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Climbing Up Career Ladders

Career ladders improve recruitment, retention, and patient care

Brad Taylor, BA, RRT, knows the look. Being in the industry for two decades, he has seen the frustration in some therapists' eyes after several years on the job.

"They feel like they've plateaued," said Taylor, manager of adult respiratory care services at the Johns Hopkins Hospital, Baltimore. "The work can occasionally get routine."

A career or clinical ladder may prove vital to reinvigorating a career, and in the process, it improves retention and patient care, he noted. Plus, a department ladder makes a facility an attractive place to work.

"It sets us apart from other hospitals," added Gary Chudow, RRT, director of cardiopulmonary services at St. Catherine of Siena Hospital in Smithtown, N.Y. "It's important to recognize good work. It motivates the employee. You don't have to become an RT
and stagnate."

Making the move
Both facilities, using varying approaches, implemented their ladders more than a decade ago.

Hopkins uses three rungs. At the first level, "you're doing what's required of you, but not much more," Taylor said. "However, as long as they do their job well, I have no problem with that whatsoever. It's totally voluntary."

The next two steps require more initiative, including at least a year of critical care experience. RTs also have to choose a mix of clinical
goals and project work from a "pick list" to earn points.

Six points brings them up to level two; 12 points reaches level three. Some examples are earning the RPFT credential, becoming ECMO certified, participating in National Respiratory Care Week, helping with staff productivity, and performing new product orientation.

On the other hand, St. Catherine's ladder is fairly straightforward. RTs earn an extra $1 an hour if they pass the registry exam, and management is considering additional pay for sleep techs who attain their RPGST, Chudow said.

The hospital also recently implemented a mentoring program. Once therapists complete a special training session, they can orient new employees or work with students. For every hour they do this task, they collect an extra buck.

Make sure the money is there with any ladder, he advised. "If it's just a quarter more an hour, then it's probably not worth
their time."

Building a ladder
When Penny Hoshell, RRT-NPS, MBA, came to Central DuPage Hospital, Winfield, Ill., in 1995, length of service
determined the hourly rate for RTs.

"It didn't seem right that if you were just here long enough - no matter what you did or didn't do - you got paid the same," said Hoshell, manager of respiratory care. "Clearly, there were some people who had the skills, ability, and desire to do more."

That fact proved to be the driving force behind their ladder, and she offers the following advice to departments considering building a program:

  • Plan ahead by aligning with your organization and getting support from administration.
  • Contact HR after obtaining approval from administration to see if there is already a process in place for the creation of a ladder. If not, identify what HR would support.
  • Create a ladder that fits your organization's needs. Identify what adds value to your facility.
  • Get staff input on what they see as the most
  • challenging skills to achieve. What do they think should be rewarded at the highest level?
  • Work with HR to design the ladder in terms of
  • market analysis for pay ranges based on the region and the type of work.
  • Do a quality analysis when implementing the program. This should include clear communication with the staff about how to move up the ladder.
  • Be prepared to revise the program as the facility's needs change. The program must be flexible in order to be sustainable.
  • Going forward, recruit people based on the skill set that you need. 

Contact Mike Bederka at

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