One of the many challenges that respiratory therapy department managers have today is not only hiring the right therapists, but also retaining those excellent employees. It has been estimated that it can cost a hospital more than $60,000 to replace a respiratory therapist, so it is imperative that managers seek to provide a work environment that not only is challenging, but also has an inviting atmosphere in which to work. Although some individuals are interested only in the money, I believe a vast majority of individuals want to work where they are appreciated and needed. Work-related benefits such as medical, dental, and life insurance, etc are often more important and attractive than money, and the ability for RTs to use their professional training, skills, and experience is a very important factor. For these individuals, salary often slips to fourth or fifth place in importance. However, one of the most important ingredients for retaining good employees is high department morale.

Employee Recognition

Berg’s team gathers for RC Week.

I don’t know that I have any magic formula for improving department morale, but I can give you some thoughts on things that we do. Our hospital has an “Employee of the Quarter,” as well as an “Employee of the Year,” and the CEO recognizes three to five employees each year with a “Meritorious Award.” These rewards come with financial benefits, such as free meal tickets for the quarter or a special parking space. Names are placed on a permanent plaque, and the individual’s picture is posted for the quarter or year as the case may be. There is an annual “Employee Appreciation Day,” during which there are nice prizes, good food, etc, provided by our administration. We also have a variety of special activities on Valentine’s Day, Easter, Mother’s Day, Memorial Day, Father’s Day, July 4th, the annual hospital picnic with good food and a dunking tank where the CEO sits upon his perch until …, Labor Day, Halloween (everyone has an opportunity to wear whatever they want as long as it doesn’t interfere with their ability to perform their work), Thanksgiving, and Christmas, and for no reason—”just because” activities.

Within my departments, we also have various activities. For example: At noon every day, all three of my departments have lunch together. I have lunch with them and enjoy the interaction and a variety of discussions. We have a potluck lunch or breakfast on everyone’s birthday. We have a potluck on or for the various holidays, and sometimes we just have a potluck for no good reason except it is Tuesday or whatever. Recently there was a good example of improving department morale; with no notice and no warning, one individual brought in shrimp for everyone, and another individual brought in a couple of cases of sodas just because they wanted to.

Respiratory Care Week Fun

During Respiratory Care Week, we always have a catered lunch for the entire department and I always present an award to every individual. Some awards are: our newest RRT; our newest mother; minuteman/woman of the year; perfect attendance; senior therapist award; greatest recall of RT equations; fastest on his feet; best sense of humor; and so on. A Respiratory Care Week committee picks one or two individuals each year to receive an award as the “Respiratory Care Practitioner of the Year,” which goes to an individual who has gone beyond the call of duty. In 2008, we gave this award to an individual who has been serving his country for 2 years in Cuba and Iraq, and with it he received a gift certificate to a local restaurant, an engraved plaque, a large basket of goodies, an all-expense-paid trip to the California Society for Respiratory Care (CSRC) Convention, as well as 1 year paid dues to the American Association for Respiratory Care (AARC) and CSRC. The names of Respiratory Care Practitioners of the Year are also engraved on a permanent plaque that hangs in the department hallway.

During the year, I write little notes to individuals thanking them for their support, activities, and help. This past winter was especially busy, and I had two full-time people out on maternity leave and for surgery. There were three individuals who stepped up to the plate and said they would work extra hours or whatever I needed; to thank them for their willingness to help, I sent them some wonderful steaks from a well-known company with a thank-you note.

Practitioner of the Year and the youngest RT.

I ask for suggestions on new equipment, new procedures, and new protocols; as a result, we now have equipment that we have never had before. Also, new procedures, such as mini-BAL or blind BAL (bronchoalveolar lavage) and arterial cannulation (art-line or A-line insertion), and new protocols (ventilator bundle and bronchiolitis/RSV protocol) were approved. One staff member suggested some wonderful ideas for rearranging/remodeling our storage room, and another came up with an idea for using various bins to store all of our supplies. Those ideas did not come from me but from my staff. All I did was use my authority as manager to get it done.

I think another thing that has really helped the morale in our department is that we have a ventilator management protocol that allows the respiratory therapist to manage the ventilator from intubation to extubation for all age groups. We also have an RT “assess and treat protocol,” and as I write this article, 75% of the patients who are receiving RT treatments today are on this protocol. How do you think these protocols make my staff feel? Needed and wanted, you bet! Our pediatricians no longer attend C-sections. They can if they wish, but they rarely attend because of their confidence and trust in the RT’s training, skills, and experience. As a result, we attend all C-sections and high-risk deliveries. We just completed an intubation study and determined that respiratory therapists at our facility have an overall intubation success rate of 97% for all age groups. Studies like this not only strengthen the therapists’ confidence, but that of the medical staff as well.

Many years ago, I decided that celebrating an individual’s birthday was important to that individual, and it should be important to us as a team and a department, so I announced that we would celebrate everyone’s birthday in some fashion, if at all possible on their actual birthday, although that can not always be done because of scheduling or requests for days off.

The Fun Committee

As a result of that decision, a self-appointed committee emerged; and these individuals come up with various ideas for birthdays and other celebrations. They decide on a theme for the luncheon and make food assignments and decorate if appropriate. (I had nothing to do with the committee that was created. I just came up with the idea or suggestion, and the staff took it from there.) As mentioned earlier, we all have lunch together every day and we have discovered everyone’s likes and dislikes. As a result, on an individual’s birthday, we usually treat them to one of their favorite foods. For the night shift therapists, we usually have a birthday breakfast. These birthday lunches/breakfasts are either potluck, catered, or fast food. I have one therapist who is currently on maternity leave and expecting a baby; on her birthday, we all got on the speaker phone, and when she answered, the whole department sang “Happy Birthday” to her. She was thrilled that we cared enough to take a moment to wish her a happy birthday. The “party committee” also provided her with a baby-shower lunch and a collection of gifts for the baby and a significant amount of cash to purchase whatever she needed.

A “feast” to celebrate RC Week.

All departments have all kinds of personalities within them, and activities such as these allow everyone to take part and express themselves in decorations and food preparation, as well as ideas for future activities. We have so many of them that everyone has an opportunity to participate and feel that they are part of the team and that their contributions are appreciated. When you add that to the opportunity to make suggestions for improvement in patient care with new procedures, new protocols, new equipment, remodeling or rearranging of the storage room, supplies, or other areas of the department, it promotes a feeling of belonging, being appreciated, needed, and wanted by the entire group. We’re family!

There is seldom a month that goes by that the self-appointed committee, which is composed of anyone who would like to be involved, which seems to be most of my staff, does not decorate the department for some occasion. Everyone gets involved in these fun activities, and most of the time the employees will stop at the dollar store and pick up special napkins or tablecloths for the occasion, which they are willing to donate. On my birthday, my office is often decorated with toilet paper or my car develops black spots or some other decoration. All these activities bring our department together.

Another activity that has grown spontaneously over the past couple of years is a biweekly dinner on Friday evening for everyone except those required to be on duty. I have been invited repeatedly to join them, but I have resisted, as I think it good for my staff to have at least one activity where the boss is not present, and they can be themselves without worrying about what I think of whatever they might be doing. Staff members take turns choosing a restaurant, and then they chitchat about it all week. So, we have fun together at work and even away from work. I think that makes for a nice environment in which to do our jobs.

Roger L. Berg, PhD, RRT-NPS, is manager, respiratory therapy, cardiology, and telemedicine, Ridgecrest Regional Hospital, Ridgecrest, Calif. For further information, contact [email protected].