Scope of Practice

The RCB often receives questions regarding the RCP scope of practice. These are inquiries in which a licensed RCP or hospital may be looking for clarification regarding an RCP's duties or interpretation of the laws that govern the practice of RCPs. The RCB has outlined a list of frequently asked questions for your review.

Frequently Asked Questions

• Is the practice of extracorporeal membrane oxygenation (ECMO) within the scope of practice of a respiratory care practitioner?

  Yes. Pursuant to Business and Professions Code section 3702.7, the practice of respiratory care includes, “All forms of extracorporeal life support, including, but not limited to extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal (ECCO2R).”

• Can respiratory care practitioners place arterial lines?

  The insertion of arterial lines is within the scope of practice of a licensed respiratory care practitioner. That being said, the onus is on the licensed health facility employing the respiratory care practitioner to develop appropriate training and competencies that would ensure this function is provided in a manner that would be safe when administered to the public.

• Are respiratory care practitioners authorized to induce conscious or deep sedation?

  Yes. Pursuant to Business and Professions Code section 3702.7, the practice of respiratory care includes, “Administration of medical gasses and pharmacological agents for the purpose of inducing conscious or deep sedation under physician and surgeon supervision and the direct orders of the physician and surgeon performing the procedure.”

• Can respiratory care practitioners insert PICC lines?

  Yes, insertion of PICC lines is within the scope of practice of a licensed respiratory care practitioner. That being said, the onus is on the licensed health facility employing the respiratory care practitioner to develop appropriate training and competencies that would ensure this function is provided in a manner that would be safe when administered to the public.

• Is the practice of polysomnography within the scope of practice of a respiratory care practitioner?

  Yes. Pursuant to Business and Professions Code section 3702.7, the practice of respiratory care includes, “The treatment, management, diagnostic testing, control, education, and care of patients with sleep and wake disorders as provided in Chapter 7.8 (commencing with Section 3575).”

• Can respiratory care practitioners administer flu vaccines?

  The respiratory care scope of practice includes direct and indirect pulmonary care services that are safe, aseptic, preventative, and restorative to the patient. As a flu vaccination is a preventative measure, respiratory care practitioners are authorized to administer these vaccinations.

• Can respiratory care practitioners administer TB skin tests?

  Respiratory care as a practice means a health care profession employed under the supervision of a medical director in the therapy, management, rehabilitation, diagnostic evaluation, and care of patients with deficiencies and abnormalities which affect the pulmonary system and associated aspects of the cardiopulmonary and other system functions. Since a TB skin test is a “diagnostic evaluation” for a potential condition that affects the lungs, it is within the scope of practice of a respiratory care practitioner.

• What are the requirements to manage a respiratory department?

  The requirements to manage a respiratory care are specified in Section 70619 of Title 22, and state:

  The day-to-day operation of the service (Respiratory Care) shall be under the immediate supervision of a technical director who shall be a respiratory therapist, respiratory therapy technician, cardiopulmonary or pulmonary technologist or a registered nurse with specialized training and/or advanced experience in respiratory care, who shall be responsible for:

  • Supervising the clinical application of respiratory care.
  • Supervising the technical procedures used in pulmonary function testing and blood gas analysis.
  • Supervising the maintenance of equipment.
  • Assuring that national and local safety standards are met.

  Although the specifics of the specialized training and/or advanced experience are not outlined here, the law specifically indicates that the technical director shall be responsible for clinical application and procedures associated with respiratory care, pulmonary function testing and blood gas analysis. This responsibility would seem to indicate that the person would need the necessary training and skills associated with a licensed respiratory care practitioner. It does not preclude the possibility that the administrative functions of a department could be successfully managed by a registered nurse with appropriate delegation of authority to a clinical expert (a licensed and experienced respiratory therapist), with regard to the clinical and procedural oversight. In either case, the RCB has no legal authority to decide the question of what the meaning may be regarding training or experience for departmental oversight. That authority clearly rests with the California Department of Public Health (CDPH). Please refer to the CDPH's district office directory.

• Can respiratory care practitioners perform venous blood draws?

  Yes. Business and Professions Code section 1242.6(c) provides that any respiratory care practitioner certified under the provisions of the Respiratory Care Practice Act may perform arterial puncture, venipuncture, or skin puncture for the purposes of withdrawing blood or for test purposes upon authorization from any licensed physician and surgeon.

• Does the Respiratory Care Practice Act specify patient ratios?

  The Respiratory Care Practice Act does not include any provisions relative to patient ratios. However, section 70405 of Title 22, does specify information regarding a 1:4 ratio for ventilator patients in certain settings. Since the ratio is specific to "ventilator patients," it appears other types of patients may be assigned in addition to the ventilator patients. However, because Title 22 falls under the jurisdiction of the California Department of Public Health (CDPH), we recommend you contact that agency for its interpretation. CDPH has various district offices that cover specific counties. Please refer to the CDPH's district office directory. CDPH can also be contacted if you believe inadequate staffing levels are placing patients at risk.

  The American Association for Respiratory Care (AARC) has also developed a benchmarking tool aimed at assisting respiratory care departments/managers with appropriate staffing. For information regarding this tool, please contact the AARC at www.aarc.org.

• Can respiratory care practitioners start IVs?

  Yes, if the respiratory care practitioner is starting the IV for purpose of delivering respiratory care medications, it would fall directly under the respiratory scope of practice. Moreover, if the IV is being started for other purposes, Business and Professions (B&P) Code section 3701 provides for the recognition of "overlapping functions" among licensed health care practitioners. For purposes of B&P section 3701, it is the intent of the Legislature that "overlapping functions" includes, but is not limited to, providing therapy, management, rehabilitation, diagnostic evaluation, and care for nonrespiratory-related diagnoses or conditions provided (1) a health care facility has authorized the respiratory care practitioner to provide these services and (2) the respiratory care practitioner has maintained current competencies in the services provided, as needed. Provided conditions (1) and (2) have been met, licensed respiratory care practitioners can start IVs for nonrespiratory-related purposes.

Additional Resources

The AARC's Clinical Practice Guidelines are a useful resource for specific respiratory care procedures. However, please note that in some instances the AARC's guidelines refer to "lay caregivers" or credentialed persons as appropriate personnel to perform certain tasks that conflict with California law. Therefore, the guidelines should not be used as a resource to determine personnel qualifications in performing certain tasks. Rather, the appropriate California licensing or certifying agency (not to be confused with private credentialing organizations) should be contacted, if applicable. If the guidelines refer to unlicensed personnel, readers may choose to contact the RCB to determine if certain tasks require licensure as a respiratory care practitioner.

In addition, on June 24, 2016, the RCB passed a motion to recognize and support the CSRC's white paper titled, "Position Statement Pertaining to Concurrent Therapy" for purposes of educating the public, licensees, and facilities that such practice is unsafe with potential harm to the public.

If you have further questions or need clarification regarding the scope of practice for a respiratory care practitioner, you may call the RCB at (916) 999-2190 or send your question by email to rcbinfo@dca.ca.gov.