Perspectives on Credential Maintenance: Part 1
by NBRC Vice President of Examinations, Robert C. Shaw, Jr., PhD, RRT, FAARC
The original continuing competency program was implemented in July 2002 and was developed with two outcomes in mind – 1) to enhance and maintain competence as time passes and 2) to require participants to provide evidence they continue to meet current competency expectations. Eighteen years later, NBRC credential holders fall into one of three categories:
Group 1: credentials do not expire
Group 2: credentials expire
Group 3: some credentials expire and some do not
If you are uncertain into which group you fall, you are encouraged to login to the Practitioner Portal at nbrc.org to review your credential information. If a credential you earned has an expiration date, it will be clearly displayed on your personal dashboard.
As time goes on, the number of credentialed practitioners in Group 1 shrinks in size because these therapists retire from the profession and no new lifetime credentials are awarded. Likewise, Group 3 shrinks in size although not as rapidly as Group 1 since earning a new credential tends to be the behavior of a therapist who continues to practice. Additionally, a therapist can transition from Group 1 to Group 3 by achieving a new credential so there is a low level of addition even as retiring practitioners shrink the size of Group 3. The size of Group 2 is maintained or grows since it is regularly replenished as new therapists enter the profession although some voluntarily let their credentials expire.
Continuing Competency Program (CCP) Details
Prior to implementation in July 2002, an advisory committee recommended the first operational details for the program. Committee members included stakeholders from various backgrounds including representation from the American Association for Respiratory Care (AARC), state licensure agencies, physicians, and respiratory therapists. At that time, most states already implemented licensing for respiratory therapy and that had an influence on credential renewal requirements.
One option for CCP participation was continuing education as documented by 30 credits over 5 years. The number of credits was defined by using the smallest number required annually by states who require CEUs to maintain a license. Another option for participation was resetting the credential expiration date when a therapist achieves a new credential. Lastly, a therapist can reset the credential expiration date by retaking the examination for the credential they are renewing. Additionally, assigning a five-year expiration period has been in place since 2002, which the NBRC reaffirmed in 2018 based on a study of expectations about therapists who stop practicing.
Credential Maintenance Program (CMP) Details
In 2020, the program name was changed to better communicate to therapists that some aspects of the program are different. The most significant change is the introduction of quarterly assessments. The way in which a therapist views these assessments is influenced by the group in which one resides. Descriptions of these points-of-view will begin with Group 2 since it is the group most impacted by the change.
Group 2 – All my credentials expire
Practitoners in this group allow their credential to expire when they do not provide documentation of the required CEUs, or earn a new credential, or pass the examination linked to their credential before it expires. The NBRC sends communications by mail and email to therapists annually and multiple communications are sent in the final year of their credential cycle. The NBRC’s database of credential holders is the source of the email and street addresses to which such communications are sent. It is the responsibility of each therapist to keep their contact information up to date. The therapist can do this by logging into their Practitioner Portal at nbrc.org or by contacting the NBRC by phone or email.
The public, who receive respiratory care, expect a professional will manage those things that are necessary to keep themselves in good standing. An employer holds the same expectation although some may remind therapists when they are getting close to their expiration dates.
By responding to quarterly assessments, a Group 2 practitioner creates an opportunity to reduce the number of required continuing education credits to 15 or even to 0. Each credentialed practitioner has a color-coded dashboard built into his or her Practitioner Portal account. A credentialed practitioner can learn their performance level (green=high, yellow=medium, red=low) from their personal dashboard and whether documented continuing education credits will be reduced (assuming the same assessment performance level over 16 quarters). Unanswered assessments are also listed in the dashboard. If a practitioner cannot log in to his or her account to see the dashboard, then an email sent to CMPSupport@nbrc.org will start the process of gaining access.
Within the subset of Group 2 who have achieved multiple credentials, the color-coded assessment performance level depends on the net score of assessments for each credential held. Illustrating net score with an example, when a therapist has taken 10 assessment items for the RRT credential and 5 assessment items for the RRT-NPS credential, the performance level is based on the net score from 15 items. The performance level affects whether a total of 30, 15, or 0 credits will be documented for both credentials. Guidance about how required credits will be distributed for a practitioner with multiple credentials is given among the CMP FAQs-How many CEUs am I required to document?
A therapist who chooses to respond to assessment items is also choosing to keep current about content in which the public should be especially interested because they will be better protected. The NBRC knows this because topics covered by assessment items were identified by a job analysis study. Assessments cover topics that change rapidly while being the highest risk to patients. As a result, the NBRC expects learning to be encouraged in therapists who respond to assessment items regardless of whether they correctly answer an item. It is the exposure to topics covered by assessments that truly adds public protection value rather than the score earned. If some practitioners in Group 2 are given a break by submitting a reduced number of continuing education credits along the way, then that is a nice added benefit but not the primary goal.
Despite the potentially added public protection value from responding to assessments, a therapist in Group 2 may choose to ignore assessments as long as he or she documents 30 continuing education credits every 5 years or resets the credential expiration by taking an examination. Whether an individual shows the highest regard for public protection by responding to assessments is up to the individual. Like any behavior impacting patient care, an employer could use assessment participation to acknowledge differences among therapists. Part 2 of this article series will address this point more thoroughly.
Group 3 – Some of my credentials expire
From the perspective of a Group 3 practitioner, only a credential with an expiration date will expire if no new credential is achieved, no retake of the initial credentialing examination is made, and less than 30 continuing education credits are documented in 5 years. By responding to assessments, someone in this group can reduce the documentation required to 15 credits or 0 credits.
The same rule about net assessment performance affecting credits to be documented is in effect for Group 3 practitioners. Even though there is a credential that will not expire, assessments attributed to this credential will contribute to the net score. Someone in this group who intends to reduce the credit documentation requirement to 15 or 0 should respond to assessments linked to credentials with and without expiration dates. If reducing the credits to be documented is not a therapist’s goal, then he or she can choose to focus on topics in the specialty area by only responding to the corresponding assessment.
Even though it is not true, a member of the public may assume every therapist who provides them with respiratory care is participating in taking assessments because they expect what is best for themselves. While there is no mechanism for the public to learn who has or has not responded to CMP assessments, practitioners in Group 3 who want to show the highest regard for public protection are encouraged to respond to assessments for specialty and respiratory therapy credentials. This article was written in the middle of the COVID pandemic when human and equipment resources were stretched thin which highlights the fact that a therapist may not have the luxury of providing patient care in the specialty to which his or her career has transitioned. Responding to assessments linked to general respiratory therapy as well as a specialty is a way to remain ready in areas that put the public at risk.
Group 1 – None of my credentials expire
Group 1 is ever-shrinking in size to the point there will someday be none. However, this day is still a couple of decades away. The NBRC considered whether to allow members of this group to access assessments with the implementation of the CMP. The conclusion that prevailed was that the public would be better protected by allowing this group to access assessments so they could engage in the same learning about vital topics. Individuals from this group that opt-in to participate in assessments will continue to have life-long credentials without an expiration date and no continuing education credit documentation is required, regardless of their assessment performance.
By opting in, each therapist should first understand that the color-coding of the performance level in the dashboard is again impacted by the net assessment score. Those who intend to see green or yellow in their dashboards should plan on responding to each assessment for each credential he or she holds.
There is again no way for the public to know who from any group has responded to CMP assessments. The highest regard for public protection is in part shown by those positive things a therapist does that are neither required nor observed by someone else. A practitioner in Group 1 who wants to opt-in should be able to do so after logging in to his or her Practitioner Portal account at nbrc.org. If the practitioner is unable to login an email sent to CMPSupport@nbrc.org will get the process started.