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Staffing: problems and solutions in 19 New England laboratories.

A small regional study discovers how labs cope as issues of money and stress drive employees out of the field.

The laboratory staffing outlook in our small comer of the United States is much like the national picture. '

In a survey conducted by our community college medical laboratory technology department, managers of 19 central New England clinical laboratories reported that some had positions available but unfilled because it is difficult to find help. Most said technical employees stay at their institutions two to five years. Salary considerations were the leading reason given for employee departures, but few laboratory managers anticipated major changes in their salary structure over the next five years. Overtime was cited as the chief method of coping with staffing shortages.

The questionnaire went out to 45 labs, and the 19 replies represented a 42 per cent response rate. Here is what the lab managers had to say about key staffing issues:

* Recruiting technical staff. We asked participants how hard it is for them to find quasified medical technologists and medical laboratory technicians on the following scale: not difficult, difficult, very difficult, or impossible. Sixteen (84 per cent) said it was either difficult or very difficult to find both MTs and MLTs. That left a few respondents at the ends of the scale: One felt it was impossible to find qualified MTs, but two had no problem finding MTs, and three had no problem finding MLTs.

*Staff turnover. Ten of the respondents (53 per cent) estimated a median length of stay with the organization of two to five years for the technical staff, including phlebotomists, and six respondents (31 per cent) placed it at more than five years. For clerical staff, nine respondents (47 per cent) said the median length of stay was one to two years, five (26 per cent) said 'it was two to five years, and four (21 per cent) said it was more than five years.

Why do technical workers stay on the job longer than clerical workers? Perhaps they feel a stronger need to gain more experience before mov-ing on.

Only one respondent reported a median stay of one year or less for technical staff and for clerical staff. At the other end of the scale, it is noteworthy that only a quarter of the respondents said employees stay in their laboratories more than five years. (We'll discuss why they leave shortly.)

* Unrilled FTEs. On average, 1 .02

full-time-equivalent technical positions were unfilled at each of the laboratories. Technical staff vacancies at larger labs ,-those with 20 or more technical FTEs-averaged 1.3 unfilled FTES. Labs with 15 to 19 FTEs were down 0.75 FTE; and smaller labs, 0.77 FrE. In contrast, unfilled clerical positions at the surveyed labs averaged 0.06 FrE, barely a two-hour position. (These figures do not include staff members on maternity leave or per diem personnel.) Help-wanted ads in newspapers indicate unfilled positions are probably much higher fight now than when our survey was conducted in late 1987.

*Part-timers and per diems. The proportion of part-ti me employees averaged 33 per cent at all of the laboratories, and nearly 40 per cent at the largest labs. The proportion of per diem employees averaged 8 per cent. *Why laboratorians leave. When we asked participants to identify the four most common reasons that MTs and MLTs leave the profession, more than threequarters cited money (salary dissatisfaction or an opportunity to cam more), as shown in Figure 1. Stress or burnout and hours were also factors, according to twothirds of the respondents. Eight respondents (44 per cent) mentioned frustration with the profession; only seven (39 per cent) mentioneda fear of AIDS and other communicable diseases.

I believe our data shed some light on a recent MLO article that called for documentation of the current technologist shortage.2 The results are also consistent with another recent article reporting that freshman MT majors place a high priority on earnings potential in selecting a career.3 This points to a conclusion that major changes in salary schedules are necessary if we want to keep current technologists in the profession and attract college-bound students to laboratory careers.

Reasons for leaving the hospital environment paralleled those for leaving the profession (Figure 11). This time, however, we only asked participants to cite three factors. Money still ranked first, followed by hours, stress or bumout, frustration, and fear of AIDS and other diseases.

*How labs cope with shortstaffing. Next we asked for four methods in use for coping with short-staffing. Of the 16 respondents to this question, well over half mentioned overtime, and exactly half mentioned schedule adjustments (Figure 111).

In other words, the technologists who do remain in the field are often asked to work extra hours and change their schedules to make up for staff shortages. No wonder that stress, bumout, and unsatisfactory hours are high on the list of reasons laboratorians leave the field.

These New England laboratories are caught in a vicious circle: Stress and burnout lead to shortstaffing, which imposes stress on the remaining staff and leads to further short-staffing. Such solutions as heightening the public's awareness of the problem or offering bonuses to new employees may bring more people into the profession, but this only feeds into the cycle. Keeping employees in the profession is the crucial need, and money appears to be a principal answer.

Surprisingly, fewer than half the respondents mentioned the use of per diem and part-time personnel to ease short-staffing. Asked to comment on how these employees affect the overall function of the lab, just over half stated there was either no impact or else a positive effect (chiefly more flexibility in scheduling). On the other hand, just under half reported a negative effect, in the form of reduced efficiency, reduced productivity, or lack of concentration on the job.

Another surprise was that only three respondents listed crosstraining as a way their laboratories cope with short-staffing. (It could be that cross-trained employees were already in place at many of the labs prior to the staffing shortage.) Interestingly, the keynote speaker at the 1988 Massachusetts Association for Medical Technology convention in Sturbridge strongly advocated cross-training as a means of laboratory survival and to increase the stature of medical technologists."

* What the future holds. Finally, we asked the laboratory managers and chief technologists to list five major changes they expect to see in their labs in the next five years (Figure IV). Nearly three-quaffers predicted increased instrumentation and automation, and about one-third predicted a decrease in technical staff. Perhaps the respondents support Lott's futuristic view of laboratories run primarily by Robotechs with very little human intervention! Notably low on the list was a possible increase in pay.

Obviously there is a risk in drawing firm conclusions from only 19 respondents. Even so, I think the staffing trends we found probably transcend the small sample. The data give us some interesting and unsettling points to ponder concerning the future of medical technology.
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Author:Starzynski, Gary
Publication:Medical Laboratory Observer
Date:Nov 1, 1988
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