Title: Manpower selection criteria in Florida clinical laboratories
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Title: Manpower selection criteria in Florida clinical laboratories
Physical Description: vii, 66 leaves : ; 28 cm.
Language: English
Creator: Rodgers, Anne Townsley
Copyright Date: 1984
 Subjects
Subject: Hospitals -- Staff -- Florida   ( lcsh )
Employee selection -- Florida   ( lcsh )
Curriculum and Instruction thesis Ph. D
Dissertations, Academic -- Curriculum and Instruction -- UF
Genre: bibliography   ( marcgt )
non-fiction   ( marcgt )
 Notes
Statement of Responsibility: by Anne Townsley Rodgers.
Thesis: Thesis (Ph. D.)--University of Florida, 1984.
Bibliography: Bibliography: leaves 63-65.
General Note: Typescript.
General Note: Vita.
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Bibliographic ID: UF00099490
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: alephbibnum - 000506245
oclc - 12203720
notis - ACS6562

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MANPOWER SELECTION CRITERIA IN FLORIDA
CLINICAL LABORATORIES








BY

ANNE TOWNSL~EY RODGERS


A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY


UNIVERSITY OF FLORIDA

1984






















Dedicated to

my Grandfather
George W. Jaqua
1896-1983











ACKNOWLEDGEMENTS

I express my thanks to Dr. Margaret Morgan, Dr. James Hensel,

and Dr. Herman Baer, members of my committee, for their encouragement

and support during my doctoral program and for their help and sugges-

tions throughout the writing of this dissertation.

Miss Mary S. Britt and Dr. James Wattenbarger also deserve

special thanks for their participation in the planning of the study

and for their suggestions for the preparation of the final form of

the dissertation.

It is unusual to find a committee chairman who is professor,

mentor and friend but Dr. Maggie Morgan has been all of these and

more to me during the past three years. I feel privileged to have

worked with her and look forward to our continued professional

association.

Special thanks to Jill, Lori and Tracey Rodgers for help in pre-

paring the questionnaires for mailing.

Finally, I express gratitude and love to my family for their

support during the whole process. I dedicate this study to my grand-

father, George W. Jaqua, who was so proud of my accomplishments but

only saw the culmination of the dream in spirit.











TABLE OF CONTENTS

PAGE

ACKNOWLEDGEMENTS iii

ABSTRACT vi

CRAPTER I INTRODUCTION............................. 1

Statement of the Problem................. 2
Review of the Literature................. 3
Current Issues in Clinical Laboratory
Science.. .......................,... 4
Assumptions.... ............ ..,......1
Research Questions............ ...........15
Hypotheses.................... ...........15
Limitations of the Study.................16
Acronyms ................... ..............LS
Definition of Terms......................19
Organization of the Report...............20

CHAPTER II DATA COLLECTION AND ANAL~YSIS.............21

Data Collection Methods..................21
Population and Sample Characteristics.... 23
Analysis of Data..... ....................25

CHAPTER III DATA ANALYSIS RESULTS....................27

Section One: Demographic Data............27
Section Two: Analysis of Results.........35
Section Three: Discussion of Results.....44

CHAPTER IV SUMMARY, CONCLUSIONS AND
RECOMMENDATIONS.......................48

Results of Analysis of Data.......,.....48
Conclusions of the Study.................51
Suggestions for Further Research.........53

APPENDICES

A COVER LETTER.............................56

B FOLLOW-UP LETTER. ................... .....57















C MANPOWER SELECTION CRITERIA
qUESTIONNAIRE ................... .......58

D TABLE 18: MEAN OF IMPORTANCE
ASSIGNED TO CRITERIA...................61

E TABLE 19: MEAN OF RANKS FOR
SELECTION CRITERIA. ................... .62

BIBLIOGRAPHY ................... ................... ......63

BIOGRAPHICAL SKETCH ................... .................. 66










Abstract of Dissertation Presented to the Graduate Council
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy



MANPOWER SELECTION CRITERIA IN FLORIDA
CLINICAL LABORATORIES

By

Anne Townsley Rodgers

April, 1984

Chairman: Margaret K. Morgan, PhD
Major Department: Curriculum and Instruction

This study was intended to show whether manpower selection

criteria in Florida clinical laboratories were different among

hospitals categorized by number of beds, location and respondent

characteristics and whether certain criteria were considered more

important than others in selection of personnel.

A survey questionnaire was sent to 194 administrators of

short-term medical and surgical hospitals in Florida. The initial

mailing and one follow-up resulted in an eighty percent return.

Analysis of data by non-parametric methods showed a relationship

between selection criteria accepted or specified and the licensure

or certification held by personnel responsible for hiring in the

clinical laboratory. No differences were found for hospital bed

size, hospital location or hospital accreditation type. Among all







respondents, the interview, applicant experience and the Bachelor

of Science degree with specialization in medical technology were

considered higher in importance after Florida licensure than other

criteria in selection of personnel. A majority of respondents

indicated use of written guidelines for selection.

Further study is needed to determine affective criteria to be

used in the interview and to determine content of written guidelines

to be used for selection of personnel. The importance of the

interview in the selection process suggests that educators in

medical laboratory education programs should provide curriculum

components that would prepare students for the hiring process used

by employers in clinical laboratories.











CHAPTER I
INTRODUCTION

Surveys made since 1974 of manpower selection practices in medical

laboratories have focused on compensation, fringe benefits and type of

certification of employees. Groups surveyed have been personnel prac-

ticing in clinical laboratory science. The instruments for these

surveys were generally inserted in the pages of magazines and journals

sent to certified medical laboratory personnel or mailed to persons on

the periodical circulation list. Thus researchers have had no guarantee

the survey reached that category of laboratory worker without national

certification. Recently a professional organization for medical labo-

ratory personnel, the American Society for Medical Technology (ASMT),

has focused on the problem of quality assurance, in particular the

assurance of quality personnel. Members of the organization feel that

the profession has little control over hiring practices. Thus the

society has advocated development of quality control measures related

to personnel. Quality control measures for personnel should include

credentials acceptable for initial employment. Personnel currently

employed in hospital laboratories are variously qualified and range

from those holding national credentials and state licensure or state

licensure alone as well as those who were trained on the job and have

no formal credentials. This study was designed to show whether









(a) both personnel who hold national certification and licensed

individuals trained on the job are being hired and (b) whether

employers are satisfied with employees of both groups, as indicated

on a survey made in Florida.

Statement of the Problem

The profession of medical technology is concerned with quality

patient care through assuring that precise and accurate laboratory

tests are performed. The profession, with the Society as advocate,

promotes quality assurance with regard to personnel performing labo-

ratory determinations. However, the literature contains no

information regarding the actual criteria used by employers to

select personnel in the clinical laboratory. We assume that, in the

best interest of patient care, employers are selecting well-trained

personnel as defined by national certifying bodies. Strict criteria

for certification have been developed in the last decade by such

organizations as the American Society of Clinical Pathologists (ASCP)

and the National Certifying Agency for Clinical Laboratory Personnel

(NCA). However, in some states--Florida included--the profession has

worked with state legislatures to develop separate licensure processes.

Certification is awarded by national professional organizations

through their examination and certifying agencies whereas licensure is

a state prerogative. The regulations for licensure may differ con-

siderably from certification requirements especially at higher levels

such as supervisor, director, and medical technologist (MIT). In some

cases licensed personnel do not hold national certification or possess

a degree from an accredited medical technology program or from a college

or university.









The American Society for Medical Technology maintains that those

involved in hiring laboratory personnel need to be educated about

credentials. Assessing manpower selection criteria could provide

information needed for resolving the issue of quality assurance.

Review of Literature

During the last 15 to 20 years many of the same technological

changes that have occurred in medical science have occurred in clinical

laboratory science. The medical technologist of the 1960s suddenly

placed in the laboratories of the 1980s would recognize few of the

procedures and little of the instrumentation that are now part of the

practice of clinical laboratory science. However, many of the tech-

nalogists of the 1960s are still practicing and most have progressed

along with the technological advances. These rapid changes have caused

laboratory professionals to be concerned about several issues that have

an impact on those now practicing or beginning to practice in clinical

laboratory science. The major issues are (a) licensure and certifica-

tion, (b) manpower standards and (c) quality assurance of personnel. In

addition, a new issue, (d) unification of the various professional

societies in the clinical laboratory sciences, has become important in

the last two years.

The literature on clinical laboratory science contains increasing

research in specialty areas such as microbiology, hematology, clinical

chemistry and immunachematology. The increase of research in specialty

areas beginning in 1970 reflects changes in the practice of clinical labo-

ratory science and is an indication of the expanded role of the medical

technologist. Literature relating to professional issues such as those

previously stated is presented in position papers or legislative reports,










but not as formal research. Research in professional issues is

generally in survey form, and data collected have been used to support

recommendations made in the various position papers published by ASMT.

The content of these position papers has generated the research questions

for this study. Personnel selection as such does not appear in the

clinical laboratory science literature but does appear in the litera-

ture of other fields such as management.

Current Issues in Clinical Laboratory Science

Licensure and Certification

Licensure was originally intended to protect the public from in-

competent practitioners (Department of Health, Education and Welfare,

1971). Licensing laws are a right and responsibility of the states to

protect the public, and decisions are made through the state legislative

process (Kelly, 1977). Licensing is designed to specify minimum require-

ments related to personal qualifications such as age, residence and

educational background. According to the 1971 DHEW Report on Licensure

and Related Health Personnel Credentialing, the main objectives are to

control entrance into a particular occupation and to enforce standards

of practice for the licensed professional. Among the methods that may

be used to accomplish these objectives are (a) administration of examina-

tions, (b) establishment of regulations concerning standards of practice

and (c) examination of credentials (DHEW, 1971). The goal of licensure

to assure competent practice is supported by ASCP and ASMT, professional

organizations representing clinical laboratory personnel. The position

of the ASCP is that licensure is a state prerogative which should not be

influenced by the federal government (ASCP, 1978). The position of ASMT,









adopted by the 1977 House of Delegates, is that licensure provides

the only legal mechanism to bar incompetent health professionals from

providing services to the public (ASMT, 1977).

The goals of licensure and its support from clinical laboratory

professional organizations imply a positive effect of licensure on

health care delivery. The literature does not support this assumption

since licensure is seen to be detrimental in several ways. Licensure

limits the numbers of professionals entering practice. It also limits

mobility because of lack of reciprocity among the states (DHEW, 1971;

Weissman, 1979). In addition, current licensure laws are often so

rigid that they deter personnel from assuming increased responsibility

as technological advances occur (Roemer, 1974). As a result of these

problems the 1971 DHEW Report recommended a two-year moratorium on

enactment of new licensure legislation. The moratorium was extended

through 1975 on the basis of a follow-up study by the Public Health

Service (Weissman, 1979). In this period a study on the effect of

licensure on clinical laboratory personnel (White, 1978) showed that

older, more stringent licensure laws increased wages but newer licens-

ing laws showed no effect on raising wages. White could find no

evidence that licensure increased quality. This study generates a

concern that licensure could increase costs but leave quality un-

changed.

Certification is a voluntary process which gives recognition to a

person who has met certain predetermined qualifications set by a non-

governmental agency. Credentialing, in its broadest sense, includes

both licensure and certification. In clinical laboratory science,

certification as a credentialing process has existed since the 1930s.








Licensure is a much later method of credentialing. Currently, three

major bodies grant certification to clinical laboratory personnel:

(a) the American Society of Clinical Pathologists (ASCP), whose

Board of Registry administers the certifying process, (b) the National

Certifying Agency for Clinical Laboratory Personnel (NCA), a certifying

board supported by ASMT, and (c) the American Medical Technologists

(AMT), a professional organization/registry that certifies medical

laboratory personnel. Each of these certifying agencies offers com-

petency examinations which an applicant must pass before being certified

by the agency. Requirements for application to take the examinations

include education and experience (AMT, 1982; ASCP, 1980; NCA, 1980).

Certification is offered for a variety of levels and specialities within

clinical laboratory medicine. Each of the three agencies is independent

of the others and does not accept credentials of the others as a waiver

of examination.

Credentialing is a concern in other allied health professions as

well as clinical laboratory medicine. Increasing numbers of health pro-

fessionals seek recognition through certification. Credentialing

standards have become an issue for the 1980s but many authors, includ-

ing Friedman (1981), feel that the National Commission for H~ealth

Certifying Agencies (NCHCA), chartered in 1977, can help to achieve

cooperation among the various certifying agencies. The NCHCA was

chartered as a voluntary body to develop standards for certifying bodies

and to encourage coordination among competing groups (Friedman, 1981).

Since credentialing procedures are in the public interest the credibility

of the credentials must be restored if they are to be viewed as measures

of competence (Davis, 1978).









The proliferation of credentialing agencies and the lack of

reciprocity of licensure laws have generated confusion in clinical

laboratory science with regard to manpower standards. Involvement

of the federal government in recent years shows the need for some

kind of coherent national policy on clinical laboratory manpower

standards to assure quality in personnel performing laboratory tests.

Enactment of Medicare in 1965 and the Clinical Laboratories Improve-

ment Act of 1967 (CLIA-67) provided personnel standards for labora-

tories engaged in interstate commerce. Dantzler (1977), in an

article regarding licensure in South Carolina, pointed out that in

this case federal authority was fragmented among several agencies and

coordination of regulatory processes was not accomplished. Since

that time, manpower standards have become an important and unresolved

issue in clinical laboratory science.

Manpower Standards

Following CLIA-67, personnel standards were the victims of dupli-

cation and were not standardized throughout the field. In 1976, the

Department of Health and Human Services (DBHS) (formerly Department of

Health, Education and Nelfare, DHEW) published proposed personnel stand-

ards in the Federal Register. No final action was taken on these

proposed regulations up to 1978 because of the possibility of enact-

ment of a new Clinical Laboratories Improvement Act in 1978 (Weissman,

1978). CLIA-78 was not enacted and in 1979 an interagency agreement

between DHHS, the Public Health Service (PHS) and the Health Care

Financing Administration (HCFA) defined responsibility of the PHS in

developing scientific and technical standards (including personnel

standards) for clinical laboratories. In April, 1979, KHS delegated









responsibility to the Centers for Disease Control (CDC) to develop a

draft of a Notice of Proposed Rulemaking (NRPM). This NRPM was

published in the Federal Register on October 12, 1979 (Rice, 1980).

HHS invited comments on the proposed standards for clinical

laboratories. Speaking for clinical laboratory personnel, ASMT

representatives commented that the proposed regulations relied too

heavily on quality control and proficiency testing and did not pro-

vide reasonable personnel standards (ASMT, 1980). ASMT cited a

paper by LaMotte presented in 1976 which reported that the "best"

laboratories (based on lack of CDC deficiencies) had a high per-

centage of qualified technologists on staff. Findings from other

studies suggest that proficiency testing is no substitute for well-

trained personnel (ASMT, 1980). Taking into consideration these

studies and an ASMIT-sponsored management survey designed to determine

the role of medical technologists in management and supervision, ASMT

submitted an alternative proposal for the NRPM of October 12, 1979

(Price, 1980).

Competence of personnel performing laboratory tests is the goal

of the proposed regulations. The CDC proposal and the alternate pro-

posal of ASMT differ in the qualifications of personnel at the director,

supervisor and technologist levels. Two points of view on the issue

of quality personnel were presented in the December 1981 issue of the

American Journal of Medical Technology. In the first article, Lanotte

of the CDC Laboratory Improvement Program Office asserted that laboratory

directors and supervisors are in the best position to determine personnel

competence. He also stated that well-developed competency statements

should be available as a basis for the expectations of the laboratory








director (LaMotte, 1981). In the second article Price wrote that

competence is complex and difficult for a supervisor to assess.

Competence should be assessed by a formal process that takes into

account cognitive, affective and psychomotor skills of the in-

dividual (Price, 1981). According to the Federal Register, these

proposed regulations were withdrawn as a result of the large number

of negative comments until more objective data could be gathered

about need or cost effectiveness (ASCP, 1981).

Unification

Fragmentation of representation for clinical laboratory profes-

sionals among several groups has long been a concern. This fragmenta-

tion is reflected in the variety of credentials offered to clinical

laboratory practitioners. During the last few years the profession

has made an effort toward unification of organizations representing

clinical laboratory practitioners in order to provide a single repre-

sentative voice. A Coordinating Committee for Clinical Laboratory

Technology (CCCLT) was formed with ASMT, AMIT and the International

Society for Clinical Laboratory Technology (ISCLT) as members to dis-

cuss unity of the three organizations. Difficulties arose when this

group tried to reach consensus on certain issues, with the result

that ISCLT dropped out of the discussions. In the early 1980s ANT

and ASMT continued to discuss unity issues (Weissman, 1982).

A "Unification Task Force" composed of representatives from AMT

and ASMT was formed in 1982 to coordinate the unification process on

behalf of the boards of directors of the two organizations. Two

future goals at the time were to begin a joint newsletter and to pro-

vide a new journal serving AMT and ASMT (Grimes, 1982). The newsletter,






10

Current Topics, began publication in January 1983. Unity of the two

organizations is proceeding according to the task force timetable.

The 1983 ASMT House of Delegates voted at the annual meeting in

June (a) to continue unification activities and (b) to accept the

report of the Unification Task Forces and begin drafting by-laws for

the unified organization (ASMT, 1983).

Research in Professional Issues

Literature related to professional issues concerning clinical

laboratory scientists is generally based on surveys. The most com-

prehensive survey related to this study was a Personnel Practices

Survey sponsored by ASMT in 1976. During the last five years, re-

searchers considering manpower have focused on job satisfaction,

promotion potential, management functions, compensation, and student

performance on the job. Specific research regarding manpower selec-

tion criteria does not appear in the medical technology literature.

The 1975 National Personnel Practices Survey was designed to

provide a profile of the medical technology profession. The question-

naire was distributed to approximately 63,000 individuals through an

insert in Cadence magazine. The total response was 4,078, or less

than 7% of those surveyed. Some 83% of the respondents indicated

they were certified by ASCP, 6% by AMIT and 11% by other agencies.

( Other data collected referred to fringe benefits, educational level

and job category. Related to this study were the findings that written

job descriptions were given to only about half of the respondents em-

played in non-governmental hospitals. Written job descriptions

generally include specifications for the qualifications of the in-

dividual (Roach, 1975a; Roach, 1975b). In May, 1976, the Laboratory









Management Consultation Office, Centers for Disease Control, con-

ducted a survey of clinical and public health laboratories to update

data from the previous surveys done in 1971 and 1975 in cooperation

with ASMT. Investigators sent survey questionnaires to a selected

sample of laboratories and obtained a national response rate of 83%.

In this study approximately 65% of the technical personnel in clinical

laboratories were reported to have at least one certification or

registration (Lawton, Dugan & Rossing, 1977).

In 1979, ASMT updated a previous compensation survey done in 1977.

Whereas the 1977 survey was intended to gather information at the

regional level, the 1979 National Compensation Survey was designed to

provide information at the state level. Final survey returns were re-

ceived from 4,854 respondents from a total of 8,000 randomly selected

ASMT members. Significant findings were that compensation had not

kept pace with inflation, salaries varied with job position and large

hospitals paid more than small hospitals (ASMT E&R Division, 1980).

Also in 1979, ASMT sponsored a management survey designed to gather

data about administrative functions of medical technologists. The

respondents totaled approximately 1,300 ASMT members holding the posi-

tion of administrative or chief technologist. The survey results

showed that more than half of the respondents performed all of the

managerial functions in the laboratory. The results of this survey

were used to develop the recommendations of ASMT for alternate per-

sonnel standards in response to CDC's Notice of Proposed Rulemaking

of October, 1979 (Price, 1980). Although these surveys provided many

results of interest to the profession, they cannot be construed as a

true picture of laboratory medicine. The sample selected for each








survey was the membership of ASMT and this does not represent the

total laboratory worker population.

Two recent studies investigated opportunities and attitudes

toward professional growth (King & Robinson, 1980; Russell, 1981).

King and Robinson, investigating staff development practices in New

York State, showed that medical technologists do not have the oppor-

tunity to participate in continuing education. Russell, in a 1981

dissertation, found in a survey of Massachusetts laboratory personnel

that medical technologists have a favorable attitude toward continuing

education. Although attitudes are positive, opportunity within the

work environment may be lacking.

Much attention has been given recently to mobility of laboratory

personnel as reflected in job satisfaction, promotion potential and

job turnover. In three recent studies investigators explored these

important areas (Broski, Manuselis & Noga, 1982; Day & McClure, 1980;

Karni, Studer & Carter, 1982). In a study of job turnover in the

Minneapolis-St. Paul area, Karni, Studer & Carter (1982) found that

although the turnover rate showed a slight decrease, avoidable resigna-

tions showed an increase during the period of the study (1970-1980).

Avoidable resignations included those due to unpleasant working con-

ditions, lack of job satisfaction and moving to a new work experience.

Broski et al. (1982), studying four allied health groups (including

medical technologists), found that medical technologists were less

satisfied than medical dietitians, occupational therapists and physical

therapists. Comments on sources of dissatisfaction from the medical

technologists included limited upward mobility, limited authority

and high stress. Day and McClure (1980) studied promotion potential






13

in medical technology. They found that most technologists believed

they were promoted for reasons other than managerial potential and

that goal-setting behaviors were more likely to lead to promotion.

In addition the respondents expressed a need for management educa-

tion for medical technologists. These studies generate a concern

about the atmosphere of the work environment. Personnel resigning

for avoidable reasons may be a reflection of the initial selection

process.

Research Related to Personnel Selection

The literature of personnel management contains much information

regarding personnel selection. The information is general but may be

applied to personnel selection in clinical laboratories. One common

theme in several papers in personnel journals is the need for a syste-

maatic approach. Malinowski (1981) advocated task analysis in develop-

ing selection criteria. Acuff (1981) expressed a need to develop

specific criteria that can predict an applicant's chance for success

In the position.

Petit and Mullins (1981) listed steps needed for good decisions on

employee selection. First, define expected performance; second, identify

key factors such as skills and motivation; third, collect information

about key factors from candidates; and fourth, evaluate candidates,

using an objective rating scale. The use of references as a criterion

is advocated by some authors but not by others. Witkin (1980) said past

performance is the most important indicator of success. Muchinsky

(1979), in a paper on validity and reliability of references, stated

that evidence suggests that references are not valuable as selection

devices.




14

In conclusion, the literature leaves several questions un-

answered with regard to criteria for selecting personnel for labora-

tories. First, no information is available about specific criteria

used for selection. Second, fragmentation of professional credentialing

does not provide a systematic approach when investigators attempt to

identify a key factor such as certification. Last, researchers have

reported job dissatisfaction among medical technologists but have not

investigated whether the dissatisfaction is directly related to the

selection process.

Assumptions

In developing research questions and hypotheses regarding man-

power selection criteria, this investigator made several assumptions:

Many laboratory supervisors are not familiar with the variety of

credentials available for laboratory personnel. Therefore these

employers will tend to select credentials similar to their own.

2. The type of laboratory found in larger hospitals differs from

that of smaller hospitals. Larger hospitals tend to be more de-

partmentalized than smaller hospitals. The latter may have only

one or two generalist technologists on staff. The same type of

differences will be apparent in hospitals serving rural as opposed

to urban populations. Therefore one assumes that the selection

criteria for small versus large and rural versus urban hospitals

will be different.

3. Laboratories that are approved by the College of American

Pathologists (CAP) would tend to have a better awareness of

American Society of Clinical Pathologist (ASCP) credentials since

these two organizations cooperate with each other. Therefore the

writer assumes that laboratories approved by the CAP tend to

select personnel with ASCP credentials.






15

4. The investigator assumes that most employers use informal guide-

lines as criteria and that these employers will prefer a national

credential over a state credential.

5. The types of degrees and education required by the various cre-

dentialing nd licensing bodies vary. Therefore the writer

assumes that employers will select employees more on the basis of

a national credential than on the type of degree or the amount

of education of the applicant.

Research questions

Based on the above assumptions, this study was designed to answer

the following questions:

1. Do employers select applicants with credentials similar to their

own?

2. Do standards for selection for large hospitals (more than 200

beds) differ from those for small hospitals (fewer than 200 beds)?

3. Do standards for selection for rural and urban hospitals differ?

4. Do laboratories with CAP approval tend to select personnel with

ASCP credentials?

5. Do employers express a preference for a national credential over

a state credential?

6. Do most employers use informal or unwritten criteria rather than

written criteria for selection?

7. Do employers place more value on a national credential than on

the amount of education of the applicant?

Hypotheses

Seven hypotheses to be tested were developed from the previous

research questions. The null hypotheses are as follows:






16

Employers do not select employees according to their own

credentials.

2. Selection standards for large hospitals do not differ from

those of small hospitals.

3. Selection standards for rural hospitals do not differ from those

of urban hospitals.

4. Employers in laboratories with CAP approval do not prefer per-

sonnel with ASCP credentials over personnel without ASCP

credentials.

5. Employers make no distinction between state and national creden-

tials in selecting employees.

6. Employers do not use informal criteria as often as written guide-

lines for employee selection.

7. Employers do not consider national credentials as important as a

college degree in selecting employees.

Limitations of the Study

This study was limited in two ways: the scope of the study itself,

and the limitations inherent in any data collection using the question-

naire method.

The scope of the study limits to some extent generalization of

results. The data were collected in a licensure state (Florida) and

thus results cannot be used to predict, in a general sense, criteria

for employment in non-licensure states. Given the professional concern

with enlightenment of employers about credentials, the results in this

study may predict tendencies in other states. This will be true in

cases where employers tend to select credentials similar to their own.

Florida is unique in another respect: the licensure law is broad and





17

allows for several alternate educational routes for licensure at the

technologist level. The national credentialing agencies (ASCP and

NCA) require a bachelor's degree including formal education in

accredited laboratory education programs or the bachelor's degree plus

experience for certification at the technologist level. Licensure is

also required for employment in non-federal hospital clinical labora-

tories in Florida and for this reason will be given a high priority

as a criterion. Criteria rated second or third will be an indication

of employer preferences in the certification and education categories.

This researcher does not believe that the limitation of generali-

zability negates the results of this study. The intent of the study

was to generate data. Information thus gained will suggest more

questions than it will answer. No specific data have been collected

regarding employment criteria in clinical laboratories that can answer

the concern of the profession regarding quality personnel. The findings

of this study should serve as a basis for further research in the area

and should stimulate discussion within the profession about quality

assurance. This research should also provide information for those

drafting the regulations for new licensure laws.

The second limitation, that of the data-gathering instrument, has

been controlled by the methods and design of the study. Allen (1975)

summarized the results of research on questionnaire design and made the

following points regarding effective questionnaires:

1. A one-page format encourages response.

2. Respondents should be given motivation to respond by a strong

cover letter and the offer of a summary of data.

3. A response rate of 30% to 40% is average for a mailed question-

naire.







18

The instrument used in this study was pretested for clarity

and data analysis. It was a one-page format with closed-response

questions. Respondents were offered a summary of data. The response

rate was 80.1%. Additional aspects of the design and control methods

are discussed in Chapter II.

Acronyms

AABB kmerican Association of Blood Banks

AHA American Hospital Association

AMT American Medical Technologists

ASCP American Society of Clinical Pathologists

ASMT American Society for Medical Technology

BS Bachelor of Science

BSBS Bachelor of Science in biological science

BSCh Bachelor of Science in chemistry

BSLA Bachelor's degree in liberal arts

BSMT Bachelor of Science in Medical technology

CAP College of American Pathologists

CDC Centers for Disease Control

DHEW Department of Health, Education and Welfare

DHHS Department of Health and Human Services

HRS Department of Health and Rehabilitative Services

ISCLT International Society for Clinical Laboratory Technology

JCAH Joint Commission on Accreditation of Hospitals

MLT Medical laboratory technician

MT Medical technologist

NCA National Certifying Agency for Clinical Laboratory
Personnel






19

OJT On-the-job trainee

SPSS Statistical Package for the Social Sciences

Definition of Terms

Medical technologist. Category of laboratory personnel with a

bachelor's degree from an accredited medical laboratory program or

completion of a structured laboratory program plus a bachelor's

degree.

Medical laboratory technician. Category of laboratory personnel

with two years of college plus a structured laboratory training pro-

gram or an associate degree from an accredited medical laboratory

program.

On-the-job trainee. A person who has worked in a clinical labora-

tory under supervision, learning procedures while employed.

Chief technologist. The person in the clinical laboratory re-

sponsible for management functions of the laboratory including hiring

of personnel. Often called the administrative technologist or lab

manager.

Section standards. Credentials, including education, licensure

and certification required for employment in a particular laboratory.

Joint Commission on Accreditation of Hospitals. An accrediting

agency for hospitals including the clinical laboratory.

College of American Pathologists. Accrediting agency for patholo-

gists and clinical laboratories. It has close ties to the ASCP.

American Association of Blood Banks. Certifies independent and

hospital laboratory blood banks.

Phlebotomist. A person trained in venipuncture whose function is

to draw blood samples for laboratory analysis.



















20

Support personnel. Personnel in laboratories such as clerks,

secretaries and glassware washers, who perform tasks supportive to

laboratory analysis.

Organization of the Report

This report consists of four chapters, each covering a specific

aspect of the study. Chapter I has been an introduction, including

background of the study, review of the literature, research problems,

assumptions of the study, limitations of the study, hypotheses and

definition of terms,

Chapter II covers the procedures used in data collection and

analysis and includes a description of the population surveyed and the

instrument used. It includes data analysis rationale and methods.

Chapter III contains a description of the results of the study in both

tabular and narrative form. Chapter IV is a summary of the report and

Includes suggestions for further research generated by the study results.










CHAPTER II
DATA COLLECTION AND ANALYSIS

Data Collection Methods

The research approach for this study was the survey. The

researcher developed a questionnaire to gather data on criteria

used by administrative personnel to select entry-level technologists

for clinical laboratories in Florida. The instrument (Appendix C)

included items designed to provide data to test seven hypotheses and

to gather demographic data, including type of accreditation, staffing,

number of employees and employment potential in the state.

The format used in the one-page questionnaire was the forced-

or closed-choice question. Items for demographic data (questions 3-8)

were based on established clinical laboratory categories. Certifica-

tion criteria used in items nine and ten were chosen on the basis of

national practice using the 1975 Personnel Practices Survey (Roach,

1975a; Roach, 1975b). Educational criteria included all categories

listed by national certifying bodies for clinical laboratory personnel

as equivalent in educational requirements for certification at the

technologist level as well as categories required for licensing at the

technologist level in Florida (AMT, 1982; ASCP, 1980; Florida Depart-

ment of HRS, 1977; NCA, 1980).

The questionnaire was field tested for clarity using ten

Gainesville, Florida, administrative or supervisory technologists who

were involved in the hiring or educating of medical technologists.






22

These persons were asked to complete the questionnaire then were

questioned in person about the content and clarity of the items.

Comments of the respondents resulted in no changes in the basic

criteria or demographic items but in minor changes in the wording

of instructions.

The investigator mailed questionnaires to hospital administra-

tors listed in the American Hospital Association Guide to the Health

Care Field (AHA, 1982). A cover letter (Appendix A) described the

study and requested that the questionnaire be forwarded to the chief

technologist, or the person responsible for hiring in the clinical

laboratory. A postcard was also enclosed to return if the respondent

desired a summary of the data. The packet included a stamped,

addressed return envelope.

Most authors of material regarding survey research recommend

avoiding the use of mailed surveys unless specific methods are used

to assure a good return. This mailing was designed to facilitate a

good return rate and incorporated suggestions from several sources.

Methods recommended for increasing the validity and return rate of a

mailed survey include the following:

Use a strong cover letter stating the purpose of the study,

emphasizing the importance of the data to the respondent

(Berdie & Anderson, 1974).

2. Give assurance of confidentiality (Bradburn & Sudman, 1980).

3. Provide internal consistency by asking the same question in

different ways (Allen, 1975).

4. Provide motivation for return by offering a "reward" such as

a summary of data (Allen, 1975).






23

5. Keep questionnaire short; a one-page format is preferred

(Allen, 1975).

These suggestions were incorporated in the methods used for

this survey. The package included a strong cover letter on letter-

head and was prepared on a wordprocessing system. Respondents were

assured confidentiality in the cover letter and on the question-

naire. The questionnaire asked only for the title of the respondent.

The hospital was indicated by a code number on the questionnaire.

Questions nine and ten asked for the same information, a rating by

importance and rank of criteria used for selecting employees. Re-

spondents were offered a summary of the data collected. The question-

naire format was one page; the instrument was composed of items to

be checked.

The investigator sent a letter (Appendix B) approximately four

weeks after the initial letter, enclosing a stamped envelope and a

copy of the questionnaire. She did not send a second follow-up be-

cause of the return rate after the first.

Population and Sample Characteristics

The investigator sent questionnaires to 194 Florida hospitals

selected on the basis of facility and control codes used in the

AHA Gude to the Health Care Field (ARA, 1982). For this study, she

chose only short-term, general medical and surgical hospitals. She

omitted federally controlled hospitals because they are not required

to adhere to state laws with regard to personnel licensure and thus

are not typical Florida hospitals. She omitted hospital categories

other than short-term medical and surgical for two reasons. First, the

facility codes listed for these hospitals varied considerably and some







24

did not have support services that would indicate the presence of

laboratory services. Second, this researcher desired to have as

homogenous a sample as possible without increasing research costs

beyond a reasonable limit.

The size of the hospitals surveyed ranged from 27 to 1101 beds.

Sample characteristics by number of beds and percent is shown in

Table 1.

TABLE 1

Size of Hospitals Surveyed

Range Number Percent of Sample

fewer than 100 beds 51 26

101 200 54 28

201 300 39 20

301 400 23 12

401 500 9 5

more than 500 18 9

Total 194 Total = 100

For the purposes of this study, hospitals with fewer than 200

beds are designated as small, those with more than 200 beds are

designated as large. In the sample surveyed 54% are defined as

small and 46% large.

Short term indicates an average length of stay for patients of

fewer than 30 days (AHA, 1982). Control of the hospitals surveyed

fell into three categories: non-federal governmental, non-governmental

not-for-profit and investor owned (for profit). Table 2 contains a

summary of the control characteristics of the sample.





25

TABLE 2

Control of Hospitals Surveyed

Category Number of Hospitals Percent of Sample

Non-federal governmental 56 29

Non-governmental
not-for-profit 74 38

Investor owned (for profit) 64 33

Total = 194 Total = 100

Analysis of Data

Selecting appropriate statistical tests for analysis of data

from this study required one major decision. Since no previous

studies had been done relating to the population studied, no in-

formation was available about distribution characteristics. Since no

assumption regarding distribution could be made the decision was

to use non-parametric tests of significance (Siegel, 1956).

This study included data about population characteristics such

as number of beds, licensure of respondent, and staffing patterns

which involved categorization. These categories can be classified

only as nominal. According to Siegel (1956), hypotheses based on

assumptions dealing with nominal data may be tested on the basis of

goodness of fit using statistical tests such as the chi-square test

of significance. Certain portions of the data could be categorized

as ordinal. For example, respondents were asked to rank their prefer-

ence for certain categories of selection standards (Question 10) on

the questionnaire (Appendix C). Ordinal data may be tested with a

variety of statistical tests, among them the Mann-Whitney U test

(Siegel, 1956). Certain of the data were related to population charac-

teristics and were analyzed using frequency counts.










26

The data obtained were entered into a Decsystem 20 computer,

using a keyboard. The data were analyzed using the Statistical

Procedures for the Social Sciences system (SPSS) (Nie, Hull, Jenkins,

Steinbrenner & Bent, 1975) Programs used included CROSSTABS,

FREQUENCIES and non-parametric statistical tests (NPAR TESTS). Since

many of the respondents failed to answer one or more of the questions,

the investigator used the SPSS option to delete missing data from

statistical computations.









CHAPTER III
DATA ANALYSIS RESULTS

The purpose of this chapter is to present the results of a

survey of manpower selection criteria from a sample of 194 Florida

hospital laboratories. An initial mailing of the questionnaire

(Appendix C) and one follow-up resulted in 156 replies. Of these,

one questionnaire was returned incomplete without comment, a

second was returned in the form of a letter stating that the respond-

ent refused to complete the questionnaire on the basis of philosophical

concern. This respondent believed that credentialing groups had

"bid up requirements for many positions" and that a "mix of educated,

trained or oriented personnel" was sufficient to accomplish the

functions of a clinical laboratory. A total of 154 completed question-

naires was used in the statistical analysis of the data. The data

and analyses are presented in three sections. The first contains

demographic data not related to the hypotheses. The second contains

results of the analyses of the data related to the hypotheses as

stated in Chapter I. The third section is a discussion of these

analyses.

Section One: Demographic Data

Data regarding characteristics of the surveyed hospitals included

number of beds, location of hospitals, licensure/certification of

respondent, hospital/1aboratory accreditation, numbers of personnel,

staffing pattern, numbers of staff openings and credentials specified

or accepted for employment.












Hospital Size and Location

Hospital size was obtained from the AHA Guideto the Health Care

Field. Respondents were asked to indicate if their hospital served

(a) a rural or (b) an urban population. These results are summarized

in Table 3.

TABLE 3

Size and Location of Responding Hospitals

Size No. Large No. Small No. Rural No. Urban

All hospitals 76 78 46 108

Small hospitals 37 41

Large hospitals 9 67



n 154

Among all hospitals, the large and the small hospitals were evenly

balanced. Eighty percent of rural hospitals were small and 20% were

large. Thirty-eight percent of urban hospitals were small and 62%

were large. A majority (70%) of the respondents indicated their

hospitals were considered urban.

Licensure/Certification of Respondent

The types of licensure and certification held by respondents in-

cluded Florida license (Fla), ASCP, AMT, and NCA. All respondents

held Florida licensure and various combinations of national certifi-

cation. Table 4 contains a summary of the types of licensure/

certification held by respondents.












29

TABLE 4

Licensure/Certification of Respondents

Credential Number Percent

Florida licensure only 41 27

Florida, ASCP 74 48

Florida, AMT 8 5

Florida, NCA 2 1

Florida, ASCP, NCA 12 8

Other 16 10



n 153

missing 1

All medical technologists responding indicated they held Florida

licensure, required for laboratory practice in the state of Florida.

The "other" category included physicians, a personnel director, a

hospital administrator and other combinations of Florida licensure

and national certification.

Hospital Laboratory Accreditation

Hospital accreditation types included Florida State, JCAH, CAP

and AABB. All respondents indicated single or combinations of

accreditation. Table 5 is a summary of hospital laboratory accredita-

tion held by responding hospitals.












Hospital/Laboratory Accreditation

All Hospitals Rural Urban Large


Small


Accreditation

JCAH

Florida State

Fla, CAP, A1ABB

Fla, JCAH,
AABB

Florida,
JCAH

Fla, JCAH,
CAP

Fla, JCAH,
CAP, AABB

Fla, CAP

Other


No. Percent


Percent Percent Percent Percent


10 6


56 36


37 24


7 6 8 5


50 31 22 50


11 30 36 13


n =154


n = 46 n = 108 n 76 n = 78


From Table 5 it can be seen that a large percentage of small, rural

hospitals have single accreditation or a combination of Florida and

JCAH accreditation. A greater percentage of large and urban hospitals

have CAP or AABB accreditation in addition to Florida and JCAH accredi-

tation.

Nulmbers of Personnel

Table 6 contains a summary of the mean numbers of employees in

various positions within a laboratory.







31

TABLE 6

Mean Numbers of Personnel

Personnel Type Rural Urban Small Large

Technologist 10.3 25.9 8.8 34.4

Technician 4.6 8.3 2.9 11.2

Phlebatomist 3.4 8.2 2.5 13.2

Support 2.7 8.2 2.1 9.7

Other 2.3 9.9 1.9 11.6



n 46 n 108

The largest number of technologists reported for a small

hospital was 34 while the largest number for a large hospital was

99. There was also a difference in the largest number (45) of

technicians in large hospitals and small hospitals (16 technicians).

The results of rural and urban hospitals are not as valid because

one hospital that serves a rural population is classified as large

and employs 99 technologists. These results also indicate that

large and urban hospitals use more support personnel such as phlebato-

mists, clerks, glassware washers and others than do rural and small

hospitals.

Staffing Pattern

Staffing patterns of most hospitals are of four basic types:

(a) 24 hour coverage, (b) days, with emergency call at nights and on

weekends, (c) weekdays only, and (d) seven days with emergency call

during nighttime hours. Table 7 contains a summary of the staffing

patterns of the responding hospitals.





32

TABLE 7

Hospital Staffing Patterns

All Hospitals Rural Urban Small Large

Percent Percent Percent Percent Percent

73 46 85 47 100


Days: call,
night &
week-ends

Weekdays

7 days, night
call

Other


Pattern

24 hours


11 5 13


17 3 14

13 3 12


These results indicate that more urban and large hospitals

provide 24-hour coverage in their laboratories than do rural and

small.

Staff Openings

Respondents for 65 hospitals indicated they had openings in one

or more positions, those in 60 indicated no openings and 29 respondents

did not answer the question. Table 8 contains a summary of the numbers

by types and openings in hospitals at the time of the survey.

TABLE 8

Numbers of Positions Open in Hospitals
Indicating Openings

Personnel Type Total Openings Small Large Rural U'rban

No. Mean No. Mean No. Mean No. Mean

Technologists 89 28 1.4 63 1.7 29 1.9 60 1.4

Technicians 20 6 0.3 14 0.4 5 0.3 15 0.3

Phlebotomists 23 0.1 22 0.6 3 0.2 10 0.2

Support 12 3 0.2 9 0.2 4 0.3 8 0.2

Other 4 0 0 4 0.1 3 0.2 1 0.0






33

All rural hospitals indicated at least one technologist opening.

Five urban hospitals indicated no openings. One of each small and

large hospital indicated no openings for either technologists or

technicians. Mean openings for all hospitals in the technologist

and technician categories were similar. Respondents for rural hospi-

tals indicated a slightly higher number of openings for the technologist

category than did those for other types of hospitals.

Credentials Specified or Accepted

Respondents were asked to indicate (a) if they specified creden-

tials, (b) which credentials are specified for employment, and (c)

which credentials are accepted if none are specified. Of the 154

hospital respondents, 129 indicated credentials are specified, five

indicated that credentials are not specified and 20 failed to answer

the question. Three respondents indicated they specify credentials

but failed to complete the second part of the question. Two respond-

ents listed credentials that are accepted but failed to answer the

first part of the question. Both of these respondents used general

terms such as education, certification and licensure and were classified

as "other. "

Credentials specified or accepted included combinations of

licensure, national certification and education. In Table 9 and

succeeding tables, BSMT refers to a Bachelor of Science in medical

technology, BSLA refers to a bachelor's degree in liberal arts, BSCh

refers to a Bachelor of Science in chemistry and BSBS refers to a

Bachelor of Science in biological science. Table 9 and Table 10 con-

tain a summary of the types of credentials specified or accepted by

responding hospitals.








34

More than half of the respondents indicated they require Florida

licensure or a combination of Florida licensure and ASCP certification.

Those first two categories were evenly distributed among all hospitals.

TABLE 9

Credentials Specified or Accepted

All Hospitals _Large Small Rural Urban

Credential Percent Percent Percent Percent Percent

Florida
licensure 38 32 42 44 36

Fla, ASCP 28 28 27 23 30

Fla, ASCP,
NCA, AMT 3 3 3 2.5 3

Fla, BS 8 9 8 13 6

Fla, ASCP, AMT 4 1 6 5 3

BS or BSMT 3 5 2 0 4

ASCP, BS 0 1 0 0 1

Other 11 15 9 10 12

ASCP only 5 6 3 2.5 5



n = 133 n = 68 n 66 n 39 n = 95






35

TABLE 10

Categories of "Other" Credentials

Credential Number

Licensure, certification 4

Licensure, certification,
education 2

Florida, license, education 3

ASCP, AMT, NCA 1

Education, experience 1

Education 1

DHEWa, ASCP 1

All Credentials 1 n 15



aDHEW refers to the proficiency examination given by the Dept. HHS
in the 1970s.

Section Two: Analysis of Results

This section is concerned with analysis of data regarding the

hypotheses stated in Chapter I (See page 15 abtove). For hypotheses

tested with the chi-square test of significance, certain categories

of data were combined in order to reduce the number of cells with

expected frequencies less than five. In case the degree of freedom

[df) is greater than one, less than 25% of the cells should have ex-

pacted frequencies less than five (Siegel, 1956). These categories

included: (a) licensure/certification of respondent, (b) type of

laboratory accreditation, and (c) importance of criteria. Laboratory

accreditation type was reclassified into two categories: (a) CAP

approved and (b) non-CAP approved. Licensure/certification of

respondent was reclassified into three categories: (a) Florida













licensure only, (b) Florida licensure and ASCP certification, and

(c) all other categories. The importance scale for specific criteria

was reclassified as (a) important, and (b) not important. In this

case (a) included "very" and "moderately important" while (b) in-

cluded "slightly important" and "not considered:". The SPSS pro-

gram CROSSTABS (Nie, et al., 1975) was used to calculate chi-square

two-sample analyses (independent samples). Some respondents did not

complete all or part of one or more questions. The investigator

used the SPSS option to eliminate missing data from all statistical

computations.

Hypothesis 1: Employers do not select employees according to

their own credentials. Licensure/certif ication of respondent was

compared with credentials specified or accepted and with importance of

selected criteria in question nine (Appendix C). Means for the impor-

tance of criteria were calculated and are summarized in Table 18,

found in Appendix D.






37

TABLE 11

Licensure/Certification of Respondent
and Criterion Importance

Credential X E n

ASCP 12.77 .0017* 152

NCA 12.41 .0020* 146

AMT 7.07 .0292* 152

Fla. license 1.06 .5883 152

BSMT 4.56 .1020 150

BSLA 1.09 .5793 141

BSBS 1.11 .5747 145

BSCh 0.26 .8788 144

Associate of Arts 2.02 .3630 143

On-the-job trainee 3.74 .1541 145

Experience 0.66 .7186 146

Grade point average 1.91 .3842 144

References 1.06 .5887 151

Interview 2.89 .2356 151



df 2

*E .05

A 3 X 4 chi-square analysis was performed to investigate the

relationship of licensure/certification of respondent with credentials

specified or accepted. The chi-square analysis indicated a signifi-

cant relationship, X2 (6) 25.09, 7 < .05.

A 3 X 4 chi-square analysis was performed to investigate the

relationship of licensure/certification of respondent with importance







38

assigned to criteria used for employment (Table 11). The chi-square

for national credentials (ASCP, NCA, AMT) indicated a significant re-

lationship, E = < .05. Chi-square analysis results for the other

criteria were not significant, E .05.

These findings led the investigator to reject Hypothesis 1.

Certification/1icensure of the respondent made a difference in the

credentials specified or accepted and in the importance of criteria

concerning certification of employees selected.

Hypothesis 2: Selection standards for large hospitals do not

differ from those of small hospitals. Size of hospital (large versus

small) was compared with credentials specified or accepted and with

ranks assigned to selection standards (Question 10, Appendix C).

Means of rankings assigned to selection standards were calculated and

are summarized in Table 19, found in Appendix E.

A 2 X 4 chi-square test of significance performed to investigate

the relationship of hospital size to credentials specified or accepted

indicated no significant relationship, X2 (3) =- 4.57, e .05.

A Mann-Whitney U test was performed to examine the relationship

of hospital size to ranks given to selection standards (Table 12).

The results of the Mann-Whitney test for all standards except BSBS and

BSCh were not significant, e = > .05. The results of the Mann-Whitney

test for the Bachelor of Science in biological science and the BAchelor

of Science in chemistry indicated a significant relationship E .05.

The investigator is led to accept Hypothesis 2. Hospital size

makes no difference in credentials specified or in ranks given to

selection standards.





a84

'E .05

Hypothesis 3: Selection standards for rural hospitals do not

differ from those of urban hospitals. Hospital location (rural and

urban) was compared with credentials specified or accepted and with

ranks assigned to selection standards.

A 2 X 4 chi-square test of significance performed to investigate

the relationship of hospital location with credentials specified or

accepted showed no significant relationship, X2 (3) 3.36, g = > .05.

A Mann-Whitney U test performed to examine the relationship of

hospital location with ranks given to selection standards (Table 13)

showed no significant relationship for all rankings, E = > .05.


39

TABLE 12

Ranks of Selection Standards

Mean Rank 2 E

8.048 -0.2657 .7905

4.512 -0.8326 .4051

4.440 -1.7371 .0824

9.155 -0.0374 .9702

7.964 -1.5772 .1147

4.786 -2.0444 .0409*

4.321 -2.5393 .0111*

3.155 -1.8344 .0666

2.214 -1.3875 .1653

6.440 -1.0751 .2823


Hospital Size and

Selection Standard

ASCP

NCA

AMT

Fla license

BSMT

BSBS

BSCh

Associate of Arts

On-the-job trainee

Experience





40

TABLE 13

SRanks of Selection Standards

Mean Rank z E

8.048 -1.3191 .1871

4.512 -0.5959 .5513

4.440 -0.3826 .7020

9.155 .2126 .2253

7.964 -0.4624 .6438

4.786 -0.8784 .3797

4.321 -1.5570 .1195

3.155 -0.7621 .4460

2.214 -0.4023 .6874

6.440 -0.2914 .7707


Hospital Location and

Selection Standard

ASCP

NCA

AMT

Fla license

BSMT

BSBS

BSCh

Associate of Arts

On-the-job trainee

Experience


The investigator is led to accept Hypothesis 3. Hospital location

makes no difference in credentials specified or accepted and in ranks

assigned to selection standards.

Hypothesis 4: Employers in laboratories with CAP approval do

not prefer personnel with ASCP credentials over personnel without ASCP

credential. Laboratory accreditation type (CAP and non-CAP) was com-

pared with credentials specified or accepted and with the importance

given to selected criteria.

A 2 X 4 chi-square test of significant performed to investigate the

relationship of laboratory accreditation type with credentials specified

or accepted for employment showed no significant relationship, x2 (3) =

4.03, p > o.0



























and Criterion Importance


41

A 2 X 2 chi-square test of significance performed to investigate

the relationship of laboratory accreditation type on the importance

given to selected criteria (Table 14) showed no significant relation-

ship, E .05.

The investigator is led to accept Hypothesis 4. Hospital labora-

tory accreditation type makes no difference in the credentials accepted

for employment.


TABLE 1

Laboratory Accreditation Type


:ion Criterion 42

3.19

2.00

0.07

.cense 0.00

1.51

0.01

0.09

0.95

.ate of Arts 2.22

:-job trainee 0.23

.ence 0.89

point average 0.08

:nces 0.33

riew 0.00


Select

ASCP

NCA

AMT

Fla li

BSMT

BSLA

BSBS

BSCh

As soci

On-the

Experi

Grade

Refere

Interv


.0741

.1572

.7942

.9948

.2188

.9284

.7592

.3308

.1366

.6329

.3465

.7779

.5671

.9895


= .05











Hypothesis 5: Employers make no distinction between state and

national credentials in selecting employees. The importance given to

Florida licensure was compared with the importance given to national

credentials.

A 2 X 2 chi-square test of significance performed to determine

the relationship of the importance given to Florida licensure to the

importance given to national credentials (Table 15) showed no signifi-

cant relationship, E .05.

TABLE 15

Importance of Florida Licensure and National Credentials

Credential X- E

ASCP 0.00 1.0000 n 152

NCA 0.00 1.000 n 145

AMT 0.00 1.0000 n =152



df I

a .05

The investigator is led to accept Hypothesis 5. There is no

difference in the importance given to Florida licensure and national

credentials.

Hypothesis 6: Employers do not use informal criteria as often as

written guidelines for employee selection. A single sample chi-square

test of significance performed to determine if informal criteria were

used as often as written guidelines in selection of personnel (Table 16)

indicated a significant result, X2 (1) = 54.63, e = < .05.










43

TABLE 16

Use of Written Guidelines and Informal Criteria

Value Expected

Written guidelines 117 72.50

Informal criteria 28 72.50

n 145 X2 54.63 df =: 1

E .0000

The investigator is led to reject Hypothesis 6. Written guide-

lines are used more often than informal criteria in selection of

personnel.

Hypothesis 7: Employers do not consider national credentials as

important as a college degree in selecting employees. The importance

of national credentials (ASCP, AMT, NCA) was compared with the impor-

tance of the college degree (BSMT, BSLA, BSBS, BSCh, and Associate of

Arts).

A series of 2 X 2 chi-square tests of significance performed to

determine the relationship between the importance of national creden-

tials and college degree (Table 17). Except for ASCP certification

and the BS in medical technology, the chi-square analysis indicated

no significant relationship, E .05. The chi-square analysis of

the importance given to the ASCP credential and the BS in medical

technology indicated a significant relationship, X2 (1) = 5.97, e =

.05.











Importance of National Credential and College Degree

Credential BSMT BSLA BSB5 BSCh AA

2 2 2 2 2
ASCP X = 5.97 X = .008 x = 0.07 x = 0.89 X = 0.36

E .014* E .7827 E .7876 E .3432 E .5497
2 2 2 2 2
NCA X = 0.00 X =0.04 X = 0.07 X E 2.62 x = 0.34

E 1.0000 = .8364 e .5962 = .1051 E .5616

2 2 2 2 2
AMT X = 006 = 0.26 X =0.28 X =1.23 x =0.00

S= .8074 e .6114 e .3465 E .2688 E -1.00000



df = 1

Ag .05

The investigator is led to accept Hypothesis 7. There is no

difference in the importance of national credentials and college

degree. In the case of the importance of the ASCP credential and the

BS in medical technology, more respondents (127) who rated the ASCP

credential as important also rated the BS in medical technology as

important.

Section Three: Discussion of Results

Analysis of sample demographic data showed that respondents were

equally divided between large and small hospitals. However, 70% of

the respondents indicated they served an urban population. In addition,

small hospitals were evenly divided between urban and rural. More than

80% of the urban hospitals were large. The results may reflect this

primarily urban hospital population.






45

Hospital/1aboratory accreditation varied between large urban and

small rural hospitals. Large urban hospitals were more likely to have

specific laboratory accreditation, such as CAP or AABB, than small

rural hospitals. This reflects the fact that larger hospitals tend to

have more specialized laboratory departments than small hospitals.

Small and rural hospitals use less support personnel than large

or urban hospitals. One can assume that technologists and technicians

still perform some of the functions of support personnel in small

hospitals.

In the past, few hospitals had 24-hour coverage. In this sample,

respondents for a large percentage of hospitals, including small

hospitals, indicated they had staff working throughout a 24-hour period

or at least during daytime hours, seven days a week, with call back

only at night.

At the time of this study unemployment was high in all areas of

the economy and people who held jobs were not likely to resign. This

economic climate is reflected in the small numbers of openings re-

ported. However, there were an average of two openings for medical

technologists in rural hospitals in contrast to an average of 1.5

openings in large and urban hospitals. Means of other positions were

similar in the other categories of openings. Rural hospitals seem to

have more staff turnover among medical technologists.

In the 1975 National Personnel Practices Survey (Roach, 1975a;

Roach, 1975b) investigators reported that only about half of their re-

spondents had been given job descriptions. Job descriptions contain

credential requirements for the position, thus only half of the 1975

respondents had written indication of job credentials.







46

In the Florida hospitals surveyed in this study, 81% of the

respondents indicated they used written guidelines for personnel re-

quirements. This may reflect a much needed increase in systematic

definition of position credential requirements.

Among the respondents, all but five were laboratory managers or

chief technologists. Of those five, two were physicians and three

were hospital administrators. A large majority of the respondents

held one or more national credentials in addition to Florida licensure.

Only 9% held NCA certification, perhaps reflecting the lack of aware-

ness of this relatively new national credential. The licensure/

certification that respondents hold seemed to influence their choices

of credentials specified or accepted and the importance assigned to

the criteria. Although chi-square analysis is in reality only a test

of "goodness of fit," the significance of the results indicated that

variations could not be attributed to chance.

A greater percentage of employers specified credentials other

than Florida license alone. Only 38% indicated Florida license alone

was sufficient for employment. This may indicate that other standards

are more important than the license. References and interviews were

considered to be moderately or very important in selection of employees

(Table 18). Experience was also considered important to the respond-

ents. The lesser importance of the NCA and AMT credential may reflect

the fact that they are less well known that ASCP certification. Refer-

ences and interview are considered most important after Florida

licensure, but ASCP certification and the BSMT degree were more impor-

tant than references when selection standards were ranked (Table 19).









47

In conclusion, there was no difference in the credentials specified

or accepted and the importance of those credentials among the categories

of hospitals (size based on number of beds, location). Ranks of selec-

tion standards among those categories appeared to show no difference.

Laboratory approval type also appeared to have no relationship to the

importance of credentials specified or credentials accepted. No relation-

ship appeared to exist between the importance of licensure, national

credentials and education. A relationship did exist between the respond-

ents' own credentials and the credentials they selected as important.









CtLAPTER IV
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

This study was designed to collect data about manpower selection

criteria used in Florida hospitals for employment of laboratory per-

sonnel. The study was intended to show whether manpower selection

criteria were different among various hospitals categorized by number

of beds and location or respondent characteristics and whether certain

criteria were considered more important than others in selection of

personnel.

Results of Analysis of Data

Analysis of demographic data indicated the following characteris-

tics for hospitals and respondents. Questionnaires were sent to 194

hospitals, of which 54% were small, 46% large. Of the 154 responding

hospitals, 49% were large, 51% small. Among responding hospitals, 30%

were rural, 70% were urban. Small hospitals averaged eight technolo-

gists while large averaged 34. Small hospitals had fewer support

personnel than large hospitals. The data indicated that a significant

number of all hospitals provided 24-hour staffing. All large hospitals

were staffed during each 24-hour period.

The economic climate at the time of this study was reflected inr the

small number of openings for personnel in responding hospitals. Hospi-

tals had an average of one to two positions open at the technologist

level and less than one in other categories.

Accreditation by the Joint Commission on Accreditation of Hospitals

(JCAH) was reported by 82% of all hospitals and College of American

48






49

Pathologists (CAP) accreditation was reported by 50% of all hospitals.

CAP accreditation was more common among large urban hospitals than

small rural hospitals. More than half of the respondents reported

some type of national certification in addition to Florida licensure.

Only 27% of respondents held Florida licensure alone. In addition,

more than 60% of the respondent hospitals specified or desired creden-

tials such as academic degree or certification in addition to Florida

licensure. When importance of credentials was rated, interview,

references, a bachelors degree in medical technology and experience

rated higher than importance of any national credential. When selec-

tion standards were ranked, ASCP certification, a bachelors degree in

medical technology, and experience ranked higher than other national

certification and degree types. In both cases, Florida licensure was

the highest rated or ranked criterion.

Hypothesis 1: Employers do not select employees according to their

own credentials. Analysis of the relationship of licensure/certif ica-

tion of respondents with credentials specified or accepted indicated a

significant relationship, X2 (6) = 25.09, E .05. Analysis of the

relationship of respondent licensure/certification with importance of

criteria indicated a significant result for national credentials,

E .05. The investigator was led to reject Hypothesis 1. Licensure/

certification of respondent made a difference in the credentials specified

or accepted and in the importance given to national credentials.

Hypothesis 2: Selection standards for large hospitals do not

differ from those of small hospitals. Analysis of the significance of

size (number of beds) with credentials specified or accepted showed no

significant relationship, 7 = > .05. Analysis of the relationship of





50

size with ranks given to selected standards showed no significant

relationship, g = > .05. The investigator was led to accept

Hypothesis 2. Selection standards are not different for large and

small hospitals.

Hypothesis 3: Selection standards for rural hospitals do not

differ from those of urban hospitals. Analysis of the relationship

between hospital location and importance given to criteria showed

no significant relationship, e .05. Analysis of the relation-

ship between hospital location and ranks of selection criteria

showed no significant relationship, e = > .05. The investigator was

led to accept Hypothesis 3. There is no difference between rural and

urban hospitals in importance or ranks of selection criteria.

Hypothesis 4: Employers in laboratories with CAP approval

do not prefer personnel with ASCP credentials over personnel without

ASCP credentials. Analysis of the relationship of laboratory approval

type with importance given to criteria and with credentials specified

or accepted showed no significant relationship, E = > .05. The in-

vestigator was led to accept Hypothesis 4. Laboratory approval type

makes no difference in criteria for applicants selected.

Hypothesis 5: Employers make no distinction between state and

national credentials in selecting employees. Analysis of the impor-

tance of Florida licensure compared to national credentials showed

no significant relationship, 7 = > .05. The investigator accepts

Hypothesis 5. Respondents considered Florida licensure of equal value

to national credentials. When all criteria were considered, Florida

licensure rated higher than national credentials. However, individually

respondents tended to give the same importance to Florida licensure as

national credentials.




51

Hypothesis 6: Employers do not use informal criteria as often as

written guidelines for employee selection. A single sample chi-square

test of significance was performed to determine if informal criteria

were used as often as written guidelines in selection of personnel.

The analysis showed a significant result, 1 .05. The investigator

rejects Hypothesis 6. Written guidelines are used more often than

informal criteria in selection of personnel.

Hypothesis 7: Employers do not consider national credentials as

important as a college degree in selecting employees. Analysis of the

relationship of importance of national credentials with college degree

showed no significant difference, E = > .05, except for the ASCP cre-

dential and the bachelor's degree in medical technology. Respondents

who rated ASCP certification as important were more likely to rate the

BSMT as important. The investigator accepts Hypothesis 7. National

credentials and a college degree are of equal importance as a selection

criterion.

Conclusions of the Study

The following major conclusions appear to be valid within the

limitations of the study.

1. Hospitals in Florida are more likely to use written guidelines for

selection of personnel than informal criteria.

2. Selection standards for small and large hospitals do not differ.

3. Selection standards for rural and urban hospitals do not differ.

4. College of American Pathology (CAP) approved hospital laboratories

and non-CAP approved hospital laboratories show no differences in

employee selection criteria.

5. Selection criteria accepted or specified are related to the licensure

or certification held by personnel responsible for hiring in the

laboratory.







52

6. Individually respondents tended to give the same importance to

Florida licensure as to national credentials.

Respondents who rated ASCP certification as important were more

likely to rate the BSMT as important. Employer ratings of im-

portance of other national certification types were not related

to a college degree.

8, Among all respondents, the interview, experience and the BSMT

rated higher in importance after Florida licensure than other

criteria.

9. Among all respondents, ASCP certification and the BSMT were

ranked highest after Florida licensure when selection standards

were ranked.

10. On-the-job trainees were rated lowest in importance and ranked

lowest among selection standards. Employers appear to prefer

more formal training for personnel.

Selection criteria for laboratory personnel appear to be similar

among all hospital categories and respondent characteristics in Florida

hospitals. One cannot assume that rural, urban, small, and large

hospitals are different in their laboratory staffing needs. Nor can

one assume that hospital approval type will have an effect on selec-

tion criteria.

A majority of respondents indicated they used written guidelines

for selection. Informal guidelines are no longer sufficient, a more

formal selection process appears to be in effect in most Florida

hospitals. Laboratory staffing policies are evidently becoming more

objective.






53

Licensure is required by law in Florida and overall this criterion

was ranked and rated highest in importance. Respondents did appear to

desire additional credentials including education for employment. A

large number of respondents specified the BSMT as a requirement for

employment, indicating that formal preparation in a medical laboratory

education program was considered a priority. Employers also tended to

accept or specify credentials similar to their own. This reflects the

investigator's assumption that many employers are not familiar with the

variety of credentials available today. Education of employers about

the credentialing process would appear to be necessary.

The employment interview was ranked high among criteria for selec-

tion. This implies that affective criteria may be important. This

fact should be of concern to educators planning or evaluating medical

laboratory education programs. The curriculum in these programs should

provide a component that teaches employability skills. Educators should

provide instruction in the interview and credentialing process. In

addition, affective criteria necessary for employment should be identi-

fied and affective characteristics developed in students preparing for

careers in medical laboratory science.

Suggestions for Further Research

Results of this study cannot be generalized to a larger population

without collecting data about manpower selection criteria in a

non-licensure state and comparing results from the two samples.

2. An attempt should be made to assess credentials held by those

currently employed in clinical laboratories. The 1977 Survey of

Clinical Laboratories (Lawton, et al., 1977) showed that 65% of

all technical personnel held at least one certification or






54

registration. In this investigation, 73% of the administra-

tive respondents had national certification in addition to

Florida licensure. The question of whether all personnel are so

credentialed should be answered.

3. A follow-up should be done to determine if current job openings

reflect an economic recovery.

A majority of the respondents indicated they used written guide-

lines for selection. Assessment of the contents of these guide-

lines would further validate this study.

5. The employment interview was ranked high among criteria for selec-

tion. This implies that affective criteria may be important.

Assessment of these affective criteria will provide information

about other characteristics perceived as necessary in laboratory

personnel. This would have an implication in educational pro-

grams.

Several other questions are raised by the results of this study.

First, criteria preferred appear to be related to the employers' own

credentials. Are we therefore perpetuating the fragmentation that now

exists in clinical laboratory personnel credentialing? Related to

this is the fact that national credentials were given the same in-

portance in licensure. Do employers feel that a national credential

is more valid? Does this mean that employers favor a single, national,

credential for clinical laboratory personnel?

Second, a majority of the respondents indicated they had written

guidelines for employment. Written guidelines may make selection of

employees more objective but the content of the guidelines will deter-

mine the quality of the personnel hired. What is the specific content
















of guidelines used for selection? Are the guidelines in a form that

is useful? Having guidelines on file does not necessarily mean that

they are in a form that is easily applied to the hiring process.

Last, formal education of some type was given high importance

and high priority in the selection of personnel. A majority of the

respondents rated the Bachelor of Science in medical technology higher

than other types of degrees. This implies that formal education,

specific to the profession, is a desirable credential. Do employers

prefer this degree because it implies a certain level of skill? Is

this fact again reflective of the need for some type of standardization

for clinical laboratory personnel credentialing?

Additional research about clinical laboratory hiring practices

is needed to determine the answers to these questions. It should be

encouraging to those involved in the education of clinical laboratory

personnel that employers recognize the bachelor's degree with a major

in medical technology as an important criterion for selection of per-

sonnel. Less encouraging is the fact that experience was considered

important to these employers. This may imply that possession of formal

medical technology training does not result in that level of skill

which is expected by employers at entry level in clinical laboratories.










APPENDIX A
COVER LETTER

Recent position papers by professionals in medical laboratory
science have emphasized the need for quality personnel. These
authors feel that little is known about actual hiring practices in
the clinical laboratory.

In order to gain information about hiring practices as part of
the work toward a doctorate at the University of Florida, I have de-
veloped a questionnaire to gather data about laboratory manpower
selection criteria in the state of Florida.

I would appreciate your assistance in routing this questionnaire
to the person in your clinical laboratory responsible for interview-
ing and making decisions about applicants for employment in the
clinical laboratory (usually the chief or administrative technologist).
A stamped, addressed envelope is enclosed for return of the question-
naire. The questionnaire should be returned by December 15, 1982.

Although I am a graduate student in the Division of Curriculum
and Instruction at the University of Florida, I am teaching in the
Department of Medical Technology at Southeastern Massachusetts Univer-
sity to support myself in this final year of my doctoral studies.
Should you have questions about the study or about my credentials,
please feel free to contact me at the college or my major advisor at
the University of Florida. The telephone numbers and addresses are
given below.

If you would like to receive a summary of the data collected,
please fill out the appropriate place on the enclosed postcard and
return it to me.

I appreciate your help and assistance in routing the question-
naire to the appropriate person. The data will be of use in assessing
manpower needs and may have an impact on the status of credentialing
of laboratory personnel in Florida.

Sincerely yours,
Major advisor:
Margaret K. Morgan PhD
Director, Center for Allied Anne T. Rodgers MT (ASCP)
Health Instructional (617) 999-8584
Personnel (617) 997-5141
University of Florida
Gainesville, FL 32611
(904) 392-2391










APPENDIX B
FOLLON-UP LETTER

We are completing the data collection phase of the study on
Florida manpower selection criteria in clinical laboratories and have
not yet received a response from your institution. The questionnaire
you received in December was to be routed to the administrative or
chief technologist in your clinical laboratory.

The information received so far shows some interesting trends and we
are anxious to include your data. In addition, the data summary
may support manpower decisions made by your institution. Perhaps you
overlooked the questionnaire or it went astray during the routing
process. We need your data to make this a complete study. Won't
you help us now?

I am enclosing another copy of the questionnaire and a stamped,
addressed return envelope. I would appreciate your routing it to
the appropriate person in the clinical laboratory for completion as
soon as possible.

If you would like a summary of the data, please send your name
and address to me at the address below or include it with the question-
naire.

Should you have questions about the study, please feel free to
contact me or my major advisor, Dr. Margaret Morgan.

Sincerely yours,



Anne T. Rodgers MT (ASCP)
(617) 999-8584 (Bus.)
(617) 997-5141 (Home)
765 Tucker Road. #1
No. Dartmouth, Mass. 02747

Major advisor:
Margaret K. Morgan, PhD.
Director, Center for Allied
Health Instructional Personnel
University of Florida
Gainsville, FL 32611
(904) 392-2391










APPENDIX C
MANPOWER SELECTION CRITERIA QUESTIONNAIRE

1. Title of person completing questionnaire

2. Type of licensure or certification held by person completing
questionnaire

3. Hospital location: In terms of the population served is your
hospital Rural? Urban?

4. Clinical laboratory accreditation or approval: Please check
JCAH State of Florida CAP
Other (please specify)

5. Number of employees in laboratory
Technologist Support (aides, etc.)
Technician Other (please specify)
Phlebotomist

6. Does your laboratory have budgeted positions that are not filled?
If yes, please indicate how many in each category:
Technologist P hlebotomist
Technician Support

7. How is your laboratory staffed?
(please check items that apply)
24-hour

Days, with emergency call-back on nights and weekends
Weekdays only
Weekdays, weekend days with emergency call-back at other times
Other (please specify)

8. Do you have written guidelines for employing persons?
Yes No

If yes, do you specify credentials? Yes No
If yes, please specify credentials
If no, what credentials do you accept?








59

MANPOWER SELECTION CRITERIA QUESTIONNAIRE

9. In terms of practice in the field, please indicate the importance
of each item listed as a criterion in employment of an individual,

very moderately slightly not
important important important considered

Technologist Level
(Certification)
ASCP

NCA (CLS)
A1MT (American Medical
Technologists)
Florida license

Other (please specify)
(Education)
Bachelor of Science in
medical technology
Bachelor of Science in
liberal arts
Bachelor of Science in
biological science
Bachelor of Science in
chemistry
Associate of Arts

On-the-job trainee

Experience
(Other)
Grade point average
Interview

Other (please specify)













MANPOWER SELECTION CRITERIA QUESTIONNAIRE

10. In terms of practice in the field, please assign the following
criteria in order of priority in employment of an individual
as an entry level technologist. (1 though 10)


ASCP Certification
NCA Certification
AMT Certification
Florida license

BS in medical technology
BS in liberal arts


BS in biological science
BS in chemistry
Associate of Arts (AA)
On-the-job training

__Experience
Grade point average


Please note below any employment criteria not listed above which you
consider essential to the process:






Responses will be held in confidence. If you would like to have a
summary of the data, please write your name and address on a separate
sheet of paper and enclose it with the questionnaire in the envelope
provided. THANK YOU FOR YOUR HELP.

Please return this questionnaire to
Anne T. Rodgers MT (ASCP)
765 Tucker Road, Apt. 1
North Dartmouth, MA 02747










APPENDIX D

TABLE 18

Mean of Importance Assigned to Criteria

Criterion Small Large Rural Urban

ASCP 3.17 3.41 3.16 3.34

NCA 2.06 2.37 1.98 2.32

AMT 2.37 2.17 2.18 2.32

Fla license 3.95 3.96 3.98 3.94

BSMT 3.32 3.72 3.39 3.57

BSLA 1.70 2.02 1.46 2.01

BSBS 2.42 2.86 2.32 2.77

BSCh 2.39 2.76 2.31 2.69

Associate of Arts 1.96 2.29 2,00 2.19

OJT* 1.70 1.72 1.73 1.72

Experience 3.58 3.56 3.55 3.59

Grade point average 2.19 1.96 2.30 1.98

References 3.61 3.39 3.67 3.43

Interview 3.90 3.81 3.83 3.87



*0JT = On-the-job trainee

4 = very important

3 = moderately important

2 slightly important

1 = not considered











APPENDIX E

TABLE 19

Mean of Ranks for Selection Standard

Standard Small Large Rural Urban

ASCP 8.15 8.26 8.00 8.30

NCA 4.75 4.46 4.36 4.70

AMT 5. 4.02 4.77 4.47

Fla license 9.32 9.12 9.57 9.05

BSMT 7.92 8.19 8.12 8.04

BSBS 4.44 5.33 4.66 5.03

BSCh 4.00 4.80 3.97 4.63

Associate of Arts 2.81 3.44 3.57 2.95

On-the-job trainee 2.77 2.22 2.28 2.57

Experience 6.98 6.26 6.91 6.49



High rank 10

Low rank 1










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BIOGRAPHICAL SKETCH

Anne Townsley Rodgers was born in Worcester, Massachusetts, and

educated in the Winchester, Indiana, public schools. She was gradu-

ated from Northfield-Mount Herman School in East Northfield,

Massachusetts, and received a Bachelor of Arts degree in bacteriology

from Ohio Wesleyan University, Delaware, Ohio. Her medical technology

clinical internship was completed at the Washington Hospital Center

in Washington, D.C. She subsequently became certified as a medical

technologist by the Board of Registry of the American Society of

Clinical Pathologists. After four years of laboratory practice, she

began work on a Master of Arts in Teaching degree at the University

of Massachusetts in Amherst and was awarded the MAT in 1971. Her

najor was public health and education. Prior to beginning doctoral

studies at the University of Florida, she was educational coordinator

of the Burbank Hospital School of Medical Technology in Fitchburg,

Massachusetts. Presently, Ms. Rodgers is assistant professor of

medical technology at Southeastern Massachusetts University in North

Dartmouth, Massachusetts.







I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is fully
adequate, in scope and quality, as a dissertation for the degree of
Doctor of Philosophy.



MrgaretlK. Morgan, Chairman
Professor of Instructional Leadership
and Support

I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is fully
adequate, in scope and quality, as a dissertation for the degree of
Doctor of Philosophy.



James W. Hensel
Professor of Instructional Leadership
and Support

Certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is fully
adequate, in scope and quality, as a dissertation for the degree of
Doctor of Philosophy. i,?



Herman Raer
Professor of Pathology

This dissertation was submitted to the Graduate Faculty of the Division
of Curriculum and Instruction in the College of Education and to the
Graduate Council, and was accepted as partial fulfillment of the require-
ments for the degree of Doctor of Philosophy.


April, 1984
Dean for Graduate Studies and
Research












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