Clinical Practice II

Course Description

Clinical Practice II continues from Clinical Practice I with a focus on critical care environments. Students rotate through specialty areas as available and complete a defined set of requirements: a practice credentialing examination, disease documentation on assigned cardiopulmonary conditions, computerized simulations, ventilator worksheets, and a substantial case study of a cardiopulmonary patient.

Within the SCNS taxonomy, RET is the Respiratory Care prefix. Daytona State publishes this at 3 credits, prerequisite RET1874, offered fall with a $200.00 lab fee. At the DSC respiratory clinical ratio evidenced by the published RET2877 (3 credits / 180 hours), that is approximately 180 contact hours.

This is the rotation where respiratory care becomes the profession it is known as. Critical care is where the therapist carries the most independent responsibility — managing ventilated patients, responding to deterioration, and making protocol-driven decisions minute to minute — and the course's deliverables are deliberately shaped toward the credentialing examinations that follow.

Learning Outcomes

Required Outcomes

• Perform comprehensive cardiopulmonary assessment on critically ill patients.
• Manage the patient-ventilator system, including monitoring, adjustment within protocol, and troubleshooting.
• Interpret ventilator graphics and respiratory mechanics at the bedside.
• Identify and correct patient-ventilator dyssynchrony.
• Perform arterial blood sampling and interpret arterial blood gases.
• Adjust ventilation and oxygenation based on blood gas and clinical findings within protocol.
• Manage artificial airways, including cuff pressure, suctioning, and securement.
• Assist with intubation and describe the therapist's role in airway management.
• Apply non-invasive ventilation and assess its effectiveness.
• Apply weaning and liberation protocols, including spontaneous breathing trials.
• Participate in extubation and post-extubation monitoring.
• Respond to emergencies, including respiratory arrest and code situations.
• Apply the ventilator bundle and infection prevention measures in critical care.
• Interpret haemodynamic and monitoring data relevant to respiratory management.
• Apply therapist-driven protocols and document the reasoning for decisions.
• Communicate effectively within the critical care team and during handoff.
• Document critical care respiratory management accurately.
• Complete disease documentation demonstrating pathophysiology and management understanding.
• Complete ventilator worksheets demonstrating settings analysis and rationale.
• Complete computerized clinical simulations and analyze decision pathways.
• Write a comprehensive case study integrating assessment, management, and outcome.
• Complete a practice credentialing examination and use the results to direct study.

Optional Outcomes

• Rotate through neonatal or paediatric intensive care.
• Rotate through pulmonary function or sleep diagnostics.
• Observe or participate in transport of a ventilated patient.
• Describe advanced modes and rescue strategies in ARDS.
• Describe extracorporeal support at an introductory level.
• Participate in interdisciplinary rounds.

Major Topics

Required Topics

• Critical care patient assessment
• Patient-ventilator system management
• Ventilator graphics and mechanics at the bedside
• Dyssynchrony identification and correction
• Arterial sampling and blood gas interpretation
• Protocol-driven ventilator adjustment
• Artificial airway management
• Intubation assistance
• Non-invasive ventilation in acute care
• Weaning, liberation, and spontaneous breathing trials
• Extubation and post-extubation care
• Emergency and code response
• Ventilator bundle and infection prevention
• Haemodynamic and monitoring data
• Therapist-driven protocols
• Critical care communication and handoff
• Documentation in critical care
• Disease documentation assignments
• Ventilator worksheets
• Computerized clinical simulations
• The comprehensive case study
• Practice credentialing examination

Optional Topics

• Neonatal and paediatric rotations
• Pulmonary function and sleep diagnostics
• Transport of ventilated patients
• ARDS and rescue strategies
• Extracorporeal support
• Interdisciplinary rounds

Resources & Tools

• Pilbeam's Mechanical Ventilation and Egan's Fundamentals of Respiratory Care — the two references you should have at hand.
• NBRC (nbrc.org) — free content outlines for the TMC and Clinical Simulation examinations. The practice credentialing examination in this course is a rehearsal for these; read the outlines.
• AARC Clinical Practice Guidelines — free, evidence-based, and the standard for each procedure.
• ARDSNet (ardsnet.org) — free protocol cards and the tidal volume and PEEP tables underlying lung-protective ventilation.
• Kettering or Lindsey review materials — the traditional NBRC preparation resources, and worth starting now rather than in your final term.
• Clinical simulation practice software — usually programme-supplied; the format is unlike multiple choice and requires specific practice.
• Manufacturer manuals for the ventilators in your clinical site — knowing a specific ventilator by name matters at interview.
• A blood gas interpretation reference and a haemodynamics quick reference.
• PubMed and library databases — free through enrollment, for the case study.
• AARC student membership — inexpensive, and the journal is genuinely useful at this stage.

Career Pathways

• Adult critical care respiratory therapist — the destination this rotation prepares for directly.
• Emergency department — airway management and acute respiratory failure.
• Neonatal and paediatric intensive care — with the NBRC specialty credential.
• Rapid response and code teams — therapists are core members.
• Transport and flight therapy — competitive, well regarded, and built on critical care competence.
• General acute care and long-term acute care.
• Home and long-term mechanical ventilation — growing, and strong in Florida.
• Pulmonary function, sleep, and pulmonary rehabilitation.
• Education, management, and clinical specialist roles with industry.
• SOC code 29-1126 Respiratory Therapists.

Special Information

⚠ Take the practice credentialing examination seriously — it is diagnostic, not decorative

The most actionable content in this course, because the practice examination is where students discover what they do not know while there is still time to fix it.

• Practice examination results correlate with credentialing outcomes, which is precisely why programmes administer them. A poor result is information, not a verdict.
• Analyze it by content area, not by score. The value is in identifying which NBRC domains are weak so that study can be targeted rather than general.
• Read the rationale for every question — including those you got right. Guessing correctly teaches nothing, and the rationales are where the learning is.
• The Clinical Simulation Examination is a different format entirely. It presents an unfolding patient scenario requiring information gathering and decision making, and it penalizes both missing key data and ordering irrelevant tests. Multiple-choice preparation does not prepare you for it — practise simulations specifically.
• Start now, not in the final term. Candidates who begin structured preparation early pass at higher rates, and the material is never fresher than while you are living it in clinical.
• Aim for the RRT cut score. Preparing to pass the CRT threshold and hoping is how people end up with the lower credential.

The connected point about the ventilator worksheets and disease documentation: these are structured exactly like clinical simulation reasoning — given this patient and these settings, what do you do and why. Treating them as paperwork wastes the best examination preparation the programme provides.

⚠ Critical care is where the therapist's judgement carries most weight

The professional shift this rotation represents, and it is worth naming.

On a general floor a therapist delivers ordered therapy and assesses response. In critical care the therapist is frequently the person who knows the ventilator best in the room, and the expectations rise accordingly:

• Therapist-driven protocols give real authority to adjust ventilation, titrate oxygen, and advance weaning within physician-approved parameters. That authority rests entirely on assessment competence.
• You will be asked for recommendations. Physicians and nurses ask therapists what the ventilator should do, and "I don't know" is acceptable once; being able to reason to an answer is what the role requires.
• Speak up about lung-protective settings. Tidal volumes set from actual rather than predicted body weight, plateau pressures above the protective threshold, and drifting FiO2 are things a therapist notices and should raise. This is patient advocacy and it is squarely within the professional role.
• Handoff is a safety event. Ventilated patients are handed over between shifts, and structured, complete handoff prevents harm. Learn your unit's format and use it.
• Deterioration is your early warning too. Rising oxygen requirement, changing compliance, and increased work of breathing precede events, and the therapist frequently sees them first.
• Know the emergency fallback. When a ventilated patient deteriorates and the cause is not immediately clear, disconnect and manually ventilate while troubleshooting. It is always available and always correct.

⚠ The emotional weight of critical care is real — and it is not discussed enough

Worth stating honestly in a guide to a rotation where students first encounter dying patients.

• You will care for patients who do not survive. Respiratory therapists are present at withdrawal of life support and at deaths more often than most professions, and the first time affects people.
• Withdrawal of mechanical ventilation is a therapist responsibility in many institutions — a clinically and emotionally demanding role that students are rarely prepared for. Ask about it in advance rather than encountering it unprepared, and expect it to be difficult.
• Families are present and frightened. How you speak to them matters, and honesty within your role — describing what you are doing, deferring prognosis to the physician — is what helps.
• Moral distress is a documented occupational issue in critical care, particularly around treatment perceived as futile. Naming it helps; carrying it silently does not.
• Use your clinical instructor and your programme. Debriefing a difficult shift is appropriate and expected, and campus counselling services are free.
• This is also where the profession's value is clearest. Patients survive because someone managed the ventilator well, and that is a genuine and durable professional satisfaction.

⚠ 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.

RET1875 is 3 credits with an estimated 180 contact hours and a $200.00 lab fee, offered fall. Assessment combines clinical performance evaluation, competency checkoffs, and the substantial written deliverables the course description names — case study, disease documentation, ventilator worksheets, simulations, and the practice credentialing examination. Clinical hours are an accreditation requirement, so missed time frequently cannot be made up.

Clinical courses do not transfer between programmes. Respiratory care curricula are sequenced and cohort-based, and CoARC accreditation must be preserved in any change of programme, since losing it costs examination eligibility rather than merely credit.