Developing Staff Through All Stages of a Career

Editor's note: This text-based course is an edited transcript of the webinar Developing Staff Through All Stages of a Career, presented by Carrie Coffman, RRT. 

It is recommended that you download the course handout to supplement this text format.

Learning Outcomes

After this course, participants will be able to:

• Recognize the different stages of a respiratory therapist career
• Identify various strategies for development opportunities
• Identify issues facing respiratory leaders regarding staffing

First Stage - New Graduate

I am delighted to be here today to discuss the vital topic of staff development. If I were to ask everyone on this webinar—or even walk into any respiratory therapy department across the country—what the top three challenges are, I am confident I would hear the same things. The issues of staff retention, recruitment, and burnout would undoubtedly be on everyone's list, if not at the top.

Speaking from my own experience as a respiratory therapist for over 26 years, with 20 of those years in leadership, I have never seen the staffing crisis reach the level it is at now. While there are no easy solutions to these complex problems, I firmly believe that one essential part of the solution is developing your staff throughout all stages of their careers.

Let's start with the first stage: the new graduate. This group is typically full of energy and enthusiasm, eager to dive into the field and put their newly acquired skills into practice. Their excitement for learning and growth is palpable, as they are ready to tackle challenges, take on new tasks, and immerse themselves in patient care. For leaders, this is a rewarding stage to witness, as these fresh graduates bring a sense of renewal and vitality to the team.

One of the biggest hurdles with new graduates is helping them channel their enthusiasm into focused learning. They are often so eager to excel that they can become overwhelmed by trying to master too many things simultaneously. As a leader, we are responsible for guiding them through this initial phase by helping them focus on one task at a time, allowing them to build a solid foundation of skills before moving on to the next challenge. While this can be a challenge, it is certainly a good one to have—managing enthusiasm and eagerness rather than apathy.

For example, take Antonio—a new graduate on our team. After completing his NICU training, He is already making significant strides and delivering exceptional care. His eagerness to learn and grow has made him a standout, and it is gratifying to see how much potential he has. This phase of development is exciting not only for the new hires but also for the entire team. Their enthusiasm is contagious and can even reignite passion in more experienced team members, including leaders. Working alongside new grads reminds us of why we entered the profession in the first place—seeing their fresh perspective and genuine excitement brings back the drive and inspiration that sometimes fades after years in the field.

It is essential to provide new graduates with structured guidance and mentorship during this stage. They need clear expectations and consistent feedback to build their confidence and competence. Early successes—like mastering key procedures or navigating challenging patient cases—serve as important milestones that keep them motivated and engaged. As they start to find their footing, they gain technical skills and a deeper sense of responsibility and connection to their patients and the team.

However, while new graduates are full of potential, they face steep learning curves. This can lead to self-doubt or frustration as they encounter situations they have not mastered yet. That is where leadership plays a crucial role—being present, offering encouragement, and fostering a safe learning environment where mistakes are treated as growth opportunities rather than setbacks. It is important to remind them that perfection is not expected at this stage and that every challenge they overcome is a step toward becoming a more competent and confident clinician.

What makes this phase so fulfilling for leaders is witnessing the rapid growth and transformation of these individuals. New graduates tend to develop quickly, and with the right support, they can move from nervous beginners to competent professionals in a relatively short time. It is a phase of development where every effort invested in their growth pays off, both for the individual and the department.

Overall, the new graduate phase is a period of high energy, potential, and growth. These new hires are the future of the profession, and by nurturing their development, we are not only helping them thrive but also strengthening the team and enhancing patient care. This stage is about laying the foundation for a long and successful career, and for leaders, it is an opportunity to inspire, guide, and shape the next generation of healthcare professionals.

Second Stage - The Proficient Stage

• The stage our team is going to spend the majority of their career in.
• This proficiency can lead to stagnation.
• Stagnation can lead to disengagement. 

The second stage could be called the "proficient stage," where most of our staff will spend the majority of their careers. In this phase, employees have fully mastered their core job skills and can execute their responsibilities with confidence and precision. They are no longer learning the basics but have instead become experts in their day-to-day tasks. Whether delivering patient care, managing complex equipment, or making critical decisions in fast-paced environments, they do it with ease and expertise.

While those in the proficient stage have a firm grasp of their duties, healthcare is an ever-evolving field. They may still need to occasionally learn new equipment, adapt to updated best practices, or master a new charting system. But even when faced with these changes, they are able to incorporate new information without losing the high level of competence they've developed. Their ability to adapt and apply new knowledge to their existing skill set is a hallmark of this stage.

These are the professionals who form the backbone of our departments. They reliably handle the demands of the job, having honed their skills over time through hands-on experience and consistent practice. Because they have moved beyond the learning curve of a new graduate, they are efficient and can manage their workload without constant supervision or direction.

However, it is important to recognize that while this group is highly competent, they may face the risk of becoming stagnant over time. Without opportunities for further growth or development, even the most skilled professionals can lose motivation. That is why, as leaders, it is essential to continue providing new challenges, learning opportunities, and ways for them to remain engaged—whether it is through mentorship roles, leadership training, or specialty certifications. By doing so, we ensure they stay at the top of their game and avoid the disengagement that can come with being in the same role for a prolonged period.

This stage is critical not only for maintaining the quality of care within a department but also for fostering a culture of reliability, consistency, and excellence. These proficient staff members are the ones you can count on during busy shifts or in high-pressure situations. Their experience and knowledge often serve as a resource for newer staff members, and their contributions are vital to the overall success of the team.

Stagnation and Disengagement

• "U.S. employee engagement took another step backward during the second quarter of 2022, with the proportion of engaged workers remaining at 32% but the proportion of actively disengaged increasing to 18%. The ratio of engaged to actively disengaged employees is now 1.8 to 1, the lowest in almost a decade."
• And that proficiency can lead to stagnation. And that stagnation can lead to disengagement. Now, as mentioned, I am located here in beautiful southern Oregon, and we have this beautiful creek here in southern Oregon. And as I was working on this presentation, what it really reminded me of sort of was a metaphor for me of how we get to this second stage, this proficient stage, and what can happen (Harter, 2022).

Imagine a beautiful creek, its water flowing swiftly along, full of energy and movement. Suddenly, it opens up into a wide area where small pools of stagnation begin to form. This image mirrors the progression of our careers. In the beginning, we are fast-moving—not necessarily in a physical sense, though that can be part of it. We are quickly learning, growing, and developing, navigating new skills and responsibilities with excitement and momentum.

Then, like the creek, our career path can widen. In these wider areas, pools of stagnation can appear. Without realizing it, we may slow down, fall into routines, and stop seeking out new challenges. What we need at this stage is something to pull us out of that stagnation—some force that pushes us back into the fast-moving current—back into the center of the stream where we can continue rolling forward, learning, growing, and developing, and most importantly, avoiding stagnation.

We all know that stagnation leads to disengagement, which can be dangerous for our personal growth and the quality of care we provide. For years, as leaders, we have discussed disengagement—what many have referred to as stagnation. Disengagement was the buzzword for quite a while. However, in recent years, we have seen a new term emerge: "quiet quitting." This refers to employees who show up, do the bare minimum required to keep their jobs, and then check out mentally and emotionally. Unfortunately, this is not limited to respiratory therapy. It is a growing phenomenon across the entire workforce.

A September 2022 Gallup article highlighted this trend. In their poll, 32% of the workforce reported being engaged, which does not sound too bad at first glance. However, 18% admitted to being actively disengaged—a number that has been steadily rising across industries and is now nearing the highest level in over a decade. This trend is expected to continue.

As leaders, both in respiratory care and across other fields, we must pay attention to this growing problem of disengagement, stagnation, and quiet quitting. Combating these issues will clearly require focused time, energy, and effort. This brings us back to the second stage—the proficient stage. It is in this stage that disengagement can creep in, and if we are not careful, it can lead to stagnation.

Third Stage - The Late Part of a Career

The final stage, often referred to as the "late-career stage," presents its own set of unique challenges and opportunities. By this point, respiratory therapists have accumulated a vast amount of knowledge and experience, having witnessed and managed countless situations throughout their careers. These professionals are invaluable assets to any department, as they have likely encountered almost every scenario the field has to offer. Their deep understanding of the profession, combined with their practical know-how, makes them an essential resource for both patient care and the ongoing development of the team.

At this stage, one of our primary goals as leaders is to tap into that reservoir of wisdom and ensure it is passed down to the next generation of practitioners. Late-career professionals often possess insights that cannot be learned in a classroom or found in textbooks—they know the nuances of patient care, how to navigate complex cases, and how to handle the pressures that come with high-stakes environments. Their wealth of experience can help guide newer staff members through situations that may seem overwhelming at first.

However, the challenge lies in finding ways to effectively harness this expertise. We must ask ourselves: How do we engage these seasoned professionals and encourage them to share their knowledge with those at the beginning of their careers? One solution is creating formal or informal mentorship programs that provide late-career therapists with the opportunity to serve as mentors or preceptors. Through these programs, they can pass on their hard-earned wisdom, guiding younger staff members in areas like critical thinking, advanced procedures, and even the softer skills of patient communication and teamwork.

Yet, while it is crucial to tap into their expertise, we also need to be mindful of the physical realities that come with the later stages of a career. Respiratory therapy is physically demanding work, and over time, some may find it harder to keep up with the physical demands of bedside care. It becomes a delicate balancing act—how do we honor their desire to continue contributing while ensuring they are not overexerted?

This requires thoughtful and personalized leadership. We must have open conversations with late-career staff members about what they still want to contribute and where they feel most effective. Some may wish to step back from the physically demanding aspects of the job, such as high-intensity critical care or emergency response, but still want to remain involved in teaching, training, or administrative roles. Others may want to focus on areas where they feel they can make the most impact, such as complex patient cases or new hire orientation.

Finding ways to offer flexible roles for late-career professionals is key. This might mean transitioning them into roles that involve more teaching, quality improvement projects, or protocol development, where they can apply their knowledge without being on the front lines 24/7. By giving them ownership over projects that allow them to use their expertise in meaningful ways, we can help them continue to feel valued and fulfilled, even as their physical role evolves.

Engaging late-career therapists in this way benefits them and strengthens the entire team. When newer staff members see that experienced colleagues are still learning, growing, and contributing in different ways, it sets a powerful example of lifelong learning and adaptability. It also helps bridge the generational gap that can sometimes arise between more seasoned and younger staff members. By fostering intergenerational communication and collaboration, we create a more cohesive and well-rounded department.

Additionally, retaining late-career professionals in mentoring or advisory roles can have a profound impact on department culture. Their leadership—whether formal or informal—instills a sense of continuity, tradition, and pride in the profession. It can be deeply motivating for younger therapists to have the opportunity to learn from someone who has dedicated decades to the field, reinforcing the importance of commitment, perseverance, and excellence in patient care.

Ultimately, managing the late-career stage requires flexibility, empathy, and creativity. It is about acknowledging the incredible contributions these therapists have made throughout their careers and finding ways to continue benefiting from their experience, even as their roles evolve. The goal is to keep them engaged and appreciated while allowing them to shift their focus in a way that suits both their physical needs and professional desires. By doing so, we not only honor their legacy but also ensure that the next generation of respiratory therapists can learn from the best, contributing to a stronger, more resilient profession as a whole.

Career Ladder

As we consider our employees at each stage, we must ask: What is the gold standard for developing our teams? The answer is a career ladder. And regardless of its structure, any effective career ladder must have two essential components.

First, the career ladder must be fluid. Second, we as leaders must be fluid in our approach. Our staff members will move through different stages at their own pace, and we need to recognize and support that. This flexibility is key to fostering continuous growth, no matter what the career ladder looks like.

I would like to share a snapshot of our current career ladder, which is currently under review as we work on making improvements. Essentially, it looks like this: our first level, RCP I, is our "floor care" role. This is typically where new graduates begin their journey. At this stage, we want our therapists to focus on honing their assessment skills—especially the critical "sick or not sick" judgments. We also expect them to utilize our therapist-driven protocols to the fullest extent.

Once they have mastered these skills, they can move up. Here is where that fluidity comes into play—there is no set timeline. For one therapist, this transition might happen in two months; for another, it could take six months. It all depends on their individual growth and development.

Once our therapists have mastered the RCP I level, they advance to RCP II. At this stage, we train them to work in our adult critical care units, including the emergency department. This is where the mandatory portion of our career ladder ends. Our expectation for every new hire is that they at least reach the RCP II level.

As mentioned, I am with Asante Health System in southern Oregon, a three-hospital system. At our regional center, we offer an RCP III level, which branches into specialized areas. Staff can apply to either the Adult Critical Care Specialist (ACC) team or the Neonatal Pediatric Specialist (NPS) team. However, this specialization is available primarily at the regional center. At our two smaller sister hospitals, RCP III might be a leadership role, but those opportunities are limited, making it more challenging for staff at those facilities to reach RCP III.

Recently, we added another level to the ladder for transport therapists, offering further advancement beyond RCP III. Each level—RCP I, II, III, and Transport—comes with its own pay scale. While there is some overlap between them, they remain distinct, which provides a financial incentive for staff to reach the next level. Currently, we have a NICU transport team in place, and we are actively working on developing an adult critical care transport team.

As I mentioned earlier, flexibility is crucial when it comes to career development. Throughout each stage of a career and within each level of the career ladder, our staff members are navigating their personal lives. They may be getting married or divorced, welcoming children, caring for elderly parents, or dealing with health issues of their own. Any of these life events can significantly impact their ability to focus on their own professional development or contribute additional time and energy to the department.

That is why it is important for us as leaders to meet our staff where they are. Understanding their personal circumstances and adjusting our expectations accordingly is key to helping them succeed. I would like to share some examples to illustrate what I mean by "meeting them where they are."

Let me start with my first example. We had a team member on our RCP III NPS transport team who was incredibly passionate about neonatal care, as many neonatal therapists are. Unfortunately, he experienced a partial loss of vision in his left eye, which significantly impacted his depth perception. This loss affected his ability to consistently and successfully intubate neonates—an essential skill for our NPS team.

As heartbreaking as it was for him—and for us as his leaders—we had to make the difficult decision to move him from RCP III back to RCP II since intubation was a critical requirement at the higher level. The challenge for us as leaders was not just addressing the technical aspect but also finding a way to keep him engaged and motivated in his new role. We had to ask, "Now what? What can we do to help you stay passionate and fulfilled as an RCP II?"

It would have been easy—almost understandable—for him to fall into disengagement and stagnation after such a setback. However, through persistent encouragement and support, we worked with him to find new areas where he could contribute. He took ownership of several key projects and gradually re-engaged in his role at the RCP II level. I am proud to say that, despite the challenges, he found renewed purpose in his work and remained engaged until his retirement.

That first example was challenging, but this second example highlights a different kind of situation. We had a new graduate passionate about respiratory therapy and floor care. She was a real go-getter, and we were confident she would quickly rise up the career ladder. She had all the signs of someone destined for success.

However, just as she was transitioning into the RCP II role, life threw her a curveball. She went through a divorce, and the change in her personal circumstances drastically affected her childcare situation. Unfortunately, this meant she could no longer work the bedside hours required in our department. Despite our best efforts to accommodate her schedule with different shifts, none fit her new reality. Ultimately, she had to leave bedside care and step away from the inpatient respiratory therapy department altogether.

We found her a position in our outpatient setting, where the 9-to-5 hours worked much better for her childcare needs. She thrived in that role for the next seven years. Fast-forward to the present—her childcare situation was no longer a pressing concern, and she came to us excited about returning to bedside care. She was ready to return to the work she loved: bedside floor care.

We started her back at the RCP I level, despite her seven years of experience in respiratory therapy, because that time did not directly translate to the career ladder. However, she quickly moved to RCP II, took on a charge therapist role, and eventually expressed interest in joining the Adult Critical Care Specialist (ACCS) team. She applied, was accepted, and is now excelling in that position.

I am thrilled that we brought her back into bedside care, where her passion lies. These two examples highlight how a career ladder must remain fluid, adapting to both the stages of a therapist's career and the life events that happen along the way. This is what makes it a gold standard for developing your team. However, as leaders, we know there are countless approaches and tactics for fostering growth and development in our teams. Here, I would like to share a small snippet of strategies we use to help our staff grow and succeed.

Other Approaches

• A level: Our solution to allowing a staff member to contribute regardless of level
• Obtaining credentials
• Mentorship with leadership
• Teaching opportunities
• Jobs within the system
• Unit councils leading to project/team leadership
• Journal Club
• Leadership training
• Conferences
• Outside education
• Professional development funds

Let me take a moment to explain what we mean by an "A level" because I know it may sound a bit confusing. An "A level" is our solution for enabling any staff member, regardless of their position on the career ladder, to contribute meaningfully to the department. Whether an RCP I or higher, you can take on a leadership role in a project or initiative that benefits the team.

The key is that the contribution must be both meaningful and measurable. it is not enough to say, "I am going to be the best therapist I can be." While That is important, it is not considered an A level contribution. An A level requires taking charge of a project, leading a team, or driving an initiative that has a tangible impact on the department.

The A level also comes with a financial reward. It adds an extra dollar per hour to the staff member's base wage—not just when they are actively working on a project but across the board. This financial incentive, combined with the personal fulfillment of contributing to the department meaningfully, makes the A level especially rewarding for those at the RCP I level and beyond.

In addition to leading projects, obtaining new credentials and taking on teaching opportunities are excellent ways to keep staff engaged and help them avoid falling into that stagnant pool. Offering leadership training, hosting educational conferences, and encouraging outside education are strategies I strongly advocate for. I have seen firsthand how attending conferences can reignite passion and spark creativity in our team members. These events allow them to come back with fresh ideas, eager to share what they've learned with the department and other teams. it is a fantastic way to get those creative juices flowing and keep staff energized and engaged.

Professional development funds are something I want to highlight because I have seen how impactful they can be. Leadership training, obtaining new credentials, or pursuing outside education can sometimes present financial barriers for our staff. Even though these tools are essential for growth, the cost can prevent team members from taking advantage of them.

If your facility offers professional development funds, it can significantly reduce—or even eliminate—those financial barriers. By providing access to these resources, we empower our teams to take full advantage of leadership training, conferences, and educational opportunities. These tools are invaluable in helping our staff continue to grow, develop, and remain engaged in their roles.

Nursing Career Ladder Pathway to Excellence

The career ladder I shared with you, along with these other strategies, is not only relevant to respiratory therapy. As we have already discussed, the issue of quiet quitting is not unique to our field—it affects many departments within the hospital setting, including nursing. These challenges are widespread, and it is important to apply these development approaches across the board to keep our teams engaged and motivated.

Now, let me give you an example of our nursing career ladder, part of a program called Pathway to Excellence. This program operates on a point-based system and is built around six key standards: shared decision-making, leadership, safety, quality, a culture of well-being, and professional development.

The program is structured annually, and nurses are responsible for accumulating and tracking their points, with proof, across at least three of these six standards. Over the course of the year, they must meet a certain point threshold by engaging in activities that fall under these selected standards. This ensures that they stay on track with their professional growth while contributing to the hospital's goals for excellence.

Nurses gather all their points and supporting documentation throughout the year and submit them annually, qualifying for a bonus based on their total number of points. I like this approach for many reasons. In fact, when we were designing our respiratory therapy career ladder, we seriously considered using a point system before ultimately deciding on levels instead.

One aspect I particularly admire about the nursing program is the inclusion of well-being activities. I would love to find a way to incorporate similar well-being components into our respiratory therapy career ladder. I truly believe that prioritizing well-being activities could be a powerful tool in addressing staff burnout. If we could help our respiratory therapists find ways to better care for themselves, it would have a tremendous impact on both their personal and professional well-being.

Guiding the Process

• Quarterly rounding
• Yearly evaluations
• Performance feedback

We have established the stages, the approaches, and the strategies for developing our teams. But how do we guide our staff through these processes? This is where gathering feedback becomes crucial.

One effective method is through quarterly rounding. As leaders, we sit down with our staff members every few months to have a candid discussion about what is working well and what is not. When they bring up issues, we encourage them to also come up with possible solutions. This not only engages them in problem-solving but also fosters a sense of ownership and accountability. What better way to motivate and empower them than by having them contribute directly to the solutions they have identified?

Encouraging staff to take ownership of an issue—whether a minor pet peeve or a significant challenge—is one of the best ways to engage them in meaningful solutions. When they are involved in fixing what bothers them, they feel more invested in the outcome.

Of course, we have the yearly evaluations, where we sit down with staff and ask those often dreaded words: "What are your goals for the upcoming year?" For new graduates, the list is endless—they are bursting with excitement and have 1,000 goals. In those cases, our task is to help them focus on just the top three.

However, this conversation can be much more challenging for the proficient group or those in the later stages of their careers. They may not have as many clear goals, or they might feel less certain about what is next for them professionally.

Often, as leaders, we need to think outside the box when guiding staff through goal-setting, especially for those in the proficient or later stages of their careers. This is where performance feedback becomes essential. Let's break down the two types of performance feedback and how we can apply them effectively, starting with the more challenging one: constructive feedback.

Imagine we are preparing for yearly evaluations, or perhaps we have received consistent, credible feedback about a staff member—let's say, Bob. The feedback indicates that Bob is struggling with his communication skills, something you yourself may have noticed or even experienced firsthand.

So, we sit down with Bob and say, "Based on the feedback we have received, it seems communication is an area where you face some challenges. What do you think? What steps do you think we can take to help you improve in this area?"

My recommendation to Bob might be a specific class, a book, a course, or even a leadership program—because leadership courses often include valuable communication training. There are a variety of tactics we can use, depending on the situation and the person. Ultimately, as leaders, our goal is to inspire Bob to actively work on improving his communication skills. In an ideal scenario, Bob returns excited about his learning. He is eager to share his newfound knowledge with his team, coworkers, and you, creating a win-win situation for everyone involved.

Now, That is constructive feedback, which can be challenging. But when done right, it can lead to real growth. On the other hand, positive feedback is something I love to give. it is a win on so many levels. When I sit down with someone and say, "Paul, I have heard nothing but great things about your knowledge of Nitric Oxide in the NICU," it is an easy, rewarding conversation.

"You have become everyone's go-to person for Nitric in the NICU. How would you feel about taking on a bigger role—maybe providing education on Nitric, handling the supply orders, or even becoming the lead for Nitric in the NICU?" By offering this, not only are you acknowledging Paul's expertise and showing your appreciation, but you're also rewarding him with ownership—something he can truly take pride in, especially in an area where he already excels.

This idea of ownership is key, particularly when discussing creating opportunities for late-career professionals to share their extensive knowledge with younger colleagues. Sometimes, there is a significant generational gap in communication, and you're absolutely right—it can be a challenge. In my experience, bridging that gap often requires leadership guidance on how to facilitate these knowledge transfers effectively.

Absolutely—creating mentorship opportunities is key. Take Deb McFarland, the RT who's been with us for 42 years. She faced challenges with the generational communication gap, but at her core, her heart was always in the right place. She wanted to help others become the best they could be in the critical care units. Once my co-leaders and I encouraged her, we coined the phrase, "Take them under your wing." We empowered her to mentor younger colleagues by teaching them everything she knew.

When Deb had concerns or faced challenges, I would guide her on how to approach the situation—offering suggestions on how to communicate feedback effectively or share constructive input. We also shared examples of how others had successfully navigated similar communication barriers.

I think sometimes it really comes down to offering clear examples and providing guidance rather than taking a completely hands-off approach. It is about finding that balance between generations and helping them communicate effectively with one another. This generational gap can go both ways. Take a new grad, for example—someone who has no patience for anything written on paper because they are used to everything being electronic. It is important to help them understand that while we may not expect them to adopt the paper methods of their mentor, they should still recognize the value of learning from someone who relies on those systems because that person may not trust computers as much.

As their leader, I do not expect them to carry on those practices forever, but I do ask them to absorb as much as they can while being precepted. Utilize the paper method to the best of their ability, and once they are on their own, they can adapt their approach—whether that means going fully digital or leaving the paper behind. it is about helping them see the value in both perspectives and how they can use that to move forward. When we talk about the stages of a career, all our tactics, approaches, and strategies for development ultimately come down to guiding our team in a way that fosters engagement and growth.

Development Is Not a Magic Solution

Imagine we all now have a magic wand at our disposal. Suddenly, no more staffing issues—our staffing crisis, retention challenges, recruitment difficulties, and burnout problems are all solved. Magic wand, the problem is completely resolved? If only it were that simple. Unfortunately, development alone is not the magic solution, as much as I wish it were.

Let me give you a snapshot of where we are right now. Despite all our efforts, approaches, tactics, processes, and policies, our current vacancy rate is 14.8%, and our turnover rate is 6.7%. Development cannot solve everything. It is not the magic answer we wish it could be.

We all know that COVID certainly did not help our staffing situation. In 2020, our vacancy rate was 6.2%. So, while things have worsened, I cannot imagine where we would be today if we had not implemented all these strategies. It makes me even more determined to keep asking: What is next? What else can we learn, improve, and develop to keep moving forward?

Forbes published an article in July 2023 titled Why Personal Development is the Solution to Quiet Quitting—there is that catchphrase again. In the article, they emphasized that to retain top talent, boost productivity, and drive innovation, it is crucial to offer more professional development opportunities for employees. This applies across all industries, not just ours. We are not facing these challenges alone—we are in good company. What is becoming clear is that many industries recognize that developing their teams is key to retaining top talent and attracting new talent. Professional development is an essential part of the solution.

What Are Your Areas of Opportunity?

As we have been discussing, what are your areas of opportunity? Do you have a career ladder in place? If not, what could it look like for your team? It could take the form of a point system, a level-based approach, or other career ladder models. There are multiple versions out there, and if you do not currently have one, I strongly encourage you to do your research.

Explore what is available and consider what might work best for your organization. A well-structured career ladder can make all the difference in developing your team, retaining talent, and fostering growth.

As a leader—often pulled in a million different directions—do you have projects that could be handed off as an A-level project or whatever version you might use? Think about what that could look like for your team. Would it involve a bonus or an increase in wages? What form of recognition or reward would make sense for your facility?

I am sure there is something you could delegate. We all have tasks we could pass on. But the key question is: How would that reward your employee? Would it provide personal recognition, increase engagement, or give them a sense of ownership? Or could it be all of those things plus a financial incentive?

Do you also offer professional development funds? I know that, especially during a financial crisis, like many facilities are facing right now—it can be tempting to cut those funds when trimming the budget. But if at all possible, I urge you not to. The benefits of keeping your staff engaged, learning, growing, and developing far outweigh the short-term savings.

What opportunities exist within your system? Do you have relationships with schools or mentorship programs in place? It is important not to overlook those opportunities. For example, we had a traveler come to our system.

She was a wealth of knowledge, having been a traveler and a respiratory therapist for many years. When she came to our facility, she found that she really enjoyed our therapist-driven protocols and the way we operated. As a result, she decided to join us as a full-time employee. We brought her on as an RCP II, given her level of experience.

Shortly after, she applied for the ACCS team and was quickly successful in securing that role. She thrived in it for some time, but then, as life and career stages shifted, she decided it was time to slow down. She came to us and said she wanted to step back from ACCS and return to an RCP II role. We fully supported her decision.

At that very moment, a job opportunity opened at one of our smaller sister hospitals. It was an RCP II position that included PFT (pulmonary function test) responsibilities, and she expressed a strong interest in it. She wanted more time to connect with her patients and felt this role would allow her to do that.

I am incredibly proud of her because she not only took on the role but quickly developed a passion for PFTs. She helped us further develop our cardiopulmonary program and even launched her own Better Breathers Club as part of that program.

This is a perfect example of how meeting your staff where they are—personally and professionally—can help you retain them, even if it means supporting them in a different role or at a different facility. By staying flexible and listening to their needs, they continue to contribute meaningfully to your system as a whole.

Summary

• Better clinicians
• Recruitment
• Retention
• Ongoing development of your staff is an important part of the solutions to the current  issues facing our profession
•  

We can all agree that when you invest in developing your staff, you will see better clinicians every time. By preventing stagnation, disengagement, and quiet quitting—where someone only does the bare minimum—you're setting your team up to deliver the high-quality care we all strive for. Engaged therapists provide excellent patient care, and That is something each and every one of us on this webinar is committed to. Not only does development improve patient care, but it also helps with recruitment. For example, we serve as a clinical site for a school in northern California, even though we are in southern Oregon.

The school sends its students to us for their NICU rotation, and every time we welcome a new group into our NICU, we introduce them to our career ladder. We show them exactly what we are willing to do to help them become the best respiratory therapist they can be. We always aim to support their growth and development, and we want them to reach their full potential.

Often, the NICU captivates them during their clinical rotation, though we do have a few who gravitate toward ACCS as well. Do they stay with us forever? Sometimes not. Some are only with us for a handful of years. But I take immense pride in knowing that I have played a part in helping them become the best RTs they could be, even if it means they take those skills to another facility—perhaps even one of yours.

I truly believe that when we focus on developing quality therapists, it makes us stronger as a profession. When we have only the best therapists, it benefits all of us. It also plays a critical role in retention. When your staff sees you as a leader, going out of your way to support them—no matter what stage of their career or the career ladder they are on—builds trust and loyalty. By finding ways to utilize each person's skills to their fullest potential, you create an environment where they can be proud of their work every shift.

This is why I am so passionate about the ongoing development of our staff. It is a key part of the solution to the challenges we face in our profession today, from retention to engagement to overall quality of care.

Questions and Answers

What metrics do you use to measure the success of your onboarding process, such as new hire retention and performance?
While I do not have the hard data in front of me, I can share that we closely monitor several key metrics. For new hire retention, we track how long a staff member stays with us and analyze the reasons for their departure when they leave. In terms of performance, we assess where each employee stands during their yearly evaluations, including the goals they set, and evaluate whether we were able to help them achieve those goals in the following year.

How do you account for differences in new hires' backgrounds, such as those from bachelor's programs versus shorter respiratory therapy programs?
We do see clear, measurable differences between new hires from bachelor's programs and those from shorter 14-month programs. In general, bachelor's degree graduates tend to progress more quickly through our career ladder compared to those from shorter programs. The discrepancy is often due to the type of clinical experience they have been exposed to. For example, some graduates from 14-month programs have not performed tasks like arterial blood gas analysis, which can result in a steeper learning curve compared to bachelor's graduates who come in with more hands-on experience.

How do you handle onboarding challenges for new hires who are not familiar with your therapist-driven protocols?
There can be a significant learning curve for new hires who have not worked under therapist-driven protocols, where therapists are responsible for decisions like bronchial hygiene treatments or bronchodilator dosages. Our goal is to get them up to speed with these protocols. However, we recognize that it is not always possible to achieve this with every new hire.

How does having a union affect your ability to move staff through the career ladder?
Having a union can significantly impact how fluidly we can move staff up or down the career ladder. Before our department unionized, we had more flexibility to make those decisions as respiratory leaders. Now, those decisions are more constrained by union agreements.

References

Harter, J. (2022, September 6). Is quiet quitting real? Gallup. https://www.gallup.com

Arruda, W. (2023, July 5). Why personal development is the solution to quiet quitting. Forbes. https://www.forbes.com