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Miller AG, Juby J, Burr KL, Roberts KJ, Hinkson CR, Hoerr C, Smith BJ, Rehder KJ. Characteristics, Identification, Training, and Perception of Leaders in Respiratory Care. Respir Care 2023; 68:1347-1355. [PMID: 37280077 PMCID: PMC10506653 DOI: 10.4187/respcare.10920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Leadership is critical to high-functioning teams; however, data are lacking for what defines successful respiratory therapist (RT) leadership. Leaders need a wide range of skills to be successful, although the exact characteristics, behaviors, and accomplishments of successful RT leaders are unknown. We performed a survey of respiratory care leaders to evaluate different aspects of RT leadership. METHODS We developed a survey of RT leaders to examine respiratory care leadership in a variety of professional settings. Different aspects of leadership and the relationships between perceptions of leadership and well-being were assessed. Data analysis was descriptive. RESULTS We received 124 responses, with a response rate of 37%. Respondents had a median 22 y of RT experience, and 69% were in leadership positions. The most-important skills identified for potential leaders were critical thinking (90%) and people skills (88%). Self-initiated projects (82%), intradepartmental education (71%), and precepting (63%) were noted accomplishments. Reasons for exclusion from leadership included poor work ethic (94%), dishonesty (92%), difficulty getting along with others (89%), unreliable (90%), and not being a team player (86%). Most respondents (77%) agreed American Association for Respiratory Care membership be a requirement for leadership; however, 31% required membership. Integrity (71%) was noted consistently as a characteristic of successful leaders. There was no consensus for behaviors of successful versus unsuccessful leaders or what defines successful leadership. Ninety-five percent of leaders had received some leadership training. Respondents reported that well-being is affected by leadership, departmental culture, peers, and leaders with burnout; 34% of respondents felt people with burnout received good support at their institution, whereas 61% felt maintaining well-being is left to individuals. CONCLUSIONS Critical thinking and people skills were the most-important skills for potential leaders. Limited consensus existed on characteristics, behaviors, and defined success of leaders. Most respondents agreed leadership influences well-being.
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Affiliation(s)
- Andrew G Miller
- Respiratory Care Services, Duke University Medical Center, Durham, North Carolina; and the Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina.
| | - Jerin Juby
- Thomas Jefferson University, College of Health Professions, Philadelphia, Pennsylvania
| | - Katlyn L Burr
- Respiratory Care, Nemours Children's Health, Wilmington, Delaware
| | - Karsten J Roberts
- Thomas Jefferson University, College of Health Professions, Philadelphia, Pennsylvania
| | - Carl R Hinkson
- Respiratory Care, Providence Regional Medical Center, Everett, Washington
| | - Cheryl Hoerr
- Respiratory Care, Phelps Health, Rolla, Missouri
| | - Brian J Smith
- Respiratory Care, University of California, Davis, Sacramento, California
| | - Kyle J Rehder
- Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
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Miller AG, Burr KL, Juby J, Hinkson CR, Hoerr CA, Roberts KJ, Smith BJ, Strickland SL, Rehder KJ. Enhancing Respiratory Therapists' Well-Being: Battling Burnout in Respiratory Care. Respir Care 2023; 68:692-705. [PMID: 37076431 PMCID: PMC10171344 DOI: 10.4187/respcare.10632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Burnout is a major problem in health care and is associated with adverse sequelae for patients, health care workers, and organizations. Burnout among respiratory therapists (RTs) is as high as 79% and is associated with poor or ineffective leadership, inadequate staffing, high work load, non-leadership position, and work environment. An understanding of burnout is necessary for both staff and leadership to ensure RT well-being. This narrative review will discuss the psychology of burnout, prevalence, drivers, mitigation strategies, and future directions for research.
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Affiliation(s)
| | | | - Jerin Juby
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | | | - Karsten J Roberts
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian J Smith
- University of California, Davis, Sacramento, California
| | - Shawna L Strickland
- Rush University, Chicago, Illinois; and American Epilepsy Society, Chicago, Illinois
| | - Kyle J Rehder
- Duke University Medical Center, Durham, North Carolina
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Strickland SL, Roberts KJ, Smith BJ, Hoerr CA, Burr KL, Hinkson CR, Rehder KJ, Miller AG. Burnout Among Respiratory Therapists Amid the COVID-19 Pandemic. Respir Care 2022; 67:1578-1587. [PMID: 35922068 PMCID: PMC9994033 DOI: 10.4187/respcare.10144] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Burnout is a major challenge in health care and is associated with poor overall well-being, increased medical errors, worse patient outcomes, and low job satisfaction. There is scant literature focused on the respiratory therapist's (RT) experience of burnout, and a thorough exploration of RTs' perception of factors associated with burnout has not been reported. The aim of this qualitative study was to understand the factors associated with burnout as experienced by RTs amid the COVID-19 pandemic. METHODS We performed a post hoc, qualitative analysis of free-text responses from a survey of burnout prevalence in RTs. RESULTS There were 1,114 total and 220 free-text responses. Five overarching themes emerged from the analysis: staffing, workload, physical/emotional consequences, lack of effective leadership, and lack of respect. Respondents discussed feelings of anxiety, depression, and compassion fatigue as well as concerns that lack of adequate staffing, high workload assignments, and inadequate support from leadership contributed to feelings of burnout. Specific instances of higher patient acuity, surge in critically ill patients, rapidly evolving changes in treatment recommendations, and minimal training and preparation for an extended scope of practice were reported as stressors that led to burnout. Some respondents stated that they felt a lack of respect for both the RT profession and the contribution of RTs to patient care. CONCLUSIONS Themes associated with burnout in RTs included staffing, workload, physical and emotional exhaustion, lack of effective leadership, and lack of respect. These results provide potential targets for interventions to combat burnout among RTs.
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Affiliation(s)
- Shawna L Strickland
- American Epilepsy Society, Chicago, Illinois; and Rush University, Chicago, Illinois.
| | - Karsten J Roberts
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian J Smith
- University of California, Davis, Sacramento, California
| | | | | | | | - Kyle J Rehder
- Duke University Medical Center, Durham, North Carolina
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Burr KL, Hinkson CR, Smith BJ, Roberts KJ, Strickland SL, Hoerr CA, Rehder KJ, Miller AG. Factors Associated With a Positive View of Respiratory Care Leadership. Respir Care 2022; 67:1236-1245. [PMID: 35701175 PMCID: PMC9994323 DOI: 10.4187/respcare.10081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Burnout within health care is prevalent, and its effects are detrimental to patient outcomes, organizations, and individuals. Effects stemming from burnout include anxiety, depression, excessive alcohol and drug use, cardiovascular problems, time off work, and worse patient outcomes. Published data have suggested up to 50% of health care workers experience burnout and 79% of respiratory therapists (RTs) experience burnout. Leadership has been cited as a key driver of burnout among RTs. We aimed to identify factors associated with a positive or negative leadership perception. METHODS A post hoc analysis of an institutional review board-approved survey to evaluate RT burnout, administered via REDCap by convenience sample to 26 health care centers (3,124 potential respondents) from January 17-March 15, 2021, was performed to identify factors associated with a positive view of leadership. Survey questions included validated tools to measure leadership, burnout, staffing, COVID-19 exposure, and demographics. Data analysis was descriptive, and logistic regression was performed to evaluate factors associated with leadership perception. RESULTS Of 1,080 respondents, 710 (66%) had a positive view of leadership. Univariate analysis revealed those with a positive view of leadership were more likely to be working with adequate staffing, were rarely unable to complete all work, were less likely to be burned out, disagreed that people in this work environment were burned out, were less likely to miss work for any reason, more likely to be in a leadership position, worked fewer hours in intensive care, worked in a center affiliated with a medical school, worked day shift, were less likely to care for adult patients, and were more likely to be male. Logistic regression revealed providing care to patients with COVID-19 (odds ratio [OR] 5.8-10.5, P < .001-.006) was the only factor associated with a positive view of leadership, whereas working without adequate staffing (OR 0.27-0.28, P = .002-.006), staff RTs (OR 0.33, P < .001), work environment (OR 0.42, P = .003), missing work for any reason (OR 0.69, P = .003), and burnout score (OR 0.98, P < .001) were associated with a negative view of leadership. CONCLUSIONS Most RTs had a positive view of their leadership. A negative leadership score was associated with higher burnout and missing work. This relationship requires further investigation to evaluate if changes in leadership practices can improve employee well-being and reduce burnout.
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Affiliation(s)
- Katlyn L Burr
- Respiratory Care Services, Nemours Children's Health, Wilmington, Delaware.
| | - Carl R Hinkson
- Respiratory Care, Providence Regional Medical Center, Everett, Washington
| | - Brian J Smith
- Respiratory Care, University of California, Davis, Davis, California
| | - Karsten J Roberts
- Respiratory Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shawna L Strickland
- Health Sciences, Rush University, Chicago, Illinois; and American Epilepsy Society, Chicago, Illinois
| | | | - Kyle J Rehder
- Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
| | - Andrew G Miller
- Division of Pediatric Critical Care Medicine and Respiratory Care Services, Duke University Medical Center, Durham, North Carolina
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Burr KL, Stump AA, Bladen RC, O'Brien PR, Lemon BJ, Tearl DK, Roby M, Daley LM, Brown JM, Hertzog JH. Twice-Daily Huddles Improves Collaborative Problem Solving in the Respiratory Care Department. Respir Care 2021; 66:822-828. [PMID: 33531358 PMCID: PMC9994132 DOI: 10.4187/respcare.07717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lean Six Sigma processes are used in health care systems to increase safety and efficiency. Daily huddles, one tool of the Lean Six Sigma process, have been used to increase patient safety, facilitate efficiency in problem solving, promote optimal patient outcomes, and reduce poor communication. Huddle utilization by respiratory care departments has not been previously reported. We describe our process of implementing daily huddles and the impact on departmental problem solving. METHOD A descriptive study of a quality improvement intervention and a retrospective study of prospectively collected data were performed. The respiratory care department was trained in the utilization of a daily huddle process to resolve issues and identify process improvement opportunities. Huddles were performed at the beginning of each shift. Process improvement opportunities were raised by the respiratory therapy staff using the following categories: Safety/Service, Methods, Equipment, Supplies, and Associates. Opportunities were placed within 3 categories; quick hits (resolution in 1-3 d), complex problems (resolution in 3-7 d), and projects (resolution in > 7 d). All opportunities included a problem statement, an immediate countermeasure, a problem leader, and a due date. Items requiring interdisciplinary support were escalated to the organizational patient care services huddle. We evaluated the number and nature of process improvement opportunities raised in huddles from January 1 through December 31, 2018, to better understand the impact of daily huddles. RESULTS A total of 366 process improvement opportunities were raised during huddles. Of those, 245 (67%) were quick hits, 77 (21%) were complex, and 44 (12%) were projects. Resolution of 174 (47.5%) opportunities was completed using only the resources of the respiratory care department, and 157 (43%) were resolved with additional interdisciplinary involvement. A small portion 35 (9.5%) of opportunities required escalation to the organizational multidisciplinary huddle for resolution. All process improvement opportunities were resolved at the end of the study period (mean ± SD of 30.5 ± 7.7 per month). CONCLUSIONS Twice-daily huddles implemented by our respiratory care department allowed for identification and timely resolution of process improvement opportunities.
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Affiliation(s)
- Katlyn L Burr
- Respiratory Care Services, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware.
| | - Angela A Stump
- Respiratory Care Services, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Rustin C Bladen
- Respiratory Care Services, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Paul R O'Brien
- Respiratory Care Services, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Brenda J Lemon
- Respiratory Care Services, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Donna K Tearl
- Respiratory Care Services, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Maureen Roby
- Respiratory Care Services, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Lauren M Daley
- Nursing Administration, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Joel M Brown
- Respiratory Care Services, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - James H Hertzog
- Respiratory Care Services, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
- Department of Pediatrics, Division of Critical Care Medicine, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
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Hertzog JH, Burr KL, Stump A, Brown JM, Penfil S, McMahon K. Impact of Helium-Oxygen Administered via High Velocity Nasal Insufflation on Delivery of Inhaled Nitric Oxide. J Pediatr Intensive Care 2020; 9:261-264. [PMID: 33133741 DOI: 10.1055/s-0040-1710057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022] Open
Abstract
Inhaled nitric oxide (iNO) may be continued during the transition from invasive to noninvasive respiratory support. Upper airway obstruction from laryngeal edema following extubation and lower airway obstruction from asthma and bronchiolitis may be managed with inhaled helium. The coadministration of helium with iNO and the impact on delivered amounts of iNO have not been extensively studied. A bench model simulating a spontaneously breathing infant received iNO at varying preset doses delivered with either helium-oxygen or nitrogen-oxygen via a Vapotherm unit. iNO levels were measured at the simulated trachea. Results from the two conditions were compared using t-tests. When nitrogen-oxygen was used, there was no difference between preset and measured iNO levels. A significant difference was present when helium-oxygen was used, with a 10-fold increase in measured iNO levels compared with preset values. The use of helium resulted in a significant increase in measured iNO at the level of the simulated trachea. Clinicians must be aware that iNO will not be delivered at prescribed doses when used with helium under the conditions used in this study.
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Affiliation(s)
- James H Hertzog
- Respiratory Care Services, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States.,Division of Critical Care Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States.,Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Katlyn L Burr
- Respiratory Care Services, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States
| | - Angela Stump
- Respiratory Care Services, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States
| | - Joel M Brown
- Respiratory Care Services, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States
| | - Scott Penfil
- Department of Pediatrics, Samuelson Children's Hospital at Sinai, Baltimore, Maryland, United States
| | - Kimberly McMahon
- Division of Critical Care Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States.,Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
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Burr KL, O'Brien P, Brown JM, Penfil SH, Hertzog JH. Occupational-Induced Secondary Traumatic Stress and Posttraumatic Stress Disorder in Respiratory Therapists. Respir Care 2020; 65:1019-1023. [PMID: 32127414 DOI: 10.4187/respcare.06840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Secondary traumatic stress (STS) may occur in the caretakers of individuals who have experienced traumatic events or are suffering and, when severe, may be associated with posttraumatic stress disorder (PTSD) at a diagnostic level due to STS. For respiratory therapists (RTs), the incidence of STS and PTSD at a diagnostic level due to STS has not been examined. We assessed the prevalence of self-reported STS and PTSD at a diagnostic level due to STS in licensed RTs. METHODS Licensed RTs who were members of the American Association for Respiratory Care completed the Secondary Traumatic Stress Scale (STSS) based on feelings experienced over the preceding 30 days and 12 months. Results were evaluated on the basis of primary patient population (neonatal/pediatric vs adult), years of experience, and usual work location (ambulatory care, acute care, or ICU) using the McNemar chi-square analysis and the Fisher exact test. RESULTS 201 licensed and practicing RTs completed the survey. 92% of the respondents worked ≥ 30 h/week, 75% worked in ICUs, 67% worked primarily with adults, and 89% had been in practice ≥ 6 years. PTSD at a diagnostic level due to STS was common in all respondents, occurring in 36% based on experiences from the prior 30 days and in 32% based on experiences from the prior 12 months. CONCLUSIONS No difference in PTSD at a diagnostic level due to STS was noted between RTs caring for neonatal/pediatric versus adult patients or between RTs based on years of work experience or based on work environment. STS and PTSD at a diagnostic level due to STS was common in RTs.
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Affiliation(s)
- Katlyn L Burr
- Respiratory Care Services, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.
| | - Paul O'Brien
- Respiratory Care Services, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Joel M Brown
- Respiratory Care Services, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Scott H Penfil
- Department of Pediatrics, Samuelson Children's Hospital at Sinai, Baltimore, Maryland
| | - James H Hertzog
- Respiratory Care Services, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.,Department of Pediatrics, Division of Critical Care Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.,Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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