Are You Really Short Staffed?

It's always a good idea for anyone to focus on the positive aspects of their job, especially if they have more difficult prior experiences that may have "seemed" better at the time they started them due to higher pay, more advanced technology such as less use of paper, etc.

At the hospital lab by which I am currently employed, we have 3-4 phlebotomists and a FULL-TIME specimen processor on night shift who only leaves the lab for her 30-minute "lunch" break - as opposed to the two "phlebotomists/specimen processors" in my prior 3rd-shift position in Texas. (Whenever they had to leave the lab and stick, one of the two techs would have to answer the phone, potentially interfering with efficiency/TAT of test results.  I've definitely noticed a difference in the number of phone calls my current colleague and I have to answer ourselves due to our different division of labor on nights here in Danville.)

I also GREATLY appreciate not having to perform phlebotomy in my current position because I dealt with severe anxiety issues due to my lack of practice with "difficult-to-stick" patients at other hospitals where this task was assigned to laboratory technologists (i.e. only having one phlebotomist working night shift).  Upon failure to obtain blood specimens from such patients, I judged myself much more harshly than any colleague or supervisor of mine, holding myself to an impossible-to-obtain standard of "perfection" would have due to my low self-esteem (stemming from difficulties in my life outside of work).

Hopefully the pay situation will change in the near future when the "powers that be" at the company which recently purchased my current hospital look at what other hospitals (i.e. a close neighbor of theirs in South Boston, VA) pay their laboratory personnel who hold BACHELOR'S DEGREES and NATIONAL CERTIFICATION in their field to reflect the importance of their work in high-quality patient care.

Until then, I'll definitely work on appreciating the non-monetary benefits I do have in this job - less involvement in matters not directly involved in generating laboratory results and resulting HIGHER EFFICIENCY.

I'll try to be patient (and have faith that "things will work out for the best") about it perhaps taking a few more years to get divorce/custody-related attorney bills, medical bills from a broken nose in summer 2007, and $2000 for replacing my car's transmission (which recently failed after 18 months, making the car non-drivable) around that same time paid off than it would have if I continued traveling with my work.

Paper is a nutty thing.  Has anyone ever checked these paper logs for errors?  I'll bet there is an error rate, a misfiling rate, and a cost attached to creating, maintaining, transporting, and storing it.  How does anyone justify an expense that causes errors?  Maybe, that's where to start.

It's not only techs.  A nurse administrator recently told me that the specimen collection time hand-written on the T sheet was the "correct" time.  That's especially nutty when this data "proves" lab turnaround times are too long.

The trick to convincing coworkers, I've learned, is to have group discussions that ask questions about paper.  What does it do for us?  How does it make our job easier?  What happens if it goes away?  Most reasonable people will concede that paper is a pain.

The next step is to convince people that paper is optional.  If you have an information system, it's just silly to mirror everything on paper.  If more questions are asked, the notion that it's OK to stop using paper emerges.  This permission is important, I think, especially for those convinced that paper equals quality.

In my previous night-shift traveling positions, I did perform a significant amount of maintenance and QC.  In Bryan, TX, the lead 3rd shift tech and I were even required to move heavy biohazard boxes to a "holding room" for waste disposal, from which they were removed from the lab the next day!

(A colleague of mine in my current job remarked that she would have obtained a physician's note to exempt her from that particular responsibility when I told her about that.  I wisely bit my tongue and refrained from replying about that approach not possibly working very well for a 30-year-old employee such as myself.)

My new permanent position is (for the most part) a cake walk compared to my previous night work experiences because day shift performs the vast majority of maintenance/QC at this hospital's lab.  The QC that must be performed every 8 hours (hematology and basic chemistry) is usually done by 2nd shift between 10 and 10:30 at night shortly before they leave.  The only QC that 3rd shift is ALWAYS responsible for performing is  normal and low-abnormal UA strip and microscopic analysis. :)

There always must be a catch, though, because no job out there is completely perfect.  As I mentioned in one of Glen's recent topics about "recession-proof health care," I am making 30 cents/hour (on night shift with nearly 5 years of experience) more than entry-level MTs currently do at the Winston Salem, NC hospital where I trained for this career field.  

Also, auto-verification was wonderful at the Lafayette, IN hospital where I worked day shift as a traveler (which had it completely implemented in their lab ONE YEAR AGO).  I cannot, however, see my current employer even introducing it OR going as "paperless" as possible in the lab any time soon.

You see, many of my colleagues are older, set in their ways, and hold on to their paper Meditech worksheets (a blank spreadsheet with handwritten results AND a printed one with results entered into the system for EVERY last "manual" test), printing pending logs for each department at the end of every shift, etc. like toddlers desperately holding on to their security blankets.  Wish me luck in transitioning back to the "Dark Ages" after working on a "paperless" basis (except for transfusion unit tags and report forms) in Texas, please; I suspect I will greatly need it. :P

Nick, your point about off-shifts is a good one.  And ironically, off-shifts are traditionally expected to support the day shift by running quality control, performing instrument maintenance, and other tasks -- all while doing everything else.  Seems a bit backwards, now that I think about it.

Is there a better way?

A staffing plan should map workload against bodies needed to get the work done in an appropriate time frame.  This can be done simply enough on an Excel or other spreadsheet if the number of orders received and time to process are known.  But this assumes a limited number of roles assigned to that processing.

Fewer techs could do more if warm bodies were trained to collect samples, spin samples, answer telephones, etc.  Autoverification can remove much decision-making at test completion.  A more important question than "Are you short staffed" may be "What's the least amount of decision-making time?"

Can phlebotomists, assistants, and clerical staff be sufficiently trained to perform most of the tasks that don't require critical judgments?  We may have to move toward outsourcing and automation to minimize the need for hands-on testing.  Imagine a tech on call "reading" an instrument result online from home.  Would that work?

I second the motion on Nick's statement- on everything, that is what is basically happening in my workplace right now. We might have some low in-patient census from time to time but,  more than 50% of our workload comes from the clinics and outpatients.

Yes and No.  If you look at the overall number of techs on staff in ours (and many other facilities) you will notice the abundance of techs in the department during the daytime and fewer as the hours go on.  

BUT -- often times the [proportional] workload remains the same or is actually increased due to increased respopnsibilities for off shifts as ancillary staff leaves.  We (off-shift TECHS) may be responsible for phlebotomy, customer service calls, registration, phones, specimen processing, stat Micro etc..  

We manage to do all of this, yet with fewer people.  We are often times shortchanged in the area of being able to take time off at will due to having fewer staff to cover.  There are people already off for working weekends and part timers that aren't there on particular days.  We often have to pick up more weekends and holidays because there are fewer of us to spread across the board to work them.  

On a second note, will laboratories really become short-staffed once the doomed retirement of baby boomers hits...... or not?  Will many continue to work?  Will some go part time?  Will some leave and never come back?  Time will tell....  

Once again, when those people that have retired to day shift finally do retire for good, many techs from off-shifts will have the chance to graduate to days, leaving vacancies behind where they came from.  How will these be filled?  There are only so many new grads and individuals that are willing to re-enter this field that competition will be fierce for warm bodies to cover these hours.  The interesting part will be what gimmicks will win the staffing?  Will it be sign-on bonuses, higher shift differentials, better scheduling hours, higher wages, working no weekends, overtime perks for existing employees ...?