Member Program Spotlight: Apex Tips and Insights From Past Recipients

In this episode of the AARC Perspectives podcast, recorded live at Congress 2025, we talk with past APEX designees Felix Khusid, BS, RRT‑ACCS, RRT‑NPS, RPFT, FAARC, FCCM, FCCP, ATSF (New York–Presbyterian Brooklyn Methodist Hospital), Emilee Lamorena, MSc, RRT, RRT-NPS, FAARC (CHOC Children’s), and Andy Klein, MS, RRT, RRT-ACCS, RRT-NPS, AE-C, FCCP (Rush University). They explore the transformative impact of the APEX designation on respiratory departments, emphasizing its role in elevating standards, attracting top talent, and enhancing departmental recognition. In addition, they share tips for overcoming challenges in documentation collection and for fostering employee engagement throughout the Apex process. This episode is a must-listen for respiratory leaders who want to pursue the APEX designation and elevate their departments to national prominence.

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Transcript

SPEAKER_03 0:10

Hi, welcome to today's American Association for Respiratory Cares Perspectives Podcast, live from Congress 2025 in Phoenix, Arizona. I'm Lisa Weisenberger, AERC Director of Engagement and Media, and I'm here today with ARC members and Apex designees, Felix Pusid, Emily LaMorena, and Andy Klein. Thank you all for joining me today to discuss why Apex designation is important and some lessons learned on obtaining it. To begin, can each of you give me some insights into why your organization decided to apply? Do you who wants to go first? Felix, you're right there. You go.

SPEAKER_01 0:41

Oh, oh, okay. So I think that the Apex designation highlights the quality and the depth of the respiratory therapy that is being delivered to the institution. And having that designation highlights those qualities of patient safety, engagement, and um employee engagement and the structure of respiratory therapy department that impacts quality of care, patient satisfaction, and employee satisfaction.

SPEAKER_02 1:10

I mean, we we want to be the best, right? And what does it mean to be the best? It means you align yourself with evidence-based national standards. And that's what the AAR, sorry, ARC did when it established the guidelines for APEC. So you know that organizations that achieve it are committed to professional development, evidence-based care, and RT-driven protocols, research, quality improvement, the best for the RTs and ultimately our patients. Second, RTs want to. So it's an incredible recruitment tool. RTs want to work where there is an effective clinical ladder, where there's RT-driven protocols and they have autonomy, where there's continuous quality improvement. And third, it creates the tools for you to actually measure your outcomes. You don't know how good you are unless you're measuring and continuously improving. And the requirement for an ongoing continuous quality improvement process just makes your practice better, makes your team better. And lastly, as a leader and as a director, it became my marketing tool. I I consider all RTs the PR for our profession, the PR for our department. And the organization looks at you to learn what respiratory care is. And when you get to stand up in front of the C-suite, in front of the organization, and say we are nationally ranked from hitting these evidence-based uh standards and we represent the best of the best and describe what that means. It puts respiratory care on the map, it makes you as a leader know, it shows that you strive for the best and uphold high, high expectations and it builds trust in your team and uh your leadership.

SPEAKER_03 2:34

That's great. Andy, what can you add on?

SPEAKER_00 2:37

I mean, I think I think uh a lot of the main points were made. I guess what I would add uh from our standpoint is so when we initially applied uh in 2017 when it was a brand new award, I think, you know, we had a we we were at a point in time with our hospital where the staff was doing a lot of things that they didn't necessarily understand why they were doing, and we just kept saying, you know, this is, you know, we're trying to, you know, best practices and all those things Emily mentioned. And I think that this sort of uh as we like went over this checklist with the staff and said, you know, hey, we're gonna submit this, you know, we're not really sure what we're doing at this point, but we're gonna submit this. And, you know, look at this checklist that they created. They got a bunch of the smartest people in our profession together to create a list of things you should do as a high functioning department. Guess how many of them we already do, and you guys didn't understand? But here's, you know, our validation for all those things we did. So I think that that that along with I think it is a nice mix of all the things Emily mentioned with the quality improvement and you know, the organizational standard that you set, but also, you know, it's sort of encourages uh individual development within the staff. It encourages them to get advanced credentials to uh drive their career forward in a you know advanced degree standpoint. I so I think it, you know, sort of gives you almost like a roadmap to not only create, you know, an organizational impact, but also within the individual careers of your staff, which I think is also important.

SPEAKER_03 3:58

Yeah, that's all super important. So for those who have not applied before, what would each of you say is the most important item to remember to be a successful designee?

SPEAKER_01 4:10

I think I think that ultimately uh for department to be very successful at what they do, as a baseline, all the members of the department should be members of AARC because it certainly increases the professional band of what they're doing, improves their performance, and it really highlights to staff the importance of the role that ARC plays in their professional development. And it ultimately all kind of comes down to the patient care, because a lot of people will transact that that information and that body of knowledge, and also take great pride in what they do. They will take great pride in what they do. So I think that that's probably the most important starting focal point.

SPEAKER_02 4:54

Yeah, that's great. Emily, yeah, what what do you think about that? I would say start early. Um it it and what I will say is the standards weren't made from fluff. They are the actual things that strong that you need to that you should strive for to lead your department to deliver excellent respiratory care. So even if you may not be hitting some of those metrics now, start measuring it. You don't know where you are until you measure it. So start tracking your professional degrees, start tracking where you are with the development of RT-driven protocols, your roadmap to eventually get there. So don't just look at it and say, we're not there yet, we'll go again next year. Get it down, see your measurement against every standard and start and start putting small steps in place. I will say the first time is the hardest. And then after that, it's a continuous tracking as your as your associates start to get new degrees, updating that list and making sure that's ready as you, as people may leave, as you onboard new RTs, as you have to update your policies, as your quality metrics improve. So I will say once you start, have a mechanism to review it every three months, six months, because if you wait for that every two-year cycle, it will be very, very challenging. Andy, what what would you add to that?

SPEAKER_00 6:03

Yeah, this is challenging going last because they make they make all the best points. Yeah. So I think for us, and I I could not agree more with Emily that, you know, for anybody who's considering this the first time is definitely the hardest because you haven't done anything yet. But I think the AARC has done a great job of uh, you know, posting all these things all the time. I mean, you can you can print this out and hang it up anytime, not even just when you're thinking about applying. And you can see sort of where your gaps are. And I think, you know, kind of I guess think of how you want to approach that. And I I think as, you know, as you identify within your department and within your individual staff, you know, sort of, okay, well, we're, you know, we don't, we don't do a lot of this, or uh, we don't, we don't have anything in place for that. And I can tell you, like when we applied our first time, there were several of our policies that didn't accurately reflect, you know, some of our practices. Like, you know, we we weren't granular, I guess, in some of our policies. So I think that's something too that you can kind of sit down and look at, your guidelines to sit down and look and see, okay, what policies do we have that address these things that we need to address? And A, are we doing these things? You know, are we not giving concurrent therapy? Are we, you know, are we identifying our staffing numbers and and and shooting for those and hitting those, you know, and do our policies reflect that? Because I think sometimes, you know, and again, we were guilty of this too, policies aren't as accurate as we might like them to be on those things. So I think that's low-hanging fruit in the beginning, where you can let's make sure our policies are aligned, then we can start going for, you know, if we don't have people that have ARC memberships, whatever the other things are we're missing, we can work on that. But the policies sometimes take time. We I mean, I I guess everybody kind of has this, but you know, they got to go through committees, they've got to be approved by medical direction, all those things. So that's a big process. So if you don't start that till time to apply, you're probably never gonna get that done.

SPEAKER_03 7:53

So I guess we'll just start with you, Andy. Um since you since you're right there and ready to roll, how long do you think it took you? And I'll go through each each of you kind of speak to this, to like gather all those materials. And I mean, the first time you've said is obviously kind of the worst time winners collecting, but that first time, if you can think back, how long would you say that it took you to get it all together?

SPEAKER_00 8:14

Aaron Ross Powell Well, I can say uh my job at the time was not administration. My job generally is not administration. This kind of stuff is not uh not really my wheelhouse. And uh we hadn't really started to collect any of that stuff, like who has a bachelor's degree, who has X, Y, and Z. I mean, they have files that we keep in our department that are supposed to be, you know, kept up to date, but you know, things fall through the cracks, people leave, people get hired. So it's almost like that snapshot in time, right? When you're collecting the stuff. So um, and then we at the time, they've they've streamlined this process since then, but at the time we had to literally print out from the NBRC website a hundred different we had to print out a hundred different uh credential verifications. We had to go to the uh Illinois Department of Uh Financial Professional Regulation, print out a hundred different license verifications. And so when I went to get ready to submit this, I probably had seven or eight hundred sheets worth of things I had to scan into uh digital documents that I had to then submit. Um but the AARC's done a great job of saying, okay, yeah, we see what people are doing. This is kind of crazy. We should do X, Y, and Z. Yeah, we we really appreciate we really appreciate that the N that the uh AARC has done that for us. But um, but yeah, that that took a long, long time because it was basically wet thumb the whole way, right? Because then you got to go through and then you know, we had the spreadsheet, and it's like, okay, do I have a credential for you know Joe Smith? Oh my, I don't have his I don't have his credential, and I but I do have his license, and I don't it was it was just a lot. So and then keeping it all straight, and you know, some departments don't have a hundred people, but um you know, even still, you know, when you get a hundred people, there's a hundred different things that you can have missing or wrong, or you know, I don't know. But that was that was the challenge for me.

SPEAKER_01 9:51

Felix, do you want to go? So what can I say? He just did such a fine job summing everything, but I'll take 50% off since he has a hundred, I only have fifty. So I think my response is gonna be fifty percent shorter. But I'll tell you this I truly think that if someone is striving to get Apex designation and are trying to line everything, uh, all the ducks in a row, if you will, to get it done, even if from the very beginning you cannot get to where you want to get, you have to start somewhere. And the bottom line is this if you aim for the stars and you miss, you still end up in a good company.

SPEAKER_03 10:30

That's that's a great that's that's like both that's a what's the word I'm looking for? Like just inspiring. Okay. Somewhere in between those two timelines. Gotcha. Um, so what is I guess kind of floating along that same idea, but what is the biggest obstacle people might face? Is it getting all the stuff together?

SPEAKER_02 10:53

Like what would you say is that I I would say in terms of meeting the actual standards, again, this will vary on your organization and your department. I would argue that the hardest work to do is the work to create um the the RT-driven protocols and changing practice. That's just a continuous ongoing. So if you if you are not yet there starting the work to do that. Um, but I would say as far as just the low-hanging fruit, what normally when I talk to leaders, their challenges with A or C membership and their percent of bachelor's degrees. The great thing is when an organization understands what it means to be Apex, they invest in it. I'm literally asked, do you need this on your a line item on my budget? And I say, yes, it's required for Apex. And because my organization values that so much, they will say, okay, if you if this is required. But we have an incentive if you get your BSRT, we continuously review that. I say it's required for Apex. I'm able to continuously fight for that. So when it be it gives the RTs a voice and allows you to advocate for what you know is right because the organization starts to value it. I will say, you know, when we talk about AARC membership, some people always remind them their CRCEs are stracking. But I think as leaders, we have to remind them the ARC is so much more than that. That's a huge bonus. We remind them of uh, you know, your connection with colleagues across the country, the the access to highest level evidence-based information when you need it, the the way that it's supporting and elevating um our profession. And they have to understand the why. And um I'll tell you, I don't require it, but we are able to, we we are able to get that because if you talk the talk, your staff will understand that. And then of course there's the many, many other steps to take. But I would say those are the two things I've heard the most from leaders.

SPEAKER_01 12:39

The biggest obstacle, and not so much of an obstacle, but really something to do is of course the first time is the most complicated one. There is no question about it, because you start in from the scratch, and they're just different, the matrix is very diverse, and you have to get everything kind of checked off appropriately. But what happens is a lot of times during that process, as you're compiling, and it's not only true, it's just first time is of course the hardest one, then it's easier. The subsequent ones are the easier ones, then it's just a matter of maintaining what you already established. But in in any event, even from very beginning to the renewals, one of the things that constantly changes is particularly uh like we had Apex designations since 2019, so we applied in 2018. So this was kind of like one or two years before COVID. We got our designation in 2019. And when COVID hit, there was such a turnaround of people. A lot of people, as you know, they joined different agencies and they moved on to the different roles. And as we got the influx of new people was the importance of impressing upon new people how important it is to be members of ARC, how important it is to, you know, obviously we wanted to make sure all their credentials are up to date. And most importantly, we wanted to make sure that they have bachelor's degrees as much as possible. You always encourage our staff, and I'm very proud to say that my staff, 70% of my staff has BS degrees, and you know, and we're trying to, obviously, and I think we're gonna be at a higher level soon. So, but that's the those are, and I think the most challenging thing is, of course, bachelor's degree. Because look, yes, people can join ARC, yes, people can change a policy, yes, people can do different things, but bachelor's degree you either have it or you don't. So it's kind of like in black and white. So if you if you're kind of like trying to look at who is gonna be getting their bachelor's degree because the or or who has the bachelor's degree, and you project that you're gonna be uh 25% of the of the total numbers, it's kind of like as much as I say, try to do the but you know what, if you if you're not even close, you need to start to work on that before you apply, because there's no sense of going through uh a very extensive, vigorous process if you are not even close. You know, but I think that the bachelor's degree is probably the most important one in the sense of you either have it or you don't. It's not like a policy where you can bring it to the committee or guideline or a protocol where you bring it to the medical board, you get it approved, you implement it, and then you're like, okay, because if you have like 10 people that need to get bachelor's degrees, it's not going to happen overnight. You know, but it's a process, and you have to start somewhere to get somewhere.

SPEAKER_00 15:29

Yeah, I can add to that, uh, and I agree with everything uh that's been said. I think um as someone who uh has been sitting on the committee for a couple of years now uh reviewing uh Apex, you know, sort of submissions, I can tell you that we can, you know, put some data to that, that the most difficult thing for most facilities is the 50% bachelor's bachelor's or better. I think that, you know, to that, you know, as Felix said, I think you get started early. So like, you know, when you first sit down and say, okay, where are we literally at right now? How close are we? If you see that, then you can start getting things in place to make sure that you've corrected that problem. Get go and see what you can do with tuition reimbursement, figure out how you can update your job descriptions to incentivize. So, like, you know, what we've done, you know, to try to keep this process fluid is, you know, in order to even take the first step in promotion, you need a bachelor's degree. So even to become a shift charge therapist at my place, you have to have a bachelor's degree and you have to be an AARC member. If you want to do anything other than the absolute, you know, walking in the door, I can go give Nebs at the bedside. If you literally want to take even the very first step, it takes a bachelor's and it takes AARC membership. So, like Emily, we don't mandate it. We don't, uh, we don't pay for everybody's membership because we kind of, you know, we feel like it should be a personal choice based on the right, you know, things and people should understand what it is that they're agreeing to and and understand the value. So um, so these are some things I think organizations can do to try to get out in front of this, knowing that we already kind of know that most organizations, it's the bachelor's degree thing. And to be honest, with the way staffing is, I'm assuming everywhere, I can tell you for sure in Chicago, the way staffing is and the challenges there, you can't just only hire bachelor's degree people. There just aren't enough of them. So you're going to have to hire from your local junior colleges to staff your department. The question is, you know, is there an infrastructure in place to grow those people at a at a you know a steady and you know, even a sort of accelerated rate from the time they hit your door. Um, and I think, you know, because we encourage, you know, promoting into the second rung of our clinical ladder and those things, I think baking things into those job descriptions and those transitions can help too, because I think most people want to at least take that first step. They may not want to go into administrative leadership or some of these other things, but they certainly want to be charge therapists and kind of take that first step out of the you know the the ground level. So I think these are things that I think organizations can do relatively simply to mitigate that process.

SPEAKER_03 17:58

So you guys have all talked about like what apex designation has done for your organization. So excuse me. Um what what would be like the single thing that you would say that is really important that you receive as an AP Apex?

SPEAKER_02 18:14

I I do think it's the recognition. It establishes respiratory care as a true profession with national standards that you know I find that I'm often educating about the profession. A they're surprised or they say, What's Apex? It's an all-of-ar branding. The hospital is so proud of it. So it really becomes this wow factor because you hear of Magnet, you hear of all the other ways that hospitals commit to excellence. So it really makes people the world, it puts uh respiratory care on the map and it sets a new standard for it.

SPEAKER_01 18:45

Uh I couldn't say anything better than that. This is just so true. But I won't I want to tell you something that was not in your question, and this is a little bit off the script, so I'm sorry. And I'm not and I'm kind of myself off the script. So I'll tell you this. As great as Apex is, I think, I think that in the future, it will be really very important to include one more piece of matrix that is not there, and that is employee engagement. Because employee engagement really drives quality of care, because a happy employee is a good employee. Employee who is not happy at what they do are never going to be great at what they do. And considering that we are not dealing with numbers and considering per se we are not dealing with uh objects and data, we just dealing with patients, I think that that directly affects patient care. Because if an employee comes in and they give you their heart and soul because they feel proud that they're working in the right department under the right conditions and being treated appropriately by the hospital, patients will feel it. And when somebody comes in and they just want to do a minimum of A to B that's required by the policy 349, patients will feel it as well. Because patients do have feelings.

SPEAKER_03 19:58

Yeah, that was a very, very good point. Andy, what did what would you add on to that?

SPEAKER_00 20:03

I would just say, and I and I love what Emily highlights about how it really amplifies sort of the quality of the of the respiratory department. And I think the reality is, and she she mentioned Magnet and um Beacon Award and some of these nursing-specific awards that sort of measure uh the overall quality of the nursing care. And whether we like it or not, respiratory therapy and nursing are sort of always intertwined and comparing themselves to each other in terms of you know, respiratory seams and a lot of uh a lot of quality, you know, if if nursing gets this and if nursing's recognized and X, Y, and Z, we should be too. And I think Apex levels a playing field a little bit in that. And certainly in our hospital, you know, um, and and I'm sure other people work at organizations like this where, you know, they they are competing with other organizations in their area and they want to highlight all of their achievements, and a lot of those are nursing-related achievements. So being able to sort of say, oh, and by the way, our respiratory department has the highest sort of national recognition as a, you know, uh metric of quality in the care that they provide. So I think that it sort of puts us on that level with nursing in terms of, you know, us being at that highest level like they are if they get magnet. And I think we're still a little behind them in terms of what that award means in terms of, you know, recruiting and things like that, because nursing, they'll talk about I don't want to work anywhere other than a magnet hospital because of what that means to their day-to-day. I think Apex has some of that same impact. It's just people don't know that and people don't know how to utilize it for that reason yet. And so I think that might be the next step. And it's something that we talk about when we meet on the committee is, you know, how do we make how do we make this magnet-ish, right? Magnet light. You know, how do we, how do we put this on that household name level where respiratory therapists around the world are like, wait, but do you have Apex? Because that's important to me as an RT looking for a place to work because I know what that means to, you know, the the motivation that's applied to staff, the opportunities that they have, the advancement, the clinical ladder, all those things that are in the guidelines. I think once that starts to be more of a household understanding like Magnet is now, then I think you'll you'll have a better, I guess, handle on how to utilize that more for recruitment, for putting your department on that higher level with your nursing staff and all these other people.

SPEAKER_03 22:15

So do each of you want to just sum up your final thoughts, I guess, as we kind of get ready to sign off today about what Apex has meant maybe for you guys individually too, and not just for your hospital, but or anything other tips or that you'd like to share with people who are thinking about applying for Apex?

SPEAKER_00 22:32

Yeah, I mean, I I I'll start this one. I I think I think that, you know, as we try to grow this and and have more departments, I think the thought is that there are departments out there that meet a lot of these requirements and just aren't applying or meet 90% of them and just feel like, okay, well, we're never gonna get this other one where it needs to be, whether that be, you know, our staff's never gonna go out and get bachelor's degrees, whatever their barrier is for their individual list of accomplishments. I think, you know, I think as leaders within the department, people need to be like, okay, look, look how close we are. Let's figure out like if all we need are 10 more staff members to get bachelor's degrees, how do we make that more accessible to them? How do we tweak tuition reimbursement? Maybe we instead of having it be a hospital benefit, we figure out a way to bake it into the department budget where we can help these people, you know, something around that versus just, ah, you know what, we're not gonna get there with bachelor's degrees. I know my staff, they're not that motivated, whatever. So I think as leaders, it's important to, you know, figure out where the gap is and then come up with workable plans to navigate those. And then my final thought is I think that Apex is such a good, good step in our profession as we try to continue to, you know, find our place as, you know, the important group that we are in the patient care, I guess, sort of arena. Um, and I know that's something in my 22-year career we have fought with every day. Like, you know, people don't know truly what respiratory does. People, people don't know how important they are. And, you know, as weird as it sounds, COVID sort of helped with that a little bit because at least people knew that there were people in the room that were called respiratory therapists that were contributing to things, which many of them didn't before that. But now we've kind of backed off to kind of where we were, where people don't really know. I think Apex gives us a great opportunity to really push ourselves even closer to being a prominent member of the patient care team that we know we are, and that we always hope that everybody else realizes that we are.

SPEAKER_03 24:30

That's great. Felix?

SPEAKER_01 24:32

So I think that um I just want to start from a little bit from the very beginning. Uh when uh prior to us applying to call uh to prior to uh prior to us applying for Apex back in 2018, we always knew that we're great. We did. And Apex helped us to validate it in an objective way, with the objective criteria and by us providing to the ARC objective data. Because it's one thing when you just think that you're great, it's another thing when it's validated by national organization at the national level. Two different things. So that's one. And number two, um, I couldn't agree more with Andrew um about the fact that if you're close, you really sometimes have to push yourself to bring everybody into the appropriate realm of things. And the truth of the matter is the role of the leader is to provide leadership and support to their staff to close that gap. Because if you're gonna rely on people uh in your jurisdiction to, if you will, to close the gap, there might be, you know, gaps that you're not counting on or not anticipating. So as I say, if you want to see a certain future, sometimes you just have to build it yourself. That's pretty much. And I I want to wish luck to all the all the all of my colleagues who are gonna be applying in the near future. I think that Apex is a fantastic program, and it helps you to validate the quality of care provided to your patients and the engagement of your employees with patients on that and and it's validated by national organization. It's not validated by you in your overinflated head, if you will, but it is done based on objective criteria.

SPEAKER_02 26:22

Yeah, that makes sense.

SPEAKER_01 26:22

Okay. Thank you.

SPEAKER_02 26:25

I I will say Apex is a journey. It's not a checkoff list. And it honestly made me a better leader. It gave me a framework. So I would say use for any leader, it tells you how to make your it gives you the steps of the framework to create uh to to create an excellent practice and uh within your department. So set as your checklist to hold yourself accountable. And as you work your way there, and you know, all of us have to set goals, choose one part of that every year of goal to inch closer and closer to where the gaps are. And ultimately, as you have these standards in the back of your mind, it's always with you. And I would say reach out to the community. I will say I reached out to many leaders who had Apex who were willing to share their dreams, their RT-driven protocols, help me implement them in the hospitals, give me kind of the tools and tricks. We all want to help each other succeed with this. And I can wholeheartedly say any Apex designated hospital right now, their leader would be happy to share that information. And ultimately, we need Apex and it elevates our professional practice. We know it uses standards that improve patient outcomes. Soon to be when it's more popular, it will help us attract and retain top talent. And it ultimately helps you drive a culture of excellence and safety, which is all what we want to do as we push this profession forward. So it becomes a journey that we're always continuing to strive for. It becomes your roadmap as a leader, and uh we are all here to help you uh do it and help you achieve those goals.

SPEAKER_01 27:53

I just wanted to say something. It still really boils down to a very famous saying United you stand and divided you fall. So we all have to unite and move forward and get more departments to join Apex family. Thank you.

SPEAKER_03 28:08

That's great. That was a great, that's a great way to end. Thanks, Felix, Emily, and Andrew for joining me today and sharing your insights with us about obtaining Apex designation. If you're interested in learning more about Apex designation for your institution or organization, visit AARC.org and search Apex. Also, don't forget to subscribe to the AARC Perspectives Podcast wherever you listen and share these important stories and resources with your colleagues. Thanks and have a great afternoon.