while trying to provide a good work-life balance for their staff.” Hakal says her ASC hires only people who can be flexible with their schedule. “For the most part, regular hires are required to be able to work the early or late shift with no commit- ment specifying the day of the week the employee is scheduled off,” she says. “We offer paid time off (PTO) accrual on hired full-time employ- ment (FTE), so if an employee is off for low census or light-volume days, they are not penalized with a lower PTO accrual.” If an employee is hired at 32 hours and works 25 hours, the PTO accrual is based on the 32 hour FTE, she explains. “It makes the low census a bit more palatable,” she says. “Employees can make the decision on whether they wish to offset the low census by using PTO time to cover the lost hours.” If an employee is sched- uled to be off on a busy day and there is another day in the week that the employee may be scheduled off for low census, the employee is given the opportunity to swap their day off, she adds.

Part-time/PRN, seasonal hires and traveling nurses. “For significant vol- ume fluctuations, we bring in agency staff,” Butterfield says. “You need to have a contract with a staffing com- pany and when you need additional staff, they send you RNs, scrub techs and medical assistants. You do not have to pay them benefits but they charge $10–$15 more per hour.” Piotrowski says she has had suc- cess using a seasonal staffing plan. “If you have a good employee who is near retirement and is moving south to a warmer climate during winter months, it is absolutely worth considering,” she says. “Maybe they go down to Florida to work during winter and work up north during the summer. That is ben- eficial to your center because you have already invested the money, time and energy to train them. Also, consider

Cross-training. “We cross-train preop and postop nurses,” Butterfield says. “OR nurses are trained to work in endoscopy and all nurses are trained to make preop and postop phone calls. We also cross-train surgical techs to be able to assist in recovery rooms as patient care assistants discharging patients in wheelchairs.” In the business office, the ASC has several positions cross- trained: a scheduler can do insurance verification, an insurance verification person can do patient registration, and a collections person can do physician and allied health credentialing. Piotrowski believes cross-training

It is important to get feedback from the frontline charge nurses when managers are creating the staffing schedule. The more you can get the staff involved, the better.”

— Tina Piotrowski, RN, CASC Metro Health OAM Surgery Center

that your regular employees, typically, go on vacation during the summer.” Canyon Surgery Center employs a good number of PRN staff, Hakal says. “We have been very successful in using PRN staff to fill in the gaps. We offer them competitive hourly wages and eligibility for the annual bonus, and we treat them like part of the Can- yon family by including them in facil- ity-sponsored social events.” If you have an employee who does

not want to do as many hours as they were hired for, managers might want to consider bringing the employee down to a PRN or resource position and not hire for job share to fill the full-time position, Piotrowski adds. “All centers should have a good process in place to evaluate and approve all changes related to FTE status.”

is essential in ASCs. “Larger centers might not have as much cross-training between OR and periop staff, but cer- tainly in the pre- and postop areas the staff should be cross-trained to work all of the periop positions, includ- ing being able to make pre-admission phone calls.”

Hakal says for her ASC, it is key to hire individuals who have a desire or the experience to take on additional project assignments. “We offer the perioperative course to those desir- ing to work in the OR,” she says. “We found it may be more successful with an initial orientation in routine proce- dures with the same physicians to gain basic knowledge of the OR prior to starting the course. We provide paid time at work to take the course with a cap on the number of paid hours.” Her staff is required to sign up for projects outside of patient care to meet the vari- ous regulatory guidelines resulting in nurses taking on other responsibilities, she says.

Maintain an optimum patient-to- nurse ratio. “Our patient-to-nurse ratio varies from 1:1 to 3:1,” Butterfield says. “Depending on the type of anesthe- sia provided and how well the patient is coming out of sedation in the recov- ery room, we may have a 2:1 ratio. If the patient is recovering from minimal sedation or a local procedure, the ratio


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