, she worked in medical ICU, surgical ICU, sleep medicine clinics, interventional pulmonology clinics and pulmonary clinics. “After going through clinicals in multiple different areas, I would love to be a sleep medicine APRT. I really enjoyed helping those with sleeping disorders and difficulties in the outpatient setting,” she said.
The Association of American Medical Colleges predicts that the country will experience a shortage of approximately 140,000 physicians by 2033. The COVID-19 pandemic has raised awareness of the importance of collaboration among medical professionals, particularly with respiratory care specialists.
At the same time, the Bureau of Labor Statistics (BLS) reports that employment of RTs is projected to grow 23% from 2020 to 2030, much faster than the average for all other occupations. The opportunity to earn an advanced degree in the profession through an APRT program will help to alleviate the shortage of respiratory specialists as it prepares RRTs to assume more clinical responsibility, especially in the cardiopulmonary realm.
Sergakis emphasized that OSU is excited to see the Advanced Practice Respiratory Therapists program grow nationally. “We are speaking with the directors throughout the country. We want to see more programs like this and some are in the works,” she said. “Some states are actively working on educational and employment opportunities and licensure. We do not want to be the only program.”
Phyllis Hanlon is a contributing writer to RT. For more information, contact [email protected].