PerspectivesAre you interested in submitting a Perspective Article? Be sure to read The Science Advisory Board's Editorial Guides for Perspective Articles. Click here. Seeking Long-Term Solutions: Laboratory Staffing Shortages by Anita Stone MT, CLS, ASCP In the following article, I am confining my discussion to the issue of the medical laboratory personnel shortages within the United States. I cannot expand the boundaries of this discussion beyond the United States as my own experience and background does not extend outside this country. It is my hope, however, that some of the ideas discussed herein may have some value elsewhere. Of course, the opinions here voiced are my own and I welcome any comments or dissent. In the United States, the medical community is facing a critical shortage of qualified, experienced staff. The clinical laboratory has not escaped this crisis. From the front office and processing clerks, the phlebotomists to the Medical technologists (CLS), every laboratory finds it difficult to fill job openings. The largest segment of the population is reaching retirement age (a majority of laboratory personnel fall into this “baby boomer” group), the toxicity of the environment increasing, the growing possibility of global epidemics is a real threat, and with greater numbers of the general population suffering the physical effects of an “affluent” society: obesity, diabetes and related diseases, the demands on the Medical laboratory as an ancillary support service will only increase. Widespread press has been given to the issues and challenges of the medical manpower crisis, with nursing shortages serving as a focal point. While this press has given voice to the concerns about the nursing problem, it has failed to present anything but a few controversial solutions. (1) Those solutions share one or more common denominators: short term, near sighted, lower standards, and a lack of real cost investment. For these reasons, such “solutions” should be avoided or implemented with guarded caution. While it must be acknowledged that some stopgap measures may be necessary to fill immediate needs, it is the long-term solutions, which must receive the greater and more careful consideration. Further, these long-term solutions must give attention to the shortages of staffing in the other ancillary support services within the medical community. For a long-term solution to laboratory staffing shortage to be successful is must incorporate all of the following principles: retain professional standards, reward achievement, endow education, and promote career traditions. Medical standards in the United States for laboratory personnel are among the most stringent in the world. These standards are based upon: educational requirements, professional licensing and a code of professional conduct and ethics, all supported by federal and state legislative directives. Compromising these standards to fill staff vacancies should never be considered. Yet, some short-term solutions, most originating from outside the Medical community, suggest exactly this action. Across the country there are legislative bills, which propose increasing the scope of practice of non-licensed staff to include laboratory test procedures and other laboratory-work related jobs. The assumption is: that a limited number of licensed staff can properly oversight thousands of tests and procedures performed by non-licensed personnel and still maintain a high level of accuracy and quality control. Essentially there will be no increase in qualified staff at all. (2) Other bills would reduce the broad-based educational requirements of Medical Technologists (CLS) to programs tailored to medical technology only. Instead of a Bachelorate in Science and an additional year of training in an accredited mentor program, a student could enroll in a two-year medical technology school. This school would focus only the "button-pushing" skills and precious little background science and theory. Upon completing this "focused" program the student would be eligible for license, with the same professional ranking as the Medical Technologist (CLS) who has five years vested in education and training. These proposed legislative actions do nothing to increase the numbers of qualified Medical Technologists (CLS) staff, they simply add "bodies" to the laboratory. They do risk the profession by placing responsibility for the testing performed by non-licensed personnel upon the licensed staff . Further, these legal actions denigrate the educational and professional accomplishments of licensed staff by suggesting their job can be performed as well by lesser educated, non-mentored personnel. This lowering-the-standard type of "solution" fails on all accounts and yet this type of approach is being extended to other laboratory-related jobs as well. In California, new legislation has markedly increased the educational and training requirements for phlebotomy certification, this is good. (3) However, this legislation limits these requirements only to the acute-care hospital setting, and fails to extend the requirements beyond. The result: phlebotomists working in hospital laboratories will be required to invest in education, training and then maintain certification while earning the same wages, doing the same job, as non-certified phlebotomists working outside the acute-care setting. It is obvious, this will not increase staffing just a shift personnel from one employment setting to another. The shortcomings of any “lower-the-standard” approach will preclude it to fail. A long-term solution must be rooted in the highest level of professionalism and educational accomplishment. Educational requirements must be retained. Legislation that requires professional certification or license should not be amended and only allow licensed professionals on the job, no matter where the job site might be located. Long-term solutions to staffing shortages while retaining professional standards must also work toward educational consistency across the country. At present, all states follow ASCP and CLIA guidelines however, some states require additional education, training or state certification. Education and mentor programs should be reviewed for content, standardized, and accredited only if they meet established criteria. If only graduates from accredited programs can obtain employment, it would promote enrollment in these schools. (4) Healthcare Corporations and Organizations must endow education. Scholarship and mentor programs should be built into all operating budgets. Only a small percentage of hospitals within the United States participate in the education processes, which would provide them with employees. Those with education programs have focused mainly on nursing. Hospital laboratories need to become a part of their own solution to provide for future staffing needs. In California, the number of Medical Technology (CLS) programs has been reduced to less then 1/6 of those in operation 20 years ago. Requiring participation in education/mentor programs as a part of hospital accreditation would encourage Healthcare Corporations to endow education and become an pro-active part of the process to alleviate staffing shortages. Hospital education programs might be developed that provide education expenses in exchange for term employment agreements. Long-term solutions for staffing shortages must also reward achievement. Rewarding achievement (education, training, experience and licenser) particularly among laboratory personnel must be brought to a level that equilibrates the rewards with the demands and challenges of the profession. If the medical community sees fewer and fewer young people choosing laboratory careers today it is because they can achieve greater financial rewards and advancement opportunities in other fields within the community or outside the medical culture altogether. Long-term solutions must give jobs in laboratory medicine a market edge against other career choices by committing to competitive salary scales, benefits and opening avenues for advancement. Rewarding achievement means guaranteeing benefits on the job and into retirement. Professionals who spend their careers caring for the health of others deserve to have their own healthcare provided for when employment comes to a close. (5) Medical Technologists, phlebotomists and laboratory clerks will remain, for the term of their employment, without the opportunity to advance their careers or salaries (beyond minimal cost-of-living increases) unless they move out of the laboratory environment. Healthcare Organizations for decades have fueled staffing shortages by holding back salaries and limiting benefits in order to balance budgets. Most laboratorians today, for these reasons and others, would not suggest their own profession as a career choice to family members or friends. A valuable resource of individuals who might have entered into medical studies and then into job vacancies has been removed. Improving salaries, benefits, rewarding professional experience and acknowledging achievement would yield an invaluable legacy: renewing the tradition of medical careers from within the medical community itself. If the future holds adequate staffing for all branches of the medical community, particularly the laboratory, then short-term solutions must be abandoned and long-term permanent solutions instituted. For long-term solutions to be successful they must incorporate all of the following actions: retain professional standards, reward achievement, endow education and promote career traditions. Investment today in long-term solutions will yield results, which will help guarantee the quality and quantity of staff needed in the future. Footnotes: (1) The recruitment of nursing staff from nations outside the USA. This recruitment places a drain on the limited medical staff resources of other nations, provides immigration challenges within the US, and questions: are the qualifications of these nurses up to US standards? (2) This idea is not new, many healthcare organizations experimented with this redesign of jobs in the 1980‚s and dropped the programs soon after implementation was completed. The errors and complications generated by utilizing non-licensed personnel in settings previously staffed only by licensed professionals was not worth the perceived staffing benefits. (3) Legislation was introduced as the result of a sentinel event, which occurred last year in the San Francisco bay area. A phlebotomist in a private lab‚s drawing station had misinterpreted protocols and was reusing needles after washing them in alcohol. The legislation however, only applies to acute-care setting and so it does not actually address the issue at the source. (4) Requiring graduation from accredited schools as a prerequisite to employment will not limit foreign applicants as long their education and training meet United States standards. (5) While many medical professionals spend their career caring for others, few Healthcare Organizations offer their employees medical benefits after retirement or beyond termination of employment. ### Ms. Stone was a member of the 2002-2003 Steering Committeee for The Science Advisory Board. Ms. Stone has experience as a Biochemical Research Assistant and Clinical Laboratory Scientist. She has served as a teacher, focusing on biology, genetics, and biochemistry. She was also a Nutritional Specialist for three years. Certifications of Ms. Stone's include being a California Clinical Laboratory Scientist and a Member of the American Society for Clinical Pathology from 1977 until present. She has also earned her California State Teaching Credential, secondary level and served as a CAP Survey Team Member since 1999. Ms. Stone believes that point of care testing is a dedication to competency, versatility, rapid response, and quality patient care. In her current position, she serves as a liaison between the laboratory, nursing, and ancillary departments for 5 hospitals and affiliated clinics. She is responsible for oversight of all aspects of POCT including quality control, assessment of new procedures/products, standardization of testing protocols and all CAP and JCAHO compliance. ### << Previous Next >> [ View All Perspectives ] |
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