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Only surveys were returned completed. Result showed that professionals felt an education above associates should be required to obtain a license prior to practice, whereas felt it necessary to obtain a higher degree while practicing. Alarming, yes, but rightfully so. Change is difficult, yet inevitable. As health care professionals, we must try to find a balance between our profession and our professional lives. While some institutions may not be able to offer higher-level degrees, other solutions should be shaped so that the needs of the health care system, patients, and practitioners are met.

In looking toward the future of our profession and the impact we can have on the lives of those who require our services, higher education should not be a question. As stated earlier, the true dilemma comes from the emotional mixture of job security and professional growth.

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The question is here is not do we need to increase the entry-level standard, but how to do so without wreaking havoc in our current system so everyone can remain employed while increasing our recognition and utilization as a profession. Many educational institutions do not have the ability to award higher-level degrees which makes change impossible for them. Articulation agreements with other educational institutions may be an excellent way for such institutions to remain in the market while meeting the proposed standards.

This change is long overdue and it is in evitable in our near future. Jankowski M. Advanced Search. This site complies with the HONcode standard for trustworthy health information: verify here. Privacy Copyright. Skip to main content. Transitioning the respiratory therapy workforce for and beyond.

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Respiratory Care. Survey of respiratory therapy education program directors in the United States. A total of comments were received. ACNPs were seen as easily accessible, approachable, very knowledgeable, committed, excellent teachers who are able to provide a holistic patient focus. The enhanced accessibility was viewed by respondents as creating an optimal environment for obtaining orders, answering questions, and responding to problems.

As well, fellows were viewed as more competent in situations involving emergent events. Conversely, the ACNPs were perceived as experts in providing care required as a part of routine daily management of patients. Commitment was uniformly perceived as an advantage for ACNPs. ACNPs received positive beneficial comments from physicians, respiratory therapists, and staff nurses in regard to communication.

Respondents saw various issues in regard to perceived credibility. There were also allusions to role acceptance and role boundary issues regarding the ACNP:. According to hospital policy at the time the study was conducted, ACNPs were required to have their orders cosigned. This restriction was viewed as a disadvantage when the ACNPs were compared with fellows. This requirement has since been rescinded, as countersignature is not required by statute.

Concern was also expressed about burnout, given the responsibilities of the ACNP role:. Respiratory therapists were primarily concerned with accessibility and quality care outcomes. Nursing perspective is valuable in and of itself. Numerous measures can be used to evaluate outcomes of ACNP practice. These measures may include medical outcomes, such as mortality, length of stay, complications, readmission rate, and costs, as well as patient-focused outcomes, such as symptom control, quality of life, and functional status.

Because practice in an ICU is highly collaborative, we chose to use an interdisciplinary perspective. We selected attending physicians, staff nurses, and respiratory therapists as respondents because of their direct daily involvement with ACNPs. To our knowledge, no other investigators have described perceptions of ACNP practice from this interdisciplinary perspective. The ACNP may function as a member of a team and, in comparison with fellows, manage less complex cases, 5, 10, 13, 14 as was done in the cardiothoracic ICU.

Orders could be more easily obtained, questions answered, and problems resolved because of the unit-based focus of the ACNP. As Hravnak 17 has noted, using multiple caregivers who are on the unit for short periods ie, clinical rotations to deliver care to patients with complex problems and lengthy stays can be risky.

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Gaps can develop in knowledge of differential diagnoses that have been examined and rejected; laboratory values that have been ordered, evaluated, and reordered; and weaning strategies that appeared successful, but were abandoned because another ventilator mode was preferred. These findings help define the unique contributions of ACNPs as members of medical management teams. Working with such patients is typically not viewed as a good learning experience for physicians-in-training. Our findings suggest that such patients benefit from collaborative medical management provided by an ACNP.

Compared with patients managed by house staff, patients managed by an ACNP were more satisfied with communication about their care but less satisfied with explanations that the ACNP gave about test results. Because of the structure of our study, we could not determine why patients were viewed as more accepting of information provided by physicians. Although viewed as medically oriented, themes identified show that the ACNP role has a clear nursing focus.

Finally, despite the perception of the role of the ACNP as medically oriented, the themes identified reflected a clear nursing focus. This study had several limitations. The study was conducted in a single academic health center and 2 specialized ICUs that handle very complex cases. It is unknown whether similar perceptions might be identified in community ICUs or ICUs with a different specialization. Finally, the study examined the practice of only 2 ACNPs.

It is unknown whether the practice of each ACNP was unique in ways that might have influenced our findings. We examined the contributions of ACNPs from the perspective of 3 disciplines: medicine, respiratory care, and nursing.

International Journal of Therapy and Rehabilitation: Vol 24, No 9

Attending physicians, respiratory therapists, and nurses in 2 ICUs that employed a full-time ACNP were asked to complete an open-ended survey by listing 3 advantages and disadvantages of care provided by ACNPs. Qualitative methods were used to identify common themes and subthemes. When the findings were examined according to discipline, physicians, nurses, and respiratory therapists described unique benefits of the role of ACNPs. We thank the attending physicians, staff nurses, and respiratory therapists from the cardiothoracic and medical ICUs who participated in this study.

RO1 NR User Name Password Sign In. Previous Section Next Section. Design and Sample A comparative survey design was used. View this table: In this window In a new window. Table 1 Number of respondents and comments by discipline. Methods The survey instrument was distributed to attending physicians, staff nurses, and respiratory therapists working in the 2 ICUs by hospital mail, direct approach, or the Internet. Data Analysis Qualitative methods were used to analyze the study data. Table 2 Coding definitions. View larger version: In this window In a new window.

Figure 1 Responses related to accessibility. Concern was also expressed about burnout, given the responsibilities of the ACNP role: View larger version: In this window In a new window. Figure 4 Responses related to system issues.


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Limitations This study had several limitations. Summary We examined the contributions of ACNPs from the perspective of 3 disciplines: medicine, respiratory care, and nursing. Previous Section.


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