Reimagining Laboratory Staffing Post-COVID-19

Four ways your clinical lab can effectively address lab staffing shortages

Photo portrait of Darryl Elzie, PsyD, MHA, MT(ASCP), CQA(ASQ)

Online and print medical magazines are replete with stories detailing the health care industry's struggle in finding workers. Unsurprisingly, staffing continues to be one of the primary challenges facing the nation's medical laboratories. The difficulty in finding qualified staff to perform patient testing implores laboratory leaders to address staffing with a more comprehensive and innovative approach.

The current laboratory staffing situation was predicted many years ago. The closing of medical technology programs, combined with students choosing better-paying health care positions with similar educational requirements, and the expected retirement attrition was noted by laboratory organizations decades ago. It would take a national event to bring the situation to a crisis.

"Recruitment strategies, retention initiatives, and repurposing existing staff can help increase the number of available testing personnel."

The coronavirus pandemic exacerbated and highlighted the laboratory staffing problems across the US. Critical testing needed to be performed while laboratory staff was experiencing the same disease and problems as the rest of the country. When asked about the difficulties in maintaining adequate staffing levels in the midst of a pandemic, an exasperated Priscilla Darville, laboratory manager for Sentara Virgnia Beach Hospital and Sentara Independence, remarked, "When it rains, it pours."

Laboratory administrators can embark on several routes to address the staffing shortage in their laboratory by increasing the number of individuals qualified to do patient testing. Recruitment strategies, retention initiatives, and repurposing existing staff can help increase the number of available testing personnel.

1. Recruitment

There are many health care professions for students to choose from requiring similar cognitive ability and training as medical laboratory scientists. Nursing and other allied health professionals have comparable educational and training requirements and have historically been compensated at a higher rate than laboratory workers. The high visibility of nursing (and similar patient-facing professions) coupled with the disparity in salary in laboratory medicine causes many students to gravitate toward those jobs. The lab field faces tough competition for fewer students.

Attending high school career day events and supporting virtual job fairs are essential for beginning the recruitment process for your lab early in a student's life. In addition, cultivating relationships with college career counselors and science department heads can help introduce undecided students to the wonderful field of laboratory medicine.

A frequent request by many employees across health care roles is the desire for onsite childcare. Onsite childcare as a benefit is a powerful recruitment tool and has an enormous stress-reducing benefit. It can be a dealmaker for technologists and technicians who plan to become parents or those who already have children.

Administrations should consider making onsite childcare available to all employees. This benefit can be revenue-neutral through sliding-scale fees; the hospital will only need to pay for space, salaries, and other fixed-cost utilities. There is significant employee emotional benefit for not worrying about childcare costs or the time required for pickup or drop-off. For example, large laboratories like ARUP at the University of Utah already offer onsite childcare as a recruitment benefit to compete with other area employers. 

2. Retention

Ensure your clinical lab makes a positive impression on new lab employees. Onboarding is the opportunity to start the employer/employee relationship on the best possible terms. Communicating clear and concise expectations reduces the "new job" anxiety most individuals experience when beginning a new job. A good impression impacts how an employee feels about staying with the organization.

Coaching and mentorship give the new employee a head start on building friendships and provide a go-to person that can answer any questions. Also, being a mentor provides the more experienced employee with a sense of fulfillment in helping someone else.

"Retaining long-term employees maintains laboratory knowledge stability and increases overall laboratory capability."

Retaining long-term employees maintains laboratory knowledge stability and increases overall laboratory capability. Retention is a focus of rural hospital laboratories as they are significantly challenged in recruiting and retaining staff due to limited resources and geographical constraints. Laboratories need to retain employees not only to perform patient testing, but because they hold a wealth of knowledge critical to providing great patient care.

There is a significant knowledge gap between a new graduate and a technologist who has performed 15–20 years of patient testing. Saline replacements, understanding validation and verifications, and understanding why and how to do serial dilution without error up are crucial to patient testing yet challenging to teach in school. Employees with these types of technical lab skills are invaluable.

Developing career ladders so employees can have opportunities for advancement is also critical to retention. If an employee should choose to leave, perform an exit interview and review the results and comments generated during the exit process to gain insight into how the organization may improve its retention rates.

3. Cross-training

Cross-training is key to doing more with existing staff. Though it is sometimes difficult to get long-term employees to move out of their comfort zone and train in other disciplines, it greatly benefits the laboratory and increases the flexibility in scheduling staff. Providing compensation incentives can encourage staff to cross-train in other areas.

During orientation sessions for new laboratory hires, ensure they understand that they will be expected to train and work in multiple departments. Let them know that being a generalist increases their value to the lab and their future marketability.

4. Repurposing

Clinical lab managers need to dedicate resources to developing a certification track for clinical lab assistants, laboratory support techs, or other individuals who often have bachelor's or associate degrees in science. According to CLIA, trained individuals with only a high school diploma can perform moderate complexity testing, while those with military training or an associate degree in science can perform high complexity testing.

"Supporting and devoting resources to helping employees already working in the lab achieve certification increases the number of testing personnel available and strengthens employee organizational loyalty."

Many laboratory support staff have the minimum requirements to perform moderate and high complexity testing but lack training and certification. Though CLIA does not require certification, it is a requirement for most hospital laboratories, especially those located in urban or metropolitan areas. (As of 2014, Department of Defense laboratories performing high complexity testing require personnel to have a certification from an approved organization.)

Certification organizations such as the American Society for Clinical Pathology (ASCP), American Medical Technologists (AMT), and AAB Board of Registry have developed several routes through which individuals with degrees can become certified. Because all of the certification routes require documentation of laboratory training, managers will need to work with interested staff in accumulating evidence of their laboratory training and experience.

Supporting and devoting resources to helping employees already working in the laboratory achieve certification increases the number of testing personnel available and strengthens employee organizational loyalty.

Tackling workforce shortages in your clinical lab

Medical laboratories face change and challenges resulting from the pandemic and the increased demand for laboratory testing. Hospital and laboratory administrators should use this opportunity to reimagine how they may grow the number of people interested in the laboratory sciences while retaining and cross-training current lab personnel. 

In terms of employee benefits, childcare is a major factor for lab techs when choosing where to work, and employers should investigate how to meet this need.

In addition, not all clinical lab personnel with degrees perform patient testing; many support team members have higher education degrees and simply lack the training documentation required to sit for a certification exam. Several certification organizations have now developed different routes to certification that employees can take advantage of. However, lab employees may need ongoing guidance and assistance to become future technicians and technologists.