Respiratory care managers find the best RT recruits often are people they already know.

By Alison Werner

Whether it is an employer’s or an employee’s market, one size does not fit all when it comes to recruiting, hiring, and retaining the best respiratory therapists. Around the country, respiratory care managers must employ proactive strategies to ensure they get and keep the top candidates and the right candidates for their departments.

Increasingly, however, it is not advertising and signing bonuses that bring the best-of-the-best to these RT departments. It is who you know and good old-fashioned word- of-mouth.

“I’ve been here 11 years, and we haven’t had one advertisement in the newspaper, the respiratory care magazine, or AARC, or any of those places, because we get all our [applicants] by referral,” says Scott Reistad, RRT-CPFT, administrative director of the respiratory care department at St Anthony Central Hospital in Denver.

It is the same at the University of California at San Diego (UCSD) Medical Center. “[Our recruitment strategy isn’t] advertising through your publication or through our paper, or even through the Internet,” says Richard M. Ford, BS, RRT, FAARC, director of respiratory services at UCSD. “It’s word-of-mouth [and relationships].”

Partnering Up

Partnerships with local community college and university respiratory therapy programs have proven to be a good source of new recruits for many respiratory care departments. The minute students walk onto the floors to start their clinical rotations, they are no longer just students—they are potential employees.

“I think our number one recruitment strategy is maximizing our relationship with the community colleges and private colleges by ensuring that we’ve got students on-site that we can actually screen through a 3- to 6-month period,” says Ford, whose program partners with one of three San Diego area associate-level RT programs to offer students an externship program.

“That really allows us to see how they function,” says Ford. And then what? “Then [we] entice those folks to stay, excite them to stay.”

Students doing their clinical rotations at Barnes-Jewish Hospital in St Louis are under the same microscope when they walk through the door. “We look at all of them as potential hires,” says Darnetta Clinkscale, RRT, MBA, director of patient care in the respiratory care and rehab department.

Barnes-Jewish hires promising students as equipment techs while they are still completing their RT program. From there, Clinkscale and her staff identify those students they want to hire as RTs upon graduation.

The hospital’s partnership with the college definitely gives these future RTs a leg up on the competition. According to Clinkscale, the ratio of student hires to outside applicants is 60 to 40 at Barnes-Jewish.

But what happens when there are not enough student applicants to fill a vacancy? Respiratory care managers still prefer to know who they are getting before a new hire’s first day.

Making Connections

When Reistad first came to St Anthony’s 11 years ago, he was faced with six vacancies in his department—about 10% of his staff. To ensure he hired the right person for the job, he turned to his staff for help.

“I said, ‘Listen, who do you know in town who is great?’ And then they gave me the names and I called them,” remembers Reistad. “That way we got people who were referred to us, who already had proven skills.”

Reistad believes that hiring the best and the right RTs for those initial vacancies has kept his department’s turnover relatively low ever since. To sustain this track record, he continues to rely on referrals to fill the rare opening in his department.

“I’m in a unique situation in that I have a department of 55, and we just had our first turnover in 2½ years. And so by the time we had that opening last month, I had 50-some applicants already on file,” says Reistad.

And who were those lucky 50 applicants? They were students or agency staff who came through St Anthony’s at one time or another and impressed Reistad’s staff.

“If you wow my staff, and my staff comes and lobbies for you, then when a position comes available, I call those people,” he says.

Build It and They Will Come

If all else fails, some respiratory care managers will take matters into their own hands to ensure the right person joins their staff.

“We’ve always had a program of grow your own, if you will, where we look within the organization at people who are looking for a second career and/or entry level positions, and then support them to go to the junior college with the commitment of working for us after completing [the program],” says Clinkscale.

She admits, however, that this strategy is partially out of necessity. “I have to grow my own in order to get them. I’d much rather hire experienced therapists. But I also prefer hiring a student that we can grow and develop [over] hiring people who are moving around place to place and don’t have the background that we’re looking for and we think we need.”

On those occasions when Reistad has been unable to find the right candidate among the students or agency staff working at St Anthony’s, he has taken a highly proactive approach.

“I know it’s maybe a social faux pas to actually call up and directly market and try to get people to come to my organization. And other directors have called me on the carpet and said, ‘What do you think you’re doing? These are my great employees,’ ” recalls Reistad. “And I said, ‘Listen, if they’re even interested in coming to my department, that means they’re not as happy as they could be in your department.’ “

To console his competitors, Reistad reminds them that they now have the opportunity to hire someone who would love to work in their respiratory care department. And he admits, it’s a two-way street.

“I am more than happy to have [my competitors] call any of my staff and do [their] dangdest to recruit them,” he adds. And should that employee chose to leave, Reistad looks on it as a good thing for both the departing employee and his department.

“If they leave, I will be happy for them because they are going to have a great opportunity and I’ll be happy for me because I’ll get an opportunity to hire someone who is going to be happier because they want to come here versus leave,” says Reistad. “That’s a hard concept for people to grab onto.”

Still, Reistad is wary of actively recruiting. “If a [manager] has to ‘go out and recruit,’ in my opinion, they’re not doing their job in leadership optimally. If you do your leadership job optimally, it’s more like ‘If you build it, they will come,’ ” he says. “If you establish an extraordinary department, the word gets out and people apply because they want to be part of a world class department.”

Putting Your Best Face Forward

The value of a respiratory care department’s good reputation when recruiting can’t be denied. And this good reputation is intrinsically linked to a department’s ability to retain its staff.

While many departments rely on rewards and perks like tuition reimbursement and bonuses to keep morale high and turnover low, Ford prefers a different approach. To make UCSD a place where his staff of 115 RTs want to stay, Ford focuses on giving his staff the time and resources to do their jobs right; keeping lines of communication open and engaging his staff in the department’s decision-making process; and investing in the continued development of their skills through opportunities to earn CEUs via on-site seminars or small scholarships to attend off-site seminars or to take exam prep courses.

Reistad’s 26 years of leadership experience in the RT field helped him develop a shared expectations strategy for him and his staff. In return for his staff’s promise to do quality work, maintain a positive attitude, and act as professionals, Reistad promises his staff that he will be honest, give them information, treat them equally, be available, and support them. For the last 3 years, Reistad’s department has had the highest staff satisfaction scores at St Anthony’s, and he gives much of the credit to these shared expectations.

A Moment For Reflection

Turnover, however, is a reality of every hospital’s day-to-day operations, regardless of how great a place it is to work, and it will impact the department and its staff.

“Anytime you have turnover, and bring in a new person, the entire dynamics of your team has to be reinvented,” says Reistad. “The more consistent you can have your people, the more consistent you can have the results that you desire.”

And whenever the turnover is the result of an employee looking for a better opportunity elsewhere or letting go of an employee who didn’t fit, often some self-reflection is in order.

“When I’ve got a quality respiratory therapist … [who] leaves, I look on it as a failure of management,” says Ford. “You have to step back and say did we fail this person somehow? And if we failed this person, are we failing someone else in the department?”

Getting the Job

So what are respiratory care managers looking for when a position opens up? While an applicant’s degree and credentials will get them through the door, that’s not what will get them the job.

“The only technical question I ask you is this one: are you certified or registered. All the other questions have to do with teamwork, positivity, empathy, quality, things like this,” says Reistad.

“What I’ve found is that … if you tell me you’re certified-registered, I know that you’re competent in the basic skills of respiratory care. The specific machinery that I have at my organization and/or specific policies I have at my organization, I can teach you those things providing that you’ve proven your competence on passing one of those exams,” he adds. “What’s difficult for me to do is to teach you how to be nice, to be positive, to be a team player, to be empathetic to the patients.”

Looking Ahead

There’s no doubt that there is a RT shortage nationally. But RTs looking for positions in Denver and San Diego will have to put their best face forward to get a job as these regions currently have a large applicant pool from which to draw.

“I’ve got 150 resumes on file right now, which is outrageous,” says Ford. “I’ve been doing this for a long time. Typically, you have got 10 openings and three people applying; that’s the way it was 5 to 10 years ago. But in the past 3 to 5 years, we have been flooded with applicants.”

In Denver, Reistad says the numbers are equally daunting for job seekers. “The degree of turnover in Denver is astonishingly low,” he says. “There are new grads from last fall, last summer, who can’t get a job.”

Speaking to a local RT school recently, Reistad shared this harsh reality with the students. “I said, [the job outlook for RTs] is awesome, but here’s the problem: it’s not in Denver. You’ve got to go somewhere [else] because for whatever reason, the hospitals have had their turnovers decrease.”

Despite these surplus pockets, the field will need more RTs to enter the profession to stem the current shortage nationally and to keep pace with future demands on respiratory care departments as the Baby Boomer bubble bursts. The US Department of Labor’s Bureau of Labor Statistics already forecasts 21% employment growth for respiratory care therapists from 2008 to 2018.

And while concern lingers about whether enough RT training programs exist to meet future staffing needs, respiratory care managers face a more serious hurdle: attracting people to the profession.

“Everybody knows what a nurse is, what an x-ray tech is, what a lab tech is. Unless you have respiratory difficulties, you don’t even know we exist,” says Reistad. “We have an identity crisis. People don’t know who we are.”


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