FEATURE Wanted
ASCs face a nursing shortage and difficulty filling leadership positions. BY SAHELY MUKERJI
W
ith more than 50 percent of the US nursing work force close to retire-
ment and the median age of nurses at 46, the current nursing shortage will not stop anytime soon, warns the American Nurs- es Association web site. The shortage will spread across the country between 2009 and 2020 with the most intense impact felt in the South and the West, concludes a state-by-state analysis, “United States Registered Nurse Workforce Report Card and Shortage Forecast.” The analysis was published in the January 2012 issue of the American Journal of Medical Quality. Consequently, ASCs have been feeling the crunch and facing particular challeng- es filling nursing leadership positions. “We are already facing a shortage of
experienced perioperative nurses who can circulate, let alone manage or charge,” says Fawn Esser Lipp, RN, perioperative man- ager and infection prevention coordinator at The Surgery Center LLC in Franklin, Wisconsin. “We have a lot of nurses who are graduating, but we need nurses with experience. In ASCs, we run everything tight and that is how we keep our expenses down and still provide high quality care. We have to have nurses with experience.”
18 ASC FOCUS JULY 2013
The Problem It is a gamble to hire nurses straight out of school, Lipp says “because operating room (OR) nursing is so different than any other nursing. The nurses don’t get OR training in nursing schools, and it is so different when you are actually in the field than in the nursing school.” As a consequence, “it is hard to find periop- erative nurses, let alone mentor them to a leadership position. We’re already seeing a shortage and it’ll probably be harder in three years.” This was not always the case, says Barbara Draves, RN, CASC, adminis- trator of The Surgery Center in Cleve- land, Ohio. When she was in nursing school, she adds, nursing students spent six weeks in surgery, getting a chance to have hands-on clinical experience. “From what I understand, they are not getting a surgery rotation in nursing schools anymore,” she says. “Before, they had more opportunities to get hands-on training. The change in the curriculum has occurred over the years. These days, nursing schools are focused on a well-rounded curriculum that gives you a little bit of everything, so if you
go into a specialty, you will need more training in that area. The schools have to focus on all the basic clinical areas to en- able you to obtain your degree but not on any one specialty.” As a consequence, you can’t just get out of nursing school and start working in an OR, Draves says. “You need train- ing at the facility. It is easier to hire a nurse for the post-anesthesia care unit (PACU) than for the OR.” So Draves’ ASC promotes from within, “from the people who have been here, have proved themselves to be in the upper 10 percent and have leadership quality,” she says. “You can hire the most competent on- paper person, those with a strong back- ground in nursing theory, and they don’t work out when it comes to actual clinical performance in the ASC setting.” Therefore, it is best to hire and train people at your ASC to take a lead posi- tion, Draves says. “You can teach skills to a nice person but you cannot teach a skilled person to be nice. So, we hire nice people—people with passion, personal- ity and perseverance—who have their basic nursing skill, and train them. Each surgery center has its own set of skills that they need in their staff.” It’s a big ef- fort to train, however, she says. “As you get busier, you cannot stop and train.” Lipp agrees with Draves. “Periopera-
tive nursing leadership is facing a crisis because of a lack of mentors. So we are seeing fewer OR managers,” she says. “I think it’s because of the position that the perioperative manager is in. There is so much change in health care, and they are trying to needle through so many chang- es, mandates and cutbacks. So they are constantly focusing on staying on top of that, cutting through red tape, and they don’t have as much energy to put to their staff. If they had time to mentor they’d have time to find the nurses who they think have potential and are up for the challenge, and mentor them to a leader- ship position.” ASCs have to deal with continuing education cuts as well, Lipp points out,
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