For years, like many hospital laboratories across the country, our organization relied heavily on travelers—individuals hired on short-term contracts to fill staffing gaps—to keep operations afloat. These personnel usually come from a staffing agency and are hired at an increased cost for three to six months. It solved the immediate staffing problem, but it quietly created a larger one: dependency. Travelers filled schedules, but they also drove up labor costs, disrupted team cohesion, and made long-term workforce planning nearly impossible. In rural healthcare, where recruitment is already difficult, and every vacancy carries operational risk, that model is not sustainable.
In our laboratory, we decided to stop treating travelers as the solution and to start addressing the real problem: building a workforce where people want to stay. As of January 2024, our laboratory became traveler-free. That did not happen because the market improved. It happened because we changed our strategy.
The hidden cost of traveler staffing
Traveler contracts are expensive, and over time, they normalize labor spending that would never be accepted as a long-term strategy in any other part of the business. The financial burden was the easiest to see, but the real cost extended well beyond the balance sheet. The operational cost is harder to measure, but often more damaging.
Permanent staff absorbed the burden of repeated onboarding, retraining, and workflow inconsistency. Leadership spent more time filling holes than improving systems. Institutional knowledge walked out the door every time a contract ended, and accountability became harder when turnover was built into the model.
The goal was never to eliminate travelers at all costs. Travelers remain valuable tools for short-term support and strategic bridging during recruitment or onboarding. The problem was allowing temporary staffing to become the permanent strategy.
We solved that problem through three connected pillars:
1. Building the business case that leadership could support
2. Developing workforce pathways that replaced dependency with long-term sustainability
3. Creating a culture where people want to stay
The business case is the people case
Healthcare leaders often ask how to justify workforce investment when budgets are tight. In laboratory medicine, that conversation usually sounds like productivity grids, worked hours, CPT volumes, and the constant need to defend every replacement position. How many FTEs per unit of service? Can the work be absorbed? What happens if we leave the position open? Those are fair questions, but they rarely capture the full cost of instability.
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Before we could change anything, we had to prove the problem. Decisions could not be based on frustration or anecdote; they had to be supported by operational and financial data. We started by documenting traveler spend and labor dependency over time. At our peak traveler utilization, we required approximately 72 FTEs to maintain operations. Today, with stable permanent staffing, we operate closer to 68. That difference is not just headcount. It reflects fewer onboarding disruptions, less retraining, stronger accountability, deeper institutional knowledge, and more time spent improving systems instead of constantly replacing people.
When strong employees leave, the replacement cost is not just recruitment. It is training time, competency validation, lost productivity, overtime burden, and the strain placed on the people who remain. Those costs are often treated as background noise because they are harder to quantify. They should not be. Laboratories are unique because minimum safe staffing does not always align neatly with productivity formulas. Some positions exist because the work must be done, not because a dashboard makes them easy to defend. Sustainable staffing requires patience, leadership discipline, and the willingness to stop solving today’s problem at the expense of tomorrow’s.
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The second pillar was workforce development, and the first step was accepting a hard truth: we were not going to recruit our way out of the problem. There are simply not enough laboratory professionals graduating each year to fill vacancies everywhere. Competing for the same shrinking pool of experienced MLS candidates is not a workforce strategy; it is survival mode.
Workforce development is not about perfection. It is about replacing dependency with sustainability. Instead, we focused on building internal pathways. That meant creating visible opportunities for people to enter, stay, and advance within the laboratory. We supported student clinical rotations, bridge programs, and distance education models while investing in internal development from entry-level roles into technical positions. This was never a high-volume pipeline. In rural healthcare, workforce development is slow by nature, and retention matters more than speed.
Lab assistants advanced into MLT roles. MLTs advanced into MLS positions. Employees who may not have originally seen laboratory medicine as a long-term career were given a clear path forward. Since 2019, 12 employees have entered our internal development pathway. Eight completed their programs, four remain with us today, and two now serve in lead technologist roles. At the leadership level, two travelers ultimately chose permanent supervisor roles instead of continuing to travel, reflecting trust in the team and confidence that building something long-term was worth staying for.
Culture is not soft. It is operational
The third pillar was culture, and this is often where organizations lose credibility because culture gets treated like a motivational poster instead of an operational strategy. Culture problems rarely announce themselves as culture problems. They show up as turnover, call-ins, poor accountability, selective communication, disengagement, and the phrase every leader hears: “That’s just how it’s always been.” Culture problems do not always look like dysfunction. Sometimes they look like normalization.
Traveler staffing had become normal. Vacancy coverage had become reactive. Strong employees carried extra weight because “that’s just how it works.” When high performers become frustrated, when mediocrity becomes protected, and when leadership spends more time managing behavior than improving operations, that is a culture problem. The greatest risk was not that people were unhappy. It was that instability had become acceptable.
The first step is honest observation. Walk the department. Listen more than you talk. Pay attention to where the friction lives and, more importantly, what people have stopped complaining about because they no longer believe it will change. Culture is built by what leadership tolerates. If poor behavior is ignored, that becomes the standard. If accountability is inconsistent, people stop trusting leadership. If expectations depend on who is working that day, culture becomes personality-driven instead of principle-driven.
We were fortunate to already have strong staff and a team that travelers often wanted to return to because they enjoyed working there. The challenge was creating enough consistency that long-term retention became stronger than short-term staffing solutions. We focused first on clarity and accountability. Professionalism, communication, and ownership are not optional personality traits; they are operational expectations.
Supervisors were expected to lead, not simply manage schedules. Leaders were given autonomy over their departments and trusted to solve problems rather than simply execute direction. Leadership also had to be visible before there was a problem. Consistent presence, honest conversations, and calm decision-making build trust far more effectively than occasional recognition programs.
That trust was reflected in our employee engagement data. Scores in leadership support, communication, and departmental trust consistently remained strong, reinforcing that retention was not driven by compensation alone, but stability and confidence in leadership. People do not stay because of pizza parties. They stay where expectations are clear, standards are fair, and leadership is stable.
The long-term strategy for clinical lab staffing
If laboratories want long-term stability, the answer is not finding better travelers or asking permanent staff to absorb one more vacancy. It is building an environment where people want to build their careers. That requires a business case leadership can stand behind, a culture that earns retention, and a workforce pipeline that replaces dependency with sustainability. None of it is fast. All of it is worth it.
