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Implementation of a Phlebotomy Career Ladder
September 2017 - Vol. 6 No. 7 - Page #10

The practice of phlebotomy is integral to all clinical laboratory operations; one that has always required an intimate interaction with patients, many of whom may be experiencing very challenging circumstances. In this regard, phlebotomy remains as perhaps the most front-facing action of the clinical lab, and despite the relative simplicity of phlebotomy in a vacuum, the process can be unexpectedly challenging. As with many rote processes in the lab, phlebotomy is expected to be performed flawlessly, thereby producing wholly viable samples for clinical testing; yet phlebotomists are rarely given appropriate recognition or opportunities to distinguish themselves professionally. As all seasoned laboratorians from the director to the bench tech know: qualified, sensitive, experienced, and reliable phlebotomists are indispensible to clinical laboratory operations.

In order to acknowledge the valuable work and vital role of phlebotomists at CentraState Medical Center, as well as create a structure in which those professionals can actively participate in career growth, our laboratory leadership approved the development of a Phlebotomy Career Ladder (PCL). The goal of this project was to properly identify phlebotomists as a crucial part of the clinical team. Further, even though phlebotomists are directed by specific supervisors, we wanted to create a direct conduit through to our laboratory technologists. Accordingly, we created a structure to identify the delineations and key aspects of the career ladder.

Structure of the PCL

The impetus for the career ladder was derived from an employee opinion survey, which made clear a feeling among phlebotomists that they were not well recognized for their contributions. Furthermore, the survey indicated that many phlebotomists felt there was no room for advancement within the laboratory and/or the medical center. The resulting career ladder is largely patterned on one we had in place for our technicians and technologists, yet tailored to the requirements of phlebotomy skills.

SIDEBAR 2 below provides details on each of the 5 ladder levels, which were developed based on the following structure:

  1. Define the requisite phlebotomist qualifications necessary for program eligibility. A minimum of “achieving expectations” on annual performance appraisals is required to remain in the program.
  2. Require both the applicant and the applicant’s supervisor to fill out their portions of the application, including job performance examples.
  3. Identify and define a process improvement (PI) project or educational presentation agreed upon by the applicant and the Lab Director.
  4. Convene committee review of phlebotomist’s application and the quality and content of the PI project and/or education presentation.

For our facility, we require phlebotomists to be employed for a minimum of 6 months and to have successfully passed the probationary period in order to be initially considered. Applicants may approach their supervisor or director and initiate the application process, or supervisors may propose program enrollment to apt phlebotomists (see SIDEBAR 1).

Program Impact on Quality Measures

The PI projects have certainly yielded benefits to our laboratory operations. One PI project initiated by a Phlebotomy I employee led to a thorough review and assessment of competency on newborn heel sticks for all phlebotomists. Since that time, we have seen a drop in rejected specimens by our State Lab. This is a very important monitor for us, as we never want to have a baby return for testing. Given the New Jersey State Department of Health’s stringent regulations regarding specimen quality, we felt our average of 2-4 returned specimens a month was too high. To assist, we asked staff from the New Jersey State Laboratory to come and retrain our staff, and one of our phlebotomists decided to use this experience as the substance of a clinical ladder project; it was his responsibility to personally observe all staff who performed newborn heel sticks to ensure proper technique. As a result, we have had no return visits due to poor phlebotomy since December 2016.

Another project serves to review outpatient prescriptions for accuracy. The employee then reviews any issues with the ordering clinician and indicates probable errors. A third project involves the outreach department, where a Phlebotomy I staff member is responsible for retraining other phlebotomists in the event of an increase in rejected specimens or failure to obtain appropriate specimens. Further, we have a phlebotomist on the career ladder who is part of our hospital’s Quiet Committee, a group tasked with reducing noise as part of the CMS requirement to make patient care areas as quiet as possible.

As expected, employee morale has improved markedly since the PCL program was incepted. The first staff members to enter the program were initially accepted in January 2016 and all are proud of their accomplishments. We currently have four staff members enrolled in the program: Three are in the Phlebotomy (Clinical) Level I, one is in Phlebotomy (Clinical) Level II. An additional phlebotomist has met all the initial requirements and is being evaluated for inclusion in the program.


The Phlebotomist Career Ladder has proven successful in recognizing and codifying an appropriate path for these vital practitioners to follow. Our goals were to improve the quality and job satisfaction of our phlebotomists, and thereby improve patient safety and satisfaction.

As dependence on liquid biopsies increases, and research continues to find new and exciting methods for using blood for diagnostic purposes, the ability to procure those samples, reliably and in perpetuity, becomes equally important. We plan to continue running this program and gearing the PI projects and presentations toward current and forthcoming needs.

Linda Pacetti, MBA, MT(ASCP), is the laboratory clinical director at CentraState Medical Center in Freehold, New Jersey. Linda has worked at CentraState in various laboratory capacities for 31 years.

MedicalLab Management: What factors motivated you to begin ascending the phlebotomist career ladder?

MLM: How have you become more invested in clinical outcomes?

MLM: What factors motivated you to begin ascending the phlebotomist career ladder?

MLM: How have you become more invested in clinical outcomes?

MLM: What factors motivated you to begin ascending the phlebotomist career ladder?

MLM: How have you become more invested in clinical outcomes?

MLM: What factors motivated you to begin ascending the phlebotomist career ladder?

MLM: How have you become more invested in clinical outcomes?

MLM: What factors motivated you to begin ascending the phlebotomist career ladder?

MLM: How have you become more invested in clinical outcomes?

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