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Another one for hospital transfusion services:

For those of you in complex blood banks (multiple ABID's, adsorptions, elutions, irradiation, neonatal aliquots, titers, student interns, Trauma, etc...), do you maintain a dedicated blood bank staff or are they all cross-trained in other areas of the laboratory?

Thanks!

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9 hours ago, LIMPER55 said:

Our "LEAN" department makes us use everyone.  

In my opinion-this has cost us quality.  Not a good idea to have a casually trained tech working-no SBB in charge for reviews.

I think this is highly dangerous, and I also think that your Pathologist should tell your "LEAN" department to butt out, if you will excuse the language.

 

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There is a very good reason why "generalists" avoid Blood Bank and transfusion medicine - it's complicated and you need a lot of specific training to do it well. Even today, with a significant level of automation, a warm body is often needed to interpret results and give recommendations. And then add the fact that there is a seemingly endless list of "exceptions", "equivocal", "indeterminate", and other levels of results that confound even a trained (SBB) person, let alone an "every other weekend, third shift" employee.

Cross-training is a must for very small, low volume facilities. No question. However, once work gets to a certain level of complexity and volume, institutions should seriously consider having dedicated staff.

I don't know how "generalists" manage to maintain their legally-required competency levels.

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Whether you call yourselves Lean (or Six Sigma or some other facetious productivity name) or not, the reality for many labs these days is that generalists are more and more necessary to keep things going in light of personnel shortages,

We are a 250 bed level 2 trauma hospital, with a fair amount of Lab work on the type of patient population we see, including BB.  The only real "dedicated"  techs we have are in Micro (and of course, Histology). About a quarter of the techs on first shift are generalists that can work on a regular basis in BB (in addition to the main Lab area).  On second and third shift, virtually all of the techs work BB in addition to the main lab area.

Whether one has BB with all dedicated staff or no, the key is to have adequate training and competency, along with extensive references, including having good P&Ps available.  This is true for all areas of the Lab (and in health care in general!).  It requires a sharp and dedicated management model and staff.

Scott

 

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45 minutes ago, SMILLER said:

Whether you call yourselves Lean (or Six Sigma or some other facetious productivity name) or not, the reality for many labs these days is that generalists are more and more necessary to keep things going in light of personnel shortages,

We are a 250 bed level 2 trauma hospital, with a fair amount of Lab work on the type of patient population we see, including BB.  The only real "dedicated"  techs we have are in Micro (and of course, Histology). About a quarter of the techs on first shift are generalists that can work on a regular basis in BB (in addition to the main Lab area).  On second and third shift, virtually all of the techs work BB in addition to the main lab area.

Whether one has BB with all dedicated staff or no, the key is to have adequate training and competency, along with extensive references, including having good P&Ps available.  This is true for all areas of the Lab (and in health care in general!).  It requires a sharp and dedicated management model and staff.

Scott

 

Well said.

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Currently I do not work in such a Facility so have Generalists that rotate, but most of the Hospitals I have worked at in my career, were large Medical Centers that fit your description and they always used Blood Bank dedicated staff.  I think you need that specialization to be performing high level testing.  Also, it would be a lot to ask of Generalists who have to rotate between all depts. that they would be that specialized in the Blood Bank, but also be able to be knowledgeable and competent in the other areas as well.  You need a certain depth of Blood Bank knowledge to be training interns; to do high complexity serology; to know how to handle difficult trauma situations.

Just my thoughts....

Brenda Hutson

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10 hours ago, Brenda Hutson said:

Currently I do not work in such a Facility so have Generalists that rotate, but most of the Hospitals I have worked at in my career, were large Medical Centers that fit your description and they always used Blood Bank dedicated staff.  I think you need that specialization to be performing high level testing.  Also, it would be a lot to ask of Generalists who have to rotate between all depts. that they would be that specialized in the Blood Bank, but also be able to be knowledgeable and competent in the other areas as well.  You need a certain depth of Blood Bank knowledge to be training interns; to do high complexity serology; to know how to handle difficult trauma situations.

Just my thoughts....

Brenda Hutson

Thanks, Brenda!  I feel the same way.  No matter how good a procedure, you have to understand the process enough to open it.

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From the posts given here it seems that there is some dependency on the size of the hospital (number of beds) and the patient populations treated. There are issues of fiscal responsibility and best utilization of staff and other recourses such that dedicated staff, although ideal, may not be cost effective in all settings. A well qualified and dedicated managerial team is always needed as this factor can make a huge difference in meeting the obligations of resource management and service delivery, and staff maintenance,  while maintaining fiscal responsibility. It is here that I have experienced the greatest shortage.

 

Edited by rravkin@aol.com

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On ‎8‎/‎17‎/‎2017 at 11:24 AM, Brenda Hutson said:

Currently I do not work in such a Facility so have Generalists that rotate, but most of the Hospitals I have worked at in my career, were large Medical Centers that fit your description and they always used Blood Bank dedicated staff.  I think you need that specialization to be performing high level testing.  Also, it would be a lot to ask of Generalists who have to rotate between all depts. that they would be that specialized in the Blood Bank, but also be able to be knowledgeable and competent in the other areas as well.  You need a certain depth of Blood Bank knowledge to be training interns; to do high complexity serology; to know how to handle difficult trauma situations.

Just my thoughts....

Brenda Hutson

I wholeheartedly agree Brenda

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On 8/19/2017 at 4:46 AM, rravkin@aol.com said:

A well qualified and dedicated managerial team is always needed as this factor can make a huge difference in meeting the obligations of resource management and service delivery, and staff maintenance,  while maintaining fiscal responsibility. It is here that I have experienced the greatest shortage.

Even the very best of managers or management teams cannot work miracles if they lack the appropriate resources.

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On ‎8‎/‎21‎/‎2017 at 7:29 AM, exlimey said:

Even the very best of managers or management teams cannot work miracles if they lack the appropriate resources.

Yes, you are correct; ..management recourses not withstanding.

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Reviving a dead post....

I am growing increasingly concerned about staffing shortages in the Blood Bank.  I'm in Texas and most of our good techs are aging out of the field.  It is almost impossible to find and experienced blood bankers that are not already working full time somewhere.  Filling positions with techs that have blood bank or micro experience is HARD!  New techs are not staying in the field and lack the experience to work alone.  At 51, I am at least 10 years younger than blood bank staff on all shifts and am worried about filling those roles over the next 5-10 years.  What are your experiences?

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I am a generalist in a 270 bed trauma 2 hospital.  The tech shortage is bad all over.  If you are in a system that cannot find some way to attract new graduates (wages), then you are having real trouble.  We can't hire people, in spite of the fact that we have a local college CLS program nearby that puts out about 15 graduates a year.  We can' t even keep the students that have interned here!

This shortage has been developing over years.  We have been begging the administration here to wake up and do something, because its starting to get really bad. Unlike other times when we've had staffing shortages (been here for 30 years), there is no relief in sight. 

According to various articles in journals over the years, in the US we are seeing about 15000 openings a year with only about 6000 graduates.  There will have to be some drastic changes to many labs to provide appropriate patient care.  The changes have to be made NOW, they should have been done here years ago.  

Scott

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We are a very popular place to move (Central Oregon) and we are having trouble finding people to hire.  To answer the original question, we have one dedicated first shift BBer and everyone else is a generalist.  We have capped the number of people trained in BB (about 24) so that they get enough shifts in here to stay competent.  They do pretty well.  We have evening shift coordinators who are a bit more advanced and staff can always call me.

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I'm at a 220 bed hospital, we have dedicated Transfusion Medicine technologists on all shifts. We have hired new grads, they are able to work successfully alone with proper training and the willingness to learn on their part. 

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I'm the only dedicated blood banker at my facility. All our new hires are generalists, almost all of them are fresh grads or have minimal blood bank experience at much smaller facilities. They all have to be competent for antibody ID and corresponding antigen negative crossmatches, emergency release, mass transfusion, neonate transfusion, basic troubleshooting for the instrument, etc. My training period for staff is far longer than anywhere else in our lab and my competency assessments are a very lengthy ordeal to ensure that all staff members are performing at an acceptable level. I spend a lot of time reinforcing the concept of 'patient safety comes first'. I send out a lot of informational emails to reinforce policy and procedure. I work one-on-one with staff members if they have questions or problems. Automation and blood bank information systems help when you are dealing with non-dedicated staff to standardize and lock down your processes.  You've got to have excellent SOPs that have exhaustive detail. Hiring smart, motivated people helps. I make myself available, even when I'm on vacation.

BUT... doing all of that is just making it work with what you've got. It expects a great deal from your generalists. It doesn't solve the problem. It's an enormous problem and it's not going to get better unless something changes. Training programs are closing every year. The average age of blood bankers is increasing. Our profession is invisible to the world at large. Smart people can get better paying (and maybe less stressful) jobs in other areas of healthcare and other occupations. Administrations everywhere are expending a lot of energy and financial resources to attract and retain nursing staff. Do that do that for lab staff at your facility? Sigh!

Edited by AMcCord

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20 hours ago, AMcCord said:

I'm the only dedicated blood banker at my facility. All our new hires are generalists, almost all of them are fresh grads or have minimal blood bank experience at much smaller facilities. They all have to be competent for antibody ID and corresponding antigen negative crossmatches, emergency release, mass transfusion, neonate transfusion, basic troubleshooting for the instrument, etc. My training period for staff is far longer than anywhere else in our lab and my competency assessments are a very lengthy ordeal to ensure that all staff members are performing at an acceptable level. I spend a lot of time reinforcing the concept of 'patient safety comes first'. I send out a lot of informational emails to reinforce policy and procedure. I work one-on-one with staff members if they have questions or problems. Automation and blood bank information systems help when you are dealing with non-dedicated staff to standardize and lock down your processes.  You've got to have excellent SOPs that have exhaustive detail. Hiring smart, motivated people helps. I make myself available, even when I'm on vacation.

BUT... doing all of that is just making it work with what you've got. It expects a great deal from your generalists. It doesn't solve the problem. It's an enormous problem and it's not going to get better unless something changes. Training programs are closing every year. The average age of blood bankers is increasing. Our profession is invisible to the world at large. Smart people can get better paying (and maybe less stressful) jobs in other areas of healthcare and other occupations. Administrations everywhere are expending a lot of energy and financial resources to attract and retain nursing staff. Do that do that for lab staff at your facility? Sigh!

I too am the only dedicated Blood Banker .  I have found it more and more challenging as staff is quickly retiring and being replaced with young grad generalists.  I try to reinforce the theory behind all of the blood bank tests in order for them to grasp the whole picture for trouble shooting those patient's that are the exceptions to the rules but there is only so much new grads can absorb during training.  They are learning our processes, a new computer system, and often have not been in Blood Bank for over a year and that was only for a rotation during school.    It takes years to become a seasoned tech. Between training new techs, 6 month competencies, annual competencies, meeting changing standards, and dealing with shortages I find it a little overwhelming. Unfortunately I believe this is the new Norm and agree we are in a staffing crisis which needs addressed now.

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I am retiring in August and my replacement is concerned because there is no one with her level of experience to be her back up as she has been mine.  We have recently lost 1 tech that just completed her training as a generalist and another who was completing her clinicals and had given us her intention to work here.  Before that, the last 3 hires were fresh out of school and did their clinical rotations with us.  We have 2 other techs retiring by March with several others on their heels.  No one waiting in the wings.  Better pay and benefits can be found with in 1 to 2 hours of our location. For us, all techs work at least 2 departments (days).  There is no easy answer - training takes time.  It seems that thee training offered today is less comprehensive than what I received back in the dark ages.:confused:

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2 hours ago, KKidd said:

I  There is no easy answer - training takes time.  It seems that thee training offered today is less comprehensive than what I received back in the dark ages.:confused:

I agree. We are a clinical site for a university program. Our students spent 7 weeks in blood bank, but only 3-4 hours a day on the bench, max. The rest of their day will probably be spent on topics other than blood bank. Hands on seems to be the best way to solidfy what they read in books (if they bother to read - many won't) and lectures, but they get such a small amount of hands on time.

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