One of the most frustrating experiences in phlebotomy isn’t missing a difficult vein or dealing with a challenging patient. It’s watching your coworkers—or worse, your supervisors—routinely ignore standards and best practices that you know exist for good reason. It’s being told “that’s just how we do it here” when you know that “how we do it” is outdated, risky, or flat-out wrong.

I hear about this constantly from recent students and new phlebotomists. They end up discouraged, confused, and sometimes angry. “My supervisor said tourniquet time doesn’t matter.” “My coworker draws from the lateral wrist vein all the time and says it’s fine.” “They told me our blood culture procedure is good enough, even though it doesn’t match what we learned in class.”

And then comes the question that breaks my heart a little: “What am I supposed to do? I’m brand new. I can’t tell my manager they’re wrong.”

Here’s what I want you to know: Yes, you can advocate for change. You should advocate for change. And there are strategic, professional ways to do it no matter where you are in your career. It won’t always work, and it won’t always be comfortable, but patient safety is worth the discomfort.

My Own Frustrations

I’ve been exactly where you are. I’ve worked with coworkers who genuinely did not know the order of draw and, when I explained why it mattered, told me they’d been doing it their way for years and nobody ever complained. I learned a coworker stuck the same patient fourteen times before finally asking someone else for help. Fourteen times. Yes, they were aware of the “two stick” rule, but their pride got in the way.

I worked with many people who had the dangerous mindset that “a vein is a vein” and saw no difference between the median cubital and the basilic. They didn’t consider—or didn’t care—about the proximity of nerves and arteries.

I watched a coworker collect blood in the wrong order of draw. When I pulled her aside and explained the correct order, and why it was important, she told me that she remembered someone had mentioned that to her once before, but no one ever explained that it was important, and she didn’t think it was something she needed to worry about.

One day a coworker asked me about straight needles. She’d never learned to use them. I explained the benefits—generally safer, less expensive, more effective for most draws. She looked at me and said, “I think they are kind of stupid.” She told me she would never stop using butterflies, and refused to even try out a straight needle.

I watched someone clean a site for a blood culture collection, and instead of letting the antiseptic dry they wiped it off with gauze. When I told them that protocol stated that the antiseptic must dry and the site can’t be touched again they told me the gauze was sterile, and “it was fine.” I had to explain that bacteria dies during the drying time.

When I brought some of these concerns to my manager, I got a lot of hemming and hawing. “Well, we trust our phlebotomists to choose the best vein for each situation.” Okay, but what if they’re choosing poorly because they don’t have updated information? “It’s really up to each phlebotomist’s preference on equipment.” Even when one choice is objectively safer and more cost-effective?

It was incredibly frustrating. And it taught me some hard lessons about how change happens—and doesn’t happen—in healthcare settings.

Why This Matters More Than Your Comfort Level

Before we talk strategy, let’s be clear about what’s at stake. This isn’t about you being right or proving you know more than your coworkers. This is about patient safety and your professional liability.

When outdated or dangerous practices are the norm at your workplace, patients get hurt. Nerve injuries happen. Contaminated specimens lead to wrong diagnoses and inappropriate treatments. Patients develop hematomas, infections, and complications that could have been prevented.

And when those injuries happen, you can be held personally liable—even if you were just “following orders” or doing what everyone else does. In a lawsuit, the standard of care isn’t “what your facility does.” It’s what the current professional standards say you should do. If you knowingly violated those standards because your workplace told you to, that won’t protect you in court.

Strategic Advocacy at Different Career Stages

The approach you take depends partly on where you are in your career, but the core principle remains the same: patient safety is non-negotiable, and you have both the right and the responsibility to speak up.

For New Graduates and Recent Hires

I know you feel like you have no power. You’re the newbie. You don’t want to come across as a know-it-all. I get it.

But here’s what you have that they might not: current training. You (should have) just learned the most up-to-date standards. That’s valuable, and you can frame it that way.

Try this approach:

• Ask questions rather than making statements. “In my training, we learned that tourniquet time over one minute can affect test results. Is there a reason we do it differently here, or is this something we could update?”
• Position yourself as eager to learn. “I was taught to prioritize the median cubital vein to reduce nerve injury risk. Can you help me understand when you’d choose the basilic instead?”
• Bring documentation. “I came across this CLSI guideline and noticed we might be doing things a little differently. Would it be helpful if I brought this to our supervisor’s attention?”

Choose your battles carefully. Focus on practices that pose clear safety risks—things like excessive tourniquet time, inappropriate vein selection, or contaminated blood culture technique.

Find an ally. Is there anyone else on your team who seems to care about doing things right? A team lead, a quality coordinator, an educator? Build a relationship with that person.

For Mid-Career Professionals

You have more credibility than you think. You’ve proven you’re competent, but you’re not so entrenched that you can’t see when practices need updating.

Use your position strategically:

• Volunteer for quality improvement committees or safety teams
• Offer to do in-services or lunch-and-learns
• Bring data when possible. “I’ve noticed we’ve had several patients with hematomas this month, all from the same site. Could we review our technique as a team?”

Document your concerns—but do it smart. Keep a personal log of safety issues and your attempts to address them. Use a notebook at home or notes on your personal phone, not company email or files. If your facility email is deactivated, you lose access to that documentation.

Build the business case. Figure out what matters to your manager and frame your concerns accordingly. “Using butterfly needles only when appropriate could save us significant money on supplies while also reducing complications.”

For Experienced Phlebotomists and Senior Staff

You have the most influence, and therefore the most responsibility. If you’ve been doing something wrong for years, it’s not too late to change.

Use your credibility:

• “I’ve been doing this for fifteen years, and I’ve seen what happens when we cut corners. We need to update our practices.”
• Mentor newer staff in correct techniques, even if it contradicts what others are teaching them
• Go directly to management with specific, documented concerns and proposed solutions

Be willing to admit what you don’t know. “I didn’t realize the guidelines had changed. I’m glad I know now so I can adjust my practice.” That humility makes you more credible, not less.

Your Most Powerful Tools: Standards and Continuing Education

When you’re trying to advocate for change, your opinion isn’t enough. You need documentation and credibility from two sources: authoritative guidelines and ongoing education.

CLSI Standards

The Clinical and Laboratory Standards Institute (CLSI) publishes the gold standard guidelines for phlebotomy practice. The key documents are PRE02 (Collection of Diagnostic Venous Blood Specimens) and GP42 (Collection of Capillary Blood Specimens).

When you bring concerns to a supervisor, don’t say “I think we should do this differently.” Say “According to CLSI document PRE02, the current standard requires [specific practice]. We’re not currently following that standard, which puts both patients and the facility at risk.”

You can also use case studies and real injury data. “There was a case where a phlebotomist drew from the basilic vein and struck a nerve, resulting in a $537,000 verdict. The attorney successfully argued that the phlebotomist should have used the median cubital vein instead.”

Continuing Education

Staying current through continuing education and maintaining national certification strengthens your position. When you can say “I maintain my national certification, which requires me to stay updated on current standards,” you’re demonstrating you’re actively invested in professional excellence.

National certification (through ASCP, NHA, AMT, or NCCT) requires continuing education because our field evolves. Standards change. New evidence emerges.

If your workplace doesn’t provide continuing education opportunities, seek them out yourself. Subscribe to professional resources like us, the Center for Phlebotomy Education, which provides up-to-date information specifically designed to keep phlebotomists current. Attend conferences. Join professional organizations.

When you complete continuing education, share relevant information with your team. “I just took a course on blood culture contamination prevention. Would anyone be interested in a quick lunch-and-learn?” This positions you as someone committed to team improvement, not just criticism.

Avoiding the “Know-It-All” Trap

There’s a fine line between advocating for patient safety and coming across as arrogant. Here’s how to stay on the right side:

Don’t: “You’re doing that wrong. I learned the right way in school.”
Do: “I was taught a different technique. Could we compare approaches and see which aligns with current standards?”

Don’t: “I can’t believe you’ve been doing it that way for years.”
Do: “Standards have changed over time. It makes sense that what we learned years ago might be different now.”

Don’t: Correct someone in front of a patient or coworkers.
Do: Pull them aside privately later. “Hey, I noticed you did [X] earlier. Can I share what I’ve learned about that?”

The goal is to be assertive without being aggressive, confident without being arrogant. You’re advocating for better patient care with kindness.

When Documentation Becomes Critical

If safety concerns are regularly dismissed, protect yourself. Document in your personal records (not company systems):

• Date, time, and specific concern observed
• Staff members involved (but never patient identifiers—no names, dates of birth, medical record numbers, or even initials due to HIPAA)
• What standard or guideline was violated
• What you did to address it
• The response you received
• Any follow-up that occurred

If something happens to a patient and you’re called to testify, these records can be the difference between “I knew it was wrong and tried to change it” and “I was just doing what everyone else did.”

When It’s Time to Walk Away

Sometimes workplaces are so entrenched in bad practices that no amount of advocacy will change them. Red flags that it might be time to go:

• Your manager dismisses or ridicules safety concerns
• You’re actively discouraged or punished for following best practices
• There’s a pattern of patient injuries related to the practices you’ve raised concerns about
• You’re told to falsify documentation or hide mistakes
• The culture actively resists any kind of change
• You feel you’re being set up to take the fall if something goes wrong

If a serious patient injury occurs and you’re implicated because you participated in substandard practices—even under protest—your career and your wellbeing are at risk. Sometimes the most professional thing you can do is document that you tried to create change, and then find an employer who values patient safety as much as you do.

The Bigger Picture

Advocating for best practices isn’t just about preventing injuries. It’s about professionalism. It’s about the integrity of our field. It’s about elevating phlebotomy from “just a blood draw” to skilled, evidence-based healthcare practice.

Every time you speak up for current standards, you’re contributing to that elevation. Every time you refuse to accept “that’s just how we’ve always done it,” you’re pushing the profession forward. And every time you prioritize patient safety over your own comfort, you’re living up to the responsibility that comes with putting your hands on another human being.

It won’t always work. You won’t always win. But you’ll know you tried, and that matters.

In the End

The patients who sit in your chair are trusting you to do what’s right, not what’s easy. They’re trusting you to follow the standards that exist to protect them, even if your workplace hasn’t caught up yet. They’re trusting you to put their safety above workplace politics and personal comfort.

That trust is sacred. Honor it by speaking up. Use the right tools—CLSI standards, data, strategic communication. Pick your battles wisely. Document your concerns. Find your allies. And if all else fails, find somewhere that shares your values.

You can make a difference. You don’t have to accept practices you know are wrong. And you don’t have to wait until you’ve been in the field for twenty years to have a voice.

Start now. Patient safety can’t wait.

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Have you successfully advocated for practice changes at your workplace? What strategies worked for you? Or are you struggling with this right now and need support? Share your experiences in the comments—we’re all in this together.

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