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Upgrading phlebotomy to cut employee turnover.

A comprehensive training program ties in

with pay raises to help this laboratory

retain its phlebotomists.

A few years ago, high employee turnover in phlebotomy seemed bound to plague our 200bed hospital forever. Frequently calling in sick or arriving late, phlebotomists had low self-esteem and a generally poor attitude. Reasons included low pay, no advancement opportunities, a lack of recognition, and inadequate staffing.

The seriousness of the problem struck home in 1985. Our staff at that time consisted of six full-time and four part-time phlebotomists, but many of the faces kept changing as 17 employees resigned. New phlebotomists barely became oriented to our system before they would leave.

Collection delays and mistakes threatened to disintegrate laborator relations with physicians and the nursing staff. That prompted us to devise plans to upgrade the phlebotomy section.

Improvement of training was the first step. In the past, phlebotomists received one or two days of on-the-job instruction; then they were thrust out to work with patients on their own. Now we set training goals, adapted American Society for Medical Technology curriculum guidelines to fit our needs, and came up with the instruction plan shown in Figure 1.

All phlebotomists must complete the course in their first year of employment. Applicants for the course, from the hospital and elsewhere, are evaluated on the basis of numerous criteria, including the applicant's goals, relevance to the applicant's current job, thoroughness and neatness of application, previous phlebotomy experience, and lab needs. Students who are not employed by our hospital pay a $ 100 fee for the course.

Two-hour sessions are held two nights a week for nine weeks. Class size is limited to 20 students, but we try to keep it lower than that because a smaller class allows for more personalized instruction.

Laboratory supervisors, bench technologists, and other personnel share instructors' duties. Each puts in two to three added hours of preparation for every hour spent in class. Phlebotomy techniques and special procedures are taught by the laboratory's director of clinical education (who also supervises the clinical rotation) and the director of phlebotomy education.

In the rotation, which occurs during the nine-week period, the student must gain at least 40 hours of practical experience performing venipunctures and capillary sticks (see Figure 11), and four hours of ECG experience. A rotation in the intensive care unit and nursery is mandatory, and the student must also become certified in cardiopulmonary resuscitation.

Once the training course was set to go, a career ladder was developed to encourage our phlebotomists to excel and to provide upward mobility. They had previously been locked into a single pay grade, at maximum pay of $6.30 per hour, with no chance for advancement.

Today, inexperienced phlebotomists start at $5.18 per hour in pay grade 6 (there are 25 grades for all hospital personnel). Upon successfully completing our training program, they receive a 5 per cent raise within their pay grade.

After seven months on the job and successful completion of the training program, phlebotomists are eligible for promotion to the next pay grade and a 2.5 per cent pay increase. They are then phlebotomy technicians.

With two years on the job and successful completion of the training program, phlebotomists are eligible for promotion to senior phlebotomist, grade 8. That's worth another 2.5 per cent raise and an increase in weekend and shift differential pay.

Promotions to higher grades hinge on a "fully satisfactory" rating on the last evaluation and the phlebotomy supervisor's recommendation, in addition to the experience and training requirements.

We also offer phlebotomists an incentive to take and pass a national certification exam after their training. If they become a certified laboratory phlebotomist (National Certification Agency for Medical Laboratory Personnel) or a certified phlebotomy technician (Phlebotomy Certification Board, Consortium of Indiana Medical Laboratory Educators), they receive a 10 per cent salary increase retroactive to the date of the exam.

At the top of the career ladder, a phlebotomist earns a maximum wage of $8.04 per hour, plus $2 per hour extra for weekend work, $1.50 extra for the 3 to 11 p.m. shift, or $2 extra for the 11 p.m. to 7 a. m. shift. A weekend 11 -to7 phlebotomist can thus make $12.04 per hour.

Our phlebotomy supervisor also addressed a common target of patient complaints by instituting a much stricter dress code. The staff must wear clean white lab coats and polished shoes, and present a professional appearance at all times. Men have to wear a shirt and tie; women, a skirt or neat slacks. Jeans, T-shirts, jump suits, tennis shoes, dirty lab jackets, and other potentially offensive attire are prohibited.

In addition, we began a phlebotomy quality assurance program. The phlebotomy supervisor chooses patients at random and gives them a questionnaire to fill out. We ask about the phlebotomist's appearance and conduct, adherence to proper procedure ("Did the phlebotomist label the specimens in your room?"), and the perceived quality of service ("Please rate the phlebotomist's ability to obtain blood, compared with other times you have had blood drawn") .

As Figure III shows, the supervisor rates performance on another sheet of the questionnaire ("Did the phlebotomist leave a hematoma at the puncture site?"). Since our program took effect, complaints have dwindled, and we have received many compliments on the abilities and professionalism of our phlebotomists.

We are writing procedures and plan on-the-job training for senior phlebotomists to perform skin testing and injections. This expansion of duties, which would lift some of the burden from our busy nursing service, has been cleared with hospital and regulatory authorities. There will be no salary increase initially, but we intend to propose one after senior phlebotomists prove they can do the job.

Our efforts to upgrade phlebotomists' skills and status have been a huge success. Turnover has gone from 17 phlebotomists (11 full-time and six part-time) in 1985 to eight (four full-time and four part-time) in 1986 and only two (both full-time) in 1987.

The current staff consists of seven full-time and six as-needed phlebotomists (no part-timers) . In the first eight months of fiscal 1988, we lost only one full-time employee and two as-needed employees.

Phlebotomy service has expanded to round-the-clock, seven days a week, and the morning shift begins at 5 a.m., two hours earlier than it did in the past.

Five of our seven full-time phlebotomists are nationally registered, including the phlebotomy supervisor (who is also director of clinical education), our laboratory relations coordinator (also serving as phlebotomy education director), and a receptionist who assists with outpatient draws. Two have joined the American Society of Phlebotomy Technicians, indicative of their commitment to the profession.

Through a concentrated effort, innovative ideas, and excellent administrative support, we have been able to staff an important area of the laboratory with an efficient group of professionals.
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Author:Adams, Terri; Menard, Connie; Stevenson, John W.
Publication:Medical Laboratory Observer
Date:Sep 1, 1988
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