AABB News: Workforce Issues Compound Blood Collectors’ Challenges

April 13, 2022

Although the COVID-19 pandemic brought increased attention to the stability of the nation’s blood supply, the reality is that blood collectors have been facing various challenges since long before the pandemic began.

Experts in the field say the current challenges faced by blood centers can be divided into four categories: donor recruitment; reimbursement/funding; the lack of a timely national warehouse capability; and staffing/labor.

The issue of staffing and labor is one that has taken on greater urgency recently. Some blood centers are reporting staff turnover rates of higher than 20%, and fewer younger professionals are entering the field, while older generations are retiring. In addition, the pandemic has  compounded these issues. Several leaders in the field are now urging the blood community to  better address workforce and staffing issues to ensure the ability to collect blood will not be further hindered.

David R. Green, MSA, president and CEO, Vitalant, and past president of AABB, has dealt with these challenges head on during his 30 years in the field. Green said he believes that the staffing and labor issue is a significant concern for the blood community — one that needs to be addressed promptly. “Without taking the necessary steps, this will continue to hinder blood centers’ abilities to collect lifesaving blood for patients,” he said.

Vaanush Nazaryan, MBA, BB(ASCP)SBB, CMQ/OE, CPHQ, the interim manager for transfusion medicine and quality manager in the Department of Pathology and Laboratory Medicine at Children’s Hospital Los Angeles, told AABB News, “The biggest workforce challenges facing the blood industry right now are not having enough phlebotomists to collect blood and sole reliance on community blood centers for blood and blood components.”

Brian G. Gannon, BA, MBA, president and CEO of the Gulf Coast Regional Blood Center in Houston and AABB’s president-elect, agreed that retaining quality staff, along with hiring and training them, is a challenge. “We are hiring a new generation of employees who have different expectations about their pay, work, promotion timelines, and more,” he said. “We are also working in an environment of increased inflation, and competition for labor is greater.”

The Labor Shortage and COVID-19

If not the only cause, the COVID-19 pandemic and the resulting stress it has produced remain a substantial reason for the current staffing shortage.

According to Green, “The COVID pandemic has impacted our staff more than we realize.  Masking, vaccine mandates, social issues and other challenges have put significant pressure on our team members. Many of our more experienced and senior staff have decided to leave the workforce early due to these pressures. Plus, the lack of staffing contributes to more overtime, less available time for paid time off [PTO] and added stress on our teams.”

Nazaryan agreed that the COVID-19 pandemic is the main reason for the staffing shortage that is challenging the blood community. “Staff are required to stay home for an extended period if they are diagnosed with COVID-19, which puts constraints on the individuals left to work,” she said. “Depending on the number of callouts, blood drives are cancelled and/or walk-in appointments are turned away to ensure the staff can safely manage the donors.”

“Many staff members in blood collection facilities are required to come into work every day,” said Green. “This includes our phlebotomists and laboratory and distribution personnel. Having to work in production during the pandemic has resulted in masking throughout the day, extra  cleaning precautions as well as heightened exposure to the COVID-19 virus despite heightened safety measures.”

Green added that some staff members have left to pursue positions that do not require such interaction, provide teleworking options, or offer more flexibility. “Many blood center staff have children that have typically been in daycare or school,” said Green. “The pandemic closed these options for many, thus forcing employees to stay home to take care of their children. With other companies offering hybrid or complete work from home options, many blood center employees have left for these opportunities. This has put increased pressure on our existing staff to maintain our production levels.”

Additional Factors Contributing to the Staffing Shortage

Several factors that may be contributing to the shortage of phlebotomists and other blood center staff: inflation driving higher wages and salary compression for blood centers; fewer candidates who are willing to work challenging schedules; federal drug testing requirements eliminating qualified candidates; issues with being competitive in critical professional fields, particularly in the areas of marketing and information technology; and a lack of new medical technologists entering the field.

According to Green, most blood centers require entry-level candidates to have a high school degree or GED certificate for phlebotomist positions, and blood centers are increasingly competing for entry-level candidates with retail, health care and fast food organizations. “Given the labor challenges throughout the COVID pandemic, blood centers increased starting wages and hiring bonuses to attract candidates,” he said. “However, many fast food restaurants and  retailers have also increased their starting wages, benefits and hiring bonuses. Additionally, inflation has also driven the need to increase wages to maintain existing staff.”

Another reason for the staff shortage is the schedule that many phlebotomists are required to work. Employees may want to take off Sunday from work, but churches are one of the largest contributors to mobile blood drive programs. This means phlebotomists are often scheduled for Sunday blood drives.

Then there is the issue of qualifications for laboratory positions. “Another example of the labor challenges is our ability to fill positions that require a medical technologist degree,” added Green. “There are very few colleges and universities that offer a medical technologist degree. As such, many blood centers and hospitals typically have several open positions that require a medical technologist. To add to the challenge, many of our existing medical technologists within our industry are retiring and leaving the workforce. So, an increasing number of positions coupled with the lack of talent moving into this field puts significant strain on blood centers to  properly staff its laboratory services.”

Nazaryan cited as an example January 2022, at the height of the COVID-19 Omicron variant.  “Forty percent of our staff were out with COVID-19,” she said. “Fortunately, we were still able to maintain an adequate blood supply since we have our own blood donor center. With the American Red Cross facing the biggest blood shortage in a decade or so, we were fortunate  enough to continuously provide the blood our patients needed. But that came with the price of our staff working long hours to sustain the supply.”

Mitigation Strategies

“To address not having enough phlebotomists, we must increase the number of per diem employees and perform competency on a routine basis to ensure they maintain their skills and are able to step in during emergencies,” said Nazaryan. “As for the sole reliance on community blood centers, we need to support hospital-based blood centers, since the number of hospital-based blood centers is decreasing.”

Gannon believes that the issue must be addressed at both the national and local level. “We should work at a national level and locally to engage blood donors and modify our work to be more appealing to new hires. Government support and assistance would be helpful,” he said.

Green agreed that the job must be made more appealing in order to attract staff and keep them  from leaving. “Employers, including blood centers, will need to offer work-from-home or hybrid  options to its nonproduction employees,” he said. “For those individuals who are in production  and must come into a facility, employers need to provide a better work-life balance and appreciate the anxiety the pandemic and other social crises have created.” In this category, Green  included set or block schedules, more available time for PTO and employer assistance for at-home care for loved ones.

“Another opportunity is to operationally shift our focus — which requires investment in marketing infrastructure and physical infrastructure, as well as a change in our business model for outreaching to donors at mobile drives — to fixed donation centers,” added Green. “These centers provide a more consistent opportunity to donate, as well as a more consistent schedule for staff. That said, a shift to a greater fixed donation center model is at odds with where most blood centers have invested over the years as blood centers operationally went to where the donors were, rather than having the donors come to them (at convenient locations).”

To achieve this operational change, Green believes there must be a more sophisticated, intentional and comprehensive approach in marketing and digital outreach in the industry. “This will require better data, better data infrastructure and team members with consumer marketing  competencies — as we try to move donors to respond just like consumer marketing companies move consumers to respond,” he said. In order to deploy these and other programs, it is important to be fully staffed to improve employee’s work-life balance, which will lead to higher morale, a better donor experience and the capacity to capture donors motivated by improved  marketing, he added.

The Need to Act Promptly

Many in the field believe that if the blood community’s workforce issues are not adequately addressed soon, the challenges will be exacerbated and could, ultimately, hinder the ability to  ensure that a stable and adequate blood supply is always available for patients who need it.

“Our ability to collect blood should never stop, since the need for blood never stops,” said  Nazaryan. “To ensure an adequate supply of blood to meet the needs of our patients, we need a steady number of phlebotomists willing and able to collect blood.” She added that increasing the number of hospital-based donation centers would decrease blood banks dependence on community-based blood centers to meet the transfusion needs of their patients.

Gannon agreed that addressing this issue now is urgent. “If we fail to act now, we may be unable to meet the needs of area patients. We will have limited blood collection capacity and some of the technical jobs will struggle to find qualified candidates,” he said.

Mitigation Strategies

“First of all, there is no magic wand,” said Green. “Solutions for these issues need to come from all departments, including operations, human resources and finance, in order to fully address the issue.” Green listed some of the programs that Vitalant has deployed:

  • PTO Payout – Allowing eligible staff who were unable to take PTO due to production needs to cash out a portion of their accrued vacation hours.
  • Hiring bonuses – Offering a hiring bonus to new employees as an incentive to join Vitalant.
  • Referral bonuses – Providing up to $2.5K to employees for the successful referral of a new employee.
  • Set and Block Shifts – Whenever possible, providing employees set days of work and/or set hours along with commitments to 2 days off in a row to provide a better work-life balance.
  • Shift to Fixed Donation Centers Operationally – To provide employees with a more routine schedule, independent of the vagaries of drives.
  • Internal Training Programs – Vitalant began an internal training program to advance existing and new employees to a medical technologist designation in blood services.
  • Buddy Program – Providing new staff a “buddy” who works at roughly the same job as the new hire so they have a connection with someone to help them get oriented.

Nazaryan added that at the Children’s Hospital Los Angeles they have had conversations to  cross-train their hospital phlebotomists to help during emergencies, although they have yet to  discuss increasing the number of per diems. She noted that the hospital already has a hospital-based blood center, which has proven to be extremely valuable during the national blood  shortage because their ability to provide blood to their patients has never stopped.

“Over the past decade, blood centers have been reducing costs, eliminating inefficient blood drives and shrinking the donor base,” said Green. “Now with the additional changes brought on  by the pandemic and labor shortage, blood centers face a new issue — not of donors, but of the  ability to attract talent to our organizations. For too long, we have suffered through high turnover  due to low wages and difficult work schedules. With the strong economy and low unemployment, it is imperative that we find solutions to meet our employee needs in order to  attract and retain employees.”