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Press Start: Lead an Empowered Life as a Clinical Laboratorian

Return to Generalists a Mixed Blessing

Published November 15, 2007 3:36 PM by Glen McDaniel
In recent years, I have noticed a return to the use of generalists even in larger laboratories. When I was just a "baby CLS," everyone started out as a generalist in all but the biggest laboratories. Many aspired and longed for the day when they would have earned their stripes enough to be able to specialize.

In fact, in my CLS training in Canada's largest children's hospital, even histology was prominent among my rotation as a generalist.

Now, it seems the shortage of laboratorians has made lab directors see cross training as a way to ensure staffing flexibility: laboratorians can be rotated from department to department based on the particular need. They feel no one should have the luxury of being well-staffed while another department is suffering. Techs should be pulled like chess pawns to wherever the work is. Makes sense on paper, doesn't it?

The feedback I am getting from laboratorians, especially boomers, is that they feel used and ill-prepared for this new trend, which they see as simply for the convenience of management. I had an enlightening moment with one lady I met at a meeting in San Diego.

She has a Masters degree and has worked in chemistry for 16 years, but has been told that in the next 3 months, she must be retrained and will rotate into hematology and bloodbank. She thinks this "drastic disruptive rotation" (her words) should be restricted to new grads who want and need the expertise.

The bulk of the work in any department should be performed by the long-term experienced specialties in that area: people who actually like the specialty, are competent in that area and who feel committed to working in that area.

So it seems while this new trend toward generalization/cross training makes sense operationally and financially, it can create resentment, poor morale, stress and the unexpected result of semi-competent laboratorians in all departments. Now, who benefits from that?

6 comments

I've read through all the comments and I still fail to see the problem with having Generalists running the lab.  I understand that some people really only have the capacity to run one department, but really, we all go through the same training.  The instrumentation has gotten easier to use in all areas.  It's certainly not the days of the SMAC any longer.  Most of these instruments have an ease of use that was unheard of in the beginning of my career.  I work in all areas of the laboratory.  I do micro, although limited to stat work, blood bank which is all inclusive in a level one trauma center, chemistry, hematology and everything else that goes with a stat lab in the middle of the night.  It's great to say "I'm a specialist" but thats not really conducive to a good working enviroment in the new fast paced labs that are out there.  Specialties are great but they make you a more limited tech.  I can and do do everything.  The more the better.  Yes, I spend at least ten extra hours a week on Continuing Ed, but thats exactly what I expected when I first made this career choice.  I've worked in physician labs all the up through a major reference lab and I've loved the change that this field has gone through.  Flexibility is the key in life and that especially includes your career.  Just my thoughts.

I hope everyone had a great thanksgiving.

Nancy

Nancy Jandorf, Generalist - Bench Tech, HealthNetworkLabs November 27, 2007 2:12 AM
Allentown PA

As an instructor in clinical chemistry in a CLS program, I always encourage our graduating students to "generalize" first, and then specialize. I think it is a good way for them to enhance the knowledge they have gained in the CLS program, and I also believe it makes the profession more interesting. It is fascinating when you circulate among departments and perform different tests on the same patient. I encourage students to try to put these results together, as in a case study and try to determine the cause.

I can also see the need for specialists in a department, whose familiarity and ease with the department's operations, instruments and test menu make things run more smoothly for all of the circulating personnel. I think there should be a mixture of personnel in each department composed of specialists and circulating personnel.

With regard to the tech who was being trained to work in Blood Bank, I can understand her concerns. I wonder how the laboratory administration handled her training in Blood Bank. Unless the personnel in that department are willing to spend the time needed with this person to help her regain knowledge and expertise so that she can release results with confidence, the experience of cross-training is going to be an unsatisfying and stressful one. Going from Clinical Chemistry to Blood Bank means getting accustomed to different testing procedures, decisions about the accuracy of results and troubleshooting techniques. These take time to learn. The person almost has to go through another rotation experience to become competent. The lab administration needs to recognize this and provide appropriate support. This support could go a long way to retaining an experienced, loyal professional rather than having to spend more money training a new employee.

I think all lab supervisors and administrators should follow Sabine's example and create user-friendly learning aids that help cross-training personnel learn the job faster and easier. I applaud her initiative in creating the decision tree to help her learn how to evaluate Hematology results.

I know this is a long post, but I also wanted to share my husband's cross-training story. He had recently switched to the evening shift in Chemistry and was told that he would have to cross-train in Hematology if he wanted to keep the shift. He spent about six weeks being trained on the day shift by Hematology personnel and now enjoys moving between the two departments. The lab personnel and the lab manager have told him often that they admire his efforts to learn a new department at his age (57). Maybe this is something else lab adminstrators should consider doing with their cross-trained employees- tell them how valuable they are!

Thanks and Happy Thanksgiving to everyone!

kathleen schulman, clinical laboratory science - clinical instructor , east carolina university November 25, 2007 5:33 PM
greenville NC

Training in a new area of the lab can certainly be disruptive, but there are ways of making it less disruptive.

For example, in my last job, after years of being a chemist exclusively,  the lab embraced the core lab concept, and I was trained in hematology.

I could handle the Cell-Dyn easily, since I find instrumentation fascinating. But it was difficult for me to get a grasp on the mind-boggling number of rules for checking, validating, and repeating tests once the CBC was run.  Because I was not yet  familiar with the patterns for lab results seen in hematology, the rules just didn’t make sense.

And it didn’t help that the lab supervisor had compiled a “do’s and don’ts” document that was merely a long list of the rules in no particular order.

So, I took the document and created a simple fishbone decision tree, which I used as a job aid.  This helped me tremendously in learning the rules, to the point where I no longer needed the job aid.  The transition to hematology seemed much less disruptive and made me more productive sooner than just expecting me to memorize rules or consult a long confusing list.

I think that often we just throw people into other departments without considering the non-training support materials that can make that transition easier.

Sabine Kirstein, Generalist - Clinical Lab Scientist, Pfizer, New Haven Clinical Research Unit November 22, 2007 8:41 AM
New Haven CT

"Jack of all trades, Master of none." Is that where we are heading/returning?  You will be hard pressed to convince me that a generalist can function at the same level of confidence, proficiency and competence in my transfusion service as my specialized staff.  With everything there comes trade offs and the decision must be made as to what you are willing to sacrifice and what you are not.  At our facility we currently have three departments in the lab, Histology, Transfusion and Everything Else.  When it was decided to combine Chemistry, Hematology, Coagulation, Urinalysis and limited Microbiology a great deal of expertise in each area was sacrificed for flexibility.  Are they still producing quality results, certainly, but not at the same levels as before.  The larger the lab the more complex the test menu and there comes a point where it is simply not feasible to expect everyone to do everything and do it at the 100%+ level that we are expected to function.  Next time you wonder why so many are leaving the profession and why so few are entering look around, you might be surprised to discover that forcing everyone to function as generalists may be one of the larger factors.  

The lady mentioned above will take retirement at her first opportunity and who can blame her.  I certainly would not want an 18 yr chemist with 3 months of "retraining" working in my transfusion service.  Especially if she dosen't want to be there in the first place.  You definetly would not want me running one of your chemistry analyzers.

John Staley, Transfusion Service - Supervisor, McKay-Dee Hospital November 21, 2007 5:28 PM
Ogden UT

Stephanie:

There is no doubt in my mind that it is valuable to have multiple skills set. It is both satisfying and marketable to be able to perform well in various areas. I always advise sudents to learn as much as they can and to seize every opportunity to acquire a new skill, even if they feel they are being used. Regardless of others' motives, we can find some personal benefit in most experinces.

I suspect the woman in San Diego has not had an honest conversation with her boss about the reasons for the change, explained her resentment and then maybe negotiated some middle ground option. Generally when people feel like pawns being moved around for convenience, there is responsibility on both sides-the pawns and the "chess player." My suspicion is that flexibility (on the one hand) and sensitivity (on the other) would both be useful in this new climate.

Glen McDaniel November 21, 2007 10:22 AM

Last year, I had the opportunity to work with one of my classmates from MT school.  I heard from her that the laboratory director of the Winston Salem hospital in which we trained had retired since we graduated - and his replacement had decided that Chemistry and Hematology/Coagulation/Urinalysis/Body Fluids should no longer be two separate laboratory departments.  My colleague's former co-workers in Hematology, etc., did not mind training in Chemistry during the "Core Lab" transition, but the Chemistry technologists seemed to have the same attitude as the lady with whom you spoke in San Diego, from what I heard.

The lab supervisor at the Indiana hospital where I am currently working as a temporary/travel technologist told me that she would rather have recent graduates working in her laboratory then someone who has only worked in one lab department for 15-20 years.  I do not feel "used" or "pulled around like a pawn" in this facility, though.  

My favorite areas of the clinical lab are Microbiology and Blood Bank, but I also find counting differentials in Hematology interesting.  I studied Physiology and Pharmacology at the graduate level for one year; therefore, I enjoy working in Chemistry.  

I believe that the level of satisfaction - or the level of "stress, low morale, and/or resentment" - one finds in their job has a LOT to do with the attitude they bring to work with them.  If a MT finds working outside of his/her comfort zone "drastically disruptive," he/she may miss out on the personal sense of accomplishment that comes from learning new techniques AND being able to contribute to patient care in new ways.  People are not perfect, so no MT will feel completely competent in every area of the lab 100% of the time.  There's nothing wrong with that, or with asking questions of someone who is more experienced with and "committed to" a lab area that is new to a cross-training MT.  I believe that no one is ever too old to learn new things.

Stephanie Mathis, Generalist - Medical Technologist, Medical Staffing Network November 17, 2007 2:17 PM
Winston Salem NC

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