Turnover in phlebotomy: looking deeper than pay

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Some turnover stems from phlebotomy students having viewed phlebotomy training as a shorter path to a health care career, Warning says, only to find later they are unprepared for the 4 AM start times required in hospital settings. Other students see phlebotomy as a stepping stone to a higher-level position in the laboratory or nursing. “You hate to see your talent leave, but you also know you helped develop them to who they are as they move on to other positions,” she says.

Retention strategies vary, and some require organizational and financial resources to implement.

Dr. Phelan says research on the costs and benefits to a health care institution of providing clinical education is thin, but points to an advantage when a hospital offers clinical training to students and subsequently hires them. The new employees tend to stay, and “the retention appears to be for a longer duration than, for example, hiring somebody off the street.” One reason, she says, may be that the clinical training period serves as a prolonged job interview.

Peggy Machon, PhD, RN, who also was on the panel last fall and who retired recently as dean of the career programs department at Moraine Valley Community College, says having preceptors train new preanalytical staff in their first days in the lab is key to conveying the organization’s mission, vision, and culture. “Developing a sense of belonging is so important,” she says.

That goal is not always attainable, though, because of time constraints. Attendees at the panel discussion said safety, accuracy, and efficiency were bigger concerns for newly hired phlebotomists, who “have to hit the ground running” because laboratories are short-staffed, Dr. Machon says. “There was not one person in the audience [at the summit] who felt they were sufficiently staffed.”

If labs can’t pay phlebotomists what they’re worth, smaller investments, such as a monthly birthday club, and more substantial investments, such as continuing education, can help to make them feel appreciated, Dr. Phelan says. Acknowledging good work with praise, or with a promotion to a trainer or mentor position, shows phlebotomists they are valued.

Dr. Machon

Encouraging certification and paying for the certification exam are also helpful, Ernst says. “When a person can tag credentials on the end of their name, that gives them a sense of pride in their profession and a sense of ownership of a procedure. That’s critical for the individual to be retained in the workplace.” Most certification exams cost about $150, he says, much less than the cost of losing an employee and retraining a replacement.

Given all that is required for successful laboratory management, Ernst recommends that managers focus on building and reinforcing their own leadership skills by attending training programs on managing health care personnel. “It’s not easy being a manager,” he says, “especially when you’ve risen up into your position as a manager from a place on the bench.” Many laboratory managers were never professionally trained to supervise staff. “You’re a manager because you were good at being a technologist. That doesn’t make you a good manager,” he says. “Unless you actively go out and seek management skills, you’re probably not good at solving personnel problems or recognizing them.”

Whatever the skill level, managing a new employee who may not be a good fit can be tricky. “It really was a concern in the audience, because they are so short-staffed, that it’s very hard to let someone go when you have a warm body,” Dr. Machon says.

Managers have better odds of avoiding the fit problem if they use a hiring process that incorporates peer interviews and establish a mentoring program for new phlebotomists, one that “shows them how things get done and how to behave or act,” Ernst says.

Some managers mistakenly hire preanalytical staff based on technical skill instead of demeanor, professionalism, and personality and then polishing the person’s skills on the job. “There are certain values you can’t teach,” Ernst says. “So you hire values and you teach the technical. Almost everybody can be taught how to draw blood properly.”
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Amy Carpenter Aquino is CAP TODAY senior editor.