All for Patient Care: Practicing at the Top of Your Scope

 Published: March 24, 2021

By: Addie Schiefer



‘Practicing at the top of your scope,’ is a phrase you hear quite often in the health care field. However, let’s take a deeper dive and refresh ourselves on what that truly means.  

For this topic, we brought in the professional help of AARC member Bob Joyner, PhD, RRT, RRT-ACCS, FAARC. Joyner serves as the Director of the Richard A. Henson Research Institute at TidalHealth Peninsula Regional.  

How is the scope of practice determined?

Scope of practice is determined at two levels. First for 49 out of 50 states, and Puerto Rico, licensure is required for respiratory therapists. With that licensure comes a legally defined scope of practice within a particular state.

“The defined scope varies from state to state,” Joyner said. “Beyond that legally defined scope, individual employers define the rolls and responsibilities for respiratory therapists in the workplace and the employer is responsible to assure individual therapists have sufficient skill up-keep, as well as continuing education.”

Joyner expressed that common questions from respiratory therapists related to scope of practice involve intubation and arterial line insertion.

“Many therapists would like the opportunity to perform these procedures,” Joyner said. “And some do have that scope of practice in their workplace. Importantly, it is the responsibility of the employer to define what is needed to assure their therapists maintain skill competency and the more complex the skill the more it requires substantial exposure to practice and considerable continuing education.”

The goal of the employer should be that the therapist not only acquires the skill, but also maintains the skill. This requirement to demonstrate competent skill level can be a significant hurdle when evaluating where a new procedure should be incorporated into skill set offered by a department.

How can the scope of practice be changed?

Joyner explains that a starting point would be to first identify a procedure or practice that is not being done well in your institution. You also have to ask yourself if this procedure or practice could be taken on by a respiratory therapist.

“Find niches that are key to successfully expanding your practice,” Joyner said.

The first place to start is working within your local institution and institutional stake holders (e.g., respiratory care department management, medical director(s), and other pertinent institutional officials).

“Discuss the ideas you have about practice expansion and solicit the opinions of these important stakeholders,” Joyner said. “This will provide some understanding of the kinds of challenges that will need to be overcome to incorporate the new procedure or task.”


How can an RT practice at the top of their scope?

Joyner gave three things he believes will help any respiratory therapist practice at the top of their scope:

  • Work hard to be valuable to your patients.
  • Be indispensable to the physicians and other practitioners you work with.
  • Be a role model for all who surround you.

“Be aware of any patient needs that are not being met and develop suggestions on how best to solve the identified needs,” Joyner said. “If those needs happen to fit with the effort to expand the RT department scope of practice, that would be a place to begin discussion on how you could incorporate that practice in the RT department duties.”

Keep the Conversation Going

How are you and your team practicing at the top of the scope of practice? Share your thoughts with your AARC Colleagues in AARConnect. 

Email with questions or comments, we’d love to hear from you.

Addie Schiefer

Addie Schiefer is the Content Manager for the AARC where she creates engaging content for the association via the AARC website, newsletters, and social media. Connect with her about potential stories by email, AARConnect, or LinkedIn. When she’s not working, you can find her listening to a true crime podcast, traveling to new places with her husband, hanging out with her dog JoJo, or browsing the aisles of the nearest Target.

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