Comprehensive orientation extends a warm welcome.

Detailed checklists and in-services for new employees at a hospital system's four sites provide thorough, consistent training that exceeds OSHA's and other standards.

DO YOU REMEMBER when you were the new kid on the block--that is, a new employee in the laboratory? do you remember feeling anxious, overwhelmed, lost? Do you remember wondering about your responsibilities and what would be expected of you?

Picture this scenario instead. You are hired by the laboratory manager and personally invited in advance to attend an orientation program on your first day at the new job. Upon arrival you receive a workbook detailing each task that you will be required to perform. You are told that a supervisor will review the material with you as you complete each step. And perhaps most importantly, you are given ample opportunity to ask plenty of questions in a low-stress environment.

How's that for lowering your anxiety level?

* Burden of training. The training of new employees is one aspect of laboratory operations that has suffered under time and financial constraints. The burden of presenting the same information to each new employee often leads to inconsistencies in training and frustration in the staff members who have many other things to do.

Yet OSHA and other governing agencies have bestowed upon the laboratory manager responsibility for training all employees in laboratory safety. Such right-to-know laws require the employer to instruct all employees on dealing with potential hazards in the workplace. A multitude of other safety-related topics must be reviewed with all laboratory workers upon employment as well.

* Multiple sites. Orientation at our institution involved the special problem of coordinating the training for four separate facilities. The approximately 220 FTEs in the laboratory services department of Baptist Memorial Hospital System in San Antonio are shared among these four sites: Baptist Medical Center, with 740 beds; Northeast Baptist Hospital, with 275 beds; Southeast Baptist Hospital, with 189 beds; and North Central Baptist Hospital, with 100 beds.

Our training program consists of a laboratory orientation day; distribution of separate checklists for general laboratory policies, laboratory safety, and department-specific performance requirements; self-instructional computer in-service programs; and reference materials. Within the first month of being hired, each employee must attend the 1-day hospital system laboratory orientation program, held biweekly from 8:00 a.m. to 4:30 p.m. The course covers laboratory safety, quality assurance, patient confidentiality, hands-on computer training, standard operating procedures, and client relations, including telephone etiquette.

At the end of the orientation day, each participant is asked to be frank in listing the benefits derived from the program and suggesting improvements. We have learned a great deal from reading such comments and have revised and updated the program many times because of them.

Laboratory management staff conduct laboratory orientation programs on a rotational basis. Involving all managers has several advantages, not least of which is to reinforce in their own minds the lab's safety procedures and effective client relations. In addition, sharing the responsibility of training new employees TABULAR DATA OMITTED enhances camaraderie among supervisors.

* Task checklists. The core of our orientation program is a series of checklists outlining the information each employee needs to know in order to accomplish assigned duties. As the new employee completes each step, he or she checks it off. Quizzes or evaluations at the end of each segment help us measure the program's effectiveness for future reference.

Upon completion of all the segments, the new employee and a supervisor or the laboratory manager meet to provide the employee with an opportunity to ask any remaining questions. During the meeting, a final checkoff is made. The checklists are then signed and dated by both parties, indicating that all the information on the lists has been absorbed, and placed in the employee's permanent personnel file.

General lab policy. Our first checklist, which covers general information about the lab, explains personnel policies, telephone etiquette, confidentiality, professionalism, and quality assurance activities. It also includes training on the laboratory computer system and time for employees to view video presentations and participate in group discussions on client relations.

Lab safety. The checklist on laboratory safety reviews all of the policies and procedures outlined in our institution's safety manual including the location of safety equipment, biological and chemical hazard information, and fire safety protocols, including how and when to use certain fire extinguishers.

Lab section information. The third step of orientation consists of instructional checklists and materials developed for each section of our laboratory with the able assistance of key personnel within that section. Separate checklists outlining the expectations and responsibilities of employees were produced for the blood bank, chemistry, coagulation, hematology, histology, microbiology, phlebotomy (which has two levels of instructional materials), urinalysis, serology, and specimen preparation and processing.

On section checklists, as with the general ones, new employees are asked to indicate that they have reviewed, understood, and performed the procedure or protocol named. Review questions follow. The checklist remains in the employee's permanent personnel file to document that the individual has reviewed the procedures and protocols of the laboratory section.

* Refinements. Our training program has been in place since June 1990. Needless to say we've faced our share of obstacles. Sometimes it's hard to coordinate the schedules of facilitators and new employees. We have had to rethink presentations for policies and procedures and revise and update program elements numerous times.

Another challenge has been in servicing management staff who participate in the program. Since we want our facilitators to present the most accurate and up-to-date information possible, we have held meetings in order to alert them to any changes in regulations, refresh their minds on pertinent information, and review and revise, if necessary, the agenda for laboratory orientation day.

Despite the obstacles, we have reaped many rewards from the orientation program. We now provide standardized instruction to new workers immediately. We have formalized the tracking of departmental instruction. Our documentation of what new employees have learned is more accurate and more consistent than before. We have gained a measure of confidence and TABULAR DATA OMITTED comfort in knowing that our new staff members understand what is expected of them.

* Kudos. The BMHS laboratory orientation training program has been well received by new employees and management staff alike. New employees have found the relaxed instructional atmosphere extremely conducive to learning. On the evaluation form, one new employee praised the "beneficial information given throughout the laboratory orientation day." Others said they appreciated receiving information on safety, participating in a realistic discussion of client relations, and experiencing hands-on computer training. Having a day set aside for orientation when questions could be asked in a low-stress environment received high marks as well.

Our laboratory staff and management personnel have praised the timely and organized way in which new employees receive important information. Supervisors are relieved to be able to spend less time providing in-services on standard laboratory practices. It has been noted that the information all employees receive is now consistent and that their training is documented more easily and more thoroughly than before.

We believe we are meeting our goal: to train new laboratory employees effectively and outline their responsibilities through comprehensive standardized information. An orderly orientation smooths the hiring and integration process for current and newly hired staff and makes new employees feel welcome by demonstrating that their arrival was carefully planned and prepared for. Perhaps most importantly, our comprehensive orientation program allows new employees to become productive, efficient, integrated members of the staff faster and easier than ever before.

Fisk is quality assurance/safety officer at Baptist Memorial Hospital System, and McNeil is laboratory supervisor at Southeast Baptist Hospital, San Antonio, Tex.