This blog post is adapted from the article “Addressing Radiation Therapist Burnout” published in Radiation Oncology News for Administrators, Vol 33, No. 5.
By Tammy McCausland
According to a 2022 Radiation Therapy Staff and Workplace Survey conducted by the American Society of Radiologic Technologists (ASRT), 10.7 percent of radiation therapist (RT) positions were vacant. It marked the fourth annual consecutive rise in vacancy rates.
The Mayo Clinic Rochester has implemented several initiatives to address its high vacancy rate, which was more than 20 percent in March 2022. Stay interviews were one effective tool.
The stay interviews revealed key irritants: departmental communication, lack of support by management, feelings of burnout and a dearth of work-life balance. The therapists indicated that unforeseen circumstances and uncertainty that affect patients and staff scheduling can make or break their day. For example, therapists reported that on some days they might not know what time they could leave, and whether they could make it to their children’s activities, like soccer games.
For supervisors the stay interviews created opportunities to get to know staff and to reflect on additional/new ways to help. “What surprised me the most in this lower morale environment was that therapists really enjoyed their coworkers,” says Sara Walerak, a radiation therapy supervisor. “Their complaints were not, ‘My day is terrible, and I don’t want to come to work.’ It was more, ‘I love my job, I want to come to work. This will make it better.’”
“We haven’t truly supported our therapists the way we’d like to, but due to staff shortages
we were just trying to stay afloat,” says Jilaine Rendler, proton therapy supervisor. Managers are returning responsibility back to the therapists to give them ownership over their day-to-day.
They developed a multi-pronged action plan that included creative scheduling, enhanced departmental communications and an RTT Aide position.
Creative Scheduling
They asked every therapist what their ideal schedule would be. Therapists stressed they wanted an end-time for their shifts and that mandatory overtime was causing burnout. “One quick win was finding out what work-life balance means for therapists, and why it was lacking. The uncertainty around the late shift is one actionable item,” says Nicole Harrison, operations manager, Radiation Oncology.
They added an “early” QA shift with a guaranteed end-time of 4 p.m. for some staff and assigned late shifts three months in advance to ensure it’s not always the same people staying late. “Previously, we just went on patient need. If a patient was running late, we asked for volunteers who could stay late that night,” says Walerak. “This late schedule now allows therapists to opt-out while those scheduled know their late nights. Whatever time that patient comes, we’ll get them treated. We’ve also found that this promotes camaraderie between the therapists because they can switch shifts.”
They also launched a creative scheduling pilot in January 2024 in which therapists choose their shifts. They can work a 12-hour shift, a 10-hour shift, and then potentially an 8-hour shift to cover the department needs as well as ensuring they’re maintaining their FTE, if so desired. “We’re promoting work-life balance: giving therapists another day off during the week allows them time for personal tasks so they can be present and focused at work,” says Walerak. They’re collecting data regarding what works and what doesn’t to develop a sustainable model for use as the department grows.
“The therapists take it upon themselves to switch shifts and make sure that their schedule works for their work-life balance,” says Harrison. “If there’s an unforeseen circumstance, we get involved and do our best to help staff meet personal and departmental needs.”
Enhanced Communications
In response to therapists’ desire for improved two-way communication, they implemented a Microsoft Teams pilot that has been very successful. Each of the 10 treatment machines has its own Teams channel, which all the therapists and physicians are part of. They can have a conversation about a specific patient within the assigned Teams channel. “There are a lot of opportunities to use different means of communication within Teams. There are GIFs, emojis, pictures, etc,” says Walerak. “In the process of improving our communication, we also improved morale because the physicians are more responsive.”
They’ve also implemented an MD of the Day (MOD) model, which allows them to have an MD contact who is available on demand. Essentially an MD has no other obligations
than to be available to check images on the treatment machines.
RTT Aide Position
They identified tasks—including retrieving patients from the lobby, helping transfer hospital patients, stocking supplies and filling blanket warmers––that could be offloaded from therapists. Then they developed a training plan for the RTT Aide position and piloted it in 2022 with college interns. They plan to make the RTT Aide position a permanent fixture within their department.
The Mayo Clinic is a high throughput, fast-paced procedural practice that sees hundreds of patients a day. RTs do many things to get those patients from point A to point B and to get their treatment completed. “We can have an RTT Aide walk with the patients, give them instructions in the changing room and stock our rooms with supplies. We’ve found the position to be really beneficial: it saves time and RTs feel less stretched in their responsibilities. RTT Aides who worked in the pilot also reported that it was a satisfactory job,” says Harrison.
“We’re focused on ensuring that our therapists are working up to the top of their licensure. We took this right person, right role methodology and ended up with our aides assisting our therapists in that day-to-day work,” says Walerak.
Key Takeaways for Administrators
A big takeaway is the value of asking staff directly about their experiences and actively listening to their ideas to resolve issues. “As leaders, it’s easy to try to take on a problem, solve it and deliver a result, but it’s more beneficial to listen to and involve staff,” says Harrison. “For both the creative scheduling and the RTT Aide, we had really active frontline staff members gathering feedback and data and spearheading some projects. A lot of the success occurred because we kept them engaged, we kept the opportunities for feedback open and adapted the models to fit staff’s needs.”
“We learned that we can be fluid and that there are some creative opportunities to improve the standard that most of us have worked in,” says Walerak.
Rendler stresses how important it is to involve your therapists and really listen. “They have so much to offer and so much insight because they are the frontline staff. If you allow them time to resolve issues, it creates better morale and everyone benefits,” she says.
They have reduced the RT vacancy rate to 10 percent. They are encouraged to continue implementing this model to reduce the vacancy rate further and increase job satisfaction.
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