Effective Retention Strategies for Clinical Respiratory Therapists

EFFECTIVE RETENTION STRATEGIES FOR CLINICAL RESPIRATORY THERAPISTS

THESIS

Presented in Partial Fulfillment of the Requirements for the Degree Master of

Science in the Graduate School of The Ohio State University

Jefferson Arthur Hunter, B.S.

Allied Medicine Graduate Program

The Ohio State University 2009

Thesis Committee:

Professor Sarah Varekojis, Advisor

Professor Herbert Douce

Professor Kay Wolf

ABSTRACT

Workforce shortages continue to threaten the ability of hospitals to provide proper

staffing to care for their patients. The vacancy rate of respiratory therapists in 2007 was

12.5% and the turnover percentage for respiratory therapists was 14.1%. Respiratory

Therapy Managers want to know the best strategies that retain their employees.

Two survey instruments were used for this study. One was given to clinical staff

Respiratory Therapists and the other was given to managers of Respiratory Therapists.

Both groups were asked questions regarding 17 effective retention strategies.

Managers rated 12 of the 17 strategies as effective and the clinicians rated 15 of the 17 as effective. Nine of the 17 strategies were rated significantly different between managers and clinicians. The most highly rated strategy dealt with compensation.

Comparisons between clinicians showed little differences as did managers. There are small differences between managers with high retention rates and managers with low retention rates.

VITA

2005 …………………………B.S. Respiratory Therapy, The Ohio State University.

2005 – 2006 …………………Respiratory Therapist Clinician, The Ohio State University Medical Center.

2006 – Present …...... Respiratory Therapy Manager, The Ohio State University Medical Center.

PUBLICATIONS

Research Publication

1. Knowles T, Mullin R, Hunter J, Douce H. Effects of Syringe Material, Sample Storage Time,and Temperature on Blood Gases and Oxygen Saturation in Arterialized Human Blood Samples. Respiratory Care 2005;51(7):732-736.

FIELDS OF STUDY

Major Field: Allied Medicine

iii

TABLE OF CONTENTS

Page Abstract ………………………………………………………………………... ii Vita …………………………………………………………………………….. iii List of Tables ………………………………………………………………….. vi Chapter 1 Introduction ...……………………………………………..……… 1 Chapter 2 Literature Review…………………………………………………. 7 Business retention theories and methods ……………………………. 7 Business retention studies…………………………………………….. 9 Nursing retention theories and methods……………………………... 14 Respiratory therapy retention theories and methods……………….. 14 Chapter 3 Methods ……………………………………………………………. 17 Study objectives and research questions……………………………... 17 Design and procedures………………………………………………… 18 Study population ……………………………………………………… 19 Instrumentation and data analysis…………………………………… 20 Chapter 4 Article ………...……………………………………………………. 22 Introduction……………………………………………………………. 22 Methods……………………………………………………………….... 23 Study design and procedures…………………………………………. 23 Study population………………………………………………………. 24 Instrumentation and data analysis…………………………………… 25 Results………………………………………………………………….. 26 iv

Participants …………………………………………………………… 26 Comparisons between managers and clinicians……………………... 27 Clinician comparisons based on demographics……………………… 30 Manager comparisons based on demographics……………………… 33 Manager comparisons based on retention …………………………... 35 Discussion………………………………………………………………. 35 Conclusions…………………………………………………………….. 42 List of references………………………………………………………. 44 Chapter 5 Summary …………………...……...………………………………. 46 Discussion……………………………………………………………… 47 Conclusions……………………………………………………………... 54 List of references……………………………………………………………….. 56 Appendix A Manager Survey .………………………………………………... 59 Appendix B Manager Survey Cover Letter ..………………………………... 62 Appendix C Manager Survey Reminder Letter ….…………………………. 64 Appendix D Clinician Survey……………..…………………………………... 66 Appendix E Clinician Survey Cover Letter ..………………………………... 70

LIST OF TABLES

Page Table 1. Demographic data respondents for survey ………………………… 27 Table 2. Results of t-tests for differences between mean clinician and manager ratings ………………………………………………………………... 29 Table 3. Manager ratings for opportunities/incentives strategies ………….. 30 Table 4. Results of statistical significant chi square for differences in frequency of ratings based on various clinician demographics ……………... 32 Table 5. Results of statistical significant chi square for differences in frequency of ratings based on various demographics ……………………….. 34 Table 6. Results of t-tests for differences between mean manager ratings ... 35

CHAPTER 1

INTRODUCTION

In the ideal workforce setting employees would never leave their job and they would stay with a company until they retire. The workers would devote their career to the organization and never have a reason to leave. However, in the real world this is not the case, employee turnover happens all the time. Employees leave a job for many different reasons. Retaining the best employees is one of the goals of most every organization striving to be successful because the employees are the backbone to a prosperous company.

This is true in the health care setting as well. Workforce shortages continue to

threaten the ability of hospitals to provide proper staffing to care for their patients.

Ohio’s hospitals continue to show vacancy rates in certain health care professions.

According to the Ohio Hospital Association (OHA)1, the field of nursing had a vacancy

rate of 4.6% in 2007. The turnover percentage for nurses in 2007 was 14.8% and has

been on the rise since 2002. The same trends are happening in other health care fields.

Respiratory Therapy also has an increased demand for therapists. The vacancy rate of

respiratory therapists in 2007 was even higher at 12.5%. The turnover percentage for

respiratory therapists was 14.1% and has also been on the rise in recent years. This is

despite the fact that, according to Dubbs2, the number of respiratory therapists in the U.S.

has grown 19% from 111,706 in 2000 to 132,651 in 2005.

The demand for health care workers is not expected to slow down or level off.

Hospitals are continuing to expand, and their need for workers is increasing. More

specifically, with the population of the United States getting older, the demand for

respiratory therapists will continue to rise. The need for respiratory care for these

patients is imperative, and more therapists are needed to deliver this care. According to

the U.S. Department of Labor, job opportunities for respiratory therapists are expected to

be very good in the next 7 years.3 Because of the increasing elderly population,

employment of respiratory therapists is expected to grow faster than average through the year 2014. The Ohio Respiratory Care Board’s 2006 annual report stated that the demand for qualified respiratory therapists continues to be strong.4 In 2006, 3 new

respiratory care educational programs were opened in Ohio in an effort to meet some of

the needs for an increased workforce. However, with the demand for health care workers

growing every day, hospitals must put forth their best efforts to retain their employees

and to reduce turnover.

In addition to the above, the actual respiratory therapy workforce is getting older.

The average age of a respiratory therapist in 2000 was 40 and that number has risen to

44.6 in 2005.2 As the workforce ages, the need to replace workers who retire will grow.

The current rate of new respiratory therapists entering the workforce is not enough to

keep up with the current demand, much less the demands of the near future. This leads to gaps in employee positions and leaves jobs unoccupied.

Another factor that contributes to the increase in demand for respiratory therapists is the fact that certain diseases and health problems that are becoming more common require services specifically from the respiratory therapist. One of these diseases is

Chronic Obstructive Pulmonary Disease (COPD). It has become the fourth leading cause of death in the United States. COPD patients receive care from respiratory therapists on a daily basis. Asthma is another disease that demands care from respiratory therapists. It affects 17 million Americans and every year kills thousands of people.5 The high acuity

of care required by these patients also adds more responsibility and job duties for the

respiratory therapist since advanced treatments and procedures require more time from

respiratory therapists.

The potential end result of not having enough respiratory therapists is a decrease

in the quality of care provided to patients and a decrease in patient safety. Less time

would be spent giving care and the ratio of patients to therapist would increase. To fill in

the gaps of unoccupied positions, current therapists would take on a heavier workload or

provide only basic care for their patients. Unfortunately, one response to the shortage is

for therapists to practice concurrent therapy. Concurrent therapy is defined by the

American Association for Respiratory Care (AARC) as “one therapist who administers

treatments utilizing small volume nebulizers, metered dose inhalers, or intermittent

positive pressure treatments to multiple patients simultaneously”.6 Also called

“stacking”, this way to provide therapy potentially cuts down on the time it takes to deliver therapy. However, the AARC claims that concurrent therapy is dangerous, unethical, fraudulent and can lead to medical and billing errors. Administering more than one therapy at the same time could be harmful to patients if complications to the patient occur when the therapist is not present.

Hospitals are competing against each other for the select number of respiratory therapists available. To retain existing therapists and reduce employee turnover, hospitals need to develop and initiate the best retention practices. There has been some research conducted on how to retain employees in certain job fields. Theories and strategies have been expressed by general business and industry and even in some in nursing as to what works best for those professions. However, little research has been done on retention in the field of respiratory care. It is hard to compare respiratory care to business and industry in terms of retention methods because the hospital setting is different. In addition, comparing respiratory therapy to nursing is also somewhat difficult because the reasons why employees leave and why employees stay could vary between job fields even in health care. Some of the strategies might be the same and some might be different. Since the job fields are different, other types of strategies could work better for retention with respiratory therapists than other employees.

Respiratory Therapists are able to obtain two different credentials. The Certified

Respiratory Therapist (CRT) is the lowest credential and represents a minimum level of competence at beginning practice.7 The Registered Respiratory Therapist (RRT) credential is awarded to those who possess the knowledge, skills and abilities required by

advanced respiratory therapists. The RRT credential has been labeled the Standard of

Excellence in Respiratory Care by The American Association for Respiratory (AARC),

Committee on Accreditation for Respiratory Care (CoARC) and the NBRC. “The RRT

credential is nationally recognized as the highest that can be achieved in respiratory care

and signifies that the individuals who hold it have passed rigorous competency

assessment examinations that measure advanced or “expert” practice.”7 A RRT is one

whose abilities reach far beyond that of a CRT.

There still is a large portion of respiratory therapists who have not obtained the

RRT and do not plan to obtain it. One reason this is true is because most states recognize

the CRT as the minimum requirement to practice respiratory care.8 If the minimum

requirement is only the CRT then why should anyone feel the need to get registered?

Most respiratory departments do not differentiate job duties and responsibilities between

the two different therapists. Depending on where you practice respiratory care there are

differences in pay between the CRT and the RRT. If a therapist worked at a hospital that

didn’t differentiate between the CRT and the RRT there is no incentive to get the RRT

credential. The AARC has been pushing employers of respiratory therapists to show

distinctions between the two credentials. Therapists who hold the RRT credential show

be rewarded and recognized for it.

Along with distinctions between credentials there is also existence between types

of degrees. Obtaining a bachelor’s degree in respiratory therapy is also available. There

are around 60 baccalaureate degree programs in the US that offer the respiratory care

degree and most are academic medical centers.9 Over the years the clinical work of

respiratory care has become more complex. The demand for greater knowledge and

skills of the respiratory therapist continue to grow.

The purpose of this study is to identify what methods, strategies and ideas are

considered effective by hospitals to retain respiratory therapists. The research questions

to be explored include:

1. What retention strategies do licensed respiratory therapists with primary clinical

responsibilities and respiratory therapy department managers in Ohio indicate are

effective?

2. Are there differences between what clinical respiratory therapists indicate are

effective retention strategies and what respiratory therapy department managers

indicate are effective retention strategies?

3. Are there differences in effective retention strategies for clinical respiratory

therapists and for respiratory therapy department managers based on demographic

data?

4. Are there differences in retention strategies used by department managers with high

retention rates and those by department managers with low retention rates?

CHAPTER 2

LITERATURE REVIEW

Business Retention Theories and Methods

In general, most businesses have dealt with issues of employee retention. Some

businesses have had success with retention and some have not. Several theories have been identified that contribute to employee turnover. Kaliprasad10 believes a negative

work environment will lead to employee turnover. Negativity can be contagious and if

people see others being negative they may act in the same manner. This will decrease the

support from all the group members and the end result is everyone is less productive and

tries to get away with as much as they can. If workers are displeased with their

environment then they won’t enjoy coming to work and a downward spiral will be

started. The workers who want to excel at their job will leave for the lack of support

from the others.

When employees performs their jobs, they need to find out how well they are

doing and if their quality of work produced meets the expectations of the organization.

This feedback usually comes from a manager or supervisor of the group. If lack of

feedback or communication from the manager exists then the worker can feel

unappreciated and may potentially leave the organization. Workers need acknowledgement of the contribution they make to the organization.11 In this same sense

managers who do not extend support to workers can make workers feel unvalued and

disengaged. Professionals who do not enjoy interacting with managers produce less work and are less loyal to them. The talented workers might consider leaving if they are not

recognized for the work they produce. People expect some type of reward, whether it is

verbal or material, for a job well done. No matter how big or how small, any kind of

gesture will be appreciated as long as employees are treated like people and believe that

they are valuable both as employees and individuals.

Messmer12 believes a wage that is not comparable with other organizations can be

a contributing factor to employee turnover. Along with wages also come benefits.

Benefits should also be evaluated by organizations to see if they are comparable to

others. Although salary and benefits can play a role in employee turnover, other factors discussed above seem to be more key components.

Critical thinking about employee turnover has led to the development of theories

as to why people stay with their current job. All employees seek to be in a positive and

supportive work environment.9 A positive environment or climate could be one leading

factor that makes employees want to come back to work every day. If workers are going

to be operating in the same climate every day then having a positive one is a must.

Positive environments lead to increased productivity and a more effective organization.

Managers need to be active listeners. Crom13 believes that managers should show sincere, honest attention when listening to their workers. Healthy relationships with staff

are important and need to be maintained. Doing this will allow the managers get to know

their staff better and the factors that motivate and displease their staff. An open

workplace starts with basic practices that can build effective communication.

Communication throughout the organization is the cornerstone to workers who feel fulfilled at their job. Managers who know how to listen can effectively build teams and engage others to produce the best results. The complaints and concerns from employees should not be ignored. Managers should involve employees in decisions instead of dictating. This will use the talents of the employees to help solve problems. Another way to effectively communicate with employees is to show respect at all times. Instead of fixing the blame one someone, a solution should be generated. Effective communication will bring coherence, energy, and tools for improvement for the entire group.

Messmer9 also believes that good employees often look for jobs where they can keep up their skills and knowledge. This would send them looking for a job where they are capable of learning while being employed. Challenging work environments have also been shown to aid in employee retention. This can stimulate the employee, let them grow and keep them interested in what their job duties are.

Business Retention Studies

Along with theories about retention, there have also been some studies conducted to determine what factors contribute to employee retention. Businesses have mission statements. These mission statements help to define an organization and express its values and intentions. The mission statement can also be used as a management tool to

aid in retention of employees. Brown14 looked at mission statements and employee

attitudes towards mission statements. Employees were surveyed from a youth and

recreation service organization. Results showed that both part-time and full-time

employees expressed levels of satisfaction towards mission statements. Two components

of satisfaction were investigated. One was questions about overall satisfaction with the

organization and the other was questions about satisfaction with compensation.

Some businesses will give bonus pay as incentives for worker behavior. This has

been believed to also aid in the retention of the worker. Bonus pay is described as a type

of compensation that is after the fact of the initial base pay. It is also been expressed as a

device to enhance production incentives. Blakemore15 studied male workers in the

management and/or administrative occupation. An analysis model was used to test bonus

pay and base pay. Blakemore’s results show that the average bonus is a powerful factor

in preventing voluntary turnover decisions.

In recent years, organizations have tried to use different pay designs that let

managers decide how much of a pay increase an employee will receive. This requires

managers to use better judgment in distribution of these pay increases. These pay designs

have been introduced to try and capture an employee’s all-around performance. A study

done by Mulvey16 tries to help determine whether these new pay performance approaches are having the expected results. The idea behind this study was to see what kind of employee satisfaction will be produced when the employee is aware of the pay increase and the method used to determine the pay increase. The final results show that managers

need to have better education in the performance pay process. The results also show that

the pay process used to determine the raises is more important to the employee than the

raise itself.

Employers are now giving more awareness to retention and could be considered

the top benefits objective. According to the 2007 Metlife Study of Employee Benefits

Trends17, more than half of employers surveyed (55%) rated employee retention as the

most important benefits objective. Compared to the same study back in 2003, less than

half of employers rated employee retention as the primary benefits objective. Businesses

seem to recognize retention as a problem and are stepping up their benefit plans to do a

better job of retaining their workers. This same study showed a positive correlation

between job satisfaction and benefits satisfaction. 80% of employees who are highly satisfied with their benefits indicated strong job satisfaction. 72% of workers surveyed

indicated workplace benefits as the reason for joining their company and 83% indicated it was the main reason for staying with the company. Employees at different life stages viewed workplace benefits differently when taking a new job. 32% of married employees indicated workplace benefits as a primary reason for joining a company compared to 10% of singles indicated it was a primary reason.

Employee retention and turnover in the RN workforce is similar to that of the general business workforce. However, with the current nursing shortage, greater efforts have been put forth to combat the continuous need for nurses. A recurring element to RN retention is the work environment and conditions where they work. According to Runy18

11 nurses want desirable work environments. This includes safe workplaces and the provision of quality health care. Nurses want a place where they have an active role in shaping the lives of their patients.

Reineck19 explains that nurses are increasingly expressing a desire for a more appropriate workload. Overwhelming workloads where nurses have too many patients produces a negative environment. Heavy workloads make some nurses want to leave the nursing field. According to Cadrain20, nurses should have a say in setting appropriate work levels and reducing mandatory overtime. Sometimes nurses are shifted or floated to another work area to even out staffing. Reineck’s survey indicates that nurses view this as being undesirable for the nurses being floated.

Within the work environment are the inter-relationships among the nursing staff.

Nurses work alongside and next to other nurses during their shift. A study by McNeese-

Smith21 found poor relations between co-workers led to a decreased organizational commitment. Employees felt less committed if they didn’t get along with their co- workers. Some nurses also felt that they did more work than others, which also contributed to a decreased commitment.

All of these instances mentioned can lead to burnout, where nurses feel fed up with working and tired of doing their job. According to Reineck15, a large percentage of nurses reported frustration with their jobs. Their commitment to their employer may remain high, but nurses feel the need for employer interventions to effectively manage the workload. Burnout can also come from the repetitive care provided to the patients.

The redundancy of the work might make the nurse choose to do something else.

Nurse retention strategies have been implemented and emphasized more each

year. Several theories have been identified as to what increases nurse retention.

Jeffries22 explains that the key to keeping good people depends on the individual leaders

and their attitude, knowledge and skills with the people. The reason why the employees

stay is because the managers create a workplace of choice. The workplace of choice by

employees is one that is influenced by their immediate supervisor. The employees do not leave companies, they leave managers. The leaders should make connections with the staff. Listening to your staff is an important way to make connections. This can build confidence and self esteem in your staff. When you have done this, then trust can be made between employees and their leaders. According to Fabre23, nurses have little trust

in the system because so many of them have been burnt by past experiences. Trust takes

a long time to build and if built properly it will bring great rewards.

Since retention of nurses is a must for some health organizations, some

organizations are trying to be more adaptive to the nurses’ personal needs. The study by

McNeese-Smith17 suggests that in order to increase the organizational commitment by the nurse, the employer has to meet the personal home and family needs of the employee.

Extra benefits for the employee that are related to work-life balance can aid in retention.

Hoffman24 explains that hospitals can add child care benefits for the employees that have

to make arrangements for the care of their children while they are at work. Other benefits

can also play an important role in retention. For example, Hoffman describes weekend

13 pay for employees, flex time for nurses with long commutes and tuition reimbursement or assistance as aiding in retention. Any type of extra benefit could be one reason why they employee stays with the organization.

Nurse Retention Theories and Methods

Some of the same values and principles used for retention in the general business field are present in the nursing field as well. Nurses, like any employee, need to feel wanted and respected by their organization. The more they feel appreciated as employees the better the work produced. The work done by nurses may be different when compared to other jobs, but the same relationships between the employer and the employee are desired. Differences in work settings and environments may exist, however some of the same ideas for retaining employees can be applied to all professions.

For example, a common retention strategy is to recognize nurses when they do a good job. They need to be recognized for their meaningful contribution to the organization. Jeffries18 says nurses need to feel appreciated for their competence and accomplishments through formal and informal recognition. Nurses should feel valued and appreciated for what they do. Hoffman20 talks about professional recognition programs as a job satisfier. Clinical ladder programs are popular and do a great job of rewarding the nurses financially while recognizing their clinical skills.

Respiratory Therapist Retention Theories and Methods

Nurses are one of the primary care givers for patients. Another type of care giver is the respiratory therapist. Working conditions, job demands and environments for respiratory therapists mimic those of a nurse. In fact nurses and respiratory therapists

work side by side with one another taking care of the same patients. A few ideas and

concepts for retaining respiratory therapists have been described in the literature.

One reoccurring approach to retention seems to be crafting departments around

training programs that will help retain valuable employees. Investing money, time and

creativity into new employees has been one way to do it. Donnellan25 explains about a

department who uses the Education / Research / Residency Program (ERRP). The

program’s emphasis is on attracting graduate students and older recruits to go through a

10 month customized program that teaches new skills and expands existing knowledge.

An intense orientation program is designed to eliminate stress and anxiety levels of the

newcomers entering the program. Eight months are then spent in intensive care units

such as medical, surgical, cardiothoracic and coronary care ICUs. This is then followed

by 8-weeks learning about special respiratory procedures and new professional topics.

Donnellan21 also describes the assessments that are completed with each student

at the end of the program. The ERRP provides evaluation and feedback to the individuals

who complete this program. The main goal of the ERRP is to recruit and retain the

therapists who experience the program. The goals of both the individual and the medical

center are hopefully met when finished.

Schools for respiratory therapy send students to hospitals to do clinical rotations.

These hospitals can also employ students to work as RTs with a provisional license.

Proctor26 describes retention strategies for hospitals that allow students to work before graduating from respiratory schools. This too is a type of program that teaches and motivates the students who want to become more educated. The students are placed with

15 a mentor and are evaluated on work ethic and professionalism. The mentors will give constant feedback and aid in the evaluation. Recognition of their performance must occur for motivation to take place.

Hiring student respiratory therapists is one strategy many hospitals are using to fill vacant positions at hospitals. Proctor27 describes how hospitals hire students and then place them into full-time positions once they graduate. The students already know the department and feel a sense of belonging and a desire to stay there. Medical centers using this strategy have developed strong ties with local respiratory therapy educational programs.

Keeping staff happy seems to play a big role in retention of RTs. Proctor describes how departments celebrate Respiratory Care Week by having meals, CEU opportunities, and decorated displays detailing staff’s accomplishments, and at one facility, a masseuse visited the department. In addition, keeping staff connected to the profession encourages staff to perform better. Staff are encouraged to become members of the AARC, which encourages networking with peers and keeping up with continuing education requirements.

CHAPTER 3

METHODS

Study Objectives and Research Questions

The purpose of this study was to identify what methods, strategies and ideas are used by hospitals to retain respiratory therapists. The research questions to be addressed include:

1. What retention strategies do licensed respiratory therapists with primary clinical

responsibilities and respiratory therapy department managers in Ohio indicate are

effective?

2. Are there differences between what clinical respiratory therapists indicate are

effective retention strategies and what respiratory therapy department managers

indicate are effective retention strategies?

3. Are there differences in effective retention strategies for clinical respiratory

therapists and for respiratory therapy department managers based on demographic

data?

4. Are there differences in retention strategies used by department managers with high

retention rates and those by department managers with low retention rates?

Design and Procedures

A survey research design was employed to answer the research questions

identified above. Two separate survey instruments were used for this study. One was a

questionnaire (Appendix A) administered online to hospital respiratory therapy

department directors to identify effective retention strategies. The instrument was

administered online through Survey Monkey®, a program designed for collecting data

through surveys. A link to the survey instrument was e-mailed with an accompanying

message (Appendix B). The message ensured confidentiality, explained the importance

of participating and included a due date and contact information for researchers. The

contact was the respiratory therapy department director. If the director was the

appropriate person, they were asked to forward the message to the appropriate person.

Two weeks after the first questionnaire was e-mailed, a reminder (Appendix C) was sent

through Survey Monkey to the non-respondents.

Confidentiality for Survey Monkey is secured through four areas of the program,

including physical, network, hardware and software features.28 The servers are kept in

locked cages with surveillance and monitored staffing 24 hours a day, seven days a week.

Multiple independent connections to Tier 1 Internet access providers and fully redundant

OC-48 SONET Rings in addition to firewall restrictions to all ports except http and https are included in this program. Uptime is monitored every five minutes. The servers have

redundant internal power supplies and are mirrored with failover in less than one hour.

The data is on RAID 10 and the operating system is on RAID 1. The software is coded in

ASP and the latest patches are applied to all operating systems and application files. Data

is backed up every hour internally and every night to a centralized backup system with offsite backups in the event of a catastrophe. De-identified, summary data will be kept in the Respiratory Therapy Division, School of Allied Medicine, The Ohio State University.

The other survey instrument used was a questionnaire (Appendix D) distributed to currently licensed respiratory therapists in Ohio. The questionnaire was accompanied by a cover letter (Appendix E) designed to explain the purpose of the study and to provide instructions for submission. It also contained an explanation regarding confidentiality and listed contact information for the researchers. The questionnaire was given to attendees of a state-wide respiratory therapy conference titled “Current Concepts in

Respiratory Care” held in March, 2008. The questionnaire was included in conference materials disseminated to all attendees at the beginning of the conference. As incentive to participate in the survey, the attendees who turn in their questionnaire received an extra raffle ticket for prize drawings conducted throughout the day.

Study Population

One of the populations in this study is the respiratory therapy department directors of the 177 hospitals included in the Ohio Hospital Association listing. The respiratory therapy division in the School of Allied Medical Professions maintains a database of contact information for department directors. This database was created through personal contact with each of the department directors, and is regularly updated, most recently in

November 2007. The data base lists the address, names, phone numbers and email and postal addresses of all the directors. Duplicate director and manager names were deleted.

The other study population is all respiratory therapists in the state of Ohio with an active license. For the purposes of this study, the attendees at the state-wide respiratory therapy conference will represent a sample of convenience of this population. The organizers of the conference invite all of the approximately 7,240 actively licensed respiratory therapists to attend the conference, and attendance is limited to 600.

Instrumentation and Data Analysis

Survey instruments (Appendix A & D) were developed to address the research questions listed above. Using the instruments, comparisons were made between respiratory therapy managers and practicing respiratory therapists. The survey instruments were developed through careful review of related literature and consultation with respiratory therapists familiar with the area of interest and with survey research.

They included demographic questions, including department size and type of credential, and contained 17 retention strategies identified by the researchers and in the literature.

Respondents were asked to indicate whether or not each of the 17 retention strategies are effective on a strongly agree to strongly disagree Likert-type scale. Numbers were assigned to the SA – SD scale to facilitate data analysis. In addition, respondents were given the opportunity to indicate any additional strategies they believe are effective that are not included in the list.

Data was inputted into a SPSS (Statistical Package for the Social Sciences) database for analysis. Data analysis included descriptive statistics, chi square, and t-tests as appropriate. The alpha level was set a priori at 0.05

CHAPTER 4

Introduction

Retention of employees is a goal of every respiratory therapy department manager. It is also an issue many managers find themselves struggling with in the current heath care climate. An aging population, an aging respiratory therapist workforce, an inadequate number of new therapists entering the workforce, an increasing demand for health care services due to rising incidence of cardio-pulmonary diseases and disorders, and expanding health care facilities all contribute to respiratory therapist workforce shortages.1-3 In 2007 the Ohio Hospital Association reported a 12.5% vacancy

rate for respiratory therapists, a vacancy rate higher than that of nurses.4 As a result,

hospitals are competing against each other for the limited number of respiratory therapists

available. To retain existing therapists and reduce employee turnover, hospitals need to

develop and initiate the best retention practices.

There has been some research published on how to retain employees in certain job

fields. Theories and strategies have been proposed by general business and industry 5-8

and nursing9-13 as to what works best for those professions. However, little research has

been done on retention in the field of respiratory care. The purpose of this study was to 22 identify what methods, strategies and ideas are considered effective by managers and clinicians to retain respiratory therapists. The research questions included:

1. What retention strategies do licensed respiratory therapists with primary clinical

responsibilities and respiratory therapy department managers in Ohio indicate are

effective?

2. Are there differences between what clinical respiratory therapists indicate are

effective retention strategies and what respiratory therapy department managers

indicate are effective retention strategies?

3. Are there differences in effective retention strategies for clinical respiratory

therapists and for respiratory therapy department managers based on demographic

data?

4. Are there differences in retention strategies used by department managers with

high retention rates and those by department managers with low retention rates?

Methods

Study Design and Procedures

A survey research design was employed to answer the research questions identified above. Two separate survey instruments were used for this study. One was a questionnaire administered online to hospital respiratory therapy department directors to identify effective retention strategies. The instrument was administered online through

Survey Monkey®, a program designed for collecting electronic survey data. The contact was the respiratory therapy department director. If the director was not the appropriate

person, they were asked to forward the message to the appropriate person. Two weeks

after the first questionnaire was e-mailed, a reminder was sent through Survey Monkey ®

to the non-respondents.

The other survey instrument used was a questionnaire distributed to currently

licensed respiratory therapists in Ohio. The questionnaire was administered in person to

attendees of a state-wide respiratory therapy conference titled “Current Concepts in

Respiratory Care” held in March, 2008. The questionnaire was included in conference

materials disseminated to all attendees at the beginning of the conference. As incentive

to participate in the survey, the attendees who submitted their questionnaire received an

extra raffle ticket for prize drawings conducted throughout the day.

Study Population

One of the populations in this study was the respiratory therapy department directors of the 177 hospitals included in the Ohio Hospital Association listing. The respiratory therapy division in the School of Allied Medical Professions at The Ohio

State University maintains a database of contact information for department directors.

This database was created through personal contact with each of the department directors, and is regularly updated, most recently in November 2007. The data base lists the names, addresses, phone numbers and email addresses of all the directors. Duplicate director and manager names were deleted, leaving a total of 140 directors and managers in the database.

The other study population was all respiratory therapists in the state of Ohio with an active license. For the purposes of this study, the attendees at the state-wide

24 respiratory therapy conference represented a sample of convenience of this population.

The organizers of the conference invited all of the approximately 7,240 actively licensed respiratory therapists to attend the conference, and attendance was limited to 600.

Instrumentation and Data Analysis

Survey instruments included demographic questions, including department size and type of credential, and contained 17 retention strategies identified by the researchers and in the literature. Respondents were asked to indicate whether or not each of the 17 retention strategies are effective on a strongly agree to strongly disagree Likert-type scale. Numbers were assigned to the SA – SD scale to facilitate data analysis. In addition, respondents were given the opportunity to indicate any additional strategies they believe are effective that were not included in the list. Strategies were considered effective if the combined number of “strongly agree” (SA) and “agree” (A) answer totaled more than 50%.

The 17 strategies were divided into three groups or categories which consist of compensation/perks (C), working conditions/environment (W), and recognition/respect

(R). There were six strategies that were placed into compensation/perks, six strategies from working conditions/environment, and five from recognition/respect. Managers were asked an extra 7 questions based on comments provided on the clinician survey.

These questions were all considered opportunities/incentives (O).

Data analysis was conducted using SPSS ® (version 17, Chicago, Illinois). The alpha level was set a priori at 0.05. T-test comparisons of manager retention strategies and clinician retention strategies were performed using the mean score of the managers

and the mean score of the clinicians. Comparisons were not made using the percentages

of “strongly agree” and “agree” between managers and clinicians.

Clinician ratings of retention strategies were compared using chi square based on

their primary clinical function, years as a practicing therapist, and type of credential.

Manager ratings of retention strategies were compared using chi square based on type of

hospital, size of department, years as a practicing therapist, and years as a manager. Size

of department was determined based on number of budgeted full-time equivalents

(FTEs). Small departments were defined as less than 15 budgeted FTEs, medium

departments were defined as 15-39 budgeted FTEs and large departments were defined as

40 or greater FTEs. In addition, manager ratings of retention strategies were compared

using t-tests based on their retention rates. Low retention rates were defined as less than

87.5% filled FTEs and high retention rates were defined as 95% or greater filled FTEs.

Results

Participants

The clinician survey was distributed to 600 respiratory therapists at the continuing

education conference. After excluding students (n = 94), managers (n = 27), educators (n

= 27), and surveys that were incomplete (n = 4), the usable data totaled 342 and the

response rate was 57%. The respondents had just under 16 years of experience as

clinicians, and 74% were RRT. See Table 1 below for more information.

Of the 177 Ohio hospitals, 140 different directors and managers were identified and retained in the database. Eighty-four of the 140 surveys were returned and 82 were

usable, resulting in a 59% response rate. The respondents had just under 12 years of

experience as a manager, and were responsible for departments with an average of 28

FTEs. Almost all of the managers were RRT. Seventy percent of the managers worked

in community hospitals, 19% in teaching hospitals, 5% in children’s hospitals, and 6% specified “other” as hospital type. See Table 1 below for details.

Clinicians Managers

Surveys sent (n) 600 140 Surveys returned (n) 494 84 Usable surveys (n) 342 82 Response rate (%) 57 59 Years as a clinician (mean 15.9 (10.2) 24.3 (8.51) (SD)) Range (years) 0 – 42 0 - 37 Years as a manager (mean N/A 11.6 (7.88) (SD)) Range (years) N/A 1 - 34 CRT (n(%)) 90(26) 2(2.4) RRT (n(%)) 248(73) 80(97.6) Budgeted FTEs N/A 28.6 (32.7) (mean (SD)) Range (FTEs) N/A 0 – 196 Filled FTEs N/A 27.6 (29.7) (mean (SD)) Range (FTEs) N/A 0 – 164.5

Table 1. Demographic data for survey respondents.

Comparisons between managers and clinicians

Of the 6 compensation/perks strategies included on the survey instrument,

managers rated 5 as effective and clinicians rated all 6 as effective. The most highly 27

rated strategy of all 17 included on the survey was “community equitable salaries” with

mean (SD) scores of 4.35 (.94) for clinicians and 4.70 (.49) for managers. Four strategies

were rated significantly different between managers and clinicians. Three out of four

significantly different strategies were rated higher by clinicians than managers. See

Table 2 below for details.

Managers rated 3 of 6 strategies from the working conditions/environment group

as effective and clinicians rated 5 as effective. The most highly rated strategy in this group was “create challenging work environments” with mean (SD) scores of 4.07 (.92) for clinicians and 4.43 (.65) for managers. Five strategies were rated significantly different between managers and clinicians. Three out of four significantly different strategies were rated higher by clinicians than managers. “Require on-call obligations/duties” was rated the lowest in this group and of all 17 strategies. See Table

2 below for details.

Managers and clinicians both rated 4 of 5 strategies from the recognition/respect

group as effective. The most highly rated strategy from this group was “Provide

additional compensation for advanced credential” with mean (SD) scores of 4.09 (.92) for

managers and 4.13 (1.05) for clinicians. There were no strategies that were rated

significantly different between managers and clinicians in this group. “Require an

advanced credential for continuing employment” was rated the lowest in this group and

was also rated as not effective by managers and clinicians. See Table 2 below for details.

Comparisons between Clinicians and Managers

Managers Clinicians n = 82 n = 383 Retention Strategy/Category % SA Mean (SD) % SA Mean (SD) p and A and A value Compensation/perks Community equitable salaries 98 4.70 (.49) 89 4.35 (.94) .000* Provide annual merit/performance raises 91 4.42 (.78) 90 4.37 (.91) .349 Provide Supplemental/ Bonus/Critical pay 77 3.95 (.99) 86 4.3 (1.13) .009* Provide or fund CEU opportunities 76 4.02 (.97) 86 4.21(1.06) .147 Provide reimbursement of exam fees for 57 3.69 (1.17) 78 3.99 (1.20) .024* earning an Advanced credential Provide paid professional fees 26 2.99 (1.01) 67 3.68 (1.32) .000* Working conditions/environment

Create challenging work environments 93 4.43 (.65) 82 4.07 (.92) .001*

Rotating patient care assignments 79 4.11 (.74) 67 3.80 (1.03) .002*

Policy of controlled / limited workloads/ 54 3.49 (.82) 73 3.89 (1.06) .002* assignments Allow staff self-scheduling option 41 3.29 (1.05) 66 3.76 (1.14) .001* Allow priority work scheduling based on 38 3.05 (1.08) 60 3.59 (1.19) .000* seniority Require on-call obligations/duties 17 2.52 (1.04) 25 2.74 (1.20) .129 Recognition/respect

Provide additional compensation for 79 4.09 (.92) 83 4.13 (1.05) .767 advanced credential Provide clinical ladder opportunities 74 4.04(.93) 73 3.86(1.12) .105 Provide additional job duties/ 72 3.93 (.95) 71 3.82 (1.06) .205 responsibilities for advanced credential Provide same job duties/responsibilities 57 3.37 (1.25) 56 3.54 (1.13) .224 for all credentials Require an advanced credential for 37 3.18 (1.18) 49 3.31 (1.21) .365 continuing employment

Table 2. Results of t-tests for differences between mean clinician and manager ratings. * Statistically significant difference.

Managers rated 5 of 7 strategies from the opportunities/incentives category as effective. The highest rated strategy in this group was “Provide opportunities to participate on departmental/hospital committees” with a mean (SD) score of 4.35 (.55).

Priority unit scheduling and departmental bonus were the only two strategies rated as not effective by managers. See Table 3 below for details.

Manager ratings only Retention Strategy/Category % SA Mean (SD) and A Opportunities/incentives

Provide opportunities for teaching 88 4.10 (.72) Provide opportunities/ rewards for participating in 74 3.91 (.79) departmental or hospital research projects Provide teambuilding activities 78 3.96 (.66) Provide opportunities to participate in RT staff peer 62 3.69 (.90) review Provide opportunities to participate on 95 4.35 (.55) departmental/hospital committees Allow priority unit scheduling 13 2.61 (.82) Offer departmental bonus for years of service 37 3.09 (1.08)

Table 3. Manager ratings for opportunities/incentives strategies.

Clinician comparisons based on demographics

Only a few statistically significant differences were realized based on primary clinical function and years as a practicing therapist in all 3 categories. In contrast, there were six strategies significantly different based on type of credential with five of six from 30 the Recognition/respect category. RRT clinicians rated 3 of 4 strategies from the

Recognition/respect category higher than CRTs. RRT clinicians also rated one strategy from Working conditions/environments higher than CRT clinicians while CRT clinicians rated one strategy from Compensation/perks higher than RRT clinicians. See Table 4 for details.

Clinician Comparisons n = 383 Retention Strategy % SA and A ratings

Primary Clinical Function Acute Diagnostics Pulmonary Long term/ p care Rehab home care value Require an advanced credential 49 59 27 30 .016* for continuing employment (R) Rotate patient care assignments 70 65 42 71 .025* and units (W) Years as a Practicing Clinician 0-10 11-20 years 21-30 years 31-42 years p years value

Provide paid professional fees 58 70 73 61 .024* (C) Type of Credential CRT (26%) RRT (73%) p value Provide same job 84 50 .000* duties/responsibilities for all credentials (R) Allow staff self-scheduling 63 67 .021* option (W) Provide additional compensation 70 87 .001* for advanced credential (R) Provide additional job 53 75 .002* duties/responsibilities for advanced credential (R) Require an advanced credential 31 54 .001* for continuing employment (R) Provide or fund CEU 88 84 .016* opportunities (R)

Table 4. Results of statistical significant chi square for differences in frequency of ratings based on various clinician demographics. * Statistically significant difference.

Manager comparisons based on demographics

Several strategies with significant differences were observed when manager’s ratings were compared based on demographics. “Rotate patient care assignments and units” from Recognition/respect was rated higher by managers of teaching hospitals while “Provide same job duties/responsibilities for all credentials” also from

Recognition/respect was rated higher by managers of community hospitals. Managers with 14 or less budgeted FTEs ranked one strategy from Recognition/respect higher than managers with 15 or greater budgeted FTEs. Managers with 40 or greater budgeted

FTEs ranked one strategy from Working conditions/environment and one strategy from

Recognition/respect higher than managers with 39 or less budgeted FTE. Managers with

21-30 clinical years of experience rated one strategy from Recognition/respect lower than managers with 0-20 or 31-42 clinical years experience. Managers with 0-10 clinical years of experience rated a strategy from Working conditions/environment lower than managers with 11-42 years of clinical experience and rated a strategy from

Opportunities/incentives lower than managers with 21-42 years of experience. The comparisons based on years as a practicing manager showed no significant differences.

See Table 5 for details.

Manager Comparisons n = 82 Retention Strategy % SA and A ratings

Type of Hospital Community Teaching p value

Provide same job 67 44 0.008* duties/responsibilities for all credentials (R) Require an advanced 25 69 0.046* credential for continuing employment (R) Size of Department 14 or less 15-39 budgeted 40 or greater p value budgeted FTEs FTEs budgeted FTEs Provide same job 81 47 33 0.014* duties/responsibilities for all credentials (R) Create challenging work 88 97 100 0.025* environments (W) Require an advanced 19 35 80 0.002* credential for continuing employment (R) Years as a Practicing 0-10 years 11-20 years 21-30 years 31-42 years p value Clinician Provide clinical ladder 75 77 69 76 .007* opportunities (R) Create challenging work 75 96 92 96 .001* environments (W) Offer departmental bonus 50 54 36 20 .008* (O) Provide opportunities for 50 88 96 88 .001* teaching (O)

Table 5. Results of statistical significant chi square for differences in frequency of ratings based on various demographics. * Statistically significant difference.

Manager comparisons based on retention

Managers with low retention rates rated one strategy from Working

conditions/environments higher than managers with high retention rates. See table 6

below for details.

Ratings Based on Retention Rates n = 61 Retention Strategy Low Retention High Retention p value (< 87.5% filled FTEs) (95% + filled FTEs) n = 12 n = 49 Require on-call duties 2.69 (1.12) 2.41 (.98) 0.017* obligations (W) Provide or fund CEU 3.97 (1.09) 4.06 (.90) 0.038* opportunities (C)

Table 6. Results of t-tests for differences between mean manager ratings. * Indicates statistically significant difference.

Discussion

The current study was developed because of the high turnover and vacancy rates

of respiratory therapists in Ohio hospitals.4 Current national trends in respiratory care

indicate similar scenarios. National vacancy rates have also increased and the workforce

shortage continues to get worse.1 Department managers need to develop data-based retention programs in order to hold onto current staff.

This study indicates there are some differences between what clinicians believe are effective retention strategies and what managers believe are effective retention strategies. Nine of the 17 strategies (53%) were rated significantly different between managers and clinicians. However, the actual differences in the mean scores between the clinicians and managers were small. For example, the managers rated 12 of the 17 strategies as effective and the clinicians rated 15 of the 17 as effective, and there were no significant differences between manager and clinician ratings for the five strategies in the

Recognition/respect category. This would indicate that managers and clinicians have the same perceptions about the level of effectiveness for most of the 17 strategies listed. The means in the Compensation/perks category were rated the highest by managers and clinicians. As a whole, clinicians rated the Compensation/perks category as the highest category.

Managers and clinicians agree that providing “community equitable salaries” is very effective. However, the clinicians do not appear to value this as much as managers.

This trend was also seen in some of the general business literature. For example, the study by Mulvey14 showed workers cared more about the pay increase process than the actual pay increase itself. The current study finding follows Mulvey’s results and could indicate that workers do not place as much emphasis on their salaries as managers think.

There were other strategies the clinicians seemed to value more than managers.

The Compensation/perks and Working conditions/environment categories contained the largest number of differently rated strategies. The clinicians seemed to place more value on some of the “perks”, including paying for professional and exam fees and providing

CEUs. In the Working conditions/environment category, clinicians placed more value

on scheduling issues and on controlling workload assignments. This parallels some

findings from the nursing literature. According to Reineck10 and Cadrain11 nurses want more appropriate workloads that do not leave them taking care of too many patients and feeling overwhelmed. These findings indicate that both nursing and RT clinicians place considerable emphasis on ensuring the work environment supports adequate time to provide care to patients.

When looking closer at some of the ratings in the recognition/respect category, there are some interesting potential dilemmas managers may face when developing a retention program. For example, neither managers nor clinicians rated “require advanced credential for continuing employment” as effective. This could be due to the perception that the RRT exam is difficult to obtain, which is reinforced by a 59.8% national pass rate for calendar year 2008 for the Written Registry Exam, and a 56.0% national pass rate for the Clinical Simulation Exams16. In addition, the RRT exam is very expensive and the

cost is $390. This leads to a situation where a policy that directly benefits the department

and aids in fulfilling the mission and goals of the department may compete with the

ability of the manager to retain employees. Clinicians in this study did rate providing

reimbursement for exam fees higher than managers. One way to meet the goals of the

department and to effectively retain employees would be to require advanced credential

for continuing employment but to reimburse exam fees for earning that credential.

Directly related to concepts discussed above, RRTs rated all strategies that

required an advanced credential higher than CRTs. Obviously if you already possess the

RRT credential, requiring the credential for continued employment, and placing value on

the credential in the form of additional compensation and additional job responsibilities,

would be considered an effective retention strategy by the RRTs. RRTs want to see the benefits of their time and effort they put into obtaining the advanced credential. On the other hand clinicians with only the CRT credential would not place emphasis on obtaining the RRT. In fact, only 31% of CRTs that responded to the survey rated requiring an advanced credential for continued employment as SA or A.

The six strategies, “professional fees”, “bonus pay”, “reimbursement of exam fees”, “controlled workloads”, “self-scheduling” and “priority work scheduling” were perceived as effective by clinicians and were rated higher by clinicians than managers.

Managers should focus on these strategies if they want the most desired ways to retain their staff. Some of these strategies are cost effective and would be easy to implement for managers.

The comparison between clinicians and their primary clinical function showed that clinicians who work in pulmonary rehabilitation or long-term care/home care rated

“require an advanced credential for continuing employment” lower than clinicians from acute care and diagnostics. Probably reasons for this difference is that there are a large number of CRTs in this study sample that work in long term/home care. Requiring an advanced credential would mean they would have to take the RRT to receive their advanced credential. Long-term care/home care clinicians may not even benefit clinically from taking the RRT exam, and the exam may not be applicable to the job

38 duties and responsibilities of clinicians who work in long-term care/home care. For example, there are only two questions related to home care on the RRT detailed content outline.16

Clinicians who work in pulmonary rehabilitation rated “rotate patient care assignments and units” lower than the rest of the group. This is probably due to the fact that most pulmonary rehab clinicians are hired to work in rehab. This may explain why they do not place as much value on providing a variety of clinical experiences as a retention tool. This topic would need some further research to find out why clinicians who work in pulmonary rehabilitation view this strategy differently.

Comparisons based on years as a practicing clinician showed that clinicians with

0-10 years and clinicians with 31-42 years rated “provide paid professional fees” lower than clinicians with 11-30 years of experience. This shows that the less experienced clinicians with 0-10 years of experience and the clinicians with the most experience do not value paid professional fees as much. The clinicians with 0-10 years of experience did rate this strategy as effective but just not as much as the rest of the group. Also with less experience, clinicians with 0-10 years might not realize the benefits of a professional association.

The results of the manager comparisons also showed several significant findings.

The main finding from these comparisons was that managers of community hospitals rated two strategies from the recognition/respect category differently than managers of teaching hospitals. Managers of community hospitals likely rated “same job duties” much higher than managers of teaching hospitals because managers of community

39 hospitals likely rely on their staff to perform a variety of duties and to be qualified in all of the services they provide. They allow the same job duties and responsibilities for all credentials because it is necessary to survive. This is likely due to the small number of therapists working in their departments. In our study sample, approximately half of the community hospitals had small departments based on FTEs, whereas approximately 50% of teaching hospitals had large departments. The specialization between therapists is minimal because of the usually small numbers of staff that they have working for them.

The comparisons between the managers with various budgeted FTEs showed similar results to that of the type of hospital comparisons. The departments with the lowest number of budgeted FTEs are probably the community hospitals who have a small number of staff that need to be trained to work in all of the environments in the hospital.

Managers who rated “require an advanced credential for continuing employment” the lowest had the smallest number of budgeted FTEs. This is not viewed as an effective strategy for these managers because they might lose some of their staff instead of retain them.

Managers with 0-10 years as a practicing clinician view the strategy of “provide opportunities for teaching” less important than the rest of the managers. Managers with

11-42 years of clinical experience clearly view teaching opportunities as an effective strategy. Reasons for this result are not obvious and further study would need to be performed. Another strategy that managers with 0-10 years of clinical experience rated lower than the rest was “create challenging work environments”. These managers did rate it as effective, just lower with an average of 75 as compared to middle 90s. There

40 also is not any clear reasoning why this was scored lower by these managers but further research would need to be performed. “Offer departmental bonus for years of service” was just barely rated effective by managers with 0-20 years of clinical experience but managers with 21-42 years of clinical experience gave this strategy much lower ratings.

The results for differences in retention strategies used by managers with high and low retention rates were somewhat unexpected. It was anticipated that there would be more differences between the ratings of managers with low retention rates and ratings of managers with high retention rates. If the managers with the high retention rates had the high rates because of implementing the best strategies then there should be a clear difference between them and the managers with the low retention rates. This result is also disappointing because it would give a better idea as to what strategies to implement.

The high retention managers would be using the retention strategies that were most effective.

The average vacancy rate of our manager sample was 6.3% and the vacancy rate reported by the Ohio Hospital Association was 12.5%. A possible reason for the difference in vacancy rates could be that the managers with low retention rates represented the non-respondents of our survey. Since the vacancy rates of our sample were low, the managers’ perceptions about retention strategies should be credible and reflect good practice.

Although the strategies included in this study are largely under the control of the

RT department manager, there may be other factors that lead to a department with low retention. The hospitals that employees work for may have policies that affect

compensation/perks, working conditions/environments, recognition/respect and

opportunities that lead to job satisfaction. For example, the RT manager is not in control

of retirement or health benefits. These other factors may play a role in whether or not an employee continues to work for that hospital. There may also be factors outside the place of employment that could cause an RT to leave their place of employment. Driving distance, relocation of a spouse, retirement, and personal health reasons all may lead to employee turnover and are out of the control of the manager.

There are several limitations of this study that need to be noted. First, when surveying clinicians, we used the CCRC conference to perform this function. This represents a sample of convenience. Second, as mentioned in the results, the response rates for our clinicians and our managers represent only modest response rates. Third, the managers were asked seven extra retention strategy questions than the clinicians. These seven strategies were only compared between the managers and not between the managers and clinicians. Fourth, managers who attended the continuing education conference may have completed the survey at the conference and not have completed the on-line survey.

Conclusions

In conclusion, managers rated 12 strategies as effective and clinicians rated 15 strategies as effective. There were some statistically significant differences between what managers view as effective retention strategies and what clinicians view as effective retention strategies. However, the actual differences in the means were relatively small, indicating that managers and clinicians by and large have similar perceptions about

42 effective retention strategies. Comparisons between clinicians and their demographics showed little difference and the comparisons between managers and their demographics also showed little difference. There are small differences in retention strategies used by managers with high retention rates and managers with low retention rates.

LIST OF REFERENCES

1. Dubbs, B. By the Numbers. AARC Times. 2006;30(4):37-43

2. Bureau of Labor Statistics. Occupationial Outlook Handbook. Bureau of Labor Statistics, 2008-2009. http://www.bls.gov/oco/ocos084.htm#outlook

3. Ohio Respiratory Care Board. Annual Report FY 2006. Ohio Respiratory Care Board:12 http://respiratorycare.ohio.gov/reports/FY%202006%20Annual.pdf

4. Hospital Workforce. The Ohio Hospital Association. 2007

5. Kaliprasad, M. The Human Factor I: Attracting, Retaining, and Motivating Capable People. Cost Engineering June 2006, Vol. 48/No. 6

6. Management Digest. Journal of Management in Engineering. July/August 1998, 21-23.

7. Messmer, M. Four Keys to Improved Staff Retention. Strategic Finance, October 2006:13-14

8. Crom, M. The New Key to Employee Retention. Leader to Leader, Fall 2000

9. Runy, L. Nurse Retention. The Nursing Organizations Alliance. 2005

10. Reineck, C., Furino, Antonio. Nursing Career Fulfillment: Statistics and Statements from Registered Nurses. Nursing Economics. Jan.-Feb. 2005, vol. 23

11. Cadrain, D. An Acute Condition: Too Few Nurses. HR Magazine. December 2002:69-71

12. McNeese-Smith, D. A Nursing Shortage: Building Organizational Commitment Among Nurse. Journal of Healthcare Management.2001;46(3):173-186

13. Jeffries, E. Creating a Great Place to Work: Strategies for Retaining Top Talent. Journal of Nursing Administration. 2002;32(6):303-305

14. Mulvey, P., LeBlanc, P., Heneman, R., McInerney, M. Study Finds That Knowledge Of Pay Process Can Beat Out Amount Of Pay In Employee Retention, Organizational Effectiveness. Journal of Organizational Excellence. 2002:29-42

15. https://www.nbrc.org/reports/rwservlet?cse_school_score&p_session_ id=266671&p_date_scheduled_begin=01/01/2008&p_date_scheduled_end=12/31 /2008&p_school_code=200167&desformat=PDF&p_security_key=300742.5

CHAPTER 5

SUMMARY

Workforce shortages continue to threaten the ability of hospitals to provide proper

staffing to care for their patients. Minimizing national trends, Ohio’s hospitals continue

to show vacancy rates in certain health care professions. One of these professions is

Respiratory Therapy. The vacancy rate of respiratory therapists in 2007 was 12.5% and

the turnover percentage for respiratory therapists was 14.1% and has also been on the rise in recent years.1 Future predictions of these numbers do not seem to get any better.

Respiratory Therapy department managers continue to try and retain their

employees. The managers want to be sure that they are using the best retention strategies

possible to keep their staff. Research has been done in other businesses and even in other

health care fields such as nursing. However, little research has been done on retention in

the field of respiratory care. The purpose of this study was to identify what methods,

strategies and ideas are considered effective by managers and clinicians to retain

respiratory therapists. The research questions included:

1. What retention strategies do licensed respiratory therapists with primary clinical

responsibilities and respiratory therapy department managers in Ohio indicate are

effective?

2. Are there differences between what clinical respiratory therapists indicate are

effective retention strategies and what respiratory therapy department managers

indicate are effective retention strategies?

3. Are there differences in effective retention strategies for clinical respiratory

therapists and for respiratory therapy department managers based on demographic

data?

4. Are there differences in retention strategies used by department managers with

high retention rates and those by department managers with low retention rates?

Respiratory Therapy managers and Respiratory Therapy clinicians were

separately surveyed. Both groups were asked questions about demographic data and also asked to rate retention strategies based on their degree of effectiveness. Comparisons were made between and among managers and clinicians.

Discussion

The current study was developed because of the high turnover and vacancy rates of respiratory therapists in Ohio hospitals.4 Current national trends in respiratory care