only in preop and the post-anesthesia care unit (PACU) but in the OR circulat- ing position as well. “Everyone is a part of the team,” she says, “and there is no line defining a preop, PACU or OR posi- tion. This ensures everyone is able to fill in some part of each of these roles.” Flexible staffing Colen says her ASC relies heavily on flexible staffing to ensure coverage. “This can be accom- plished by having a limited number of full-time employees and numerous part- time or variable staff positions.” Appleby says Menomonee Falls

Ambulatory Surgery Center is using more per diem staff members than ever before. “Many of them are nurses who are close to retirement or have delayed retirement but still want the option of working when they want to.” If you are interested in cutting back some of the hours of your full-time staff members but are concerned about them resigning, consider revising your defi- nition of a full-time employee, Colen says. “In our ASC, an employee can work 72 hours in a pay period and is considered a full-time employee. They get their holidays, health insurance por- tion and disability, and pro-rated sick and holiday time. It was worth it to me to give those benefits to people who did not work 80 hours because I am sav- ing money on those eight hours. This approach allowed me to flex people down and up and cut some costs. We did not lose talent in the process.” Flexible scheduling Since ASCs

typically do not maintain a consistent schedule, Appleby says it is important to staff accordingly. “We staff for the hours we have physicians and patients present in the facility. Staff leave when their work is completed. Given that many of our staff nurses are nearing retirement, they are not unhappy with shorter days.” To achieve optimum scheduling requires an involved administrator, Thrasher says. “You need to look at the schedule every single day and

We have mandated cross-training between departments as a condition of employment. This permits us to move staff during busy times and cover absences.”

— Dianne (Wallace) Appleby Menomonee Falls Ambulatory Surgery Center

prepare for the next day accordingly. You do not ever want to have staff just sitting around. When the cases are done, the lights go out and every- one heads home. If staff is waiting on a case, this is the time to fulfill other duties, such as checking expired drugs or completing any necessary paperwork. The administrator needs to be involved daily to ensure appro- priate scheduling and that all tasks are completed appropriately.” Colen says it is important for ASCs not to guarantee a set work schedule when hiring employees. “They should be prepared to work short days or 10–12 hour shifts to cover the sched- ule. It is also advisable to bring staff in for 4–6 hour shifts to cover busy times on the schedule or cover breaks and lunches. This enables you to staff with a larger number of employees one day and the minimal needed on slower days. There are a lot of variations on this theme, but the key concept is flex- ible staffing, and staffing to census.”

Engaged Managers

Management should be prepared— and willing—to fill a staff role if necessary, Appleby says. “We do not

have department managers that just stay in their offices. They divide their time between their administrative responsibilities and providing clini- cal support. They will move in and take the charge nurse role if we have a staff deficit and the charge nurse will move into the staff role. Our managers are always out and helping during busy times.”

When management is involved in this manner, it builds a stronger team, Thrasher says. “Having an admin- istrator and clinical director that is involved and a part of the staffing as well truly makes them a part of the team and not external to the team. It is important not to just be a driver of the team. When you are a part of the team, it builds trust, and staff know that if there is a crunch in the staffing, you can participate and contribute.” While there are many different

ways ASCs can achieve full cover- age, any changes made to scheduling staff must not alter an ASC’s standards, Colen says. “ASCs must always staff in a manner that assures the delivery of safe, efficient, effective and quality patient care.”


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