Those who have been working in laboratory medicine for any length of time are well aware that staffing shortages predated the pandemic by a wide margin. Before COVID, we knew that this shortage was driven by increasing numbers of Baby Boomer laboratorians having reached retirement, as well as decreasing numbers of laboratory programs at colleges and universities having shut down for various reasons.1 By adding the ongoing stressors of the COVID pandemic to this already difficult scenario, laboratory management is finding itself facing a large production gap that is widening by the day.
Today, a qualified laboratory technologist can find work practically anywhere in the country while likely enjoying ample sign-on bonuses and other benefits. This has only proven a concept that seasoned leaders have always known—skilled and consistently capable staff members are essential to successful laboratory operations. Although the future of staffing in medical laboratories may seem uncertain, one element must remain constant: a strong laboratory safety program that protects current staff, as well as the tasks they perform. Of course, among the significant challenges for lab leaders is maintaining a safety-first focus while operating with a minimal staff. Illnesses, time off, and even disaster situations can create sudden personnel shortages that can potentially affect overall lab safety.
Encourage Engaged Safety Orientation
One of the ways to foster a strong safety culture is to begin all new employee orientation with safety education. Understanding safety measures associated with operations throughout the laboratory is integral to all other training and work that will be done in the department. New staff members should not sit at a lab work bench without first performing a thorough safety review.
The Occupational Safety and Health Administration (OSHA) regulates many areas of laboratory safety related to bloodborne pathogens, chemicals management, personal protective equipment (PPE), and more specific practice areas. In the written standards, OSHA plainly states that training in these subjects needs to be completed within the first ten days of employment or “at the time of an employee’s initial assignment to a work area where [hazards] are present and prior to assignments involving new exposure situations.”2 Emphasizing the importance of this education sets a powerful standard concerning the priority of safe operations in the lab.
New employee safety training will likely include some computer-based lessons, but the majority of this orientation should performed via face-to-face reviews of specific safety policies and procedures (P&Ps). This hands-on training can be provided by the laboratory manager, senior and experienced laboratory staff, or a designated lab safety team member.
Given the inherent importance of following government regulations as well as internal guidance when it comes to safe health care practices, several safety topics should be discussed and drilled with new employees, including biosafety P&Ps, chemical hygiene, fire safety and evacuation, donning and disposing of (or recycling) PPE, and more (see FIGURE 1). Consider providing a safety orientation checklist to help ensure all pertinent information is reviewed and create a safety training packet to be given to each trainee for future reference.
Keep in mind, when staffing shortages become critical, safety training cannot be cut short. While on-boarding new team members needs to be an expeditious process, cutting corners with safety training will lead to increased risk of exposure or injury incidents, which in turn, would lead to more staffing issues.
Test Safety Competency
In technical work areas of the clinical testing laboratory, the Clinical Laboratory Improvement Amendments (CLIA) require each employee to undergo a competency assessment. This assessment is intended to provide evidence of a staff member’s ability to apply proper skill, knowledge, and experience in the execution of assigned laboratory duties. This process should be implemented and overseen by the laboratory director, and consist of six assessment procedures,3 including direct observation, review of test results, and the use of blind testing samples. While not required, performing competency assessments over safety topics can provide multiple benefits as well.
Reviewing (and assessing) safety competencies on a regular basis raises departmental risk awareness and can help improve the overall safety culture. Observing safe work practices, performing drills, and reviewing PPE donning, use, and doffing are all activities that will help keep the lab running smoothly in perpetuity. If it is evident that laboratory staff members have formed good safety habits through these assessments, it is more likely they will retain these practices, even when emergency situations and staffing crises arise.
A safety competency assessment may consist of a series of observations of specific safety tasks as well as separate safety quizzes that test specific knowledge (see FIGURE 2). The assessment can be altered each time it is performed, and the focus may change to reflect recent safety issues that may have occurred in the department (eg, a chemical spill or repeat injury). Remediation that includes a P&P review as well as a return demonstration should be performed for any employee who does not satisfactorily complete the assessment.
Short-Staffing Safety Tactics
Laboratory staffing shortages can occur via attrition over time, or they can occur when there is a sudden exodus of several employees. A disaster situation can also create holes in the schedule. Many emergencies and disasters are unexpected, which makes planning for a shortage more challenging, but foreknowledge of an approaching emergency (eg, a bad weather forecast) can allow for advanced planning.
When a potential staffing crisis looms that is expected to be temporary, having an established P&P to address the situation enables the laboratory to respond effectively and maintain testing expectations throughout the shortage. For example, if a hurricane or a bad winter snowstorm is predicted, there is usually plenty of time to prepare adequate staffing both during and after the event. The ability to come and go from the laboratory may be hampered by bad weather, blocked roads, floods, or other severe conditions. Thus, a staffing algorithm can be used to help maintain appropriate levels of essential personnel as the event transpires.
The ABC Teams method divides laboratory staff members into three even groups. Teams A and B are kept in the facility while Team C is sent home so they may return as soon after the event as possible acting as relief. In a department that runs 24 hours a day, each team should plan to work twelve hour shifts when the disaster arrives. Teams A and B alternate the twelve-hour shifts. Each team should arrive on site before the event and bring extra clothes, medications, and other personal effects. Once Team C is able to come back to the facility to relieve the on-site teams, management should stagger personnel home in a manner that least affects the department’s workflow until schedules can return to normal (see FIGURE 3).
It is important to remember that natural disasters affect not only the facility and operations, but the homes and lives of our staff. Management may need to take into consideration specific aspects of a staff member’s personal life when working through disaster situation scenarios. Planning and procedures help, but flexibility will also be key when chaotic situations arise.
Seek Novel Safety Training
The COVID-19 pandemic has forced laboratory managers and safety professionals to re-think traditional emergency response plans. Some forms of staffing and scheduling issues have been typically considered, such as in natural disaster events previously mentioned, but the pandemic caused other types of shortages that now need attention. Virus exposure events have occurred in departments that have forced the removal of large groups of employees at the same time. Long-term illnesses or the need to take care of sick family members or children schooling at home have created unusual staffing gaps not previously experienced. The already growing laboratory workforce shortage has been exacerbated by a pandemic, which at certain times has prevented lab students from finishing clinical rotations, and which has led experienced staff out of the workforce because of fear, illness, and even vaccine mandates.
Management must ensure that laboratory safety remains important and receives due attention, no matter how dire staffing issues become. This is certainly easier said than done, but there are methods to maintain safety and to incorporate it into daily work even as departmental staffing remains low. Make sure safety orientation is completed for all on-boarding staff, even temporary staff who will not be on site for more than a few weeks or months. Continue performing safety competency assessments in order to guarantee working knowledge of safe practices that prevent harm.
Likewise, continue to incorporate safety into the workday. Start every laboratory meeting or huddle with a safety moment or story. Ask for a team member to discuss a safety story they witnessed or in which they were involved. Placing safety first in this way lets team members know it has priority and discussing a safety issue or incident with the team has benefits as well. The safety moment may be as brief as praising an employee who provided PPE to a vendor that came into the department. These safety stories may also be those that do not necessarily illustrate a success. Telling people about an incident and asking how it could have been avoided is a quick, yet educational plus for safety culture. Reviewing safety incidents also serves to inform staff and can urge them to consider methods to avoid similar situations. Talking about safety in these ways may take time, but if safety is incorporated into the language of the department, the culture will be positive, and it is easy to fit this habit into your schedule.
Part of any job in the lab involves talking to other people. Leaders should make safety a part of those conversations when the opportunity arises. Speak to the lead technologist about an instrument installation. Ask about new reagents that might need to be added to the chemical inventory. Find out if there will be new waste streams generated. Was a risk assessment performed to look for other possible dangers? These talks reinforce safety in any staffing situation. As laboratory directors, acting as a consistent role model is another simple way to incorporate safety into daily management tasks. Wear the correct clothing and shoes. If walking in and out of the department, dress the part. Open-toed shoes or mesh sneakers should not be worn. Wear PPE when performing any work in the lab, including leading huddles or team meetings. It takes little extra time to model the safety behaviors expected from staff members and doing so demonstrates where safety stands in the department.
The US Bureau of Labor Statistics predicts that clinical laboratory workforce jobs will grow at a rate of 11% by 2026 adding 35,100 new job openings.4 That number does not include jobs which will be open due to retirements or vacancies for other reasons. As we move forward, the value of the laboratory employee’s health and safety continues to grow as well. Protecting laboratory staff working today is critical, and it can be done with proper orientation, training, continued competency assessments, and a comprehensive emergency management plan. Working to make safety a habit, to incorporate it into every workday is a strategy that can have far-reaching results and that can perpetually protect your staff from exposures and injuries on the job.
Daniel J. Scungio, MT(ASCP), SLS, CQA(ASQ), has over 25 years’ experience as a certified medical technologist. He worked as a laboratory generalist in hospitals ranging from 75 to 800 beds before becoming a laboratory manager, a position in which he served for 10 years. Dan is now the laboratory safety officer for Sentara Healthcare, a system of more than seven hospitals and over 20 laboratories and draw sites in the Tidewater area of Virginia. As “Dan the Lab Safety Man,” he also serves as a professional speaker, trainer, and lab safety consultant. Dan received his BS in medical technology from the State University of New York at Buffalo.