Recruiting and retaining competent,  dedicated RTs require innovative strategies

Good help is still hard to find. It was that way 5 years ago; it will likely be that way 5 years into the future. The reasons for this dilemma are well known: the existence of too few respiratory therapist training programs, which, combined, mint too few practitioners of the airway sciences to satisfy a growing demand for pulmonary care and related services.

So what is an institution to do to recruit and retain a sufficiently sized, high-quality team of respiratory therapists? If that institution is anything like The Regional Hospital for Respiratory and Complex Care in Tukwila, Wash, it will start by attracting therapists before they officially become therapists.

“We’ve taken the step of affiliating with a community college and serve as that school’s clinical education site for respiratory therapy students. That’s proven to be our best source for recruitment of new employees,” says Donavan Knight, RRT-NPS, respiratory care manager at The Regional Hospital, a long-term acute care facility. “The students—four or five per semester—come here as part of their training, they become intimately familiar with us in the course of receiving training, and then, when they graduate, at least some decide they want to keep working here. We’ve been able to recruit quite a few truly outstanding grads from this program.”

Creative Recruitment
To encourage students from other community colleges and 4-year universities in the area to consider applying for openings at The Regional Hospital, the institution conducts interview and resumé workshops for those who are soon to graduate from those respiratory therapy schools. Attendees receive help putting together an impressive curriculum vitae and learn how to make a good impression when meeting with employment application screeners and decision-makers. “It’s a way to acquaint these other students with us,” says Knight, who oversees a staff of 23 RTs.

The Regional Hospital also recruits by offering bonuses—paid not to newly hired employees but to existing members of the respiratory staff who bring recruits to the attention of human resources decision-makers. “We operate on the theory that employees are the best recruiters of qualified, desirable applicants, so we pay $4,800 to each employee who refers a friend,” Knight says. “The referred friend has to be hired for a full-time position and remain with us for an entire year before the referrer can receive all the money, but, nevertheless, this bonus-paying strategy is advantageous because the only people our employees will refer are those they’re eager to work with.”

Three thousand miles away, at Brigham and Women’s Hospital in Boston, respiratory care director Paul F. Nuccio, RRT, FAARC, last year managed to fill eight of the 10 positions opened up in his expanding 75-therapist department by likewise using creative recruitment strategies. For him, though, the main concern is not so much attracting the applicants as it is making sure the applicants possess the right blend of training, philosophic underpinning, thinking skills, and enthusiasm.

“What I look for in an applicant is not necessarily lots of experience,” Nuccio says. “We value the experience, but we also strongly desire therapists who are open-minded and willing to learn new things. We are a very fast-paced, high-acuity hospital, and we do things a little differently than other places. We are an evidence-based service here, and we do believe that things tend to go better when everyone is on the same page. We see it as crucial that, when we step out into the other clinical areas around the hospital, we  have consistency in the way we perform our procedures.”

Thus, the RT applicants to Brigham and Women’s Hospital most able to command the inside track in the hiring derby are those exhibiting “a positive attitude and who appear motivated, have an interest in research, and seem interested and excited about things that my staff are involved in,” Nuccio divulges. “Strong critical thinking skills are a must. I consider respiratory therapists to be experts at what they do and would hope that they are the ones providing most of the recommendations concerning how to best meet the respiratory needs of the patients.”

Going Home
Anna Chiappetta, RRT, cofounder of 5-year-old Access Respiratory Homecare in Metairie, La, finds the recruitment of top therapists especially daunting, simply because the pool from which she pulls consists almost exclusively of hospital-based RTs—practitioners who in general know little about providing care in a patient’s home. “Among RTs, there is hardly any training offered in home care,” says Chiappetta, who serves as the company’s vice president of clinical services. “Home care requires the therapists to be able to think on their own out on the street, to be well organized, and to be real self-starters. There’s also an element of salesmanship involved, because the therapist is going to have to convince patients that the therapy they’re being placed on will help them and that they need to be compliant with instructions.”

RTs who wave good-bye to hospital work in favor of home care tend to do so in the hope of experiencing greater job satisfaction, Chiappetta asserts. “In the hospital, there isn’t the opportunity to interact with patients to the extent that is routine for us in home care,” she says. “In the home, you have to assess the patient’s entire environment and then tailor therapy to suit how that individual actually lives. You also have opportunities to provide lots more patient education. Therapists who leave the hospital environment feel that they’re able in home care to make a bigger difference in the total well-being of the patient.”

There also is appreciably more freedom. “There is flex-time scheduling, something ideally suited to the environment of home care. You can work a full day one day, followed by a partial day the next to allow for family commitments or to attend to personal needs.” But with great freedom comes a need for great self-discipline. “People who don’t function well in their jobs without being supervised every minute and constantly being told what to do have difficulty thriving in the home care world,” she says.

The trade-off in moving from hospital life to home care is that therapists often must settle for less pay and fewer benefits. There are exceptions, and Access is one of them: Chiappetta says her firm’s salaries for respiratory therapists come close to matching those paid by hospitals in the area. “A therapist who joins us from one of our local hospitals would be making a lateral move as far as income is concerned, especially when you factor in that we reimburse for mileage,” Chiappetta says.

When an RT is hired by Access, a first order of business is to provide that new employee with training in the art and science of home care. That training consists of classroom instruction where various scenarios likely to be encountered in homes are presented. There also are a few hands-on activities to further prepare the recruit for working with patients of all types in the unsupervised setting of the home. After completing the in-class portion of training, the new employee spends several weeks becoming acclimated to home care by accompanying a seasoned staffer on rounds to patient domiciles. Gradually, over a span of 6 to 12 months, the experienced RT hands over to the trainee more and more responsibilities until, finally, the trainee is doing all of the work and the trainer is merely along for the ride, making sure that the new employee genuinely has mastered the lessons. “It takes a long time to develop a good home care RT,” says Chiappetta.

Money Matters
 It is difficult to put an actual dollar amount on the cost to recruit, train, and retain a single therapist in whatever setting one chooses to examine. Many factors—job description specifics, length of time the opening has existed, amount of training that will prove necessary for the individual, etc—greatly complicate the equation. Knight, however, guesses the typical hospital in the Northwest spends at least $30,000 to fill each vacant RT position.

“In my organization, at least, one of the biggest pieces of the expense is having to obtain a temporary worker to pick up the slack during the time the position remains open—typically, about 8 to 12 weeks,” he says. “There’s also the cost of putting ads in the newspaper, staff time consumed with sifting through applications and resumes, the time expended during the interview process, plus the training of the new hire.”

Meanwhile, the intensified demand for respiratory therapists has driven up RT salaries all around the country; and, while the promise of better pay may bring applicants through the door, what keeps them on board is a challenging yet pleasant work environment. “Once they’re on the payroll, what matters most to therapists is how they’re treated by their peers, supervisors, and practitioners in other fields,” Knight says. “Respiratory therapists want to be seen as valued members of the team—and if they feel they are, then it’s more likely they’ll stay with you a good long time.”

Rich Smith is a contributing writer for RT.