An analysis of needs for respiratory therapists in northeast Ohio and development of strategies to meet increased recruitment demands

BACKGROUND: The 2005 American Association for Respiratory Care Human Resources Survey suggested that the national demand for respiratory therapists (RTs) exceeds the supply. At the Cleveland Clinic an expected hospital expansion of 350 beds by 2008 has increased the need for RT staff. This report describes a strategy by which we developed a plan, in concert with local RT colleges, to recruit RTs. METHODS: Local RT managers were surveyed regarding demand for RTs. We developed a recruitment plan, based on discussions with RT program directors. RESULTS: The survey data and models estimated an annual mean of 33.4 new positions in northeast Ohio. Despite the fact that approximately 84 people graduated from northeast Ohio RT programs yearly in 2004 to 2007, the growth in demand for RTs exceeded the estimated supply. The main factor that caused RT schools to limit the supply of RTs was the paucity of clinical sites. Our analysis shows the schools could achieve a 40% increase in student output, and that if the Cleveland Clinic could essentially double its graduate hires, all RT staff needs in our hospital would be met by 2010. CONCLUSIONS: To assure a needed supply of RTs, this work shows the value of modeling supply and demand scenarios, coupled with surveying local RT leaders and fostering dialog between local RT leaders in hospitals and colleges. The product of this activity was a strategy for achieving recruitment goals while assuring that other regional demands for RTs are also met. We recommend this approach to colleagues facing similar challenges.     

The impact of a respiratory therapy consult service on house officers' knowledge of respiratory care ordering

BACKGROUND: Although available studies show that implementation of respiratory care protocols by respiratory therapists can enhance the allocation of respiratory care services, concern has been expressed that respiratory therapists' involvement in assessing patients and in determining treatment plans may detract from medical trainees' education and experience in ordering respiratory care services. OBJECTIVE: Compare the rates of correct responses to case-based questions about respiratory care ordering in two groups of internal medicine house officers at academic medical centers: one group training at an institution using respiratory care protocols (The Cleveland Clinic Foundation) and the other group training in an institution at which respiratory care protocols have not been used (University of Nebraska). DESIGN: Prospective cohort study. SETTING: Two academic medical centers, one using respiratory protocols and the other not using respiratory care protocols. MEASUREMENTS: Percent of correct responses to questions regarding respiratory care management posed in 5 case studies administered to both groups. RESULTS: Responses were available from 41 and 17 internal medicine house officers at The Cleveland Clinic Foundation and University of Nebraska, respectively. Respondents represented postgraduate years one, two, and three, and constituted a similar percentage of all internal medicine house officers at each institution (33%). The rate of correct responses to the 20 questions posed in the 5 case studies was high overall (76.8%) and similar in the two house staff groups (77.2 +/- 11.6% at The Cleveland Clinic Foundation and 75.8 +/- 12.0% at University of Nebraska, p = 0.69). The 95% confidence interval for the difference straddled zero (-5.4%, 8.1%), making it very unlikely that any important difference exists between the two groups in rate of correct responses. Analysis of covariance also showed no difference between groups, suggesting that postgraduate training level did not affect this conclusion. In one of the 5 case studies, the percent of correct responses was higher among trainees where respiratory care protocols were in use (86.8 +/- 18% at The Cleveland Clinic Foundation vs 69.1 +/- 14% at University of Nebraska, p = 0.0001). CONCLUSIONS: In this comparison of internal medicine house officers' knowledge regarding respiratory care ordering at institutions using versus not using respiratory care protocols, the rates of correct responses by both groups were similar and unlikely to differ significantly. For one of the 5 case studies, respondents from the institution using respiratory care protocols scored significantly higher. Taken together, these results suggest that use of respiratory care protocols implemented by respiratory therapists does not detract from internal medicine trainees' expertise in respiratory care management. Whether these results generalize to other institutions or reflect expertise in actual practice remains uncertain.     

Staff training and computers in respiratory care

The respiratory therapists' (RTs') knowledge base is among a hospital's greatest assets. RTs routinely use advanced medical technologies and must understand the patient's physiology, anatomy, and condition to deliver safe and effective treatment with those technologies, especially within critical care environments. Also RTs often must educate patients and patients' families, which requires thorough understanding of the operation of medical equipment. RT education must include both tacit and explicit knowledge, so RT education can be complex, which may present challenges to clinical educators. RTs must have continuing education, and computer-based education can help meet education challenges, promote safe and effective patient care, improve patient outcomes, and improve employee satisfaction, which may improve RT recruitment and retention, while decreasing the cost of staff training. However, since computer-based education is relatively new to health care, RT educators should learn from other industries that have extensive experience with computer-based staff education.     

Utilizing simulation technology for competency skills assessment and a comparison of traditional methods of training to simulation-based training

BACKGROUND: The respiratory care department of one campus within our health system evaluated simulation-based medical education for training and competency evaluation of the mini bronchoalveolar lavage (mini-BAL) procedure, with an emphasis on patient safety and procedure performance standards. METHODS: Training and competency evaluation occurred in 4 phases. In phase one, 24 staff respiratory therapists (RTs) were randomly chosen and individually underwent a simulation-based test of their mini-BAL performance, using a patient-simulator mannequin. Their performance on this test reflected the effectiveness of traditional training methods. In phase two, 83 staff RTs were given unlimited access to a Web-based curriculum on mini-BAL, including a video of a mini-BAL. They then took 2 tests: one online Web-based test, then a patient-simulator test. In phase three, the same 83 RTs attended a workshop that used the patient simulator for training and practice, then were re-evaluated with the patient-simulator test. Phase four was another simulator-based re-evaluation, 90 days after phase three, to study skills retention. RESULTS: The mean scores were: phase one 73 +/- 10%, phase two 77 +/- 11%, phase three 95 +/- 5% (p < 0.01), phase four 92 +/- 8%. CONCLUSION: Our results suggest that employing simulation technology within a comprehensive departmental program can enhance staff training.     

Educational technology integration and distance learning in respiratory care: practices and attitudes

INTRODUCTION: Educational technologies have had an important role in respiratory care. Distance learning via postal correspondence has been used extensively in respiratory care, and Internet-based distance learning is now used in the training of respiratory therapists (RTs), clinical continuing education, and in baccalaureate degree and higher programs for RTs and educators. OBJECTIVES: To describe the current scope of respiratory care educational technology integration, including distance learning. To investigate online research potential in respiratory care. METHODS: A probabilistic online survey of United States respiratory care program directors was conducted on educational technology practices and attitudes, including distance learning. A parallel exploratory study of United States respiratory care managers was conducted. RESULTS: One-hundred seventy-seven (53%) program directors participated. One-hundred twenty-eight respiratory care managers participated. For instructional purposes, the respiratory care programs heavily use office-productivity software, the Internet, e-mail, and commercial respiratory care content-based computer-based instruction. The programs use, or would use, online resources provided by text publishers, but there is a paucity. Many program directors reported that their faculty use personal digital assistants (PDAs), often in instructional roles. 74.6% of the programs offer no fully online courses, but 61.0% reported at least one course delivered partially online. The managers considered continuing education via online technologies appropriate, but one third reported that they have not/will not hire RTs trained via distance learning. Neither group considered fully online courses a good match for RT training, nor did they consider training via distance learning of comparable quality to on-campus programs. Both groups rated baccalaureate and higher degrees via distance learning higher if the program included face-to-face instruction. Online distance-learning participatory experience generally improved attitudes toward distance learning. There was a good match between manager RT expectations in office-productivity software and program instructional practices. CONCLUSIONS: Educational technologies have an important role in respiratory care. Online distance learning for baccalaureate and higher degrees in respiratory care is promising. Online distance learning in respiratory care must include face-to-face instruction. Distance-learning deployment in respiratory care will require resources. A follow-up probabilistic survey of United States respiratory care managers is needed. Online surveys conducted for respiratory care are promising, but neither less expensive nor easier than conventional means.     

Changing patterns of inpatient respiratory care services over a decade at the Cleveland Clinic: challenges posed and proposed responses

INTRODUCTION: Changing characteristics of hospitalized patients over the last decade have created challenges for all health-care providers in delivering optimal care. In the specific case of respiratory care, trends that hospitalized patients have generally become sicker over time and that average lengths of stay have generally become shorter have posed the challenge of meeting demands for more services delivered with greater immediacy. We undertook the current analysis to assess how the delivery of respiratory care services at a tertiary-care academic medical center, the Cleveland Clinic Foundation Hospital, has evolved over the decade 1991 to 2001. In this observational study, we examined concurrent departmental trends and speculated that the capability to increase clinical activity with maintained or improved clinical outcomes, preserved costs, and a lower turnover rate among respiratory therapists reflects features of the professional environment within our Section of Respiratory Therapy. METHODS: This analysis compares patterns of respiratory care service delivery in two 5-year intervals: from 1991 to 1996 and from 1996 to 2001. Data were collected using a respiratory care information-management system and an inpatient hospital information system, which track the volume and actual cost of services provided. These analyses accounted for the actual time-based cost of the services, including labor (with benefits), necessary equipment and supplies, medications, and equipment maintenance and depreciation. Hospital case-mix index values were determined according to guidelines from the Centers for Medicare and Medicaid Services, as the weighted average of resource allocation scores assigned to diagnosis-related-group categories of hospitalized patients. RESULTS: From 1991 to 2001, there were important expansions in the scope of respiratory care practice by our Section of Respiratory Care, while the volume of respiratory care services delivered per year increased 1.96-fold (from 339,600 to 665,921 services/y). The number of respiratory therapy consults performed yearly, beginning in 1992 when the service was first implemented, rose to over 10,000/y by 2001. At the same time, the cost of respiratory therapy services delivered per patient decreased by 4.2%. Regarding staffing trends, the number of full-time-equivalent employees increased by 50% (from 65 to 97.5). However, the percent turnover rate among respiratory therapists decreased by 2.3-fold (from 11.5% to 5%). In the face of these trends, the hospital mortality rate for patients with diagnosis-related group 088 (high users of respiratory care services) decreased by 53%, and the length of hospital stay for all patients receiving respiratory treatments decreased by 30%. CONCLUSIONS: This analysis shows that trends of growing demands for respiratory care services have been accompanied by generally improving clinical outcomes and favorable retention of respiratory therapists in our section. We believe that a focus on the process of care, including enhanced professionalism, communication, and participation, has permitted a favorable response to these rising demands.     

儿科门诊护士工作家庭冲突对离职意愿的影响

目的 ：了解儿科门诊护士离职意愿、工作家庭冲突现状,并分析工作家庭冲突对离职意愿的影响,为儿科护士离职的预防及干预提供一定参考。方法：采用工作家庭冲突问卷及离职意愿问卷,对山东省13家三级甲等综合医院的243名儿科门诊护理人员进行调查。结果 ：儿科门诊护士的工作家庭冲突总均分为（2.31±0.58）分,有47.7%的护士离职意愿较强。Logistic回归分析显示年龄、加班时间、基于压力的冲突、基于行为的冲突是儿科门诊护士离职意愿的影响因素。结论 ：儿科门诊护士受工作家庭冲突影响,离职意愿较高,医院应针对儿科门诊工作特点采取措施减轻工作家庭冲突,降低儿科门诊护士的离职率。     

Wheeze detection in the pediatric intensive care unit: comparison among physician, nurses, respiratory therapists, and a computerized respiratory sound monitor

OBJECTIVE: To correlate wheeze detection in the pediatric intensive care unit among staff members (a physician, nurses, and respiratory therapists [RTs]) and digital recordings from a computerized respiratory sound monitor (PulmoTrack). METHODS: We prospectively studied 11 patients in the pediatric intensive care unit. A physician, nurses, and RTs auscultated the patients and recorded their opinions about the presence of wheeze at baseline and then every hour for 6 hours. The clinician auscultated while the PulmoTrack recorded the lung sounds. The data were analyzed by a technician trained in interpretation of acoustic data and by a panel of experts blinded to the source of the recorded data, who scored all tracks for the presence or absence of wheeze. The degree of correlation among the expert panel, the staff, and the PulmoTrack was evaluated with the Kappa coefficient and McNemar's test. The determinations of the expert panel were taken as the true state (accepted standard). RESULTS: The PulmoTrack and expert panel were in agreement on detection of wheeze during inspiration, expiration, and the whole breath cycle; in all cases the Kappa coefficients were 0.54, 0.42, and 0.50 respectively. The PulmoTrack was significantly more sensitive than the physician (P = .002), nurses (P < .001), or RTs (P = .001). However, the specificity of the PulmoTrack was not significantly different from that of the physician, nurses, or RTs. CONCLUSIONS: Between the physician, RTs, and nurses there was agreement about the presence of wheeze in critically ill patients in the pediatric intensive care unit. Compared to the objective acoustic measurements from the PulmoTrack, the intensive care unit staff was similar in their ability to detect the absence of wheeze. The PulmoTrack was better than the staff in detecting wheeze.     

PracticeCALM: Coaching Anxiety Lessening Methods for Radiation Therapists: A Pilot Study of a Skills-Based Training Program in Radiation Oncology

PracticeCALM is an 8-week on-the-job training program to teach radiation therapists (RTs) techniques for assisting patients who are experiencing treatment-related anxiety. Twelve clinical RTs in a regional oncology program were recruited on a volunteer basis to participate in the training. A mixed-method approach was undertaken to evaluate perceived benefits to clinical practice. The quantitative findings from the Perceived Stress Scale (PSS) showed there were no changes before and after training. Qualitative findings showed significant benefits to RTs, including (1) ability to empathically attune more effectively and earlier to signs of anxiety in patients; (2) improved confidence and self-efficacy for effectively intervening in difficult treatment situations; and (3) enhanced creative problem solving in partnership with patients to assist the acutely anxious patient. The PSS results suggest that intrinsic and extrinsic stressors are a variable but consistent part of the everyday reality of RT practice. A training program focusing on the therapeutic presence dimension of RT practice has a direct impact on effectiveness in assisting anxious patients undergoing RT. When embedded in the clinical life of a radiation therapy department, such a training program has the potential to capture the lived practice wisdom and creative skills of RTs, and effectively mediate these skills across a team through group discussions and documentation on patient charts.     

Bedside spirometry in a tertiary care hospital: the cleveland clinic experience

BACKGROUND: In contrast to outpatient, laboratory testing, which is performed by a small, dedicated group of pulmonary function technologists, inpatient, bedside spirometry at the Cleveland Clinic Hospital is performed less frequently and by a larger group of respiratory therapists with broader responsibilities. A 1998 audit of bedside spirometry tests at our hospital showed that American Thoracic Society acceptability and reproducibility criteria were infrequently met (15% of instances). METHODS: To address that shortcoming, we initiated an improvement plan for bedside spirometry that included: (1) A didactic review of American Thoracic Society acceptability and reproducibility criteria that was videotaped and reviewed by all but one of the therapists performing spirometry; (2) limiting the number of operators to a "core group" to allow more tests per therapist; (3) producing printouts of the pulmonary function tests, which allows immediate review of volume-time and flow-volume curves; (4) central review of all tests by a pulmonary function technologist and feedback and constructive suggestions on test quality and reproducibility to operators. After initiating the program we performed a consecutive survey of all inpatient spirometry sessions performed from July 16, 1998, to March 2, 1999. RESULTS: During the survey period, 63.5% of the tests (n = 137) were deemed acceptable, exceeding the low baseline rate of 15% (p < 0.001). Values for forced expiratory volume in the first second were reproducible in 83.9% of sessions. Values for forced vital capacity were reproducible in 80.3% of sessions. CONCLUSION: A quality improvement program for bedside spirometry testing that emphasizes training and routine feedback on test quality can enhance the quality of inpatient spirometry testing.     

Turnover, age and length of service: a comparison of nurses and other staff in the National Health Service

Using information collected from more than 100 district health authorities in England for the year 1989–1990, this paper examines turnover rates amongst a range of nursing and other staff groups in the National Health Service (NHS), and their relationship to the age and length of service characteristics of the labour force. The evidence collected suggests that the NHS employs a significantly younger workforce than is found in the economy as a whole. The age profile of nurses is even more skewed towards younger age groups than that of non-nursing staff working in the NHS. Nurses tend on average to have longer lengths of service than non-nursing staff groups, and it would seem that the average length of service has increased over the last 20 years, certainly amongst registered nurses. Overall, the study found an annual turnover rate amongst all NHS staff of 13.6%. Turnover rates were significantly higher among full-time staff than part-time, and amongst non-nursing staff groups compared with nurses. Broadly, turnover rates decline with age then rise close to retirement. However, there is a more complex relationship between length of service and turnover: turnover rates tend to be high in the first year of service, and to remain high or even rise during the second year of service, before declining. Turnover remains a poorly understood issue in the NHS. The evidence presented here should move some aspects of debate onto a more solid empirical foundation.     

Transitioning the respiratory therapy workforce for 2015 and beyond

The American Association for Respiratory Care established a task force in late 2007 to identify likely new roles and responsibilities of respiratory therapists (RTs) in the year 2015 and beyond. A series of 3 conferences was held between 2008 and 2010. The first task force conference affirmed that the healthcare system is in the process of dramatic change, driven by the need to improve health while decreasing costs and improving quality. This will be facilitated by application of evidence-based care, prevention and management of disease, and closely integrated interdisciplinary care teams. The second task force conference identified specific competencies needed to assure safe and effective execution of RT roles and responsibilities in the future. The third task force conference was charged with creating plans to change the professional education process so that RTs are able to achieve the needed skills, attitudes, and competencies identified in the previous conferences. Transition plans were developed by participants after review and discussion of the outcomes of the first two conferences and 1,011 survey responses from RT department managers and RT education program directors. This is a report of the recommendations of the third task force conference held July 12-14, 2010, on Marco Island, Florida. The participants, who represented groups concerned with RT education, licensure, and practice, proposed, discussed, and accepted that to be successful in the future a baccalaureate degree must be the minimum entry level for respiratory care practice. Also accepted was the recommendation that the Certified Respiratory Therapist examination be retired, and instead, passing of the Registered Respiratory Therapist examination will be required for beginning clinical practice. A date of 2020 for achieving these changes was proposed, debated, and accepted. Recommendations were approved requesting resources be provided to help RT education programs, existing RT workforce, and state societies work through the issues raised by these changes.     

Hospital discharge of respiratory-technology-dependent children: role of a dedicated respiratory care discharge coordinator

BACKGROUND: Preparation of respiratory-technology-dependent children for hospital discharge presents many challenges. Adequate training and education of parental caregivers, discharge planning, and coordination with the durable-medical-equipment and home-nursing companies must be completed. A process using multiple respiratory therapists (RTs) to achieve this may not be efficient. METHODS: We evaluated our model, in which a dedicated RT discharge coordinator provides education and coordinates discharge planning of respiratory-technology-dependent pediatric patients. This system provides a single contact for caregivers and outside agencies, a single respiratory-care educator for the caregivers, and a clinical pathway that involves the entire multidisciplinary team. Patient length of stay and customer satisfaction were evaluated before and after implementation of the discharge-coordinator program. RESULTS: Our dedicated-RT-discharge-coordinator model was associated with rapid initiation of frequent family-training sessions. Durable-medical-equipment-company personnel reported that they had increased satisfaction with the quality of training of the family caregivers. The members of the hospital multidisciplinary team had increased satisfaction with the discharge process. Patient length of stay nonsignificantly decreased after the implementation of the discharge-coordinator program. CONCLUSIONS: There are several advantages to using a dedicated RT-discharge-coordinator system for home-discharge preparation of respiratory-technology-dependent children.     

Smoothing the Way: The Perception of Unit Supervisor Radiation Therapist Roles at the British Columbia Cancer Agency

BackgroundThe “resource therapist” supervisory radiation therapy roles at the British Columbia Cancer Agency were recently evaluated.MethodsThe process included interviews with resource therapists (n = 22) and an electronic survey of stakeholders including department managers (n = 5) and clinical radiation therapists (RTs) (n = 230).ResultsThemes from both sets of data included the ability and advisability of maintaining clinical expertise, role clarity and job creep, and the definition of leadership. The resource therapists were balancing an increasingly complex administrative workload that varied between provincial centres. The understanding of the role differed between stakeholders. Only 48% of the RTs agreed that they had a good idea of what resource therapists do and many desired the resource therapists to be more “hands on.”ConclusionsIn agreement with the literature, many resource therapists view themselves as clinicians first and managers second. There is also a marked difference in how the role is viewed between resource therapists and RTs. Role incumbents may benefit from access to more formal preparation, including job shadowing, training, and mentoring. There is also a need to increase understanding of the role across all stakeholder groups.     

Respiratory care managers' preferences regarding baccalaureate and master's degree education for respiratory therapists

OBJECTIVE: Determine respiratory care managers' preferences regarding baccalaureate and master's degree education for practicing respiratory therapists (RTs). METHODS: A survey was mailed to 1,444 members of the Management Section of the American Association for Respiratory Care. Managers were asked about their preferences for RTs who hold or are pursuing baccalaureate degrees, the value of various courses of study (majors), and degrees earned via distance learning. Demographic data and attitudes about distance learning, content, and target audiences for master's degree programs were also collected. RESULTS: Twenty-six percent of those polled responded. Thirty-four percent of respondents preferred baccalaureate degree over associate degree for entry-level RTs, 28% had no preference, and 38% no opinion. Regarding hiring of experienced RTs, 70% of respondents preferred RTs with baccalaureate degrees. Regarding baccalaureate completion degree majors, advanced respiratory care practice was most highly valued. Sixty percent thought that a degree earned via distance learning was equivalent to one earned in the traditional classroom setting; 23% thought a distance learning degree was of less value; 3% thought a distance learning degree was of greater value; and 14% were uncertain. The respondents thought graduate degrees were valuable for managers, clinical specialists, educators, and supervisors. Although 95% of managers would recommend graduate programs that have some distance learning courses, only 75% would recommend programs offered solely via distance learning. CONCLUSIONS: For RTs who plan to complete a baccalaureate degree, majoring in advanced respiratory care practice is potentially valuable. Managers showed preference for hiring experienced RTs with baccalaureate degrees but did not prefer entry-level therapists with baccalaureate degrees. Graduate degrees are supported for managers, clinical specialists, educators, and supervisors. Most managers supported some use of distance learning for graduate degrees.     

Does a communication skills program enable symptom and distress screening?: The impact of training on radiation therapists’ confidence,knowledge, and use of distress screening

IntroductionDue to the prevalence of distress following a cancer diagnosis, routine symptom and distress screening is recommended as best practice. RTs perceive psychosocial support and screening to be part of their role, however feel they lack the education and skills to perform this confidently. The study aimed to evaluate the impact of providing communication skills training (RT Prepare CST) on the perceived barriers, knowledge, attitude, role, and confidence of radiation therapists (RTs) in using routine symptom and distress screening.MethodsA single-arm, pre-post intervention design was implemented. All RTs at one regional and one rural centre participated in RT Prepare CST. RTs completed a questionnaire: pre-intervention (T1); immediately post-intervention (T2); and, three months post-intervention (T3). Cochran's Q and McNemar's tests for non-parametric data were conducted to compare outcomes over time.ResultsOf 39 RTs approached, 37 (95%) consented to participate with 36 (92%) completing questionnaires at all three time points. Significant and sustained improvements post-intervention were noted from T1-T3 including: confidence in describing the PROMPT-Care tool to patients (p=0.002), discussing psychosocial issues (p=0.014); recognising signs of anxiety/depression (p<0.001); dealing with signs of anxiety (p=0.002), depression (p=0.015) and distress (p=0.008) as well as agreeing ‘the tool is useful in identifying psychosocial problems’ (p=0.029).ConclusionsRT Prepare CST was effective in increasing confidence, knowledge and attitudes of RTs in the psychosocial care of patients with a change in RT behaviour noted by a significant increase in the number of patients screened following the intervention. Providing routine CST and emotional cues training to RTs enhances their ability to care for patients holistically, equipping them with skills to be included within a psychosocial model of care. Engaged leadership and role models are essential to sustain the learnings from education programs and provide an environment to discuss and define roles within radiation therapy departments.     

Staff turnover and quality of care in nursing homes

PURPOSE: In this work, the association between nurse aide (NA) plus licensed practical nurse (LPN) and registered nurse (RN) turnover and quality indicators in nursing homes is examined. DESIGN AND METHODS: Indicators of care quality used are the rates of physical restraint use, catheter use, contractures, pressure ulcers, psychoactive drug use, and certification survey quality of care deficiencies. In addition, we used a quality index combining these indicators. Turnover information came from primary data collected from 354 facilities in 4 states and other information came from the 2003 Online Survey, Certification and Reporting data. The turnover rates were grouped into 3 categories, low, medium, and high, defined as 0% to 20%, 21% to 50%, and greater than 50% turnover, respectively. RESULTS: The average 1-year turnover rates identified in this study were high at 85.8% for NAs and LPNs and 55.4% for RNs. Multivariate analysis shows that decreases in quality are associated with increases in RN turnover, especially increases from low-to-moderate levels of turnover, and with increases in NA and LPN turnover, especially increases from moderate-to-high levels of turnover. IMPLICATIONS: These findings are significant because the belief that staff turnover influences quality is pervasive. The cross-sectional results are only able to show associations, nonetheless, few empirical studies in the literature have shown this relationship.     

Respiratory care practitioners as secondary providers of endotracheal intubation: one hospital's experience

The management staff of the Respiratory Care Department at the suggestion of the Department of Anesthesiology determined that there was a need for respiratory care practitioners (RCPs) to be trained to perform endotracheal intubation. This need was demonstrated by the frequency with which anesthesia personnel were called away from the operating room (OR) to perform endotracheal intubations in other hospital areas. METHODS: The training program included didactic instruction followed by written examination, simulations, and intubation experience in the OR under the direct supervision of a staff anesthesiologist. RESULTS: Initially 15 therapists, from all shifts were trained. Currently, there are 20 fully-trained RCPs on staff. These therapists have successfully intubated 160 patients in 178 attempts over a 49 month period. All attempts followed failed attempts by other professionals. No major complications were observed in the patients intubated by RCPs. DISCUSSION: This training program has successfully provided support for endotracheal intubation procedures, sparing the anesthesiology staff and expanding the role of RCPs in our hospital.