Real-life heroes: rural lab techs.

Working in a small rural laboratory can offer unusual challenges and rich rewards - here are the stories of laboratorians who made that choice.

If you enjoy being the emergency medical technician who brings the cardiac patient to the hospital, works closely with the emergency room personnel, performs the tests to determine the diagnosis of a heart attack, and later helps the patient with cardiac rehabilitation, life in a rural lab is for you (see box, "Advantages of working in a small rural lab," p. 42). You could become a multiskilled jack-of-all-trades with a wide range of experience if you choose to work in this type of setting.

The special challenges of rural labs

When I graduated from medical technology training, I had the impression that technologists and technicians working in rural areas were not quite as sharp as the techs in large labs in the big cities. After working with rural techs for the past 25 years, I realize how wrong I was. Rural techs often have to perform a wider variety of tasks on a daily basis than their urban colleagues do. They work in all departments of the laboratory and often do so alone. Sometimes they work long hours during call, weekends, and holidays that require Herculean strength and endurance.

One reason for the necessary independence of rural laboratory personnel is the small staff size typical of those institutions. While managed care has caused urban laboratories to reengineer their laboratory space and "right size" and retrain their staff members for handling multiple tasks with multiple skills, rural labs have always operated this way because of the high costs associated with serving a small population. So, for many rural techs, working in the lab is not just a job, it is a mission.

The rural laboratories I serve are located in communities of fewer than 10,000 people, and the hospitals vary in bed capacity from 14 to 50. The term "rural" doesn't adequately describe many of these laboratories when you drive in one direction for 125 miles without encountering a town with a hospital, the term "frontier" seems more accurate than "rural."

Job experiences. Often these laboratorians encounter problems specific to a rural environment, such as performing tests on patients injured from snakebites; farm implement accidents; and toxic exposure to fertilizers, pesticides, and herbicides. The challenges in microbiology include identifying animal pathogens that infect the wounds caused by farm and ranch injuries.

Migrant farm workers, who often come from Mexico and work their way north during the harvest seasons, can pose special challenges in parasite identification. When they become ill, they may present the laboratorian with parasites that are not indigenous to the area.

Laboratorians frequently serve as the head of a hospital's infection control committee, thanks to their knowledge of microbiology and infectious disease. Because of their training in chemistry and laboratory safety, they often head the safety committee and become a local expert in handling, disposing, and cleaning up hazardous materials.

Management. Rural laboratory managers are usually "testing managers." They must function as a manager and still perform testing and take their share of call and weekends. In the smaller rural labs, a medical laboratory technician (MLT, certified by the American Society of Clinical Pathologists) will often serve as the lab manager.

Laboratory managers in rural hospitals also face special challenges. Rural hospitals serve a high percentage of Medicare patients, and reimbursement by Medicare here is often less than in urban areas. The high costs associated with performing a low volume of testing make finances a primary concern. For example, a rural laboratory may have only one patient test in a run. Because two controls are required, the reagent cost of doing a single-patient run is triple the cost of doing a run in which only two controls are required but 100 patients are tested in that run. Further, the amount and cost of labor required to set up a run for just one patient cannot be divided by 100 patients when only one patient test is performed. It is difficult to compete with the large reference labs for outpatient testing.

Continuing education. For a variety of reasons, rural techs do not have access to continuing education programs at their institutions as do urban laboratorians in teaching hospitals. Rural laboratories are not usually affiliated with a university teaching program, and they do not have in-house pathologists and other advanced-degree laboratorians to present in-services. The rural laboratories in our area are located approximately 300 miles from the nearest dries where laboratory educational programs are presented by the national professional societies.

The rural laboratorians rely on their consulting pathologists and technologists to provide their in-service education. Few small rural labs have continuing education budgets that allow the lab techs to attend off-site meetings and conferences.

Rural techs often take advantage of the continuing education programs provided by journals, subscription programs, and teleconferences. A promising new avenue to continuing education is the Internet (see box, "Continuing education opportunities on the Internet," p. 44); the World Wide Web is a good resource for information on any lab topic. Already some sites offer continuing education for lab techs; undoubtedly, more will do so in the future.

True heroes

When I was a child, my heroes were fictional characters like Superman and the Lone Ranger. As an adult, my heroes are real: They are the medical technologists and medical laboratory technicians working in rural labs. These laboratorians often demonstrate the strength and stamina of Superman and a talent for working alone like the Lone Ranger.

To help you better understand my heroes and their jobs, I will describe three individuals. Note the sacrifices these laboratorians made to serve their communities then consider why they chose to do this when easier jobs may have been available.

CLARENCE. After receiving his laboratory training, Clarence Shultze came to work at Cheyenne County Hospital in St. Francis, a rural Kansas town with a population of 1,300. On arrival, he discovered that in addition to providing traditional laboratory tests, the laboratory was also responsible for furnishing radiology services and performing electrocardiograms. To make matters more challenging, all this had to be done with a staff of one - himself!

To say Clarence kept busy is an understatement. Although the physicians understood that Clarence could not do more than one job at a time, e.g., taking X-rays of an auto accident victim while performing cardiac enzymes on an emergency room patient, they did complain occasionally to the administration that Clarence needed help. Because there was no other place in town for outpatient testing, Clarence often had an outpatient or two waiting. (Like many rural hospitals, this one was operating on a tight budget and could not afford to increase staff size until it was proven absolutely necessary.)

When Clarence wanted to take a vacation or a weekend off, the hospital had to hire a tech from out of town because he was on call every day of the year. I was always amused when Clarence took one week of his vacation each summer to help harvest his brother's wheat crop. Clarence joked that this was really a vacation because he had to work only from dawn to dusk with the harvest crew - plus, he was not on call during the night!

When asked why he continued to work at this job instead of looking for other opportunities with higher income and more personal time, Clarence laughed and replied, "How would they find anybody crazy enough to do my job?" He enjoyed his work and felt he was on a mission.

After Clarence ran the laboratory single-handedly for 17 years, the hospital did get some additional help. That was several years ago. (Today, all of the hospitals I serve have more than one person working in the lab. The call schedules require techs to work from every other weekend to every fifth weekend, depending on the size of the staff.) Why did Clarence tolerate working alone for so long? I believe it was because he felt needed and appreciated. He received a lot of appreciation from hospital physicians, hospital staff, and citizens of the community.

Whenever outpatients come into the lab, they call Clarence by name. They often bring him baked goods or candy to show their appreciation for the job he performs; and on his birthday, the entire hospital staff always throws a big party for him. He is obviously a hero of theirs, too.

MELONIE. After graduating from high school, Melonie Morrison, MLT (ASCP), began working as a lab aide at the Callaway Hospital District in Callaway, a small town with a population of 600, located in the Nebraska Sandhills. The hospital was new, and the laboratory had the latest instrumentation, which is an exception to the rule that small communities rarely have budgets that allow for new construction or timely replacement of lab equipment.

The laboratory supervisor had her medical technologist certification (ASCP) and routinely worked every other weekend and took blood bank call on the weekends when she didn't work. This was necessary because her only help was Melonie, who had received all her training on the job. When the Clinical Laboratory Improvements Amendments of 1988 were introduced, Melonie's supervisor and the hospital administrator were concerned about how they would meet the personnel standards for high complexity testing when Melonie was not directly supervised. As a consultant to the hospital, I suggested Melonie enroll in the medical laboratory technician training program at an area community college. Then she could obtain her associate's degree from an accredited program in medical laboratory science and meet the minimum CLIA requirement for performing high complexity testing without supervision.[1] Melonie's supervisor and administrator were supportive, as was the hospital board, which agreed to pay her tuition.

Melonie agreed to the arrangement, but seeing it through was not easy for her and her family. For two years, she had to drive 70 miles each way over rural roads in all kinds of weather to attend classes. She had a husband and two small children at home who were also affected by the sacrifices she made for the laboratory. When classes were over early enough for her to return to the lab, she worked a couple of hours before going home. She also took 2-3 nights of call each week as well as every other weekend.

When Melonie wasn't working part-time in the lab, attending classes, studying, or caring for her two young children, she helped her husband with chores on their farm. Once she told me how she had almost drowned when heavy rains caused flooding in their pig pen and she tried to carry the panic-stricken hogs to higher ground. Because she is only 5 feet tall and weighs about 100 pounds (not exactly the physical equivalent of Wonder Woman), this was a mud wrestling challenge she was able to laugh about only at a later date.

Today, Melonie has her associate's degree and MLT(ASCP) credentials. She shares half of the call, weekends, and holidays with her supervisor. Although she claims that no course work or exam was quite as difficult as mud wrestling drowning hogs, her hard work has paid off - she has the recognition and support of her supervisor, administrator, and medical staff.

ARLENE. Arlene Harms, MT(ASCP), lives on a farm with her husband and children. When she graduated from college with her degree in medical technology, there were no jobs in the 25-bed hospital in the town near her home. So, she took a job at another rural hospital, Melissa Memorial Hospital, in Holyoke, Colorado, 45 miles away. The job required her to take X-rays and share call with the radiology tech. Arlene is a fast learner and capable of juggling many responsibilities at once. She soon became the manager of the lab and X-ray departments. She also took emergency medical technician training and shared ambulance call in addition to lab and X-ray call.

When Arlene's hospital decided to implement a cardiac rehabilitation program, Arlene volunteered to take on the project. With extra training in cardiac rehabilitation, Arlene developed a program at her hospital, which saved the cardiac patients in that area from driving more than 50 miles to a rehabilitation program in a larger community.

Arlene leads her hospital's infection control and safety committees. When guidelines were released for handling patients with tuberculosis, Arlene became the local expert at writing procedures, training personnel, and performing mask fittings. Hospitals in her area learned of her expertise and invited her to help them meet the guidelines and wain their personnel.

When medical laboratory technicians from an area community college rotated through her laboratory, they were astonished at how much they learned from Arlene in a short time. The community college offered Arlene a part-time teaching position with the MLT program. She tried it for one year, but the college was located 70 miles east of her farm, while her lab was 45 miles west of her farm - even Wonder Woman could not be in two places at once. After 1 year of part-time teaching as well as trying to keep up with her hospital duties, Arlene gave up the teaching position. Her students claimed that she was the best teacher they ever had. Arlene is certainly one of the best technologists that I know and a real-life hero.

A real commitment

Clarence, Melonie, and Arlene are strongly committed to their jobs. It would not be surprising if their circumstances - and those of other rural lab techs - caused a higher turnover rate and lower job commitment. Yet studies show that rural techs are just as committed and dedicated as their urban counterparts.[2] This may be because the personal rewards more than justify the efforts needed to accomplish the job.

Rural techs have higher visibility and more recognition from patients and other healthcare workers; they may have an unusual amount of patient contact. For instance, the rural tech acting as an EMT - may drive the ambulance to a heart attack patient's home, initiate care, transport the patient to the hospital, draw the blood, obtain the electrocardiogram, perform the cardiac enzymes, and work with the patient after hospital discharge in cardiac rehabilitation. A bond may form between the patient and the lab tech in fact, to a rural tech, the patient is not just a patient but also a friend. After a hospitalization, often a patient will give baked goods or homemade craft items to laboratory staff members.

How to be a hero

Most things worth having are worth the sacrifices required to get them. A job in a small rural lab is certainly worth the sacrifices for those who want less supervision; more responsibility; knowledge about and involvement with patients; and more recognition and appreciation from patients, medical staff, other caregivers, and administration. The next time you wonder if your job could be more challenging and rewarding, check out a job in a small rural lab!

Advantages of working in a small rural lab

* Work independently with minimal supervision; often report directly to the CEO 

* Gain expertise in many areas; generalist in the lab as well as areas outside of the lab

* Work closely with patients, physicians, other caregivers, and administration

* Have greater visibility with patients, physicians, other caregivers, and administration

* May receive more recognition, status, and appreciation from others

Disadvantages of working in a small rural lab

* Small staff size; must work more call, weekends, and holidays

* Less in-house expertise; must use phone consultations with pathologists and others

* Fewer in-house CE opportunities; must take responsibility for own CE

Continuing education opportunities on the Internet

* http://ww.aacc.org/

* http://www.ascp.org/teleconference/index.html/

* http://www.clma.org/

* http://www.medweb.emory.edu/MedWeb/

* http://www.medwebplus.com/

* http://www.mlo-online.com

References

1. Clinical Laboratory Improvement Amendments of 1988; Final Rule: Standard: General Supervisor Responsibilities, Federal Register, February 28, 1992;40:7182.

2. Lunz ME, Sharp S, Castleberry, BM. Career commitment: Nature, nurture or both? Lab Med. 1996;27:736-740.

David W. Glenn is a laboratory consultant, laboratory manager, and corporate pilot for Pathology Services, P.C., North Platte, NE.