Primary Children’s Medical Center collaborated with Weber State University to develop a respiratory internship program that offers all near graduates advanced training in pediatric and neonatal critical respiratory care.

Primary Children’s Medical Center (PCMC) in Salt Lake City is a pediatric and neonatal 250-bed tertiary care center for the intermountain west that covers five states. The facility has a 43-bed level III neonatal intensive care unit (NICU) and a 26-bed pediatric ICU (PICU). Over the past few years, physical facility expansions have added 20 beds to the previous 24-bed children’s medical surgical unit. An 18-bed rapid treatment unit was developed for patients requiring less than a 24-hour stay. The infant unit was expanded from 30 to 38 beds and the immunocompromised unit was increased from six to 24 beds. The facility also has a 24-bed rehabilitation unit along with a sleep laboratory and numerous outpatient clinics.

In addition to facility expansions, the respiratory care department has been asked to expand its service lines to include, but not be limited to, perianesthesia care, asthma education, discharge planning, tracheostomy and home ventilatory care education, electrocardiography, extracorporeal membrane oxygenation, fixed wing transport, and the creation of an assessment team. Both facility expansions and expanded respiratory service lines have dramatically increased the overall number of patients requiring respiratory care. In light of these expansions, PCMC’s administration generously allocated additional budgetary funds to increase the number of full-time RCP positions. Along with filling new positions, RCPs lost to attrition must also be replaced. Budgetary allotments are only part of the complex solution in filling respiratory care positions. At PCMC, the difficulty was the limited number of applicants with neonatal and pediatric experience.

History of PCMC
PCMC is a clinical site affiliated with the Weber State University (WSU) Respiratory Care Program—a 4-year BS RRT prepared program. The first year is made up of prerequisite classes required to be accepted into the program. The second year begins once a student is accepted into the WSU Respiratory Care Program. After completing the second year, the student can take the CRT examination and receive an applied associate degree. Most, if not all, students obtain their CRT credential. In the third year of the program, students are introduced to advanced adult critical care, home care, and neonatal/pediatric care. Upon completion of the third year, the students are registry eligible and graduate with an associate degree. The fourth year of the program consists of bachelor degree credits, which require five respiratory-specific electives and 10 hours of upper division classes in a related curriculum.

Graduates who demonstrated exceptional skills during their clinical rotations at PCMC were occasionally hired to fill the large number of vacant positions. We found that new graduates often lacked advanced intricate problem-solving and communication skills needed to function in our high acuity environment in addition to the expanded services now being offered.

The Internship Program
PCMC’s Respiratory Care Department, in collaboration with WSU, decided to design a respiratory internship program to allow near graduates advanced training in the area of pediatric and neonatal critical respiratory care. Until this time, the options for the five respiratory-specific electives of the fourth year or bachelor degree portion of the WSU program had been a research project, health promotions project, question and answer project, and asthma camp. PCMC proposed to the university that they add the respiratory internship program as another elective option. Most students in their fourth year have already obtained their CRT credential and are eligible for hire. For students to be considered for the internship program, they must be a CRT, licensed in the state of Utah, and have a current basic life support certificate. They must have completed their neonatal and pediatric clinical rotations and have met all qualifications for a bachelor degree at WSU. The internship consists of 36, 12-hour shifts that must be completed in 6 months from the start of the program. The student is assigned a primary and secondary preceptor. The preceptors are volunteer staff RCPs who are willing to participate in the program. The interns match the schedules of the preceptors to best suit their needs. The preceptors are instructed to clinically educate and document competency. A few items listed on the competency form are: use of a resuscitation bags (anesthesia and self-inflating), aerosol and metered-dose inhaler administration, patient assessments, and ability to set up ventilators. As the intern demonstrates proficiency, it is documented that they are allowed to perform these tasks without the direct observation of the preceptor. It is hoped that these interns can manage uncomplicated ventilator patients for an entire shift with preceptor backup by the end of the program.

PCMC’s Respiratory Care Department has a team that assesses patients who are receiving daily respiratory therapy treatments outside the ICU areas. They also see patients when a respiratory consult has been requested by either the bedside nurse or the physician. The team uses patient assessments, patient-driven protocols, and scoring systems to determine the effectiveness of therapy. They suggest alternatives in therapy when indicated. We believe it is extremely important for new graduates to gain advanced assessment skills, especially in the area of pediatrics. Of the 36 shifts, 12 are assigned with an assessment team member. The other 24 shifts are in the PICU and/or neonatal ICU.

The Interns
Interns are hired as temporary PCMC employees. A stipend is paid for each shift worked. They attend a hospital orientation, which includes a department orientation. At the end of 36 shifts, the internship and PCMC employment end, and the intern is given a certificate of completion and receives a “pass” as a WSU grade. A pass is determined by the intern’s ability to demonstrate competency for specific skills as specified on a check-off form. If interns do not complete the 36 shifts within 6 months, or they have disciplinary problems, they are dropped from the program and employment ends. They do not get a certificate of completion and will “fail” the WSU grade. Upon completion of the program, interns may apply for a permanent full- or part-time position. Then they go through the same interview process as any other candidate for an open position and may or may not receive the position applied for.

During the program, we have the opportunity to observe the students for clinical performance, communication skills, work ethic, time, and attendance. This insight provides us with additional information during the intervening process to determine if they would be qualified candidates for permanent hire. To date, three interns have completed the program, two have applied and were accepted for permanent full-time positions, and the other decided not to take a position at our facility.

This internship program thus far has allowed us to hire new graduates with a higher degree of NICU, PICU, and assessment skill experience. The preceptors and other staff members appreciated the extra assistance performed by the interns while they are here. The program has increased our ability to hire RCPs with an increased neonatal and pediatric knowledge base. This type of program should be considered by high acuity facilities to provide education, exposure, and clinical hands-on training in order to ultimately hire new respiratory therapy graduates who would have ordinarily not been hired. PCMC and the Respiratory Care Department look forward to the continuation and development of the internship program to better provide care for our young patients.

Jim Keenan, RRT, FAARC, is technical manager, and Glenna McKinley, RRT, is internship coordinator, at Primary Children’s Medical Center, Salt Lake City.