Insider debate: Overcoming the staffing shortage
In today’s staffing shortage, which professionals should be cross-trained?
Read our insider debate and see where you side.
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Today’s clinical workforce is in the midst of a major transition. According to recent reports, the healthcare industry faces an unprecedented increase in demand for services and a shortage of practitioners to provide those services. In fact, the U.S. Bureau of Labor Statistics has calculated that by 2024, the healthcare industry will be the largest employer in the nation, with job openings due to growth and replacement totaling nearly 5.2 million—1 million of which are for nursing positions and 1 million for technologist positions.1 This incredible need translates to a significant shortage of key professionals today.
Falling short in COPD
Chikita Mann, MSN, RN, CCM, states, “This shortage of skilled practitioners is particularly problematic for the treatment and care of the COPD patient population.” She adds, “It’s been established that an integrated, team-based approach helps us provide holistic care to our COPD patients. When key members of the team are stretched thin or absent, that can have an impact on the quality and safety of care patients receive.”
Shortages in the clinical workforce are pushing us to expand the roles of our practitioners in order to extend limited resources.”
Vernon Pertelle, RRT President and CEO of StratiHealth Management Consultant for ACOs
As it pertains to COPD care, two key disciplines in overwhelming demand are nurses and respiratory therapists. Today’s shortage is forcing care teams to evolve or to risk a decline in quality outcomes. Vernon Pertelle, RRT, explains, “Having practiced as a respiratory therapist and nurse, I can see the critical need for all roles in the ‘whole-person’ care and management of COPD.” Pertelle continues, “Shortages in personnel are pushing us to expand the roles of our practitioners in order to extend limited resources.” Pertelle is now a certified case manager.
Contributors
Chikita Mann, MSN, RN, CCM
Disability RN Case Manager Supervisor Genex Services, LLC for the State of Georgia
Vernon Pertelle, RRT
President and CEO of StratiHealth Management Consultant for ACOs
Krystal Craddock, BSRC, RRT-NPS, AEC
COPD Case Manager UCalDavis
Debate: Which is the best professional to cross-train?
Many believe that the solution to a shrinking workforce and increasing demand is to expand the roles of the skilled professionals who comprise the COPD care team. There is, however, a difference of opinions as to which discipline is most appropriate for cross-training initiatives and taking on new responsibilities.
Respiratory therapists:
More specialized knowledge
Respiratory therapists, while considered part of a specialized field, are gaining, or encouraged to gain, new skills to extend their roles with training in nursing-focused areas such as general pharmacology, fluid and electrolyte balance, and IV therapy.2 Due to their distinctive knowledge of COPD care, they may have a shorter learning curve from a cross-training perspective. According to Robert Czachowski, PhD, nurses are not the most likely candidates. That’s because nursing programs receive very little, if any, formal education in respiratory care3. Pertelle agrees that nurses simply do not have a concentrated focus on the respiratory management of patients with COPD.
Nurses:
More whole-person focused
Mann has a different perspective. She explains, “COPD is a multifactorial disease with comorbidities. “Because nurses are trained to evaluate the patient as a whole, they are not looking solely at COPD. They are noticing that the patient has lost weight, they discover the patient is not eating, and they see that the creatinine levels are way off.” Mann maintains that nurses have the advantage of being able to determine which disease processes the patient is presenting—some of which have nothing to do with COPD. Mann concludes that a nurse could predict that the patient will need to be hospitalized—not for COPD, but for kidney failure.
Nurses are trained to evaluate the whole patient and not focus solely on COPD.”
Chikita Mann, MSN, RN, CCM Disability RN Case Manager Supervisor Genex Services, LLC for the State of Georgia
Krystal Craddock, BSRC, RTT-NPS, AEC, admits that respiratory care is primarily about making equipment and medication recommendations and providing critical education for the patient and caregiver to help them transition safely home, which reduces unnecessary readmissions. Craddock points out that respiratory care is moving from being predominantly task and treatment oriented to patient-centric. She notes, “An RT can look at a patient and tell immediately that a non-invasive ventilator is needed, and based on height and breathing patterns, be able to write the correct orders for the right ventilator settings.”
The cross-training consensus
The consensus among these healthcare professionals is that in the midst of the nursing and clinical workforce shortage, cross-training is a cost-effective and efficient means to extend and maximize limited resources, all while maintaining the quality of care provided to COPD patients. Which discipline is most appropriate for cross-training initiatives? Pertelle is adamant, insisting, “It’s absolutely essential that RTs and RNs be cross-trained. Each has valuable skill sets that, with the proper education and training, will help us navigate the changes in this healthcare environment.” Mann agrees, “It’s important that both disciplines expand their roles so that no matter how limited resources become, patients continue to receive the quality care they deserve.” Where do you see the greatest opportunity for your care team?
Where do you see the greatest opportunity for your care team?
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Further reading
COPD insider
As COPD continues to plague millions of people, we continue searching for solutions. Each new initiative or program is another step forward in care delivery. As you and your team embark on new, innovative initiatives, rely on COPD insider for the proven strategies that can bring success closer.
References 1. 21st Century Sourcing: Solving the Healthcare Supply-Demand Crunch. AMN Healthcare. https://www.amnhealthcare.com/latest-healthcare-news/healthcare-supply-demand/. Accessed March 16, 2018.
2. Bennion K. Expanded roles for RCPs. http://www.rtmagazine.com/2007/02/expanded-roles-for-rcps/. Published February 3, 2007. Accessed March 15, 2015.
3. Czachowski R. Study finds respiratory care instruction very limited in nursing schools. AARC Times. 1994;18:99-108.
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