Advancing from Within: The Value of Clinical Ladders


Respiratory therapists who want to get ahead on the job tend to think they need to seek out a management position.

But in a field where the direct care of patients is at the core, should it really be that way? Many departments believe the answer is no, and they’ve set up clinical ladders aimed at making sure therapists who want to remain at the bedside are rewarded for their skills and abilities.

From novice to expert

Ginder Weido, BS, RRT-NPS, is a clinical leader at Children’s Healthcare of Atlanta at Egleston, where a clinical ladder has been in place since 2006. Therapists move up the ladder from the novice rung all the way to the expert level. “There is up to an 8% raise to move up the ladder,” she says. While no one has reached the expert level yet, she feels her three hospital system has had a great experience with the concept.

At the Cleveland Clinic Foundation, the clinical ladder consists of two tiers and was started about four years ago. Clinical Educator Donna Tanner, BSRC, RRT, says she loves it. “It’s a voluntary process, so if the RT is content where they are at professionally within the department then they are not pressured to climb the proverbial ladder. However, our leadership team now has laid out all the tools so that each member of our department could achieve Tier II if so desired.”

Requirements for Tier I, which results in a $0.75 per hour raise, include keeping all competencies up-too-date, earning the ACLS, having a low call-off rate, becoming a preceptor, and being trained in an additional area. Tier II carries an additional $1.50 per hour bump in pay and calls for the therapist to get involved in his professional organization, complete volunteer hours, participate in research, earn an advanced degree, and become a clinical specialist.

A simplified version of the clinical ladder is in place at Penn State Hershey Children’s Hospital in Hershey, PA. Clinical and ECMO Specialist Tammy Angeletti, MS, RRT-NPS, RN, CPFT, AE-C, believes it helps to put therapists on a level playing field with nursing.

“Currently we have one rung on the ladder, you must be an RRT to apply,” she says. Requirements include being an NRP, PALS, ACLS, or BLS instructor, earning an additional credential, and serving as a preceptor and charge therapist. “They must also do an educational item for staff yearly and be involved in a quality/safety initiative yearly,” says Angeletti.

18 competencies

A clinical ladder has been in place at the University of California San Diego Medical Center since 2009 and includes a menu of 18 competencies therapists must meet to complete all the rungs. Each step up comes with a 2.5% increase in salary.

Richard Ford, BS, RRT, FAARC, who recently retired from his director position with the department but is still involved in the facility, says the clinical ladder has helped to build employee engagement. “The increased compensation may have initially stimulated a therapist to take on a project, program, initiative, etc.,” he notes. “However once they become part of these programs they become more driven by what they can achieve and by a feeling of accomplishment.”

Kimberly Firestone, MSc, RRT, neonatal respiratory outreach clinical liaison at Akron Children’s Hospital in Ohio, says the clinical ladder in place in her facility has five rungs, similar to the ladder in place for nursing. Therapists who complete the rungs earn perks like professional development funds that can be used for AARC membership, the purchase of books, or even educational days off. A monetary benefit is offered as well, along with a maintenance benefit for those who continue to meet the program requirements year after year. Reaching the highest rung requires taking the lead on a research project.

She believes the program promotes professionalism among her peers. “Nursing often has these programs in place so having this available for RTs promotes their profession in a unique way.”

Paramount for recognition

Jon Inkrott, RRT-ACCS, says there isn’t a clinical ladder at the hospital in Florida where he is currently serving as a flight therapist, but he saw how these ladders work during his years at Christ Hospital in Cincinnati, OH, and he misses the excellence they inspired in staff.

“Level IV was the highest attainable level and with it you were given a Certificate of Achievement, recognized by the hospital, and also, you were given a 15% bonus based on base salary,” he says. Most staff — himself included — reached Level III, which carried a 10% bonus.

“At my employer in Cincinnati, where there was a Ladder program, you could sense and see the involvement and what people were driving for, to help make the department the best it could be and to bring recognition to all of us,” says Inkrott. “Here in Orlando, while certainly a place of outstanding practitioners and leadership, my opinion is that folks don’t seem as willing to get involved on that scale.”

His bottom line take on clinical ladders: “I think they’re paramount for the recognition we deserve as part of a critical interdisciplinary team.”

Heading to the New Era

Elevate | Engage | Advocate | Educate