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Marching into the Twenty-First Century: The Need for Advanced Education

Posted By Kiley A. Hodge, Wednesday, May 28, 2014
by Jeryl Huckaby

The field of Respiratory Therapy is relatively young compared to other healthcare professions.  It is only through the ingenuity and efforts of the Inhalation Therapists of our past that we have progressed into the discipline we are today.  However, progress cannot stop here.  It is a completely new world, not only with treatments and technology that were only a dream in the 1950s, but with new disease processes and Healthcare Reform tugging at our lab coats.  “Respiratory Therapists should move beyond learning just the basic knowledge of treatment modalities; they should also help to find the most appropriate therapy delivery method for each patient, be sensitive to age-related issues, adapt clinical policies across a broad range of practice settings, conduct research and disseminate research findings to advance the profession and effectively communicate with all health care team members” (Kester and Stoller, as quoted in Becker, 2003).  In order for the profession to survive, the Respiratory Therapists of today must fight new battles.  One of the most important weapons in our arsenal is advanced education.

2015 and Beyond Project
The American Association for Respiratory Care (AARC) ‘2015 and Beyond’ project is “examining how the profession needs to change to meet the demands of patient care in the future” (Barnes, et al., 2010).  Healthcare Reform has caused a shift from treating an illness to promoting health (Kacmarek, et al., 2009).  Clinical decisions are becoming evidence-based driven.  “Patients and their families will be important members of the health-care team and must be informed, empowered and engaged in personal health management” (Kacmarek. p. 378).  Biomedical innovation is changing the way medications are given, along with the way patients are ventilated and non-invasively monitored (Kacmarek).  The Respiratory Therapist of 2015 will require more advanced skills and knowledge than ever before.

“Current accreditation standards require therapists to have, at a minimum an associate degree from an accredited program” (Kacmarek, 2009).  Advanced degrees, whether a Bachelor’s, Master’s or even a PhD, have multiple advantages.  The degree may enrich clinical skills and the ability to solve patient problems; expand career options; enhance the use of evidence-based practice; and most importantly, impact professionalism (Graham, et al., 2011).  During training, the Respiratory Therapist will meet others from diverse professions with different perspectives.  This exposure may assist the therapist in finding a different solution.  Going beyond the basics will also help improve critical thinking, communication and leadership skills. 

Critical thinking is the ability to go forego the emotional tie and examine the problem objectively.  “It means thinking like a scientist instead of a layman, thinking about many solutions instead of narrowing in on one idea, and examining evidence instead of jumping to conclusions” (Darksyde, 2011).  Critical thinking can broaden the scope so that nothing is impossible.  “The desire to have easy answers is understandable, but can also be dangerous. Excessive simplification of complex problems often leads to simple ‘solutions’ that can make matters worse” (Kenedy, n.d.).  With thinking critically, the therapist is more likely to find a solution that works because they have examined all the evidence and data (Dayksyde).

Technology has caused us to focus on the written word and lose the art of talking with and listening to others.  People tend to forget when communicating in person their body language can relay a different message. As an essential member of the patient care team, it is not enough just to be heard; the Respiratory Therapist must know what to say, when to say it, and most importantly how to say it.  “Poor communication is responsible for mistakes, conflict, and negativity in the workplace” (Meyerson, 2009).  People hear things differently; clear and concise words are essential.  Advanced training can give the Respiratory Therapist the needed tools to be more aware of the different communication styles as well as the confidence and knowledge base to accurately convey their thoughts. 

There is a difference between managing and leading.  A manager is responsible for activities such as time, equipment, materials, and money with a focus on planning, organizing, directing, budgeting and problem solving (Johansen, 2007).  A leader influences people by focusing on vision, inspiration, motivation, relationships, and listening (Johansen).  An advanced degree can open the therapist’s mind and allow them to see more than the facts in front of them; it can help them delve deeper into the situation and see facts that may not be as apparent. 

Pursuing an advanced degree is not a decision to take lightly; sacrifices must be made. In the study by Graham, time was the greatest barrier along with family obligations and money. (2011). The therapist must be willing to give up watching television or reading a novel, missing a child’s sporting event, or ask for help with the daily chores. Attending classes requires scheduling time for schoolwork, similar to scheduling time for a doctor’s appointment.  However, one of the conclusions in Graham’s study was that those who pursued an advanced degree felt the benefits outweighed the hardships (Graham, 2011).  In a survey of Respiratory Care managers, it was concluded that the managers preferred hiring experienced therapists with Bachelor’s degrees but showed no preference for entry-level degrees (Becker, 2003).  Each therapist must decide their priorities, goals and if they are willing to make the time and emotional commitment to achieve them.

Fields of Study

The choice of the field of study is up to the therapist based on their goals and interest.  Business and Healthcare Administration. Majoring in business or healthcare administration will help improve the understanding of the financial aspects of the discipline.  The reimbursement rate from Medicare for healthcare services has decreased every year since 2000 (Kacmarek, 2009).  With the current economy, many are losing their health benefits or having their coverage reduced.  Consumers are no longer looking for the closest place to receive treatment: they are doing their research to find the most cost-effective business with the best outcomes.  Respiratory management is tasked with delivering a higher level of care at a lower cost. 

As the population ages, more patients will be diagnosed with respiratory diseases.  Chronic obstructive pulmonary disease (COPD) is now the fourth leading cause of death in the United States and predicted to be ranked third by 2020 (Kacmarek, 2009).  Asthma affects over 20 million people in the U.S., and although death rates are falling, over 5000 patients die each year from exacerbation of their asthma (Kacmarek).  The respiratory therapist is needed to educate not only the patient and family, but nurses, doctors and other therapists to help move the patient through the healthcare system as efficient and expedient as possible.  A major in education will help the therapist understand different learning styles and program development. 

Research and Evidence-based Practice
The current trend of medicine is to base clinical decisions on evidence-based practice. Using data from the literature, the healthcare team must critically evaluate the articles and develop protocols and patient care plans.  New modes of ventilation or medications to be aerosolized are also on the rise.  A major in clinical research will give the therapist knowledge of research methods and statistics (Kacmarek, 2009), build on their knowledge base and be the thinker, creator, and innovator.

Advanced Respiratory Care Practice
New innovations with ventilator modes, monitoring and aerosolizing medications will require the therapist to have an in-depth understanding of physiology and pharmacology.  Also with the shortage of physicians, therapists are leading the patient management team on pulmonary disease.  Concentrating on advanced respiratory care practices can lead to the therapist becoming a clinical specialist. 

No matter the field, it must be one that the sparks the therapist’s interest and gives them the drive required to achieve their goal.

Funding Options

There are many options for helping to fund the advanced degree and the Financial Aid department in the program chosen can assist in finding the best solution.  Federal and state financial aid is available at reasonable interest rates.  The school may have scholarships that don’t need to be paid back.  An employer may have tuition reimbursement available as long as certain requirements are met.  Other avenues of tuition reduction opportunities include veteran/active duty benefits, transferring credits from a previous degree, or the family plan - multiple students from the same family attending at the same time or related to an alumnus.  Investigate all available sources and map the pros and cons in order to make an informed decision.

The following websites are a place to start the investigation:

Federal education loans:

Private education loans:


‘New World’ Online versus ‘Traditional’ Brick and Mortar

When choosing a school, each individual must understand their learning style, motivation and time commitments.  The traditional brick and mortar setting allows face-to-face interaction and promotes an open exchange of ideas.  The class schedule is set and support from other classmates readily available.  However, the professors have a schedule to keep; if the lecture fills the entire class time, there is no time for discussion (Hutcheson, 2010).  In addition, if the student is a non-verbal or introverted personality, they may not participate actively, communicate problems they are having with the course or seek out other classmates for guidance or support (Hutcheson).  Finally, the student is limited by the programs offered within driving distance of their work or home.

In this new world of technology, online programs are a great alternative to the traditional brick and mortar format.  As long as the student has access to the internet, they have access to any program offered in that format that meets the student’s need.  Online courses address multiple learning styles by utilizing different modalities such as reading, viewing videos, and audio presentations.  The time commitment is more flexible, allowing those to work and attend family obligations while also taking classes (Jackson, 2006 & Hutcheson, 2010).  The students in online classes are more diverse, whether with life or work experiences. Some programs even have international students, broadening the diversity (Jackson).   The student that chooses online learning must be self-motivated and disciplined (Jackson).  Online classes typically move at a faster pace than the traditional classroom course (Jackson).  Whether choosing the new world online or traditional brick and mortar, the student must ensure that the program is accredited and reputable.


Common reasons why adults return to school include career advancement, salary increase or personal growth and development (Jackson, 2006).  “The desire to learn was the most common motivating factor” (Thomas, et al., as quoted in Graham, 2011).  As the Respiratory

Therapist moves into ‘2015 and Beyond’, additional skills are needed.  Whatever the motivation, we owe it to ourselves as well as the future Respiratory Therapists to push our profession to its maximum potential.  Gone are the days when Respiratory Therapists are only responsible for setting up oxygen or processing equipment.  We have created our special niche at the bedside.  We have become respected members of the patient care team.  If we do not support our profession by improving our critical thinking, communication and leadership skills through advanced education, the patient care team may be without the voice of the Respiratory Therapist.


Barnes T, Gale D, Kacmarek R, & Kageler W. (2010).  Competencies needed by graduate respiratory therapists in 2015 and beyond.  Respiratory Care, 55 (5),  pp. 601-616.

Darksyde (2011).  What are the benefits of critical thinking?  Retrieved December 30, 2011 from

Graham C, Burton R, Little K, Wallace T (2011).  Attainment of doctoral degrees by licensed physical therapists: perceptions and outcomes of graduates.  Journal of Physical Therapy Education, 25(2), pp. 8-16.

Hutcheson, A. (2010).  Benefits of online classroom versus traditional classroom.  Retrieved December 29, 2011 from

Jackson C. (2006).  Online learning vs. the traditional college.  Retrieved December 29, 2011 from

Johansen M. (2007).  How to develop leadership skills.  Retrieved December 30, 2011 from

Kacmarek R, Durbin C, Barnes T, Kageler W, Walton J, & O’Neal E (2009).  Creating a vision for respiratory care in 2015 and beyond.  Respiratory Care, 54(3), pp. 375-388.

Kenedy R. (n.d.).  Why critical thinking?  Retrieved December 30, 2011 from

Meyerson H. (2009).  Communication - Seven verbal communication skills that improve workplace management effectiveness.  Retrieved December 30, 2011 from

Thomas S, Turner K, Jensen G, Goulet C (2003).  Physical therapists’ perceptions of motivational factors and barriers to pursuing a transitional DPT degree.  Journal of Physical Therapy Education, 17(2), pp. 38-43.

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Interview with Bob Harwood

Posted By Kiley A. Hodge, Wednesday, May 28, 2014
by Adrian R. Childers, RRT

During the course of the AARC National Congress there are a multitude of things happening. There are many lectures presented and also many awards of achievement and recognition are presented as well. One of the most prestigious awards for our profession is the Fellow of the American Association for Respiratory Care or FAARC. In 2013 twelve people were awarded the FAARC. One of those people was Mr. Bob Harwood, Respiratory Care Program Director for Georgia State University. I feel honored to have spent time with Mr. Harwood and discuss him receiving the Fellowship award and the profession that we are all a part of.
The Fellow of the American Association for Respiratory Care is the most prestigious award that the AARC offers. With that prestige come’s an in-depth process for nomination and selection. One can only be nominated by someone who is already a Fellow. Once they are nominated, the nomination committee reviews the persons Curriculum Vitae and then makes their selection. The main points reviewed are prominent leadership, influence and achievement in clinical practice, education or science.
New Fellows are inducted during the Awards Ceremony held in conjunction with the annual AARC International Respiratory Congress. Newly inducted Fellows have their names added to the list of Fellows and have the right to identify themselves with the FAARC surname.
Mr. Harwood’s career began forty years ago. He joined the faculty of Georgia State University in 1987 and was promoted to Program Director in 2011. During his career he has written numerous publications, been involved with multiple organizations and received many financial grants.
Mr. Harwood was nominated for Fellowship by his friend Dr. Jonathon Waugh from The University of Alabama at Birmingham. Dr. Waugh was previously part of the Georgia State University faculty. Mr. Harwood said that he was surprised when he found out about the nomination. He said that the nomination confirmed that what he had done over his career had made a difference and that through professional respect, someone chose to acknowledge that. Standing on stage his thoughts were that he was very proud to be part of the only twelve people that were chosen for this award.
We talked in depth not only about the Fellowship but the Respiratory profession as well. Mr. Harwood had so many positive and motivating comments about our profession. He said that enhancing our profession started with enhancing ourselves first. Professional involvement and education are a necessity. He urges everyone to become involved the local, state and national levels. Small volunteering efforts can have a big effect. He said that advancing our education would only strengthen our profession. Now more than ever, more Graduate Level degrees were needed. Especially with CoARC ’s proposed Advanced Practice Respiratory Therapist (APRT) program.
There were many words of wisdom that Mr. Harwood had for us professionals that I can not list all of them. The two that stood out the most were:
Pursue what you love in both life and profession! 
Be proud to be a Respiratory Therapist!

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Harold Oglesby Receives Heroes Award

Posted By Kiley A. Hodge, Wednesday, May 28, 2014

Congratulations to GSRC member Harold Oglesby for receiving the Georgia Hospital Heroes Award. Click here for more information.

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Interview with Jackie Williams

Posted By Administration, Wednesday, May 28, 2014
by Adrian R. Childers, RRT

Jackie Williams is a Respiratory Care Practitioner at Emory University Hospital Midtown, recently presented an abstract at the 2013 AARC Congress in Anaheim, California entitled:
The Impact of Different Closed Suction Catheter Designs and pMDI Adapters/Spacers on Aerosol Delivery in Simulated Adult Mechanical Ventilation with “Wet” and “Dry” Exhalation
I recently had the pleasure of interviewing Jackie about her experience in California. Jackie is a very intelligent, professional and compassionate practitioner who inspires others to give more to their profession.
This topic came about after my co-workers and I questioned the effectiveness of our pMDI therapy given to mechanically ventilated patients. A white residue was observed in the ETT and/or closed suction catheter system after medication administration, depending on the MDI spacer or adapter position in the circuit. I began to research the topic of aerosol deposition in relationship to the closed suction catheter system. I found no information even thought it is very common to find MDI spacers or adapters that are paired with closed suction catheter systems or in the ventilator circuit itself.
I started researching this topic almost three years ago and it is still ongoing. It has been enjoyable but challenging, considering that I graduated from college thirty three years ago. I had to refresh myself on various topics including: research, research protocols, aerosol therapy, suction catheters and humidification. The many hours spent reading the articles associated with my research has increase my knowledge and had enhanced my bedside practice with aerosol therapy on ventilated and non – ventilated patients. I have also learned to read articles with a more detailed eye.
The laboratory testing of my research was performed at Georgia State University by Dr. Arzu Ari, Dr. James Fink and myself. Both Dr. Ari and Dr. Fink were very patient and supportive of my research. The hospital based research would not have been possible without the support of Jane Bockman (Director of Respiratory Care), Tim Isaac (Assistant Director) and my fellow therapists at Emory University Hospital Midtown.
My topic was selected and presented to the AARC Congress this past November, in the Open Forum phase. The presentation of new research is done informally. The research topics are presented in two parts. First, the investigators stand beside their research posters. They answer questions and discuss the details of their research with the forum attendees for a thirty minute period. This allows the audience to have an understanding of the research topic. After the one on one period the investigator is called to the podium and speaks on their topic for about eight minutes, followed by questions and discussion from the audience.
Presenting my research was very exciting to me. Knowing that my topic was unique and had never been investigated, sparked a lot of interest and discussion among myself and my peers. Due to my fear of public speaking, I was very glad that I completed the podium presentation without a hiccup. An outline of my presentation helped me stay focused and also a familiar face from GSU in audience was supportive.
A person does not have to be pursuing and advanced degree to have an impact in research. Many bedside clinicians are some of the world’s best problem solvers and problem identifiers. There will always be clinical situations that require us to think outside of the box. Thinking outside of the box, in most cases, is not evidence supported but the interventions do work! Partnerships between bedside clinicians and researchers can help validate real life clinical interventions that are both practical to implement and cost effective as well. This creates a win-win for our patients and institutions. I believe that partnerships should be both encouraged and implemented whenever the opportunity arises.
Presenting original research at our National Congress has been a highlight in my professional career. This experience has validated my views regarding learning and professional comradery. Despite the fact that I am considered “Seasoned” or “Old School” I believe that learning and professional enrichment should never stop as long as someone has the desire. Positive outcomes for our patients and profession are only achieved through teamwork and comradery.

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