FEATURE
which adds on to the hindrances of men- toring for a position. The new health care reform act also is not making things any easier. “There is so much paperwork that there is no time to support the staff and be a patient advocate,” Lipp adds. “There are a lot of meetings and trial and error with the new health care reform act and it is dif- ficult time management. I am spending time learning those instead of finding someone, mentoring them and promot- ing them up.” Dianne Appleby, executive director of Menomonee Falls Ambulatory Sur- gery Center in Menomonee Falls, Wis- consin and an ASCA board member, agrees with Lipp. “The whole direction that health care is going is to do more with less,” Appleby says. “The econom- ics of health care is changing, and as a result, the hospitals are probably going to be affected with a worse OR nursing leadership crisis than ASCs.” Compared to ASCs, hospitals have
bigger budgets and a larger span of con- trol. “Anybody who is working in a hos- pital is doing more with less,” Appleby says. “The economy is one reason. They are stretched to the max. The people who are entering the hospital are very, very sick. And the sickest people who are going in there are not covered by insur- ance. That is putting extra pressure on the hospital, and they are having to cover it with fewer support staff. It is a much more difficult setting than it used to be. It is driving more and more nurses to the outpatient setting. Bedside nursing is not necessarily the only option any more. It is those positions that are going to be most difficult to fill.”
It is not just hospitals. Even in ASCs,
it is getting harder to get OR nurses, Appleby says. “There’s a smaller pool of people out there to pull from,” she says. “And I don’t hire if they don’t have expe- rience. OR nurse positions take longer to fill than PACU or other nurses.” The Employment Projections 2010– 2020 from the Bureau of Labor Statis-
tics, published in February 2012, sup- ports Appleby’s point. The report shows the RN workforce to be the top occu- pation in terms of job growth through 2020. It is expected that the number of employed nurses will grow 26 percent, from 2.74 million in 2010 to 3.45 million in 2020. The projections also explain the need for 495,500 replacements, bringing the total number of job openings for RNs to 1.2 million by 2020.
Other than the lack of OR training in nursing schools, a lack of mentorship and a more complicated health care system, there is one other reason for the dearth of perioperative nursing leadership, says Bruce Bardall, RN, vice president of clinical services at AmSurg. “There’s a generational shift, a shift in leadership philosophy and personal goals between who is coming out and who is already there,” he says. “Seems to me like the newer generation of nurses are more fo- cused on family and quality of life, on personal needs, and so they are not step- ping up to the plate to lead. When you are in a leadership role, it takes more dedication, longer hours and increased stress. It is a multifaceted role. You may be dealing with financial, regulatory, patient care, physician issues, and any other issues that pop up. This generation is not interested in those kinds of roles.” Bardall has been in the health care
industry for almost 30 years and has been involved with ASCs since 1998. “I remember when I started out in health care, the managers or the unit managers in the hospitals functioned very differ- ently than what we do today,” he says.
“Part of that is increased regulations. An individual can come to work and do nothing but fill out forms and paperwork for 10–12 hours a day and still not be done. Part of that we have brought on ourselves because our society has al- lowed and encouraged litigious actions. We encourage people to make money from our individuals’ mistakes and com- ments. However, nurses just want to take care of people and not deal with paper- work and/or bureaucracy. People go into nursing because they want to take care of people, not process papers.” In ASCs, the administrator and the nurse leaders have to wear so many dif- ferent hats and balance and prioritize so much, that they cannot take direct care of patients, Bardall says.
The Solution The Association of Perioperative Reg- istered Nurses (AORN) has started to address the perioperative nursing short- age issue by working on a perioperative program that hospitals or ASCs can buy, Lipp says. “The online program is for graduate nurses. You have them come in and shadow a real nurse in addition to doing this perioperative nursing 101 online. It is a monetary investment, but I think AORN is working on getting ma- terials to train more OR nurses. We did utilize that one time, but unfortunately, that nurse still found that OR nursing is not for her. But at least AORN is trying to provide us with more options to find perioperative nurses because ASCs don’t have as many resources as hospitals.” AORN also is putting position state- ments out stating that nursing schools need to add perioperative rotation as a clinical part of the program, and spend more than just one day in the OR, Lipp says. “Nursing schools are starting to put the perioperative arena back in,” Bardall says. “They had removed it for a while. Some of the bachelor programs were not focused on it, but that’s all changing now. So, that’s a good thing.”
ASC FOCUS JULY 2013 19
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