Rebecca Matthews, MLS(ASCP)CM
Imagine being a new graduate, fresh out of school and hungry for your first real job in the professional world. You have passed your certification exam and you begin searching for a generalist position in an effort to remain competent in all the disciplines. You are offered a position to work the night shift at a 300 bed hospital 45 minutes from your house. While not ideal, you know that there are few generalist positions in your area so you happily take it. You receive 3 weeks of training in each department, enough time to learn the laboratory information system, basic protocols, and maybe a few odd-ball things here and there. Mind you, this is on day shift where there are two other technologists on the bench to help you.
Nine weeks after your hire date, you are sent to your first night shift with no other trained blood banker available to assist you, neither in person nor on call. It’s 3 o’clock in the morning. Over the intercom, you suddenly hear “Double Alpha Trauma, Male, E.T.A. Now.” As the operator echoes the alert, every muscle in your body tenses up as you realize that not only have you never dealt with a single Alpha trauma by yourself, you most certainly have never dealt with two at the same time. Deep breaths. Think about what you know. Male – okay, so we are going to get the four O positive emergency release units in the fridge. Take the pink slip out, run them over to the ER, come back, set up four more. Got it. Go! Within 10 minutes, eight emergency release units are over in the ER fridge and four more are set up to keep ahead. Everything is fine, you did great!
3:30 a.m. The phone rings; you see it’s the ER, but you are confident that they are just calling to tell you the trauma is over; that’s what always happens on day shift after all. You calmly answer the phone only to hear the charge nurse say, “The doctor wants to activate the Massive Transfusion Protocol. NOW.” Your heart stops. Your hands are shaking, you stutter to gain more information, then hang up. There is a man 100 yards from where you are standing that is expected to lose his entire blood volume, approximately 6 liters, in the next 24 hours or less. What do you do?
Over the course of the next 12 hours, I released over 25 products to support this patient, including packed RBCs, Platelets, Fresh Frozen Plasma (FFP), and Cryoprecipitate (which I initially thawed by accident instead of FFP). I ended up calling 3 different supervisors and no one answered. I was fully convinced that this young man was going to die because I wasn’t getting the blood out fast enough. Eventually I was able to reach my supervisor who rushed over at 4:30 a.m. and spent the next 6 hours alongside me issuing blood, processing STAT orders from the American Red Cross, filling out work cards, completing all the computer work, and communicating with the floor. For 12 hours straight I worked in blood bank. For 12 hours straight, I took no bathroom breaks, no food breaks, no water breaks.
After returning to work a mere 12 hours later, I found both young men were stable enough to be sent to a larger hospital in the big city with the resources more equipped to monitor their treatment and recovery. A part of me was proud that, despite feeling anxious, scared, and unprepared, I was still able to provide an adequate level of service that contributed to saving the lives of these two young men. On the other hand, I began to think, “This was a really close call. What if I am put in another situation where I am really not prepared and there’s no one there to help me?” So, I wrote an e-mail to the laboratory manager detailing my concerns. I didn’t feel experienced enough, not only as a new employee but as a new professional, to be left with an entire blood bank on my shoulders. In an effort to help, I offered to sit down and discuss solutions: maybe a staggered shift or an on-call system, scanning the protocols into a shared drive for easy access, providing minimal blood bank training to the other night shift workers. I made it clear that I was more than willing to take on extra projects to improve this situation.
Six weeks went by with not so much as a response acknowledging my concerns in any way, shape, or form. Feeling the stress closing in again, I decided to take my concern a step further and file a formal complaint with Human Resources. I told them of the working conditions I felt were unsafe for both me and the patients. They said they would investigate and get back to me. I heard nothing. Another 3 weeks went by; then it happened again. This time a cardiac catheterization had gone wrong and a 56 year old woman was rushed to open heart surgery. For 9 hours I did nothing but thaw plasma, tube crossmatch red blood cells, fill coolers with products for the Operating Room (OR), scan components so I could perform the modifications, and computer work after the fact. Again, no bathroom break, no food, no water, no relief. I had to order 2 STAT deliveries of donor units because the O POS inventory was depleted twice. I issued over 45 blood products by myself. I didn’t have time to think about calling for help, I just jumped into survival mode.
Unfortunately, this case didn’t have a happy ending. There was nothing else I could have done on my end; the OR ended up returning the last 15 products I had issued out. This was the last straw. I had managed to escape a potentially devastating liability suit for a second time now. I could no longer justify working in a facility where I felt I was not given the resources to succeed, where progress was not welcome, my voice was not heard, and where I really didn’t feel like I was helping people anymore. I finally quit. I was able to accept a position at a larger facility in a new city and start over.
I share my experience as a new professional with you for several reasons. First, I think as a new professional, it is easy to feel like you don’t have any status. You have a lot of knowledge but little experience to back it up; meanwhile, some of your new co-workers have been in the field for more than 40 years. It is easy to feel intimidated and that your voice has not been “earned”; but it’s not true! If you don’t understand something, ask. If one person may be reluctant to answer or even make you feel silly for asking, ask someone else. If you don’t feel comfortable or confident enough to work on your own just yet, ask for more time and be patient with yourself. Know that you will get there, but on the timeline that is right for you. The work we do is important and even though we may rarely get to see the patients, we still have their lives in our hands. That’s no small responsibility, nor is it one you want to carry before you are ready.
Secondly, don’t be afraid to be an advocate for yourself and for your patients. If something doesn’t sound right or makes you uneasy, bring it to someone’s attention: talk it out, bounce ideas off of your co-workers, and get other perspectives on the matter. Our number one goal as health care professionals is to provide the highest quality of patient care we possibly can. This entails voicing concerns, being open to new ideas, continuing to search for ways to make workflow more efficient, and maximizing patient safety. As new professionals, we are a tremendous asset to laboratories. We have a wealth of knowledge in all the disciplines that is fresh in our minds, including the newest theories and practices. We have little experience in the lab which means we haven’t had time to become entrenched in one particular mindset or pick up bad habits. Furthermore, we are a fresh set of eyes that can add a new perspective. The clinical laboratory is a beautifully dynamic field that is ever evolving; but progress can’t happen without people willing to question and speak up.
Finally, don’t be discouraged if you don’t immediately find the place that you want to spend the next 40 years of your career. Another beautiful thing about our profession is that there is no shortage of jobs. If you are in a situation where you have done everything you can to share your ideas and concerns, tried to connect with your co-workers and create a community dedicated to evolving laboratory practices and patient safety, and tried to provide the best patient care you can but are not provided adequate resources – give yourself permission to let go. I was in a situation where as much as I was willing to facilitate change, there weren’t enough people with me or behind me to make it happen. That doesn’t mean I’m a failure. It means I pick myself up, move on, and try again.
For all of you new professionals out there who are still trying to find your way, know that you are not alone. There are so many different environments in which we can use our knowledge and our skill sets to provide a service to those in need. If the first one isn’t right for you, keep looking, keep trying. Be patient with yourself and remember why you chose this field in the first place. Keep working hard my fellow lab rats, and keep advocating for yourself, your patients, and your profession!