could be 3:1. For pediatric patients, we have a 1:1 ratio.” Follow the American Society of PeriAnesthesia Nursing (ASPAN) standards in the pre- and postop staffing and Association of periOp- erative Registered Nurses (AORN) standards for staffing in the OR, Piotrowski recommends. “Keep in mind that some states have laws that require an RN circulator in every OR or procedure room.” Hakal’s ASC, typically, has a 2:1 patient-to-nurse ratio. “We do not have a step 1 and step 2 post-anesthesia care unit (PACU),” she explains.

Work closely with your schedulers. Flexibility is key to effective staffing, Piotrowski says. “You will have sea- sonal and surgical volume variations but you will always need a core volume and then fill in for variations from day to day and week to week,” she says. “Encour- age your physician office schedulers to send over their surgery scheduling requests in a timely manner so you can correctly project your surgical volume more than a few days out. Also, encour- age the surgery schedulers to commu- nicate with your ASC schedulers when their physicians are going to be releas- ing their block time due to vacation or conferences as well in advance as possi- ble, so you can plan in advance for that decrease in volume.” Having both the ASC scheduler

and the OR manager always looking ahead to see what cases are scheduled two-three weeks out is ideal, she says. “There will be higher number of last- minute add-ons in certain specialties, but if you have your scheduler and OR manager looking out for holes, you should have a tight schedule.”

In Summary

The recipe for success is starting off on the right foot with hiring the ideal candidate, Hakal suggests. “During the interview process, we have a full disclosure about flexibility of staffing

We offer the perioperative course to those desiring to work in the OR. . . . We provide paid time at work to take the course with a cap on the number of paid hours.”

—Elizabeth Hakal, Canyon Surgery Center

and how an ASC is uniquely different than a facility that schedules staff via shift assignments. We do this to make sure that there are no surprises for the new hire. We also have the interviewee meet with the director of nursing, clin- ical charge nurse and the administrator. Hearing how we staff from more than one manager makes more impact.” After hiring, during the orientation

process, the new hires sign the “Guide- lines for Staffing” that outlines the ASC’s staffing guidelines, Hakal says. “At the end of the day, when we have a good match, we have the potential for a long-term employee,” she says. It is important to retain that “good match” after hiring. Staffing and


supply are the highest costs in an ASC, Piotrowski says. “Measure your staffing costs so you can better manage it; recognize that what is not measured cannot be managed. Depending on your center’s specialty, there will be different benchmarks. ASC managers need to keep up on the industry benchmark and the

ASCA Benchmarking

Survey. [For more information, see marking and employeesalaryandbenefitssurvey.] “The only way to effect change is to

really see where you compare within the industry,” Piotrowski concludes.

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