Medical and Clinical Laboratory Technologists

Transcription

1 SOC : Perform complex medical laboratory tests for diagnosis, treatment, and prevention of disease. May train or supervise staff. Introduction Clinical laboratory scientists, formerly known as medical technologists, are allied healthcare professionals who perform clinical testing of human specimens for the detection and diagnosis of human disease and provide data to physicians to aid in monitoring the progress of medical treatments. Clinical laboratory scientists prepare, test, and analyze human tissues, cells, and body fluids to detect evidence of abnormalities that compromise good health. Clinical laboratory scientists have the grave responsibility of reporting accurate results, because their determinations result in the diagnosis and medical treatment a patient receives from their physician. Clinical laboratory scientists must ensure adherence to the highest level of accuracy, judgment, and understanding of clinical testing principles, procedures, and interpretation. Some clinical laboratory scientists who have received training and licensure in specialty areas use sophisticated diagnostic instruments and techniques to perform complex laboratory testing. Specialty areas may include body fluids, chemistry, coagulation, cytology, forensic pathology, hematology, histology, immunology, molecular diagnostics, microbiology, medical informatics, phlebotomy, surgical pathology, and transfusion medicine. Nature of the Work Within California, clinical laboratory scientists (CLSs) are no longer called medical technologists, because licensing in California refers to that held by a clinical laboratory scientist. CLSs work under the direction of pathologists to perform clinical testing of human specimens for the detection and diagnosis of human disease. They analyze body fluids, cells, and tissue samples. They cultivate cultures of these fluids and cells, and harvest them based on knowledge of cell cycle differences and according to culture conditions. They also monitor the effects of prescribed medication and response to medical treatments in the laboratory and may prepare vaccines and biological serums for disease prevention. Clinical laboratory scientists use computers, sophisticated medical testing equipment, microscopes, cell counters, and instruments in their work. CLSs may also establish clinical procedures; evaluate processes; and operate, calibrate, and maintain equipment. Clinical laboratory scientists multitask by preparing, performing, monitoring, and analyzing clinical tests throughout their workday. Due to advances in technology, many tests are automated and occur simultaneously, which allows CLSs to focus on analyzing test results. A regular part of the work includes maintaining worksheets, laboratory logs, inventory lists, quality control procedures, and other records. Clinical laboratory scientists also set up, clean, and maintain laboratory and testing equipment. Because the nature of the occupation is to work with chemical solutions and infectious specimens, clinical laboratory scientists are trained in proper infection control, sterilization, and strict safety protocols to reduce the risk potential. Clinical laboratory scientists work a variety of schedules. Because of the immediate needs of some tests for diagnostic purposes in hospital and acute-care settings, these workers work day, evening, night, and weekend shifts, including holidays, but there is typically a pay differential for those who work non-standard shifts. Reference laboratories are responsible for a large number of test results, so they have staff working around the clock. A small percentage of CLSs work at more than one laboratory for per diem work, which pays better but does not tend to include benefits. Most laboratory workers work in hospital and public health laboratories. Many work in reference laboratories, facilities where no patient contact occurs and testing is performed on behalf of medical facilities. Others work in laboratories in doctors offices, veterinary laboratories, blood and 91

2 Knowledge, Skills & Abilities organ banks, forensic laboratories, pharmaceutical and biotechnology companies, molecular diagnostics, and research laboratories, including fertility clinics. Job Requirements Skills/Characteristics This is a great occupation for those who want to have an active role in the healthcare field but prefer not to have contact with patients. Clinical laboratory scientists are science minded and many prefer to work alone and tend to be somewhat introverted. While detail is critical, CLSs must be able to grasp global concepts. Because the work is about problem solving, they must be inquisitive and tenacious and exercise good analytical ability and judgment at all times. They must draw upon the scientific principles in their education for the practical application of their work. Clinical laboratory scientists must be able to work with routine and protocol. The stakes are high in clinical laboratory work, as inaccuracies and testing errors can result in incorrect diagnoses, medical problems, and even death. CLSs must pay strict attention to detail and be able to follow a prescribed order and written procedures exactly. They must be able to prioritize and multitask actions while managing their time under stressful conditions and pressure. Clinical laboratory scientists must keep their work environment clean to avoid contamination of samples and highly organized to maintain the integrity of patient records. Clinical laboratory scientists must be comfortable using computers, sophisticated testing equipment, microscopes, and other instruments. They must have the mechanical ability and manual dexterity to manipulate testing equipment as needed. CLSs must have the strength and stamina to stand and walk for several hours. They must also have excellent or correctible vision, preferably with normal color vision due to the need for accurately identifying differences and similarities in specimens. While working independently is a large part of the work, CLSs also work with other laboratory professionals as a team, and interpersonal communication skills are essential. It is critical that clinical laboratory scientists have a good grasp of English and can speak and write clearly to convey information. Training/Experience Clinical laboratory scientist training typically occurs as a 12- month internship for candidates who already have a bachelor s 60% 50% 40% 30% 20% 10% 0% Knowledge Chemistry Biology English language Customer and personal services Public safety and security Mathematics Skills Quality control analysis Equipment maintenance Reading comprehension Troubleshooting Operation and control Operation maintenance Abilities Near vision Problem sensitivity Inductive reasoning Oral expression Written comprehension Deductive reasoning Top Employing Industries (California) 92

3 degree in a science-related area. For the first 38 weeks of the program, students perform clinical laboratory work in a participating hospital four days per week and attend classes one day per week. For the remaining 14 weeks, students gain full-time practical experience in a hospital laboratory. Due to the full-time nature of the training students are advised not to work during the internship. Classroom learning may include the following topics: hematology, microbiology, urinalysis, toxicology, clinical chemistry, immunology and serology, laboratory information systems, molecular biology, cytogenics, and reproductive endocrinology. Candidates must have a bachelor s degree to be considered for CLS training programs. Ideal undergraduate majors for CLS candidates are in life sciences, biology, microbiology, medical technology, and clinical laboratory science. Those who apply must have completed prerequisites in biology, advanced math, physics, and chemistry. Some training programs require the completion of prerequisites within a certain number of years of entrance into the program. Due to the nature of clinical laboratory science programs as internships, the number of students admitted to programs is dependent upon the number of spaces affiliated medical facilities can accommodate for clinical rotations. Programs are not considered extremely competitive; however, the number of applicants usually exceeds the openings available. Candidates are expected to have an above-average grade point average. Some programs require that CLS candidates receive a Hepatitis B immunization, and present their immunization records and proof of a recent TB test. Once employed, clinical laboratory scientists receive ongoing training to learn new technology, testing equipment, techniques, and instrument usage. Employment Licensure/Certification Following clinical laboratory scientist training, graduates are eligible to take the California CLS licensing exam and to seek national licensure. In order to maintain licensure, continuing education of twelve units per year is required. Many clinical laboratory scientists are certified by the American Society for Clinical Pathology. Those who receive state-approved training in a specialty area will be eligible to take the licensing examination for their specialty from the California Department of Health Services. Recruitment/Hiring There is a dramatic shortage of clinical laboratory scientists in California, due to a number of reasons. In the late 1980s and early 90s, many CLS training programs were forced to close due to funding cuts. Additionally, many students who had strong math and science abilities went into more lucrative professions during the technology boom years causing a brain drain of sorts for the clinical laboratory field. The expected retirement rate for clinical laboratory workers many of whom were trained in the 1960s far exceeds the number of CLS graduates who will replace them. One local director of laboratory medicine interviewed for this study described the crisis as follows: In the next year, we will create 700 vacancies and graduate 70 clinical laboratory scientists in Northern California. Considering that California has the lowest CLS-to-patient ratio in the nation, these graduation statistics do not come close to meeting the demand. In addition, the ordering of tests by physicians will steadily increase as the population ages and improved tests advance patient care. A general lack of public awareness of clinical laboratory professions has been fairly consistent over time. Efforts in the last five years to promote these professions have led to the regrowth of CLS training programs. A career as a clinical laboratory scientist will appeal to those who have a strong proclivity for science and math. Those who have training and experience in the medical field or in bioscience, biotechnology, pharmaceuticals, and engineering are strong candidates for a career as a CLS. Though a bachelor s degree is required in order to enter CLS training, many people in the above fields have already completed advanced science coursework and may be able to complete a BS degree in reasonable time. Individuals with a bachelor s degree who have completed prerequisites for allied health training programs can usually complete the additional prerequisites unique to CLS preparation in one or two semesters. Those considering a career as a CLS must carefully con- 93

4 sider that these professionals have no patient contact, despite the importance of their role in the healthcare system. Education Distribution Those who have already worked in a clinical laboratory setting, such as phlebotomists and laboratory assistants, are strong candidates for CLS training. However, not all phlebotomy and laboratory assisting coursework may be transferable toward a BS degree or CLS training, particularly if the program was completed at a vocational school. Recruitment for clinical laboratory scientists usually occurs as a result of the clinical internships that CLS trainees perform. Other opportunities are posted with healthcare career Web sites and professional and membership organizations for the laboratory sciences, in medical laboratory science publications and newspapers, and by word of mouth. It is fairly common for employers to offer sign-on bonuses to recruit CLSs. Benefits & Challenges Some may find the responsibility in this profession a welcome challenge, while others may find it distressing. Because there is no room for error, mistakes could result in patients serious health problems or death. Fortunately, many tests are helpful in errorproofing, and training for clinical laboratory scientists provides preparation for various forms of problem solving and test checking. Most clinical laboratory scientists find great satisfaction in their work and appreciate that they are able to separate themselves from patients issues and therefore do not take their problems home with them. At the same time, CLSs are helping people and have a crucial role in the healthcare system. As with other healthcare occupations, there is a risk of infectious disease and blood-borne illness. For this reason, laboratory staff take safety precautions, including the use of protective clothing, masks, gloves, goggles, and hoods, as needed. Safety procedures and protocol are strictly adhered to by clinical laboratory staff. Laboratories are overseen by outside health agencies and must perform proficiency testing to ensure their competency for a multitude of tests. For some, the need for standing and walking may be a challenge. Repetitive motion problems in the hands and fingers can be common. Some employers encourage ergonomically correct practices, good posture, and regular stretching to ensure the health of their clinical laboratory staff. Due to the widespread shortage of CLSs in California, some laboratories may have staff shortages, which can impact workloads and morale. There is already a tremendous expectation to perform highly accurate tests, so the potential for increased stress and pressure due to thin coverage in the lab can be fairly high. The greater impact of the shortage on patient care and the healthcare system is the potential for specimen mislabeling, testing errors, and a delay in test results. $60 $50 $40 $30 $20 $10 $0 $60 $50 $40 $30 $20 $10 $0 Occupational Wages 94

5 Career Ladders & Lattices Those who have worked as phlebotomists or laboratory assistants can pursue CLS training, should they want greater responsibility and a greater salary. Clinical laboratory scientists can increase their responsibility through licensure in a specialty area. Those who gain extensive experience or have specialty training can advance to the level of laboratory supervisor or manager. Director-level positions are typically held by pathologists and clinical laboratory scientists with graduate degrees. Other career paths include genetic or other testing, quality assurance and evaluation, medical research, laboratory testing education, and consultation for diagnostic equipment manufacturers. Clinical laboratory professionals can demonstrate professional commitment and increase their career opportunities through membership and participation in professional associations, conference attendance, and reading journal articles on developments in the field. One of the ways that some clinical laboratory professionals in California are attempting to address the need for clinical laboratory workers is by creating a new category of laboratory worker, the medical laboratory technician (MLT). MLTs perform moderate- and low-complexity testing in the clinical laboratory setting. While many states have certified MLTs, this occupation does not currently exist in California. Proponents of training and staffing MLTs expect that the lesser MLT scope of practice will alleviate pressure on CLSs to do routine testing. The assistance by MLTs will not reduce the need for CLSs, but is expected to reduce their demanding workloads, thus lessening the impact of the CLS shortage in California. In September 2005, MLT licensing standard regulations were approved and filed with the California Secretary of State. However, at the time of publication, the certifying exam for MLTs in California had not yet been adopted. To qualify to take the exam, an individual must graduate from a state-approved MLT training program, but no programs in California have yet been approved. Though Hartnell College s MLT program is NAACLS-accredited and De Anza s MLT program is pending NAACLS accreditation, NAACLS accreditation is not currently recognized by the California Division of Laboratory Science (DLS) for MLT training. Those interviewed for this study expect that MLTs will be able to practice in California in two to five years. Students who are interested in MLT training are strongly advised to contact the DLS to ensure that the state has approved the training programs and to research current legislation related to certification for the medical laboratory technician occupation. 95

6 Victoria Bello Point-of-Care Testing Coordinator 1. Please tell us about your current position and how you arrived there. When I was in college, I knew I wanted to major in biology. I took an interest exam about future careers, and I found that I had a proclivity toward pharmacy and medicine. I really liked microscopic things and wanted to work in infectious disease control. I completed my general education at West Valley College, then went to San José State University, where I received a BS in microbiology with a chemistry minor. In my last year of college, my hematology professor asked me if I wanted to work temporarily as a receptionist in a laboratory. At the time, I had no idea about the profession of medical technology now known as clinical laboratory science. After working with clinical laboratory scientists [CLS] for 11 months, I realized then that I wanted to become a CLS. I completed one year of postgraduate school and clinical internship to become a CLS. Early on, I aspired to work at the Centers for Disease Control in Atlanta. I worked at San Jose Hospital, which later became San Jose Medical Center. My first job duties were as a microbiologist, and next as the education coordinator for San Jose Hospital s School of Medical Technology. I later worked at another medical facility as an administrative director for about six years. I currently work in the hospital setting, where I have both inpatient and outpatient laboratory responsibilities. 2. Please describe your typical workday so that a job seeker might get a sense of what you actually do. I wear a couple of different hats. As the point-ofcare [POC] testing coordinator, I work with nursing directors, managers, and physicians regarding point-of-care testing, which is bedside testing for hospitalized patients or lab tests performed in doctors offices. I do regulatory compliance, ensuring quality control based on policies and procedures. I ensure that everything is functioning properly and accurately with no deviations. We provide 15 different point-of-care tests. Some use handheld devices that print out the test results. There are over 40 approved POC tests on the market currently, and it is an area of laboratory medicine that continues to grow, because it reduces laboratory testing time. Regular tests require drawing blood, taking samples to the lab, testing or viewing the specimen, and sending the results back to the patients care team via computer. In a life or death situation, you need immediate lab test results. This is why point-of-care testing is expanding. I train the nursing personnel and physicians and periodically evaluate their technique to ensure they are performing tests correctly. Consulting with personnel is another enjoyable aspect of my job. I do troubleshooting and validation of new equipment and supplies and ensure that there is POC computer connectivity from the nursing unit to the central laboratory. My work involves financial forecasting of the test devices, as well. 3. Which aspects of your education and/or training made you more capable or marketable in this field? You have to have a baccalaureate degree and a California license to practice as a CLS. I became licensed in California, then became certified on the national registry with the American Society for Clinical Pathology (ASCP). The ASCP qualifies me to practice as a CLS in other states, although California has the strictest licensing standards in the U.S. It also has the highest salaries for CLS. I received an MS in healthcare administration in addition to my BS degree and CLS training, which is very helpful with regulatory compliance. My 97

7 experience as an education coordinator was very helpful for the teaching that I do. 4. What are the most exciting aspects of your job? What do you like most about your job? I enjoy interacting with the doctors, nurses, and the laboratory staff. Because new point-of-care tests continue to become available, results come quickly, and therefore patient care decisions can be made more quickly. 5. What do you dislike or find challenging about your job? Because there is great opportunity for upward mobility with my current employer, there is sometimes a lot of personnel turnover. It is also sometimes difficult to get those unfamiliar with laboratory procedures to understand quality issues with testing. 6. What advice would you give to a person seeking a job in this field? For people in this career, there is a lot of variety. You can move into different aspects of lab work: microbiology, chemistry, transfusion services, point-of-care testing, etc. There are a lot of specialty areas. 7. What qualities make someone a star performer in this occupation? Conscientiousness is extremely important. Being a great detective, detail-oriented, and having analytical and troubleshooting skills. Clinical laboratory scientists must multitask and work well under pressure, so endless patience is a must. The importance of this work cannot be underestimated 70 percent of a patient s medical record is made up of diagnostic services, both diagnostic imaging and laboratory services. 98

8 Report Evaluation