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Designing an in-house phlebotomy training program.

Designing an in-house phlebotomy training program

A structured course provides a community hospital with a steady source of well-trained phlebotomists.

We used to train phlebotomy personnel at our 195-bed community hospital exclusively on the job. While we preferred to hire experienced phlebotomists, or at least people who had worked in a health care setting, most applicants fit into neither category.

Another problem was that our training was unstructured. New employees learned by watching others before performing tasks themselves. Although a checklist standardized training somewhat, the extent to which new employees learned the job depended on the quality of work and the teaching ability of the phlebotomists with whom they happened to be making rounds on a given day. At times, short staffing forced us to ask phlebotomists with as little as two or three months of experience to train new employees. The result was an increasing deviation from established procedure, too much variation from standard phlebotomy techniques, a high turnover rate, and low morale.

Over the years, as our laboratory grew in size and our work grew in complexity, the job of phlebotomist became more and more demanding. Knowing how to draw a blood specimen was only the beginning. Our phlebotomists had to understand the preanalytical factors affecting the quality of specimens they collected. They had to be able to handle the many kinds of situations encountered when dealing with patients and to operate our laboratory-wide computer system. They had to comprehend the legal implications of what they were doing, follow safety and infection control procedures--the list went on and on. Traditional on-the-job training was no longer sufficient.

Our solution was to develop an in-house phlebotomy training program. We soon found out that designing such a program was far more complicated than we had thought. I was assigned to turn the idea into reality.

* Getting started. The first step was to meet with the phlebotomy supervisor and with the hospital's education and employment managers to establish goals and objectives and to discuss the format of our program. We decided on a 10-week program with six hours of class time per day. The program would be divided equally between theory and clinical experience.

I was to be the primary instructor for the didactic portion of the program as well as program coordinator. Clinical experience would be provided by the phlebotomy staff under the supervision of the phlebotomy supervisor.

Although our primary goal was to provide enough trained phlebotomists to meet our staffing needs, we had secondary goals as well. We hoped that by standardizing the training we would improve the overall quality of phlebotomy work in the lab. We also wanted to fill some of the gaps in training experienced by our current phlebotomy staff, thereby improving morale and decreasing turnover.

To promote commitment and professionalism, we planned to investigate the possibility of gaining the permission of an outside agency to let students who had successfully completed our program take a phlebotomy certification exam. We achieved nearly all these goals. * Jump start. The timetable we established allowed only a few weeks to set up the entire program and sign on our first students before classes began. Why the rush? I was about to go on maternity leave and was determined to see "my" students through the didactic portion of the program.

We placed an advertisement in the local newspaper asking interested parties to fill out an application in our facility's personnel department. The only educational requirement was a high school diploma or equivalent. The course would be free except for the purchase of a textbook and a lab coat. Although a job would not be guaranteed upon completion, students would be considered first for any available positions. * Syllabus. Although I had no background in teaching, I was excited and challenged by the prospect. I began my research.

To determine what I would be teaching, I referred to the listing of phlebotomist competencies that appear in the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) Phlebotomy Programs Approval Guide. I wanted our program to be as comprehensive as possible; following NAACLS guidelines would insure that nothing was left out.

Next on the agenda was to prepare lectures that would meet the NAACLS phlebotomist competencies. I read everything I could find about phlebotomy and specimen collection. Using my own experience and available references, I prepared an outline of topics with the behavioral objectives that needed to be met for each lecture--and began writing.

I had decided to use the comprehensive "Phlebotomy Handbook" by Diana Garza and Kathleen Becan-McBride (2nd ed., Appleton & Lange, 1989) as our textbook. Information from several other books supplied additional information as I wrote the lectures. It was a time-consuming process to refer to numerous books while consulting the phlebotomist competencies to make sure each lecture was thorough. During this time I prepared handouts and transparencies for an overhead projector to use as teaching aids.

Once my handwritten lectures were complete, I typed a syllabus that included reading assignments for each lecture and listed the dates of tests. The irony did not escape me that I had tests scheduled even though I had no tests made up to give. Arrangements were made to borrow audiovisual materials and equipment from our hospital's education department and to use classroom space. For that first course, the best I could find was a closet-sized room--but it was ours for the duration. * Avalanche of applicants. Although I was far from ready--I still had those tests to write--it was time to solicit applications. I had expected 20 to 25 people to apply. What a surprise to hear the personnel department had stopped accepting applications when they reached 80!

We informed all applicants that interviews would take place at a specific time one Tuesday morning about a week later. Approximately 60 would-be students were ushered into a meeting room. Although the coffee and doughnuts we had ordered from our dietary department (and promised the arrivals) never materialized, everyone stayed. A couple of students in our first class later confided that when they walked into that room full of people, they were so intimidated by the size of the group that they nearly walked out again.

Six of us--the phlebotomy supervisor, the supervisor of our reference lab, the hospital's education manager, the employment manager, a personnel assistant, and myself--somehow managed to interview them all in just over an hour at stations set up in the hallway. We used a standard set of questions adapted by the personnel department from those used to interview applicants for our hospital's nursing assistant training program.

It took longer to make our final selections than to hold all the interviews. Lacking specific criteria, we relied on our instincts, concentrating on such attributes as health care experience, communication skills, professional demeanor, genuine interest in our program, and perceived ability to succeed in it.

At last we chose six students and two alternates, one of whom did join us when one of the six was unable to begin the program. On Friday, the personnel department called the applicants we had selected. Class would begin on Monday. Interviewees we rejected were notified by mail.

Many questions ran through my mind during the next few days. Was I really prepared? What would my students be like? What if they didn't catch on? When was I going to find time to write those tests? When Monday came, I was prepared, my students were great, they did catch on, and I somehow found time to write the tests before I had to give them.

During the next five weeks I spent most of my non-teaching time either preparing for class or planning for the students' clinical rotation. In class I was learning right along with my students and finding it easy to get caught up in their enthusiasm. One student was so excited by her first venipuncture, performance on a volunteer from the lab, that she hugged the "patient." I watched the students' interest grow even as they struggled to memorize which tubes to use for which tests and other important information.

The students were exposed to many different situations, including the emergency room; critical care, neonatal, and pediatric units; outpatient services; satellite laboratory at a nearby urgent care center; and psychiatric health department. They performed venipunctures with an evacuated tube system, with syringes, and with a butterfly collection device. They performed hand sticks, heelsticks, and fingersticks. They instructed outpatients on proper collection of stool, clean-catch urine, and other specimens. During the clinical rotation period, the students kept a daily log of their activities.

Each week, a preceptor evaluation form was filled out by a phlebotomist who had been working with the student that week. The form graded 12 tasks as acceptable, needs improvement, not acceptable, or not observed (Figure I). Space was provided for specific problem areas and for comments or suggestions. At the conclusion of the course, the phlebotomy supervisor judged students' technique in detail (Figure II). * Grads hired. All six students successfully completed the program. My new son was the guest of honor at our graduation party; in fact, my students insisted that he be included in the group picture. We held the party in the evening so the students' supportive families could attend.

We hired the entire class immediately and spent a few days bringing them up to speed on our computer system before allowing them to function independently as employees. Two years later, three remain in the laboratory. The quality of their work is excellent and their enthusiasm for the job is undimmed. One of the original students has joined the radiology department in our hospital's new diagnostic health center. One has left clinical work but is employed in our hospital's materials management department. The sixth decided that phlebotomy was not for her and has left the field. * Certification. Our third group of six students has completed the program, now approved by the International Academy of Phlebotomy Science (IAPS), in Columbus, Ohio, as preparation for its certification exam. Approximately 16 of our students have taken the exam; all have passed with flying colors.

Phlebotomists who had worked with us before the program began have expressed an interest in receiving in-service education, which we have expanded to embrace phlebotomy concerns more than before. We have also shared our course materials with existing employees to prepare them for certification, for which our hospital pays a differential. Suddenly almost our entire phlebotomy staff is certified! In fact, we have become a testing site for IAPS. Not only do our employees and students no longer travel to take the test, but phlebotomists from other hospitals take both the written and practical portions of the exam at our institution. The situation provides good public relations for the hospital while enhancing our professional image. * Improvements. Evaluation forms filled out by our students have provided excellent suggestions, some of which we have adopted. One was to charge a flat fee for the program that would include the textbook and lab coat. We have made about two-thirds of the fee reimbursable by the hospital if the student is hired and remains in the position for a designated period.

Students said they found the transition from student to employee rather difficult. Since we ended up hiring all of them, we changed our focus to prepare them more specifically as employees, including more training on our computer system. They now require less orientation upon starting work.

I have added many visual aids to the program, including video-cassettes on our new VCR. On the new personal computer in my office I have typed my lesson plans, including the handouts and audiovisual aids needed each day. I am now transferring other materials to the PC as well.

Our institution is undergoing major renovation. In about 18 months the ancillary departments will enjoy spacious new quarters. Our lab will have a lovely conference room in which to hold phlebotomy classes.

Our ultimate goal is to improve our phlebotomist retention rate, thus limiting the need for a constant influx of new employees from the course. For the foreseeable future, however, classes will continue. * Valued career. Phlebotomy is emerging as a distinct profession. More and more people are choosing it as a career rather that as a stepping-stone to something else. Clinical laboratories must demonstrate a commitment to the phlebotomist by providing adequate training and continuing education opportunities through in-service education. [Figure I and II Omitted]
COPYRIGHT 1991 Nelson Publishing
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Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Author:Hargrove, Catherine A.
Publication:Medical Laboratory Observer
Date:Oct 1, 1991
Previous Article:The making of a new certification exam.
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