Getting Our Mojo Back: Reframing the Way We Recruit and Retain

Editor’s note: This text-based course is an edited transcript of the webinar, Getting Our Mojo Back: Reframing the Way We Recruit and Retain, presented by Angela Saunders, MS, RRT-NPS.

Learning Outcomes

After this course, participants will be able to:

• Identify the problems associated with recruitment and retention.
• Recognize the demands and needs of the Respiratory Therapy profession.
• Discuss potential solutions to any issues regarding recruitment and retention.

Introduction

We are going to talk about recruitment and retention, including a little background on what it is and what it means. We will talk about the current state of hospitals and respiratory therapy as a profession, the problem that we are facing with recruitment retention in our profession as a whole, and some solutions on how to fix that. We will discuss our employees in the organization and how we can focus on them and engage them in their work. Then we will wrap up with the “Us” factor, what we can all do to partner together to make respiratory better for everyone.

Recruitment and Retention

This is a topic that really interests me and is something that I love to focus on. We are experiencing a drought with respiratory therapists in the Cincinnati area and we are building a lot of new hospitals in the area, so there is a huge demand. It has opened my eyes to where some of the struggles are for all the organizations surrounding us. When you look at the data across the nation, this is just not a Cincinnati problem. This a problem everyone faces.

Recruitment

Recruitment is the process of identifying, attracting, interviewing, selecting, hiring, and onboarding employees. We have a responsibility to not only attract people to our organizations, but also to the respiratory profession and to our schools. When you are struggling because your staffing is not well, you have to think this is just not me. This is not just what I am facing every day. If I am not seeing new respiratory therapists start, the other hospitals are not, which means there are not people enrolling in respiratory therapy as a profession in their colleges. We have to fix that.

We also have to remember during the recruitment phase, it is a lot like dating. The attraction stage of recruitment is the most important to create that larger applicant pool. If your organization is not attractive and the profession is not attractive, then people are not going to want to come to your organization. They are not going to want to work with you or even as a respiratory therapist.

If you attract more people and have a larger applicant pool, you can have more diversity in your organization. This also allows the organization to be selective and not just hire anyone. We have to remember that just filling the position is not getting it done. The goal is to have satisfied employees and retain those satisfied employees. We also need to think about diversity as we recruit for our organization, schools, and professions.

Retention

Retention is the ability to keep your employees engaged, motivated, productive, and focused so that they stay. You want to keep the employees that you have invested the time in. You want to keep all the people that work with you so that you do not have staffing shortages and you can provide the best care to the patients that you are serving.

We need to work on our turnover. Sometimes turnover is good. You may have a disgruntled employee that is making everyone else disgruntled, or maybe someone needs to see that the grass is or is not greener on the other side. What you can work on is your avoidable turnover. Those are the employees that you need to take the time to have a stay interview with. It is not just managers that need to do this. The employees can have stay interviews with each other. If one of your peers is having issues and they are not feeling like they fit in, or they do not want to be at work or they dread coming into work, you can talk to them and find out what is working well and what is not working. What should we keep doing? Or what should we start doing? Managers need to take time to have those conversations with those employees to make sure that they stay focused and engaged.

The problem with that is 80% of the staff are those employees that are engaged, but managers oftentimes have about 20% of the people that they spend the most time with because they are the ones that are causing issues or having issues. We really need to focus on that 80% that are engaged to keep them satisfied. We want to create opportunities for them and we really want to focus on recognition. There are so many ways to recognize employees. We will talk about some of those examples later.

Remember, turnover can be good. It might be good for the 20% that you struggle with to go because you can get new staff in and train, mentor, and coach them to be that 80%. An example of this is in my market area, fiscal year 19, there was about a 14% turnover rate. We implemented a lot of changes around here to really engage our employees and create opportunities. We had about 230 employees. The average years of service were about 7.2. The average age of these employees was 37. Now with all the work that we have done, we are down to a 9% turnover rate. I believe some of these good ideas that you guys are going to learn about will work in your organization as well.

Current State of Respiratory Therapy

The current state of respiratory therapy is probably what causes the most problems with us. We are going to talk about some solutions later on, but first, we have to understand the current state and why we are having such a low enrollment in schools. The growth in healthcare is happening at exponential speed. If you have been in the respiratory field for longer than 10 years, you know that the respiratory field has grown tremendously.

The demand for the respiratory therapist grows every day. The respiratory vacancy rate in hospitals continues to grow. The respiratory care job outlook projected by the Department of Labor is to have a 21% growth rate for the next 10 years. That is huge. The average growth rate for all occupations is about 5%, so we are much faster than the average occupation.

There are concerns that are beginning to surface that the respiratory therapy vacancy rate will become a crisis if not addressed in the near term. I think a lot of us are seeing that now due to COVID. Finally, everyone kind of knows what a respiratory therapist is and the importance of us being at the bedside. Hopefully, we can look at the bright side of the pandemic and it will help our profession grow tremendously and help enrollments in our schools.

There is still the supply and demand issue. It does not always match up. This is an ongoing problem for healthcare and the educational system to recruit, train, and graduate new practitioners. One of the issues is the inability to accurately predict future needs. This causes dyssynchrony between the education system and the healthcare system. We are growing faster and we do not have the students. That leads to an imbalance of education and employment. For example, in 1992, for the respiratory care programs, the colleges, and the associate degrees, there would be about 100 applicants every year, and they would select the 20 that would make it. In 2001, they are not even filling up to that 20. The colleges around us have about 10 to 15 applicants each year when they have 20 to 25 spots, we need to fill those spots.

There are numerous articles, recommendations, and guidelines for safe and effective care that have been published by the Society of Critical Care Medicine saying that at least one respiratory therapist should be in every area. We need more RTs due to the acuity of the patients.

The presence of ICU therapists has proven to decrease the ICU length of stays and decrease the ventilator days. For level one, two, and three ICUs, you must have a respiratory therapist and nursing 24/7. We all know that a team of various disciplines working together improves patient outcomes and decreases costs. However, right now we are not meeting that demand. We need to increase our recruitment and work on our retention.

Some states are even starting to have T ratios, just like nursing. For example, in California in the ICU, nursing is one to two max and RT is one to four. The financials even prove the growing need for respiratory therapy. In 2005, Hospital Connect published an article stating that respiratory therapy was the seventh most profitable hospital department in 2001 with a gross margin of 60.7%, according to CMS.

The personal crisis that I am facing right now with the growth in my area has really sparked my interest in recruitment and retention. We even call it RNR where I am from. How do you hire this many employees? How do you get them trained? How do you get them ready to provide safe care? How do we keep the employees we have when there are wage wars going on right next door? I know this is not just a now thing. This is a forever thing. This is one of the most beneficial things we can do as RTs or as leaders to strengthen our profession and continue to provide the safest care for all of our patients. We need to focus on recruitment and retention.

Respiratory Therapy is Everywhere

Respiratory therapists work inpatient and outpatient. We can work on transport teams or doing in-home care. We can work with lung transplants in the pulmonary units with pulmonary function testing, sleep lab, and bronchoscopies. We can work in simulation centers, helping people get ready to take care of patients in real life.

We have many therapists that work with electronic medical records. There are respiratory therapies that we do in schools. Asthmatics really need that follow-up, so respiratory can go out to the schools and check on the patients. They can make sure that they are taking their controller meds and can get them the things they need to be successful at home and keep them out of the hospital.

We provide education that is hospital-based and school-based. We can be in leadership roles, such as managers and vice presidents. We are qualified to do many things in the leadership realm. We are involved in disaster planning and management. We have all seen that this year with COVID and distributing ventilators, teaching people how to use ventilators, and all kinds of other respiratory stuff. We are the experts. If you want to work in research you can do sales for pharma and device. We are liaisons for long-term care facilities and we could also work on quality improvement and data.

The Demands Keep Coming

Every day I hear of new demand for a respiratory therapist. We are being asked to work in physician’s offices because Medicare is now reimbursing for COPD care managers that are respiratory therapists to reduce readmission rates.

What can we do in the outpatient setting? We can do pulmonary function tests (PFTs), office-based spirometry, and CPAP initiation and management. We can also do smoking cessation classes, administer a six-minute walk test, and bronchodilation evaluations and/or administration. These are just a few of the many things that we can do.

There is also a need for respiratory therapists because of the need for increased respiratory support outside the ICU. We are seeing more critically ill patients going to general care units from the ICU. They are taking the sicker patients and putting them in general care areas quicker. We are seeing those critically ill patients and high-flow nasal canulas making their way to general care and other places in the hospital. You need a respiratory therapist to care for those patients as well as the devices.

There are new incentives for doctors to hire a respiratory therapist to work in their office. Our services are covered because we are improving the care of their patients. They need us for transitional care and chronic care management. We understand the discharge process for these chronic diseases, such as COPD and asthma. It is starting with adult care right now, but I am sure it is going to trickle down to pediatrics. Eventually, we are going to lose our hospital respiratory therapists to these jobs because the hours are really nice. They do not have to work weekends or holidays. We have to keep recruiting these employees so that we can keep filling our hospitals with the best respiratory therapists to take care of our patients.

The Problem

Not a week goes by that I do not hear of a new place that wants a respiratory therapist to take care of their patients. The problem with this is marketing. Our profession is just not marketed like other professions. I am going to stick with nursing on this one because that is the one we all see. Does anybody see any billboards, commercials on TV, or hear commercials on the radio asking, do you want to be a respiratory therapist? I know I have not. I see billboards saying, do you want to be a nurse? Do you want to go to this two-year degree school to be a nurse? Or do you want to get a bachelor's in nursing? Do you have another bachelor's degree and want to quickly become a nurse? We have an accelerated program.

Everything is nursing-focused, which is not a bad thing. Nurses are very important as well. Did anybody in their high school have their counselor asked them, do they want to be a respiratory therapist? No, but I am sure when you said that you were interested in healthcare, they said nursing was an option. There are plenty of allied health professions out there that the schools do not even know about to even educate their students and to get them in the right field. You hear about nursing all the time, and I do not want to pick on them, but it is just what people think about when they are in healthcare. How many of you say, oh, I work at X hospital and people say to you, oh, are you a nurse? That is the first thing. You do not hear much about the advertisement of any allied health professions, so we need to fix that.

There is also a low supply of respiratory candidates and they are not very diverse. Everyone has this problem. We have to increase the enrollment, but how? We have to create more opportunities. There is low enrollment in the schools. We need to partner with our schools and we need to start early. Mentor students or have them shadow a respiratory therapist. We have to start when the kids are younger, such as in elementary school and middle school.

We are fighting a competitive market in the competition. Every couple of months I hear that a different hospital is giving a $10,000 or $15,000 sign-on bonus or maybe the hospital next door increases their pay by 25 cents. Then the next closest hospital increases their pay by 50 cents. Now everyone has to keep increasing their pay to attract and retain the employees that they have. I know around here, our hospitals in Cincinnati are very close together so this happens often.

The positions for respiratory therapists are not always attractive to the employees. A lot of times, beginning positions are PM shift or night shift. People think that they deserve days or special treatment or just a day shift Monday through Friday working no weekends and no holidays, but we have to remember that patients are sick all of the time. They are not just sick Monday through Friday, nine to five. They are sick on Christmas. They are sick on the 4th of July. They are sick on Saturday night. We need skilled experts in all the organizations to give them the care that they deserve.

Respiratory therapy is a small family. We have to make sure we work on our reputation and our perception. It is like living in a small town where everyone knows everything. This is going to be a culture change because we need to make decisions to collaborate with our surrounding hospitals and stop competing. We all have to work together to make sure that we are staffed well to take care of our patients. How can we fix this? Leaders do their best to recruit and retain good staff. Sometimes that does not work, especially when we have some big things to tackle.

Diversity

While we are doing all this, we need to think about diversity. We need to realize that there are not a lot of diverse people in respiratory therapy. We also have to remember that a lot of people do not know what we do. According to the Bureau of Labor Statistics (2020), most of the respiratory therapists surveyed were millennials, followed by Generation X.

• Generation Z (1997 and later) - 2.6% (6)
• Millennials (1981-1996) - 57.8% (133)
• Generation X (1965-1980) - 33.5% (77)
• Baby Boomer (1946-1964) - 6.1% (14)
• Traditionalist (1926-1945) - 0.0% (0)

You also have to think about how those employees are going to work. The work ethic is different between generations X and Z, millennials, baby boomers, and the traditionalist. It is very important for leaders to educate themselves on how to communicate and how to get those staff engaged because it is very different amongst those groups. Looking at gender, 78.7% are females and 21.3% are males. We need to increase males that are interested in respiratory therapy as we work on the diversity aspect.

When I was looking through recruitment and retention, my leadership asked me, how are you going to fix the diversity at this organization or in your profession as a whole? There are not really any diverse RT groups on LinkedIn or social media. I searched many social platforms and I asked a lot of people. I reached out to colleges and there is just not that support system. That is something that we can definitely improve on and we need to work on that together. According to the Bureau of Labor Statistics (2020), most of your respiratory therapists are White, about 89.6%. The rest are Black (6.1%), Asian (0.9%), Hispanic (0.9%), and 2.6% are other. While this is close to home for me and not for the entire nation, I want to put it into perspective on what I am facing.

We have a very low candidate pool. We have low diverse enrollment in the respiratory care programs. We have a low number of diverse schools offering respiratory care programs. We have to find ways to fix that. Diversity is very important and everybody needs to have equal opportunity. We have to focus on these places where we are not meeting the need, and we have to get creative on how we are going to fix this and give everyone the same opportunities.

The Solution

Some of the solutions that we have include strategic planning, partnering with human resources, and marketing for your organization and the profession, which includes changing the perception of respiratory therapy. We can also create a pipeline, helping schools’ enrollments and commitment. Another solution is retention, including investments you can make in your staff.

The Strategic Plan

Recruitment and retention should be in everyone's strategic plan because it helps create the buy-in from your senior leadership. If you can create the buy-in, you are going to get more support from the organization for your profession. It is important to first build it into your division's strategic plan, then integrate it into your organization's strategic plan.

We can always be more efficient and do better at retention. Even if you are fully staffed and do not have to focus on recruitment, you can focus on your retention. Having a high level of support makes it easier for you to secure dollars and get the extra support needed for recruitment and retention.

Here is an example of what a strategic plan would look like for a division that needs to create processes to help satisfy division staffing requirements. To do this we have some short-term strategies, long-term strategies, and key metrics.

Short-term strategies. Identify the difference between anticipated demand and forecasted supply. We spoke earlier about how this is extremely difficult because healthcare is growing quickly. Ways you can do this include monitoring your day-to-day productivity, your turnover rate, and the need. As you monitor these things, try to fix them accordingly. Another short-term strategy is to create opportunities for internal staff to become respiratory therapists via cohort programs. You can also create education days for students at the hospital such as lectures, tours, and lunches. Increase awareness of respiratory care as a career option through partnerships with schools in the community. For example, you can have staffed booths at career fairs, provide career information sessions, and offer shadowing opportunities. You can design targeted marketing campaigns for potential nursing school applicants, undeclared undergraduate students, and high schools. Those are short-term strategies that can be done quickly done.

Long-term strategies. Long-term, you want to recruit student respiratory therapists to work as a respiratory therapist technician with a provisional license under a mentor. Most states allow this. Every year, when your students graduate and get their RRT, you have new open positions. You need to recruit before those students vacate so that you can be ready to have your next student become an RRT. Work with the surrounding universities to increase the program enrollment capacity by adding evening and weekend clinicals and classes for non-traditional students. A lot of times they can only take about 25 students because they do not have the clinicals that they can go to. Create growth opportunities in your division to boost RT retention rates. Respiratory therapists can get an associate degree, bachelor's degree, or master's degree. Now there is an opportunity to have advanced practice for respiratory therapy. The problem is there are not as many opportunities within the division so you lose these people to other divisions. Create opportunities in your own area.

Key metrics. These are the metrics that you can measure to see if your strategic plan is working. Check out your respiratory enrollment rate with local colleges. Look at the internal candidate graduation rate, your time to fill open positions, your respiratory therapy retention rates, and your source of hire. As we did this at my agency, what we wanted and what we achieved was a waiting list to work here. We did that until mid-COVID. Now things are a little different and people are scared. This is not an easy profession. The main point I want you to take away is recruitment and retention are ongoing, dynamic, and we have to keep it in our plans and prepare for the future at all times.

Partnering with Human Resources

It is important to partner with your human resources department. The human resource departments in our area do not really go out and recruit. They are not sending text messages to the 7,000 respiratory therapists in Ohio. They are not calling them or sending letters. They are not pounding the pavement. We have to create a team-like approach with our human resources partners to make sure that we are working together to recruit and retain our employees. Working with your talent acquisition specialist or your human resources recruiter is important. It is not all about them and it is not all about you. It is about us so that we can bring value to the team.

Our team has outsourced to advertisement firms. One thing you can do is hire a company to target your social media, specifically what people click. We have all had that happen, where you are talking about how you cannot wait to get a coffee and all of a sudden coffee is on your Facebook or your Instagram. We market for what we call the CCB, or critical care buildings, that are being built around here. These are really hard to fill areas. We have done mailers to different groups. Our Ohio Society for Respiratory Care will not give you the email addresses, but they will send an email out for you advertising your organization to all of their members. Check with your state organization to see if they will do the same.

The AARC is a good partner and they will advertise open positions for you. Another thing we did was a boomerang turnover spreadsheet. For example, I had the managers call anybody that had left the organization over the past five years and talk to them about coming back. We had two people hired from that. Sometimes it is just nice to hear why people do not want to come back so you can change things. Sometimes it is nice to reconnect with those people and reestablish that relationship so they want to come back. You have to have a timeline and you have to have expectations set amongst the group so that everybody knows their role.

As I said, we utilized social media a lot. We highlighted respiratory therapy on the Cincinnati Children's Hospital Medical Center Careers Facebook page. You can work with the marketing department of your hospital to make a respiratory Facebook page if you do not already have one. We made a video and we reached 24,000 people. There were 2,800 people who actually watched the video and we had 49 shares and 125 likes. That was a huge success for us because we had never done that before.

On LinkedIn, we created a pipeline builder to attract candidates. Our audience was RTs in Ohio, Kentucky, Indiana, Illinois, and Tennessee. That was about 7,200 people. We were trying to let all those people around us know that we wanted them to come work for us. We created this with a timeline and expectations so we could decrease our turnaround time to contact candidates and schedule interviews for respiratory therapists and respiratory techs. If there is such a need for us and there are so many open positions, people should not have to wait to be called for interviews. They should be scheduled quickly and in a timely manner. Partnering with our human resources department has helped us make that happen quickly. It is something that you can easily do as well.

Marketing

When I say marketing, I think a lot of people assume costs are associated with this, there are a lot of free things you can do. You can spend money on marketing, but you do not have to. Free things include employees re-posting things on social media. This may be a great news story, a picture, or something about respiratory therapists they want to share it or repost. That is free marketing because your staff is doing it for you.

Another type of free marketing is when employees go to schools. For example, there are about 44 colleges surrounding us. We surveyed our staff and asked if they wanted to help recruit by going to different colleges about talking about the profession of respiratory therapy and working at our facility. You have to find people that are very passionate about the organization they work at as well as the profession to go to these colleges and ramp up the excitement. Our respiratory department and human resources contacted all of the colleges and the managers and staff took time to go visit them. Our human resources department sent us some marketing tools like pamphlets, pencils, and hand sanitizers to distribute when we visited.

Because of COVID, we had virtual meet and greets because we could not go to the schools. Some schools wanted lunch which was a cost, but we did take them lunch and talk to them about respiratory therapy. It was really exciting for the students, as well as the staff, who were so engaged in this. These are the things that you need to do to help retain employees. Not only are you recruiting, but you are retaining the employees you have by creating opportunities and engaging them in their work.

Respiratory therapy is like living in a small town when it comes to word of mouth. Once one person starts talking about how great or how terrible something is, everybody seems to be talking about it. You have to make sure when you are having positive changes in your organization, doing exciting research, or great things happened at your organization that you share that information. There are respiratory therapy videos all over YouTube. You can make your own video and put it on YouTube. Again, work with your marketing and social media teams at your organization.

Another marketing opportunity is to have a photo op. We had the organization’s photographer come in and take pictures of therapists taking care of patients. They were approved to be used and now we use them on our posters. We can use them for any marketing materials, such as pamphlets and flyers. The respiratory therapists and the patients really enjoyed it.

Not every place has the ability to take on role transition students, but when you can do it, it can be very beneficial. There was a time when we could only take about half of the requests, but we made a commitment that we were always going to take 100% of our applicants for role transition or summative. That is the easiest way to recruit an employee when they are here because they want to be ready for school. Then they get a few weeks of orientation. You get to feel that person out and they get to feel you out and you can keep those people as soon as they graduate.

Another great marketing opportunity is career fairs. You can start your career fairs at any age. We start around here at some of the schools in kindergarten. We do a lot of fun things, such as making slime because it represents mucus. All the kindergartners think that is the greatest thing. We talk to them about smoking. We take dolls with tracheostomies in them and let children suction them. We let them ask questions and take that time to teach them about respiratory therapy, such as what to do if somebody is having a hard time breathing. We are a pediatric institution so we do focus on pediatrics. We show children that everybody can be different. Now if they see somebody with the tracheostomy, they know what it is and they are not sitting there staring and pointing. This really helps out everyone. As I said, it is never too early to start.

When those kids are in middle school, it is a good idea to go see them again. That is when they are starting to think about what they want to do, such as healthcare. They might be interested in that again in high school, which is where you really need to spend your time so that you can educate them on what respiratory therapy is. It is great to take a ventilator if you can, with a pig lung, and let people bag it. Another thing you can do is let them look at the ET tubes. You can take a practice head and let them practice intubating. It is all free and it really helps out your organization.

The things that cost are the advertisements. I added up all of our costs from last year. This will help you have a ballpark cost when you talk to your senior leadership. The AARC packages were around $4,000, which included having a booth at their conference. Another conference in a surrounding area cost around $2,000. Advertising on different social media platforms, including LinkedIn, was around 1800. That totaled about $7,800. If you take that number and divide it by the number of employees you hired, you can see if it was worth the cost of advertising. For us, it was. From those advertising methods we got about 20 plus employees. Just remember, there are lots of free things you can do and you have to use your resources and engage your staff.

The top things that most people look for when they are looking for a new place are messaging, organizational reputation, and corporate image. Remember, the attraction phase includes messaging. You have to make sure you are focusing on the organizational reputation and the corporate image. No one wants to go to a place that looks unorganized or like the leadership does not care about their staff.

The employees. You need to change the perception and help the employees understand that they are valued. We need them to help us get new people. Include all of your staff. It does not matter if someone has been here for five years or five days, anybody can help recruit.

Take the time to shoot a video talking about respiratory therapy as a profession and the joy and the fulfillment you have by taking care of patients. That is what people want to see. That is why people go into healthcare. You can put it on YouTube or work with your marketing department and use different social media areas. We like to show our video at the beginning of the year to remind everyone why they are here. Why are we respiratory therapists? What are we going to do? We like to get everybody pumped up before the start of a new fiscal year and just get ready. You can use it internally for retention and externally for recruitment.

As I said, we did a photoshoot. We took pictures of different respiratory therapists doing different things, such as taking care of trach patients, working in the trauma bay, the ICU, and the general care floors. We took pictures of the leadership team at a meeting, working on decisions to support the organization. It was a lot of fun and it was kind of like a party day. Everybody was excited. Everybody did their hair and their makeup and made sure they were their best self. Everybody was really proud of the photos that were shot.

Keep engaging your staff. We are currently working on another video with several different allied health disciplines that we are going to send out to the schools so they can watch them and be educated about respiratory therapy and other healthcare fields. While respiratory therapy is important, there are other people in the world like x-ray techs, audiologists, and speech-language pathologists. We have to remember everybody because we make the team.

Recruitment and Retention Committee

We have a recruitment and retention committee, which I often call R&R. This is something that is very easy to get together. You find people that want to recruit and are excited to be there and get them together. Give them time to have meetings and plan things. We do so much for recruitment and retention and the staff drive this. They are the rock stars. They support leadership by doing many things which make a huge difference helping with our marketing, creating the pipeline, and our retention.

These people are ambassadors for respiratory therapists. They put it everywhere on social media. They go to the schools, talk to their friends and kids about it, and are always doing something. The Flying Pig Marathon is a big marathon in Cincinnati and they work the Flying Pig at the medical tents. That is something fun that they do. They tell people that they are respiratory therapists and they are proud of what they do. We also go to career fairs, which are easy and free.

We have what is called a code lavender, which is a relaxation code. Everybody knows a code blue is an emergency, and we see a lot of emergencies. Sometimes our days are not the greatest when we are at work, and even though we gave it our all, our patients do not make it. Sometimes you see a very sad situation or maybe you are dealing with something in your home life that is just not very good and you just cannot shake it when you get to work. We have code lavender bags that have a little sweet treat in them or a little thing that is comforting like a candle or a pen or anything that could make somebody happy or brighten their day. Any of our staff can give that to another person. We keep them in our division and they can go get them.

Let us say, for example, Susie had a really bad code and her patient did not make it. She just needs a five-minute break. As her peer, you can go get a code lavender bag and give her a five, 10, or 20-minute break so that she can get it together before she goes back to work. We all have those days where we just need a moment. We have to think about each other, supporting each other as one of the keys to retention.

We have a code lavender day which is something you have to organize with your hospital unless you just have these things at your fingertips. Before COVID, we had a room where we lit a bunch of candles to remember all the patients that we lost. We had essential oil lavender in the room. We had sandwiches, cookies, chips, and drinks for them. We had couches so people could come and hang out and relax and take a minute away from their day. We also had massage therapists that work at the hospital come. They donated their time and did 10-minute shoulder and neck massages. The thing people really liked is that we had our child life team bring our therapy dogs. I have so many people that have pictures of the code lavender day and talk about how awesome it was and how they just enjoyed petting the dogs.

Those are really easy things you can do and you can partner with your other groups to see if they would be willing to do something like that for you. We also have “Love the way you ventilate” bags. They work the same way as the code lavender bag. If you catch somebody doing something awesome or they found a safety issue and fixed it before it reached the patient you can give them a celebration recognition bag. Another example is if somebody went home sick and another respiratory therapist took over that whole assignment and just nailed it. We call the bags “Love the way you ventilate” bags. It has a small picture of a man holding up a Mapleson bag on it and it is filled with all kinds of goodies.

We do a lot during respiratory care week and recruit a lot of people to organize different things. We have a coffee bar and have the leadership team walk around and make coffees for all the employees, just like a fancy coffee place. We have an ice cream social which is easy and very inexpensive. We work with our vendors to see if they could come in and do education and bring lunch so that not only can staff get CEUs, but they get lunch.

We go to different conferences and set up booths to talk about respiratory therapy. There is usually a cost to have a booth at a conference. We do special crafty thank-yous that we give to respiratory therapists. When COVID started and it was getting really bad in places like New York and New Jersey, our recruitment and retention team made thank-yous, just to let other therapists know they were not in this alone. We might not be next to you, but we are thinking about you. We mailed them to a bunch of different hospitals. We got a lot of replies, which was awesome.

Because of that, we took it to the next level. In pediatrics, we are not seeing the same volumes of COVID patients as the adult care hospitals, so we made baskets for the 18 surrounding hospitals filled with tons of snacks, drinks, gum, candy, and a big thank you card. We had everybody sign the card and we dropped them off at the different hospitals. That made everybody's day. I got so many phone calls from directors and employees and our Facebook page and Instagram were blowing up. People thought it was great how others were thinking about them because adult RTs really are not getting breaks.

We dropped one basket off at a hospital and the person delivering it said, Oh, this is for nursing. We said, no, this is for respiratory therapy. This is a fun thing that we are doing and we are going to continue to do it. We just want to connect with other organizations and work together and let everybody know that respiratory therapy is awesome.

We have advancement support at our hospital as well. We have clinical ones, clinical twos, and clinical threes. The recruitment and retention committee helps out with advancement and try to get people engaged. We have a Buckeye luncheon for employees that have been at Cincinnati Children's for over 25 years to celebrate them and their years of service.

We do a lot of fundraising so that we can have monies to do these things. We do not get any money from the organization for any of the things that I have mentioned. We have raffles and bake sales, and we sell t-shirts and all kinds of stuff to raise money so that we can keep doing these things. As I said, everybody in your division might not want to do these kinds of things, but you have people that are very passionate about this kind of stuff. Those are the people you need to get on this committee.

We have a kudos box so every time you get a kudos card you can put it in the kudos box and get a candy bar. We have respiratory outings. Right now, we are planning a scavenger hunt for our respiratory therapists and their families. There will be 20 things they have to find and take pictures of and then turn it in. We usually have a picnic in the summertime and a Christmas holiday party, but due to COVID, those have been temporarily canceled. We are a big division and we try to get together as a group, but not everybody comes. We try to make it something to look forward to.

Nursing has the Daisy Award and respiratory therapists constantly got nominated for it, but could not participate in winning the Daisy Award so we developed the Sunflower Award. Every month we have a Sunflower Award winner. Patients and families nominate respiratory therapists and then our recruitment and retention committee picks the winner. The winner gets a cake and they get a sunflower to put on their badge.

We do well-wishes keeping in mind all the people who have lost somebody in their immediate family, are struggling at home, or have gotten sick. We will send well wishes or flowers to them. I know this sounds like a lot, and you are probably thinking that it costs so much money, but it really does not. Your first year doing all the bake sales and other fundraising may seem like a lot of work, but eventually, once you get the hang of it, people will keep coming with new ideas to raise money to be able to do these things. It is really fun to watch all the employees be engaged. It makes them happy to do all these fun things while they are at work.

The Continuous Flow

The other thing you can work on is the continuous flow. Create a pipeline by reinventing the way you recruit and retain employees. By doing this, we can safely care for and meet the needs of all patients. We strategized using our barriers to create opportunities to decrease our open positions for hire for our new buildings and with the end goal to have a waitlist.

We are beginning the education on respiratory therapy in the elementary schools that is creating a pipeline for our continuous flow of future respiratory therapists. It is important to start early so that you do not have that lack. We worked with local respiratory directors in the area and with the surrounding colleges as well. Many times, colleges and organizations will have a cohort for an associate’s to a bachelor's degree.

What we thought would be more beneficial was to get those people that already worked at the organization who were interested in respiratory therapy. We have a cohort for anybody that is interested in respiratory therapy who currently works for us at least halftime (a 0.5 FTE). This program enables current employees to apply to the Associate Degree Respiratory Therapy program at Cincinnati State or UC Clermont, and if accepted, the hospital covers the cost of tuition and fees.  The program will accept up to 20 employee applicants per year who meet the hospital and academic requirements for this program.  Employees must maintain a .5 FTE, have no outstanding disciplinary action, and meet the program’s academic pre-requisites.  Upon successful completion of the program, the employees will take on new roles as an RT within the division of Respiratory Care and will commit to 3 years working there.

We see people that are predetermined for the cohort and then we hire them as either clinical assistants or they can keep their current position. Someone might work somewhere else in the organization then come work for me as a clinical assistant. Those are people that put the equipment together and deliver tanks, or they might have another position in the organization like a surgical tech or an EEG tech or work in the cafeteria or cleaning. We put them into the cohort and then eventually they get their student license. Then we can hire them to be a student tech and work as a liaison, or they can keep their other job. Then we have that respiratory therapist secured for at least three years.

We committed to the 100% role transition placement and have seen a lot of success with it. At our opening meeting, we had more than 300 employees that were interested in going to respiratory school. This year we have six students that have started and they are still all in the program starting their second semester. This has been so successful. The other organizations around us have also implemented the cohort in their organization. Now we are all going to have opportunities for our internal people.

Creating the pipeline cost. I want to put this into perspective because you might not see the benefit of talking to elementary school kids. If you follow them to middle school and high school, you are building a relationship. We offer advice that helps us to give a multifaceted approach and to give our kids a future opportunity, helping to keep them off the street and helping us build trust. We also built a cohort because it helps children you may have talked to in elementary school, middle school, and even in high school. They may have shadowed a respiratory therapist, but do not think that they can go to respiratory school because they cannot afford it, but they still want to work in the hospital. Let’s say they decided they are going to work in materials management. Now they have an opportunity to be a respiratory therapist because we are going to give them the financial means they need to be successful. We also have mentoring to help them with studying and things like that.

Let’s look at the cost of doing this. We have four clinical assistants. Three of them work PRN and one works full-time. I took the market numbers from all the organizations for these, and for those four employees, it costs about $156,000. Those are employees that are working for you, so you are getting a benefit out of that. We have 11 students working PRN as techs which cost about $206,000. The cohort costs $75,000 for the six students for the two-year program. This is a total cost, not an individual.

If you think about the fruits of our labor by fiscal year 21, I am going to have 30 employees that can be respiratory therapists and I only have 20 spots. You might think that that poses a problem. However, there is always turnover. Since making this presentation, I already have additional spots. That is 30 employees that you did not have before, but you opened up your doors. You started that conversation early, so now you are setting yourself up for the future.

Retention and Creating Opportunities

Employee engagement and development are key to retaining your employees. I have talked about that throughout the entire course. When the organization invests in improving the knowledge and skills of its employees, the investment is returned as a more productive and effective employee.

Create opportunities and develop staff. Build on their strengths. If you have a questioning employee, tell them to get involved in evidence-based practice. If you have an employee that definitely knows all the rules, have them get involved with writing policies and guidelines. We all have the person who is the safety police that tells everybody what is safe and what is not. Have them help you with your regulatory stuff. This helps them learn about the organization, but it also gives all these people purpose and leadership skills. Think outside of the box on what your staff strengths are and focus on those.

Socialization

Another key thing is socialization. Socialization and belonging are everything and definitely help with retention. Retention and happy employees equal a decreased turnover. The annual cost of turnover is projected to be about 3.4 to 5.8% of the annual operating budget in healthcare. That is a lot of money. The socialization process, including building strong relationships, establishes our credibility. If this is done correctly, we will increase the effectiveness, satisfaction, and retention of our employees and that is your return on investment.

Take time to sit down with new employees, buddy them up with someone, and start a mentoring program so that they have a mentor through their entire orientation. This does not stop after orientation, it should continue the entire time they are working for you.

The Us Factor

We also have to focus on the us factor. I talked a lot about what we are doing around Cincinnati and in my organization. These are all things that you can take to your organization, but we also have to work together. Even though there might be a different hospital next door, we cannot work against each other, we have to work together.

We need to be transparent about our numbers more so now than ever. Share your open spots with the other organizations. How can you work together to get people interested in respiratory school? We need to connect even if it is just in our states to work together to help the schools improve their enrollment rates.

We need to share our ideas and plans for everything from protocols to best practice, to how to keep employees happy. Share what we are doing for recognition. We all have different ideas and not one idea is better than the other, but we need to share those. We need to continue to be supportive of one another and not competitive.

I think if we do all of these things, we can really increase the recruitment for respiratory therapy as a profession and our hospitals will not be struggling for staffing and will be able to meet the needs of all the patients. If programs and doctors are looking to put us in areas not in the hospital in the future, we are going to have to meet those demands as well. Why not start early?

References

American Association for Respiratory Care Entry Level Requirements to Respiratory Therapy Practice 2030 (2019). AARC. https://www.aarc.org/wp-content/uploads/2019/09/issue-paper-entry-to-respiratory-therapy-practice-2030.pdf

Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Respiratory Therapists, at https://www.bls.gov/ooh/healthcare/respiratory-therapists.htm (Last Modified Date: Tuesday, September 1, 2020).

Mathews, P., Drumheller, L., Carlow, J. J., Assistance of the American Association for Respiratory Care, National Board for Respiratory Care, & Council on Accreditation of Respiratory Care (2006). Respiratory care manpower issues. Critical care medicine, 34(3 Suppl), S32–S45. https://doi.org/10.1097/01.CCM.0000203103.11863.BC

Miller, A. G., Haynes, K. E., Gates, R. M., Zimmerman, K. O., Heath, T. S., Bartlett, K. W., McLean, H. S., & Rehder, K. J. (2019). A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit. Respiratory care, 64(11), 1325–1332. https://doi.org/10.4187/respcare.06626

National Heart, Lung, and Blood Institute. Taking the Science-Driven Approach to Address the Vaping Threat. (December 2019). NIH. https://www.nhlbi.nih.gov/directors-messages/taking-science-driven-approach-address-vaping-threat

National Respiratory Care Week Brings Awareness To Growing Workforce Shortage In Allied Health Care. (October 2006). RT Magazine. https://rtmagazine.com/disorders-diseases/critical-care/national-respiratory-care-week-brings-awareness-to-growing-workforce-shortage-in-allied-health-care/

Strickland, S., Breaking Down Barriers to Professional Growth. Respiratory Care (Oct 2018), 63 (10) 1316-1317; DOI: 10.4187/respcare.06593

Telschow, K. (September 24, 2019). The 5 Stages of Recruiting. Jersey Staffing. https://jerseystaffing.com/

The National Board for Respiratory Care Credential Maintenance Program (Revised Feb 2020).  NBRC, Inc.  https://www.nbrc.org/

Tool Kit for Respiratory (2016). American Association for Respiratory Care. https://www.aarc.org