Shanise Keith, an occasional contributor to Phlebotomy Today, is the Phlebotomy Program Coordinator and a Medical Assisting Instructor at Mountainland Applied Technical College in Lehi, Utah. 

When I was a young phlebotomist entering the healthcare world, I encountered a difficult situation. I was a new hire working in a busy hospital, and I was eager to learn the ropes of the job. I consider myself a hard worker and not afraid to go the extra mile to do my best, and like many new employees, I wanted to prove myself as a good choice for the job.

I had only been there for a couple of days and so far had been enjoying everything I was learning and found myself getting along well with my new coworkers. However, the first few (of many) issues were going to overwhelm me that day when I began an orientation shift with someone I had yet to work with. For the purposes of this story, we will call this person Janet (not her real name).

I had seen Janet around a few times and said hello to her. She seemed nice, and I had been told that she had worked at the hospital "forever" and would be a great person to ask for help if I needed anything. I later found out that she had been working there for over twenty years. Understandably I was eager to make a good impression, and as we began our tasks for the day, I carefully observed how she did things and tried to absorb as much as I could. Even diligently taking notes so I would remember later.

Soon we received our first lab order of the day. Janet and I entered a patient's room who needed some routine labs drawn. To my surprise, Janet informed me that I was to be the one who drew the patient's blood, and she would be supervising. Admittedly this unexpected news made me even more nervous than I already was. I wished that she had at least told me the plan before we entered the room so I would have been able to prepare myself mentally as this was still a new experience for me. I had been hoping to watch her once or twice to see how she did things before starting to draw blood myself. At least that was how it had worked with the other phlebotomists I had been training with. I figured she must want to see my methods before she influenced me with hers.

Although nervous, I began the procedure. I introduced myself to the patient and gathered the necessary information. I was extra cautious, not wanting to make a mistake; after all, it was the first draw of the day, and I had someone watching me  with whom I had never worked before, and given her experience with the hospital, I believed she was critiquing everything I was doing as part of my training. I also could not forget that the patient was counting on me to do a good job as well. Fortunately, I discovered that the patient had great veins, which gave me confidence that I would be successful.

I assembled my supplies while I chatted with the patient. She was surprisingly very kind and did not mind having her blood drawn which gave me even more confidence. I vividly remember her joking that she had "made some blood just for me." She was the ideal patient. So far, so good. Carefully I inserted my needle and knew right away that I had hit the vein. My left hand reached for my first blood tube, but I quickly noticed that they were not on my tray where I had set them. I was surprised and afraid that I had somehow forgotten to set them out. My eyes went to Janet, who I then realized had the tubes in her hand and was applying the labels.

"You forgot to label these first," said Janet.

I stared at her, surprised and confused. No one else that I had worked with had labeled the tubes before the collection. "Oh... thanks," I said, unsure of what else to say and not wanting to make the patient nervous. Janet handed me the first tube. It was a lavender tube. I held it hesitantly and then set it back down on the tray next to me. "Can you please hand me the light blue tube?"

Janet raised her eyebrows and handed the tube to me. "Why do you want that one first?" she asked.

I popped the tube into the tube holder and inwardly sighed with relief as blood quickly filled the chamber. "It is supposed to be first out of these tubes," I said. I was guessing that she was testing my knowledge and how I would deal with this situation. Unfortunately, I was very wrong.

"Oh, you mean the order-of-draw thing?" Janet said. "I don't think that really matters."

I looked at her again, confused. Maybe she was joking? I looked for signs that I had misheard her or that she was playing a prank on me. Nope, she kept a straight face and seemed very serious, almost irritated. She handed me the green tube next. I set it down on the tray next to the lavender tube. Sweat had broken out on the back of my neck. I glanced at the patient who was listening to the conversation we were having. "Almost done," I said, trying to smile reassuringly at her. "Can I have the red tube instead, please"? I still was not entirely sure what Janet was expecting from me, but I stuck to my training and continued focusing on the job and the patient.

Janet handed the red tube to me silently. I let it fill up and then followed it with the green and lavender tubes. Janet was standing next to me with her arms folded as I finished the draw and inverted all the tubes. "Thank you so much, Ma'am. Your doctor should have your results from these in the next few hours." The patient nodded, her gaze moving from me to Janet and then back.

I bandaged the patient, and then we stepped out of the room. We began to walk back down the hall. My heart was racing. I began doubting myself, and I was terrified that I was in trouble. That was irrational, though, right? It's fine, I told myself, You didn't do anything wrong. I mentally tried to reassure myself that I had done the right thing. I had followed the order of draw that I had learned and had always used. No one had said to do anything different. I felt a little crazy. Had I mixed something up? Was I stuck in a fever dream? It almost felt wrong to be questioning someone who has so many more years of experience than I did.

As soon as we were out of earshot from the nearby nursing station, Janet stopped walking and turned to look at me. Quietly she said, "You don't ever disagree with me in front of a patient ever again. Do what I tell you, and if you have questions, you can ask me in private." Then she turned and continued walking. I followed after her, shaken and embarrassed but mostly confused. My worst fears were coming true at that moment.

I knew what I had done was correct, but Janet either didn't know about the importance behind these practices, or she was choosing not to care. I was not even one week into my new job, and now I was going to have to find a way to address this problem without creating too much of a stir. I had never dealt with an issue as significant as this in any job previously, and I had no idea about how to approach things.

So What is the Solution?

Unfortunately, experiences like this are far too common. Many of us have a Janet in our workplace who is a bit "stuck in their ways" or unwilling to update themselves. These situations are challenging to say the least. On the one hand, we don't want to point fingers at coworkers or embarrass anyone, but on the other hand, we know that speaking up is the right thing to do for the patients whose lives we affect with our decisions.

I can tell you what I tried to do. It ended up working out, though today, I would do things a little differently. After I had a few minutes to think, I first apologized to Janet if it seemed like I was questioning her in front of the patient. I told her that I was just doing what I had been taught. I asked her if I was supposed to follow a different draw order and if we were supposed to label the tubes before the collection? She again said the order of the tubes didn't matter and that she preferred to label the tubes before the draw so that she didn't forget. "This was how she had always done it."

I asked a couple of other coworkers their opinion about what I had seen, and none of them wanted anything to do with it. Many ended up admitting they had similar experiences when working with Janet. As you can imagine, this was very upsetting, and I was not okay with the situation. I took my concerns to the department manager, who said Janet was a good employee and that patients loved her. While I did not doubt that, the order of draw is important and does matter. The manager ended our conversation by saying she said she would talk to Janet and make sure she would begin following it.

Because of my actions, the issue was addressed, and change ended up being enforced. Some people involved did not enjoy having to alter their practices, but ultimately it was much safer for patients, and that is the only reason needed to try to improve things. The negative outcome was that Janet was never a fan of mine after everything settled. It was unfortunate, but I ended up being okay with that. I continued to do my best to always be professional and make sure I was following protocol.

So what is the best way to strategically deal with these situations and hopefully find the best outcome when you have a coworker who is in the wrong, and they have seniority over you? Usually, the first thing to try is a one-on-one conversation with the person involved. Be respectful; start with an apology for any misunderstanding. Let them know you would like to address the issue to ensure you are doing your job correctly. Often a simple conversation is enough to resolve the situation and move forward with mutual respect and understanding.

If the one-on-one conversation does not provide the solution you are looking for, it is time to involve a superior. When bringing the problem to the supervisor/manager, the goal should be to clarify and resolve the situation. It should not be to prove you are correct or to put down a coworker.

Below you will find a list of 10 things to help if you find yourself in a similar circumstance.

1. Make Sure you are Correct---Double-check your information, and have resources prepared to back up your understanding of the issues.
2. What is Your Goal?--- Is this an issue worth bringing up? If it is something small, you may end up looking like a "tattle tale." If it is an issue of patient safety, it should always be brought to light, but carefully do so to avoid sounding like you are just complaining.
3. Time It Right---Make sure you address this situation at a good time and in a private area. Do not address it publicly or when things are busy. If you see an issue that is critical and needs immediate attention, don't hesitate. Speak up and help prevent an accident.
4. Show Respect---Ask for permission to discuss a sensitive topic. This will help get your coworker/supervisor in the right mindset to listen to you. It is not helpful to attack a coworker or a situation. This will put them on the defensive. Come to them with a sincere resolve to address the matter because it is in the best interest of everyone involved. Do not gloat or seem gleeful about the issue. Humility goes a long way in these situations.
5. Language---Use collaborative language, and avoid placing blame on people. Try to make it a problem-solving meeting rather than complaining with no solution in mind.
6. Escalate Cautiously---If this issue is not being resolved by speaking to your coworker directly, then take it to a supervisor. If it is still not being addressed, then you could consider escalating to HR or the person above the supervisor. Be careful when escalating. This will bring actions to attention and also put your reputation at stake. Make sure you have tried other solutions before this and that this escalation is warranted.
7. Admit Mistakes---During this process, you may realize that you are in the wrong. If this ends up happening, be ready to accept it. Graciously apologize, and ask for advice on how to prevent it from happening again. This shows maturity and sincerity.
8. Accept that Nothing May Change---If you bring up an issue with a coworker or supervisor, they may be unwilling to listen or change. Pushing them too much may cause them to "dig in their heels" even more. At this point, you will need to determine if you want to escalate things to the next step or decide if you can live with it and just let it go. Sometimes, you have to be flexible if it means a better working environment for everyone.
9. Change Takes Time---You may not see a change immediately. Trying to change the routines and habits that people have developed over the years is going to cause frustration. Things may get a little worse before they get better. You must hold to the hope that your fellow healthcare workers will choose to do what has been proven as best for the patient in the end.
10. Document---My last bit of advice for any situation like this is to document everything. Document your procedures with your patients, document your disagreements with your coworkers, document the conversations you have, and document any questionable practices you may witness. You never know when the information you have documented can help your cause in making changes and/or defending yourself against blame or false accusations.

Communication is essential in the workplace. People who work together need to accept constructive criticism and be willing to continuously educate themselves in their field. Healthcare is constantly changing, and if people are unwilling to change with it, they put others at risk.

Throughout my career, I have worked with several "Janet's" in one form or another. She represents some of the most significant challenges in a job. It is difficult to take on a "Janet," but it is absolutely the right thing to do. Ultimately it all comes down to what is best for the patient, and that should be more than enough reason to always function at the highest standard of care.

Outpatient Manager

Great article by Shanise. I will be sharing this article with my staff. We all had or have someone like "Janet".

Shanise Keith, 07/12/2021 14:47:03

A very good way to approach a difficult situation. These things do happen and unfortunately it seems to be the "lifers" who often are guilty. This kind of situation needs to be dealt with and not allowed to continue

Shanise Keith, 07/13/2021 09:00:07

CMA(AAMA)/Phlebotomist

I am a lifer. I feel we can always improve. I do not mind if a new person questions my knowledge and or technique. I am a life learner. I take courses at the local college to keep up to date and around the younger generation.

Monica Gardner, 07/13/2021 14:44:33

lifer

Fellow lifer, I can always learn. But when training someone new I like to find out how they like to learn. Whether its standing by when they draw, or instructing before you go into the room. It helps to go over things before you start.

cassie mathieson, 07/13/2021 20:41:23