The Science Journal of the American Association for Respiratory Care

2003 OPEN FORUM Abstracts

AGGRESSIVE FLEXIBILITY AND EXPANDING ROLES FOR RESPIRATORY THERAPISTS (RT)

Kris D. Hammel RRT RPFT; Kenneth J. Murry RRT CPFT; Curtis F. Buck RRT CRNA BS; Respiratory Care; Mayo Clinic; Rochester, Minnesota

Background: Until 1992 our hospital, ICU-based Respiratory Care (RC) Department had limited opportunities for staff advancement or involvement in department decision-making. We hypothesized that increased staff participation and more opportunities for advancement would result in increased professional involvement, improved recruitment, lower attrition, and improved job satisfaction. Under new leadership we transitioned from a skilled, workroom based department into one that is flexible, progressive, and provides diverse opportunities for motivated RT staff.

Methods
: Five initiatives were identified to achieve our goal of creating a highly motivated and involved RT staff: 1)Reorganized the department supervisor/staff structure. 2)Created a department committee structure. 3)Created a separate job classification and salary for an advanced practitioner, Clinical Specialist (CS) role with higher level of responsibilities. 4)Aggressively pursued expanded roles and services for RT. 5)Developed internal and external out-reach training and educational programs to improve the visibility of the RT profession. Departmental staff involvement, recruitment, attrition, and measures of staff satisfaction were monitored.

Results
: Restructuring resulted in improved supervisor/staff ratios (1:25-30), allowed more efficient ICU staffing, and facilitated the development of ICU based multidisciplinary teams. The department decision-making process now involves 39 staff therapists. Committees created were Equipment, Practice, Safety, Teamwork, and Recruitment. The CS role provided the foundation to support both professional development and advancement opportunities. The staff now includes 35 CS who have higher levels of responsibilities in such areas as critical care transport, pulmonary research, staff development, and chronic ventilation management. Aggressive pursuit of opportunities for expanded roles and services led to involvement with the following:

Adult/Pediatric Critical Care transport In-patient Pulmonary Rehabilitation
Management and staffing of a Pre-operative Evaluation Center Clinical Critical Care and Anesthesiology Research
PACU full time coverage Percutaneous tracheostomy
Web-programming/Information Services Percutaneous enterostomal gastrostomy
Airway management for ECT therapy Intravenous line placement
General care assessment team Research bone densitometry
GI research endoscopy Advanced research cardiopulmonary testing
Full-time ED coverage Chronic ventilation management


RT now participates in community tobacco education, asthma education, CPR training, career information sessions, mentoring, and provide instruction in general high school and college science courses. High quality educational offerings to the public as well as health care providers involve the RT while enhancing the RC profession. In 1993 with 101 staff the RT attrition rate was 5.0%. In 2002 with 144 staff the RT attrition rate was 2.8%. In 2002 there was a zero vacancy rate. Overall RT job satisfaction as measured by institutional opinion surveys climbed from 57% in 1994 to 81% in 2002.

Conclusions:
Successful expansion of services and opportunities for RT in a large academic medical center has been dependent on diligent proactive volunteering and marketing of the indispensable skill set and flexibility of the Respiratory Therapist. Diverse opportunities facilitate a desirable and professional workplace with implications for retention and recruitment of staff. 

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