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Ten-hour shifts solved our turnover problem.

Ten-hour shifts solved our turnover problem

Until a few years ago, we had the same staffing problem most hospital laboratories experience: It was very hard to recruit and retain qualified personnel on the afternoon and midnight shifts.

At our 522-bed hospital laboratory, nine of the 12 full- and part-time positions on these shifts changed hands during 1982 alone. That was the year I took on supervisory responsibilities in addition to my duties as a bench technologist. The high turnover rate became my problem, and I shuddered each time another technologist resigned.

Ten-hour shifts, with more time off between blocks of work days, were suggested periodically as a night duty inducement. Tentative schedules were even drawn up, but they always fell by the wayside amid the next onslaught of resignations. The laboratory was too busy scrambling for help; it couldn't discard the old, comfortable eight-hour system at the same time. Besides, wouldn't we "lose' two days per pay period for each employee on a 10-hour shift?

A climate favoring change developed by the spring of 1983. We enjoyed a moment of stability with all positions filled. Through extremely selective screening of applicants over the previous two years, the lab's administrative director had created a pool of skilled medical technologists who brought an average of 12 years of experience to the afternoon and midnight shifts. Backgrounds ranged from one year of lab work (for our homegrown former interns) all the way up to 30 years.

Several could claim supervisory experience, and two had master's degrees. What our younger employees lacked in length of service, they more than made up for with enthusiasm and a willingness to work. As a unit, the staff exhibited a strong commitment to quality, a creative bent of mind, goal-oriented motivation, teamwork, flexibility, and a good comprehension of management objectives.

These attributes plus a liking for night work--for personal reasons such as educational needs or a desire to spend more time with family--made our staff particularly well suited to longer shifts. A few technologists soon approached me about switching to the 10-hour system, and I suggested they survey the others on the second and third shifts. The verdict was unanimous--everyone wanted at least to try the 10-hour option.

Now our technologist task force had to develop a schedule that I could sell to higher management. I reminded the technologists about lab administration's concern: how to cover those extra days off. Although each full-timer would continue to work the standard 80 hours per two-week pay period, compressing the schedule would reduce total days worked from 10 to 8.

Available personnel numbered five full-time technologists and three part-timers on the second shift, and three technologists and one phlebotomist on the third shift. Like most laboratories, we had days when the staff was hardpressed and others when we seemed to be overstaffed. To guide the task force on the number of technologists needed for a given day and shift, I relied on past experience and workload recording levels.

The afternoon workload was heaviest at the beginning of the week and tapered off on Thursday, Friday, and Saturday, reflecting the rise and fall of outpatient and preoperative testing volumes. The midnight workload was less variable from one day to the next.

This meant we needed five afternoon technologists Monday through Wednesday, four on Thursday, and three on Friday. Weekend staffing required three technologists on Saturday afternoons and, as outpatient and preop demand began to rise again, four on Sunday. The midnight shift could generally be covered by two technologists, with a third available when needed.

It took several weeks, but the technologist task force came up with a schedule that met all the stipulated criteria. The two-week schedule shown in Figure I is entirely the result of their efforts.

The technologists also prepared sample alternate rosters to provide coverage during illnesses and vacations. In addition, they proposed new position descritpions, incorporating some tasks that could be transferred from the day shift. And they listed the program's expected benefits, which I would present to higher management.

The advantages to the staff were obvious. For an investment of just two extra hours per workday, technologists would gain six days off per pay period to spend with the family or in school.

Since that promised to alleviate boredom and burnout, our problem shifts would have a more stable and contented staff. As a supervisor, I would gain the flexibility of a four-hour block of time when the shifts overlapped. Instead of seeing the staff drop from five technologists to one or two at midnight, I'd have up to eight laboratorians on hand during the overlap period for the worst of the evening rush. This would allow me to better regulate the work flow and assign added tasks to fill out occasional slack periods.

Summing up the benefits for management, we felt that a switch to 10-hour shifts would decrease turnover, reduce overtime, minimize staffing problems related to absenteeism, and eliminate overstaffed days. At the same time, it would expedite the training of new hires, increase our efficiency, and provide staffing flexibility for the midnight shift.

The recommended schedule would foster a sense of teamwork on the second and third shifts. We also expected that it would create a demand for these once hard-to-fill positions.

The careful planning and presentation paid off: Our new schedule was approved for a three-month trial. At the beginning of a pay period in June 1983, 10 of the 12 staff members made the switch. All four midnight employees --the three technologists and one phlebotomist--were now working 10 hours at a stretch. The 10-hour technologists on the afternoon shift included four full-timers and two part-timers, the latter working 40 and 60 hours per pay period, respectively. A third part-time technologist, scheduled for 48 hours, remained on the old system to give us some flexibility. And of course, since it wasn't feasible to have the supervisor out of the lab for six days at a time, I continued on my standard eighthour shift.

The changeover went smoothly, but it took employees a while to adjust to those two extra hours each night. They were tired by the end of the shift, especially after a heavy-duty day. The lab work never suffered, however, and the anticipation of a six-day weekend was enough motivation to get everyone through an eight-day week. Most settled comfortably into the new routine after the second or third long weekend off.

Although laboratory administrators had worried about employees stretching their work to fill 10 hours, this wasn't the case at all. The work pace did not slow down but rather proceeded with a lot less stress.

The knowledge that there were now 10 hours to complete the night's work seemed to lessen anxiety levels. When things got hectic on the afternoon shift, technologists knew that the cavalry would arrive at 9:30 p.m., the new starting time for the midnight shift. If a late-night testing avalanche hit the lab, the afternoon staff pitched in to get the workload under control before leaving at 1:30 a.m.

My own schedule provided for one three-day weekend per pay period. I had the first Friday off and then the following Friday, Saturday, and Sunday. That wasn't bad, but it was hard not to be envious when a tech casually mentioned spending her "weekend' in Italy.

The entire laboratory benefited from the new schedule almost immediately. When the day shift faced an unexpected staff shortage, one of the afternoon technologists was able to fill in for three months. Instead of working her usual hours--3 p.m. to 1:30 a.m.--she came in at 11 a.m. and stayed until 9:30 p.m. Then the four-hour shift overlap from 9:30 p.m. on tided us over.

When our afternoon shift returned to full staff, we picked up half the daytime profiles. A new chemistry analyzer capable of handling both profiles and discrete analysis--and requiring considerably less training and technical time--made it possible to absorb the increased workload.

The three-month trial went well, even though we launched the program at the worst possible time for a 10-hour schedule, right in the middle of the vacation season. In order to cover for a vacationing co-worker, particularly on weekends, some employees adjusted their cycle by a day or two as needed.

Others agreed to break up their six-day weekends. We appreciated the cooperation, and staff members acknowledged that the sacrifice wasn't that difficult, coming off, say, a four-day break. The part-timers were also a great help. Luckily, everyone stayed healthy, so there weren't any sick days to worry about.

Once we were over the vacation hump, the absorption of new duties went smoothly, althoug each task that was picked up from the day shift required a trial-and-error period while we adjusted the workload. With up to eight technologists on hand in the evening, there were no unsolvable problems. The day shift grew less hectic as we took on much of the profiling and computerized test requesting and some of the RIAs and instrument maintenance. Our staff welcomed the challenge of performing these new procedures.

With a few minor adjustments along the way, we have followed the same schedule for 2 1/2 years (Figure I). When a pay period ends on the second Saturday, the schedule reverts to day 1 (Sunday). The technologists decided among themselves who would work which days, and they all get some Saturday and Sunday time off. As a result, there is very little need for swapping. We encourage technologists to make alternate arrangements for coverage--as long as they note the change on the master schedule.

The the 10-hour shifts have met virtually all of our goals:

Stress reduction, job satisfaction. Many of our employees like the extra time for family activities during conventional hours. Others have finally been able to pursue advanced degrees. The six-day break also provides ample time to defuse after a high-stress week. Our varied workload minimizes laboratory malaise and gives technologists a chance to broaden their expertise.

Reduced turnover. We expected to see a drop in the turnover rate, thanks to adequate stress recovery time and greater job satisfaction. As a matter of fact, turnover is virtually nil now. One employee did transfer to the day shift but eventually returned; our schedule is a tough act to follow.

Less training time. Reduce turnover and you spend less nonproductive time breaking in new hires. We also believe that when training does become necessary, it will be accomplished more quickly and efficiently on the compressed schedule. So far, we haven't had an employee recruited from the outside on whom we could put that supposition to the test.

Drop in overtime. With each employee working two extra hours each shift, and the overlap temporarily increasing the total staff on hand, we reasoned that weekly overtime would drop. It has, primarily because we no longer feel compelled to seek reinforcements when the workload gets heavy. We can take care of a surge in test demand during the four-hour overlap.

Greater efficiency. Changes in when routine and specialty tasks are done, to match staff availability, enhance the efficiency of all three shifts. The effect is partly psychological because no one feels overwhelmed. But we have found that the four-hour block of time with maximum staff can be highly productive.

The second shift usually takes care of all routine and Stat testing until 9:30 p.m. When the third shift arrives, a couple of us can then tackle the profiles, specialty tests, and whatever batched work has accumulated. On heavier hights, we work all out to clear the bench and thus free the midnight technologists for the extra chores.

In any event, there's always work to do. We no longer have an extra technologist hanging around, as is common with conventional schedules.

More help for midnight shift. Since the overlap makes for a gradual transition into the latenight shift, midnight staffers don't feel abandoned. If the workload looks really heavy at 1:30 a.m., a second shift technologist can stay on until things calm down, but this is rarely necessary.

Second and third shift allure. The new popularity of these shifts has surprised everyone. The offhours staff has become an elite group, a psychological boost that helps offset the traditional negatives associated with these shifts. When a position does open up. I am sure we'll see volunteers from the day staff. There's also less "us and them' hostility between shifts. Ten-hour scheduling has turned the afternoon and midnight shifts into one extended tour. Overlap at either end improves communication with our daytime colleagues.

Fewer problems related to absences. The afternoon-night overlap enables us to spread the effects of an unexpected absence over two full shifts. Technologists are so committed to the schedule that no one minds working a little harder to cover for an ailing coworker. Besides, the need doesn't arise that often. Job satisfaction has brought absenteeism way down. Not one employee called in sick during the first year of 10-hour shifts. Last summer was a bad one for viruses, but superior cooperation pulled us through.

Our type of schedule may not succeed in every lab, but you can take certain steps to improve its chances:

Make sure 10-hour employees are classified as exempt from the Fair Labor Standards Act. This avoids overtime pay when their regular time exceeds 40 hours in a given week. In some cases, waivers of one kind or another may be necessary; consult with your personnel department.

For example, midnight employees asked to sign a waiver giving up their half-hour dinner break, which they were often unable to take due to the workload. They now have a quick meal during one of the 15-minute breasks, and they go home a half-hour earlier, at 7:30 a.m. instead of 8.

Determine whether day-to-day workload fluctuations are noticeable and predictable. Since each technologist will work two fewer days per pay period, it's wise to schedule any additional time off on the lower-volume days. An assessment of overall workload distribution is also necessary, in order to shift routine tasks into times of maximum staff availability.

Be sure that all staff members are committed to the program. A strong sense of responsibility for the plan leads employees to fill in as needed during emergencies and vacations.

Develop a pool of reliable parttimesrs. Our part-time staff is essential for smoothing out the scheduling rough spots. For example, the part-timer scheduled for 40 hours per pay period pulls a Friday-through-Monday tour. She's able to spend more time with her children, and I gain invaluable weekend coverage. I try to keep the part-time hours as constant as possible, butthe flexibility is there when needed.

Cultivate generalists. I do not assign technologists to particular section each night. Since our workload is spread over as many as eight areas with variable nightly volumes, it is impractical to set up rigid assignments. Instead, the staff is prepared to cover whatever section currently requres the most attention. If the workload suddenly changes direction, so do the technologists.

This may sound a bit disorganized, but it works out quite well, largely because of our open-lab floor plan. A staff member can check out all areas--from specimen control to hematology, coag, urinalysis, blood bank, general chemistry, profiling, and microbiology --simply by walking down the center aisle. One lesson for new employees is determining the workload status by scanning all areas for the Stat and Attention stickers that tell us what needs to be done and how quickly.

Be creative and stay flexible. We don't hesitate to adopt unusual shift hours if the workload warrants and a staff member volunteers. One technologist, for example, prefers to work from 5:30 p.m. until 3:30 a.m., and she's willing to adjust her shift four hours in either direction if necessary. This straddle shift acts as a buffer in the event of scheduling problems on the midnight shift.

Consider simultaneous implementation on both shifts. I think it's best to go all out and make the change on both shifts at the same time. Once the dust settles, you'll have a greater concentration of staff for longer periods of time and thus create the overlap that enhances efficiency.

Limit vacations to 80 hours or two work weeks. This is the only area where we take a hard line. There are no exceptions. Even so, an employee can parlay the twoweek maximum into 20 days by adding in the six days of time off at the end of the work schedule. That's all the system can handle if everyone is to get a summertime break.

Set a specific trial period, preferably well ahead of peak vacation times. We started with a threemonth trial and, having survied the summer vacation season, found that each subsequent threemonth period brought additional diffculties (as well as solutions). We moved from vacations to the holidays and winter's inclement weather. By spring, we had the system pretty well figured out, just in time to start juggling vacation requests all over again!

My best advice is to give the program a full year to prove itself. If it doesn't work, you can always go back to the traditional schedule. At the very least, you will have learned a great deal about the laboratory's volume and staffing patterns. You can always try again later, and you will be better organized than before.

Prepare schedules well in advance. This gives you time to anticipate problemes and come up with solutions. I distribute a tentative schedule roughly two months beforehand, taking into account holiday rotations and special requests. After employees see the exact dates they will be working, they can call any problems or conflicts in plans to my attention. I issue the final schedule at least one month before it takes effect. If necessary, employees can still change their hours as long as they arrange for adequate coverage and note the substitution on the master schedule.

If 10-hour shifts get wholehearted management and staff support and detailed planning and follow-through, they should reward the laboratory and its personnel with all the benefits I've mentioned. What's my next project? Getting myself on the 10-hour program!

Table: Figure I The 10-hour shift schedule
COPYRIGHT 1986 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1986 Gale, Cengage Learning. All rights reserved.

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Title Annotation:medical laboratories
Author:Maynard, M. Jean
Publication:Medical Laboratory Observer
Date:Jan 1, 1986
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