Engaging Rehabilitation Technicians Through a Career Ladder During a Pandemic.

Journal Article (Journal Article)


Nursing assistant turnover is a growing healthcare concern that negatively impacts healthcare organization work environments and has significant financial implications. The purpose of this study was to implement a career ladder program for rehabilitation nursing technicians-nursing assistants who specialize in performing care duties aligned with therapeutic goals in inpatient rehabilitation. The study evaluated the effect on organizational quality metrics of employee engagement, job satisfaction, and annual turnover of rehabilitation nursing technicians.


This pilot study was conducted using a quality improvement approach and a between-subjects pretest-posttest design.


A three-tier career ladder intervention for rehabilitation nursing technicians in a 76-bed inpatient rehabilitation facility was implemented. Employee engagement and job satisfaction were evaluated in all rehabilitation nursing technicians (n = 44), with a pre-implementation sample size of n = 23 and a post-implementation sample size of n = 21, from January 2020 through December 2020. Twelve rehabilitation nursing technicians participated in the intervention, which consisted of online learning modules, added job responsibilities, and continuing education and were included in the post-implementation sample size. Nondirectional statistical tests were performed with the level of significance set at .05 (two tailed).


A majority of the pre-post intervention sample (n = 44) were female (91%), African American (91%), and aged 30-59 years. Employee engagement increased from 78% favorable in 2019 to 86% favorable in 2020. Overall job satisfaction improved from 74% favorable in 2019 to 86% favorable in 2020. Annual turnover decreased from 35% in 2019 to 31% in 2020.


In this pilot study, a career ladder program for rehabilitation nursing technicians was effective in increasing and improving employee engagement and job satisfaction while reducing turnover.

Clinical relevance

Rehabilitation nursing technicians are crucial members of the interdisciplinary rehabilitation team providing direct bedside care to optimize patient function. Rehabilitation nursing technician career ladders have the capacity to engage an often underrecognized employee population by creating a positive work environment that promotes job growth and retention in the rehabilitation setting.

Full Text

Duke Authors

Cited Authors

  • Squires, E; Shafer, K; Winters-Todd, B; Granger, B

Published Date

  • March 2022

Published In

Volume / Issue

  • 47 / 2

Start / End Page

  • 43 - 49

PubMed ID

  • 35234404

Electronic International Standard Serial Number (EISSN)

  • 2048-7940

International Standard Serial Number (ISSN)

  • 0278-4807

Digital Object Identifier (DOI)

  • 10.1097/rnj.0000000000000361


  • eng