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How internships eased our phlebotomist shortage.

A good phlebotomist is getting harder to find. The high rate of turnover in the field seems to guarantee open positions almost everywhere. Like many other hospitals, we found ourselves facing a serious shortage of phlebotomists. In late 1988, we decided to do something about it.

Although we continued to advertise in local newspapers, too few good applicants appeared. Since our pay rates were in line with other hospitals, salary didn't seem to be the problem. In speaking with other phlebotomy supervisors in nearby hospitals, I realized that I wasn't the only one who always had slots to fill. Other supervisors, I learned, had found the answer in lowering standards for the quality of individuals they hired. I didn't want to do that. Still, I needed to fill our open positions and to keep them filled.

For years I had frequently received calls at the lab from people asking whether our hospital offered a training program in phlebotomy. They had called the hospital in general and been switched over to us. Since we did not offer such a program, I had routinely referred them to the nearby Indiana Vocational-Technical College (IVTC), which offered an 11-week course in phlebotomy that provided 44 contact hours. These calls suggested an untapped potential of new employees. I began to explore the idea of starting our own phlebotomy school.

I knew that I could call on the assistance of the hospital's in-house medical technology school, which trained fourth-year technology students from various local colleges. The school's phlebotomy team trained students and new employees. For more ideas, I called some hospitals that had their own phlebotomy training programs. My fellow professionals generously shared their experiences and suggestions. We were getting there.

* Tie-in. In reworking my plan, I thought about the classes taught at IVTC. The phlebotomy course consisted of three or four classes of about 20 students each. The classes, offered quarterly, graduated about 240 students each year. Approximately two-thirds of the students took the course as an elective in conjunction with majors in radiology and other fields. Many of the rest, however, anticipated making a career of phlebotomy. Why not join forces with the school, I thought, and tap this promising source of employees?

The one shortcoming of the course was that it was almost purely theoretical. In class, students took blood specimens from each other a few times, and that was about it. Graduates might be knowledgeable about the theory of specimen collection, but they were not up on their technique.

Clearly, the students needed practical training supplemented by lectures. If we started a phlebotomy school at the hospital, who would give the lectures? The hospital MT school instructors and I didn't have time. Our budget wouldn't accommodate hiring an additional person. I had to admit that we lacked the personnel and funding to provide a complete course on our own. Why not link up with the college and establish an internship program for their students at our hospital? Like so many simple ideas, this one had been too obvious for anyone to think of before.

When we took our proposal to the hospital lawyers, they nearly went through the roof. What about insurance for the interns, who would be nonemployees being exposed to patients' blood? We were able to reassure them that we could easily plug into the hospital's existing policy, held in conjunction with the college, to cover students in other health care programs, such as licensed practical nurses (LPNs).

* The right people. Our laboratory management team--myself, the lab manager, the lab director, and the coordinator of MT training--wanted students with the right personality and aptitude. How well they worked with patients and our phlebotomists, whom we call specimen technicians, would be paramount. Technical skills, we felt, would improve with experience.

During interviews with applicants for positions as phlebotomists, I have always looked more at the applicant's personality and approach to dealing with others than any proven ability to draw blood. You can train someone to draw blood, but you can't change anyone's personality.

We hoped to find people who wanted to improve their skills and their chances of employment in phlebotomy. The internship would provide us with an opportunity to evaluate each intern on site and decide whether we wanted to offer him or her a job.

* Logistics. We planned to offer the internship during the last four weeks of the college's 11-week phlebotomy course. At that point, each student would have undergone 28 hours of classroom training. Our program would involve 20 hours of practical phlebotomy experience a week, the most we thought students and our phlebotomists could squeeze into their busy schedules.

Training would take place from 8 a.m. to noon on Monday through Friday or from 1 p.m. to 6 p.m. on Monday, Tuesday, Thursday, and Friday. On Wednesday afternoon, the students were taking their four-hour weekly course at the college.

I structured the days and times around the students' phlebotomy classes. Administrators at the college decided to allow students to move to a different section if eliminating such a conflict enabled them to participate in the internship. If a conflict with a job or an unavoidable overlap with another class arose, however, the student would have to be eliminated from the applicant pool.

Now we had to sell the plan to the technical college. No problem! When presented with the idea, they supported it enthusiastically.

* Selection. It was clear that we could not accommodate all 60 students per class session. Since our goal was to groom future employees, we handled the selection process somewhat like a series of employment interviews. I started by visiting each class during its fourth week, when I explained the programand distributed application forms to interested students.

Fortunately, not all 60 students were interested in pursuing the internship the first time we offered it. Some had jobs at times that conflicted with our schedule; others, majoring in radiology or respiratory therapy or training to become LPNs, were taking the phlebotomy course as an elective and didn't intend to enter the field.

The students' ages ranged from teenagers just out of high school to women in their 40s reentering the job market after raising their families. One class included a mother and daughter. Since neither applied for an internship, we didn't have to choose between them.

For the 18 students who applied, I conducted five-minute interviews at the college. I invited the eight most promising candidates for separate follow-up interviews at the hospital with me and my lab manager. Of these, we selected three.

In doing this, we were following our usual procedure for interviewing job applicants. Starting with the second set of interns, I was delegated to make the selections myself after the preliminary interviews at the college.

We wanted to begin gently. The first internships were granted to two students in the mornings and one in the afternoons. The second time around, we expanded; I picked five interns from 23 interviews. The number of interns has remained stable at five in the five internship sessions we have held since then.

* The program begins. Our program began in earnest in April 1989. We started off each intern with the full laboratory orientation program, including a video-tape on how to handle spills and other emergencies. Some of this, including the need to follow universal precautions, falls under state requirements. I take interns on a tour of the hospital, including the intensive care unit. Some feel faint at first, but most start to take the hospital environment in their stride very quickly.

The hospital pays for materials necessary for our training manuals, which I prepare myself. Like the rest of our staff, interns must obtain and launder their own lab coats. Gloves and other supplies are provided by the hospital.

At the beginning, when the internships were only four weeks long, students performed adult venipunctures only and observed nursery and pediatric techniques. Now that our program lasts for five weeks and students have completed more coursework before they begin, we let them do venipunctures on children and infants when we feel they're ready, usually during the last two weeks of the internship.

We involved the instructors at our hospital's medical technology school as well. Each spent an hour escorting the interns into the section of the laboratory in which he or she specialized. The lab staff showed them how to produce good-quality specimens and how specimens were processed.

I demonstrated certain techniques myself, such as arterial punctures (on a model) and fingersticks, and occasionally spent a session telling interns how they were doing. They spent most of their time, however, under the wing of one or another of our approximately 40 phlebotomists. While those who have proved to be the best at teaching do most of the hands-on instruction, we rotate interns to work under most of the staff.

The key to successful phlebotomy, we feel, is not only the ability of the staff but also the extent of their cooperation. Furthermore, being able to draw blood does not in itself guarantee the ability to teach the procedure.

I have been very fortunate that all of my phlebotomists are willing to teach and have the patience required to work with students. I learned not to make judgments in advance about who would be good at this. Someone who works slowly most of the time may get enthusiastic and excel when given the challenge of teaching someone. Throughout the training period, the phlebotomist in charge of the intern that day fills out a check-off list of procedures the intern has completed successfully. Our phlebotomists' job descriptions and evaluations now include the need for proficiency at training our interns.

The four-week training period pretty much tells me how well an intern will perform on the job. If I expect performance to be good, I may offer the student a position in the laboratory. In the first year of the program, we accepted 17 interns and hired 14 as part-time or full-time employees. One has left, 12 are still in the laboratory, and one has transferred to the nursing department of our hospital. A summary of current employees who started out as interns can be found in Figure I.

* Hints for success. I found out that it always pays to listen to my interns. More than once they have alerted me to discrepancies in my staff's technique by noting that two instructors had done things differently.

Retraining the instructors corrected the problem.

Keeping the phlebotomy staff fully informed is crucial in the planning of an internship program like ours. The teaching competence of the staff phlebotomists determines the success of such a program. In many cases it was necessary to teach the instructor how to teach.

Early on, I realized that some areas in the didactic training needed more emphasis and a few other changes needed to be made. To have more influence on the content of the syllabus, I started to teach some sessions at IVTC. Participating in this way gave me a better opportunity to observe students in the classroom as well as in the work setting.

* More changes. In September 1990, the technical college revamped its schedule from quarters to semesters. Formerly, classes had changed each quarter and lasted for 11 weeks; now each semester is 16 weeks long. Instead of taking place during the last four of the 11 weeks, the internship is offered during the last five weeks of the semester, after the didactic class has ended. At that point, most of the students, whose other courses are continuing, simply stop their phlebotomy instruction. Those who become interns received additional credit and a separate grade.

At first, when the internship took place during the quarterly classes, it did not entail any additional tuition; participating students did not earn a separate grade or class credit. Under the semester system, they receive grades and credits for internships and pay the college accordingly.

Besides myself, one other person teaches phlebotomy at IVTC. My fellow instructor is now the senior phlebotomist from another hospital in our city. When she was hired, she was asked to establish an internship program at her hospital that is similar to ours, and as of Nov. 19, 1990, seven interns began the first such program there.

When the time came to start choosing interns from the latest graduating class at the college, she and I sat down and discussed the students in each other's classes. All had been told about the internships at the beginning of the semester and informed that selection would be based heavily on their performance and grades in the course. There's a little competition between us for the best prospects, but since the students are asked which hospital they would prefer to work in, some of that burden is removed from us.

The program coordinator at the college continues to encourage other local hospitals to set up similar internships. We're not sure how successful she will be, since some hospitals have their own in-house phlebotomy programs.

One rewarding development is that class sizes in the college phlebotomy course have been increasing. Even better, may phlebotomists tell me that the latest crop of students are picking things up more quickly than ever before. Surely one contributing element is that they have had 11 weeks of class rather than seven before arriving at our lab.

For the last three years, all the phlebotomists I have hired were either former interns or otherwise experienced in the field. This is a vast improvement over the past, whe I was sometimes compelled to hire people with no experience and train them on the job--only to have some of them not work out.

In fact, one unforseen benefit of our program is to help students who are not cut out for a career in phlebotomy to learn that fact early. When I told one of our interns that I couldn't offer her a job, for example, she was relieved. She too had realized that phlebotomy was not her cup of tea. Having worked with us only part time, she still had another job and lost nothing by not being hired by the lab. For our part, we had identified a potential problem employee at the outset and parted friends.

I continue to receive calls from people asking about training in phlebotomy. It is a pleasure to be able to describe our internship program rather than simply referring them to the college.

* Valuable employees. We attribute the success of our program to several factors. First, we know before hiring how well each intern will work with associates and patients. Second, we know the person is capable of being trained. Third and most important, we know that we have brought on staff an individual who wants the job, who has worked hard to get the chance to apply for it, who is relatively knowledgeable about phlebotomy, and who is already familiar with our staff, our setup, and our techniques. Virtually no orientation is required.

By expending some extra effort and time but very little money, we now have phlebotomists eagerly knocking on our door. We are only too happy to open it to them.

The author is technical supervisor in the clinical laboratory at St. Vincent Hospital and Healthcare Center, Indianapolis.
COPYRIGHT 1991 Nelson Publishing
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Author:Hoeltke, Lynn B.
Publication:Medical Laboratory Observer
Date:May 1, 1991
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