Clinical Practice I

Course Description

Clinical Practice I is the first supervised clinical experience in a respiratory care programme. Students gain practical experience with cardiopulmonary procedures — working with equipment, performing patient evaluations, delivering floor-based therapy, maintaining records, teaching patients, and responding to emergencies — and complete an article review paper on a pre-approved topic in the cardiopulmonary sciences.

Within the SCNS taxonomy, RET is the Respiratory Care prefix. Daytona State publishes this at 4 credits with a $132.10 lab fee, offered summer. At the DSC respiratory clinical ratio evidenced by the published RET2876 (4 credits / 240 hours), that is approximately 240 contact hours — a derived figure, since the institution publishes credits rather than contact hours.

This is where a respiratory care student first treats patients, and the emphasis on floor therapy is the right starting point. General care areas are where the volume is, where the fundamentals are consolidated, and where a student learns the thing that cannot be taught in a laboratory: how to be useful to a real patient in a real hospital on a real schedule.

Learning Outcomes

Required Outcomes

• Apply standard precautions, hand hygiene, and isolation procedures in the clinical setting.
• Verify patient identity using two identifiers before every procedure.
• Review the medical record and extract information relevant to respiratory care.
• Interpret a physician order for respiratory therapy and clarify ambiguity appropriately.
• Perform a focused cardiopulmonary patient assessment, including inspection, palpation, percussion, and auscultation.
• Measure and interpret vital signs and pulse oximetry.
• Assemble, verify, and troubleshoot respiratory care equipment before use.
• Administer oxygen therapy by appropriate device and verify delivered concentration.
• Administer aerosolized medication by nebulizer and metered-dose inhaler with spacer.
• Perform lung expansion therapy, including incentive spirometry and positive pressure techniques.
• Perform airway clearance therapy and bronchial hygiene procedures.
• Perform suctioning safely and describe its indications and hazards.
• Assess patient response to therapy and modify or discontinue within protocol.
• Provide patient and family education about therapy and equipment.
• Document care accurately, completely, and contemporaneously in the medical record.
• Communicate effectively with nurses, physicians, and the wider care team.
• Recognize deterioration and escalate appropriately.
• Participate appropriately in emergency response within the student role.
• Apply patient safety practices and report errors and near misses.
• Apply confidentiality and professional conduct standards.
• Locate, evaluate, and summarize a professional article and write a review to academic standard.
• Manage time and a patient assignment within the clinical shift.

Optional Outcomes

• Assist with arterial blood sampling and describe the procedure.
• Observe bronchoscopy and describe the therapist's role.
• Describe respiratory care in the emergency department.
• Describe the therapist's role in rapid response and code teams.
• Describe smoking cessation counselling.
• Describe departmental workflow and productivity expectations.

Major Topics

Required Topics

• Infection control in the clinical setting
• Patient identification and safety practices
• Medical record review and order interpretation
• Cardiopulmonary assessment and auscultation
• Vital signs and oximetry
• Equipment assembly and verification
• Oxygen therapy devices and delivery
• Aerosolized medication administration
• Lung expansion therapy
• Airway clearance and bronchial hygiene
• Suctioning technique and hazards
• Assessing response and protocol modification
• Patient and family education
• Clinical documentation
• Interprofessional communication
• Recognizing deterioration and escalating
• Emergency response within the student role
• Error and near-miss reporting
• Confidentiality and professional conduct
• Literature review and academic writing
• Time and assignment management

Optional Topics

• Arterial blood sampling
• Bronchoscopy assistance
• Emergency department respiratory care
• Rapid response and code teams
• Smoking cessation counselling
• Departmental workflow and productivity

Resources & Tools

• Egan's Fundamentals of Respiratory Care — the field's standard reference; bring it to clinical or have the app.
• AARC Clinical Practice Guidelines (aarc.org) — free, and the operative evidence-based standards for the procedures in this course. Read the guideline for each therapy you perform.
• Your programme's clinical competency checklists and evaluation form — the graded criteria; read them before day one.
• AARC — student membership is inexpensive and includes practice resources and the journal.
• NBRC (nbrc.org) — free TMC content outline; start referencing it now rather than in your final term.
• A drug guide covering respiratory medications, and a laboratory reference.
• A quality stethoscope. Auscultation is a core skill in this course and a poor stethoscope genuinely limits it.
• PubMed and your college library databases — free through enrollment, and where the article review paper's source should come from.
• Purdue OWL — free citation and academic writing guidance for the review paper.
• CDC — free infection control and isolation precaution guidance.

Career Pathways

• Registered respiratory therapist (RRT) — after a CoARC-accredited programme, the NBRC examinations, and Florida licensure.
• General acute care — floor therapy, oxygen management, and airway clearance; where this course's skills are used daily.
• Adult critical care — ventilator management; see RET1875 and RET1265C in this repository.
• Emergency department.
• Neonatal and paediatric intensive care — a specialization with its own NBRC credential.
• Pulmonary function and sleep diagnostics.
• Home care and long-term ventilation — a growing Florida sector.
• Pulmonary rehabilitation, transport therapy, and case management.
• SOC code 29-1126 Respiratory Therapists. Florida demand is strong given its older population and high burden of chronic respiratory disease.

Special Information

⚠ First clinical: you are assessed on professional behaviour before competence

The thing students most often misjudge, and getting it right makes the rotation straightforward.

Nobody expects you to be fast or independent. You have completed the didactic courses and a laboratory; you have never done any of this to a person who is unwell. What clinical instructors evaluate first is whether you can be trusted in a patient care environment — and those judgements form in the first week.

• Arrive early, every shift. Reliability is the most-cited professional behaviour in clinical evaluations across every health programme.
• Prepare the night before. Look up your assigned patients — diagnoses, why they are on the therapy, what you expect to find. Arriving prepared converts a stressful shift into a learning one.
• Ask for patients. Students who seek out procedures perform better and are evaluated better than students who wait to be assigned. Standing against a wall reads as disengagement even when it is nerves.
• Introduce yourself as a student, to every patient, every time. Never let anyone assume otherwise.
• Take feedback without defending it. "Thank you, I'll work on that" and then visibly working on it is the strongest signal available.
• Ask questions at the right moment — not during a procedure, not in front of a patient, and not about something you could look up.
• Say when you do not know. "I haven't done that yet — may I watch first?" is a good answer. Attempting something you are not competent at is not.
• Never hide a mistake. Report it immediately. Instructors expect students to err; concealment ends placements.
• Phone away entirely. This is noticed more than any other single behaviour.

⚠ Assess before, during, and after — therapy is not a task to complete

The clinical habit this rotation exists to build, and the one that distinguishes a therapist from a technician.

Respiratory therapy is assessment-driven. An order is an authorization, not an instruction to proceed regardless of findings. The professional sequence is:

• Assess before. Breath sounds, work of breathing, saturation, and whether the therapy is still indicated. A patient whose lungs are clear may not need the bronchodilator that was ordered three days ago.
• Monitor during. Heart rate response to beta agonists, tolerance, desaturation, and distress. Therapy that is making the patient worse stops.
• Assess after and document the change. "Breath sounds improved, wheezing decreased, patient reports easier breathing" is a clinical outcome; "treatment given" is a task record.
• Recommend, within protocol. Where the department uses therapist-driven protocols, assessment findings drive escalation, modification, or discontinuation — and that authority depends entirely on the assessment being sound.
• Report what you find. A therapist frequently sees the patient more often than anyone else on a shift, which makes you a primary source of early deterioration information. Say so, to the nurse and to the physician.

The connected point on auscultation: it is the highest-value physical skill in this rotation and it is learned only by listening to many chests with someone experienced confirming what you heard. Ask your preceptor to listen with you and describe what they hear. Adventitious sounds are genuinely hard at first and become automatic with repetition.

⚠ Oxygen is a drug — and the reflexes around it are frequently wrong

Content worth flagging early because oxygen is the most-administered therapy in the hospital and the most casually handled.

• Oxygen requires an order and a target, and both the device and the flow determine the delivered concentration. Knowing which device delivers what range, and where each is variable with the patient's breathing pattern, is basic competence.
• More is not better. Hyperoxia is associated with harm in several conditions, and the evidence has moved decisively toward titrating to a target saturation range rather than defaulting high.
• The hypercapnic patient deserves care, not fear. In patients with chronic hypercapnia, uncontrolled high-flow oxygen can worsen carbon dioxide retention — but hypoxaemia kills faster than hypercapnia, and withholding oxygen from a hypoxaemic patient is the more dangerous error. Titrate to the appropriate target and monitor.
• Pulse oximetry has real limitations — poor perfusion, motion, nail polish, and carboxyhaemoglobin all mislead it. It also performs less accurately in patients with darker skin pigmentation, a finding with substantial recent evidence and real consequences for detecting occult hypoxaemia. Correlate with the clinical picture and with blood gases.
• Oxygen supports combustion. Fire risk with oxygen in use is real, and smoking or open flame near an oxygen source has caused deaths.
• Humidify where indicated, and know when it matters.

⚠ The article review is not filler — use it to learn the literature

The academic component named in the course description, and it is worth doing properly.

• Pick a topic you will actually meet. Something from your rotation — a therapy you questioned, a protocol you did not understand — makes the paper useful rather than an exercise.
• Use the library databases, not a general web search. Access is included in your enrollment, and PubMed is free to everyone.
• Prefer primary research and systematic reviews over opinion pieces and vendor material. Learning to tell them apart is a professional skill.
• Read the methods, not just the abstract. Sample size, design, and who funded it change what a result means.
• Connect it to the AARC Clinical Practice Guidelines, which are evidence-based and free — comparing a paper to the guideline is a genuinely instructive exercise.
• Cite properly. Paraphrase requires citation as much as quotation does, and patchwriting is treated as plagiarism.

The professional reason this matters: respiratory care runs on protocols, and protocols are built from evidence. A therapist who can read a paper critically is the one who can improve a protocol rather than merely follow it.

⚠ CoARC, NBRC, and Florida licensure — the pathway, in order

• Graduation from a CoARC-accredited programme is required for NBRC examination eligibility. Accreditation is a gate, not a quality signal — CoARC publishes status and outcomes data, and both are worth checking before enrolling anywhere.
• The NBRC pathway runs through the Therapist Multiple-Choice (TMC) examination. A lower cut score yields the CRT; a higher cut score plus the Clinical Simulation Examination yields the RRT.
• Aim for the RRT. Most Florida hospitals require or strongly prefer it, and the difference in employability and pay is substantial.
• Florida licenses respiratory care practitioners under Chapter 468, Part V, Florida Statutes, through the Department of Health. Licensure is a separate process from credentialing, with its own application, screening, and fees — begin it before you finish the programme.
• Specialty credentials — neonatal/paediatric, sleep disorders, pulmonary function, and adult critical care — extend a career and pay.

Rule 11 applies — NBRC examination structure and cut scores, CoARC standards, and Florida licensure requirements all change. Verify with each body directly.

How Florida course levels affect transfer

The first digit of an SCNS number denotes the year of offering, not transferability. Courses at the 1000 and 2000 levels transfer transparently between Florida public institutions, and 3000 to 4000 is unproblematic since both are upper division. The boundary that actually matters is 2000 to 3000, where lower-division credit generally cannot satisfy an upper-division requirement.

RET1874 is 4 credits with an estimated 240 contact hours and a $132.10 lab fee, offered summer. Assessment combines clinical performance evaluation — typically pass/fail against a competency instrument — with graded competency checkoffs and the article review paper. Clinical hours are a programme and accreditation requirement, so missed time frequently cannot be made up and absence can end progression.

Clinical courses do not transfer between programmes: placements are arranged under a specific programme's accreditation and affiliation agreements. Respiratory care programmes are sequenced and cohort-based, so individual course transfer is uncommon. A.S. degrees are applied and do not carry the A.A.'s junior-status guarantee, though Florida institutions — including Daytona State — offer RRT-to-B.S. completion pathways.