Orienting new respiratory therapists into the neonatal/pediatric environment: a survey of educators and managers.

BACKGROUND Neonatal/pediatric respiratory care is recognized as a unique and complex area of clinical practice. Despite the substantial effort and costs associated with orienting neonatal/pediatric practitioners, few data exist related to the process of training respiratory therapists (RTs) in the acute neonatal/pediatric environment. To gain insight into the adequacy of preparation of RTs entering the neonatal/pediatric environment, the length of orientation necessary to achieve a base level of competency, and the methods used to train new neonatal/pediatric practitioners, we surveyed neonatal/pediatric respiratory care educators and managers. METHODS The invitation to participate in the survey was distributed via e-mail to 1,259 members of the AARC education specialty section and 1,828 members of the AARC managers specialty section. The survey included 15 questions (not including the demographics questions), scored on 5-point Likert scale, and asked about: what type of degree program (associate's degree or bachelor's degree) better prepares new RTs for the neonatal/pediatric environment; experience requirements for orientation of neonatal/pediatric RTs; the role of simulation in training neonatal/pediatric RTs; and whether the neonatal/pediatric specialty credentialing exam should be used as a method of competency testing. There were 4 questions regarding simulation (the use of interactive full-body manikins in a realistic patient care environment), orientation times based on experience, and where the majority of the orientation time was spent. RESULTS We received 251 responses (response rate 8%). The majority of respondents were either affiliated with or worked for urban, not-for-profit, non-government organizations. Sixty-three percent disagreed that an associate's degree respiratory therapy program, and 42% disagreed that a bachelor's degree program adequately prepares a new RT to work in the neonatal/pediatric critical care environment immediately after graduation. Seventy-one percent strongly agreed that children's hospital respiratory care departments should have a dedicated respiratory therapy educator. Seventy-six percent agreed that simulation is an effective tool for training RTs for neonatal/pediatric critical care. Sixty-five percent agreed that RTs should be required to take an exam at the end of the orientation period to verify competency. Fifty-nine percent strongly agreed that neonatal/pediatric RTs should have the National Board for Respiratory Care Registered Respiratory Therapist (RRT) credential. CONCLUSIONS There appears to be a discrepancy in the educational preparation expected prior to entering the acute-care neonatal/pediatric environment and what training methods are most appropriate and cost-effective for orienting new RTs to this specialized environment. A dedicated respiratory therapy educator is valued. Simulation is considered an effective tool for training RTs and provides training opportunities that otherwise would not be available. The neonatal/pediatric specialty certification exam appears to be recognized as a valid method of determining mastery and verifying competence.