Firemen hats, candy, and games can increase productivity
Create positive work environment in outpatient surgery for stress relief; retention
In 1974, the magic number for Hank Aaron was 715 as he broke the home run record held by Babe Ruth. It also was the magic number for the staff at Butler County Surgery Center in Hamilton, OH, when they reached their goal of 715 procedures in one month. Movie tickets and popcorn were distributed to all 65 employees. "It was a simple gesture that showed that the physician owners and I recognized what they did and appreciated it," says Mary Ann Gellenbeck, RN, CNOR, facility administrator of Butler County Surgery Center. (For other ways to show appreciation, see Same-Day Surgery, August 2002, p. 106.)
Showing appreciation is a critical component of being a same-day surgery manager today, say experts interviewed by SDS. The volume of procedures causes stress and increases the likelihood of burnout and staff turnover, they say. Even though 57.72% of the respondents to the SDS 2002 Salary Survey did report an increase in staff, as compared to 52% in 2001’s survey, same-day surgery workloads continue to increase. The survey was mailed in July to 897 subscribers. There were 123 responses, for a response rate of 13.7%.
"The increase in surgical technology has made it possible to move more complicated surgeries to the same-day setting, but it also increases the nurse’s role in discharge education because these surgeries require more education for the patient," says Pat Hickey, RN, BSN, MS, CNOR, director of performance improvement for Palmetto Health Richland in Columbia, SC. This need for more patient education also comes at a time when the emphasis is on quick turnaround, he adds. Same-day surgery nurses find themselves pulled in many directions as they try to balance patients’ needs with the scheduling needs of surgeons and anesthesiologists, he adds.
Increased volume and balancing everyone’s needs requires lots of time. In fact, 92.69% of the survey respondents work more than 40 hours per week, with 14.64% of those respondents reporting more than 56 hours per week. (See chart.)
How do same-day surgery managers handle the problem of staff stress? "I try to create a positive work environment by having fun when we can," Gellenbeck says.
At Brookwood Medical Center in Birmingham, AL, $1 appreciation certificates (called "wow" certificate) for the hospital cafeteria or $10 wow certificates for local stores or restaurants are given to employees for helping other staff members or going above and beyond, says Lorraine J. Butler, RN, MS, CNOR, assistant vice president of surgical services. "We also publish a newsletter each month that lists the names of staff members who received our wow certificates," she adds.
Salary increases alone don’t relieve stress
Although 16.26% of survey respondents reported a salary increase of 7% to 10% in the past year, salary alone is not enough to relieve stress and create a pleasant workplace, Gellenbeck says. (See chart.) "It is important to offer competitive salaries, but people want to work in a place where they feel useful, appreciated, and recognized," she says. "I’ve had nurses take pay cuts to come to work for me." (See Same-Day Surgery, July 2002, p. 85, and p. 87.)
Appreciation of a job well done and a willingness to listen to employees’ concerns and suggestions is more important than salary levels, adds Gellenbeck.
One way to make employees feel valued and respected is to have an open-door policy, suggests Hickey. "Employees need to know they can talk with their manager about anything and they’ll be listened to," he says. Open communication enables employees to talk about problems when they are small instead of letting them fester and grow into big problems, he adds.
"The most important thing a manager can do is to be a good listener," Butler says. Not only do you need to listen, but you also need to be an advocate for your staff, she adds. "I frequently talk to our OR committee, as well as individual surgeons, about issues that staff members discuss, so they can be realistic in their expectations of what staff members can do," she adds.
Hickey also recommends the use of work groups to address issues in the program. "When you give employees a chance to make decisions related to the work, they are more positive," he says. "Involvement in committees also gives employees a better understanding of the issues managers face each day."
With 33.33% of the SDS survey respondents indicating that they are administrators, and 18.7% saying that they are directors or CEOs, with whom can managers talk to relieve stress? "It’s hard for any manager to find appropriate people to whom they can vent their frustrations," Gellenbeck admits. "But all managers need to remember that they never vent to their employees," she adds. Choose someone to whom you report, or network with other people in similar positions in other same-day surgery programs, she suggests.
Networking and attending conferences is an important part of a manager’s stress relief, Gellenbeck emphasizes. Although 66.67% of the survey respondents have worked in health care for 22 or more years, and 58.55% of the respondents have worked in same-day surgery for more than 10 years, there always is something to learn, Gellenbeck says. "Learning new things is exciting and rejuvenating," she says. (See chart.)
Although technology makes life easier, new technology also can cause stress if the employee doesn’t feel comfortable using the equipment, Hickey says. "Make sure you tap into resources from your industry representatives for inservices," he says. "Provide employees with one-on-one demonstrations as well as group instruction, and make sure you train everyone, including part-time employees."
Special challenges for freestanding programs
Training for all situations is especially important for the staff of freestanding surgery centers, Gellenbeck says. A total of 73.17% of survey respondents indicated they were located in a freestanding center. Of these, 26.83% are hospital-affiliated, 8.13% are part of a chain, and 38.21% are independent.
"The staff members of freestanding centers have challenges not faced by hospital-based employees because they are on an island," says Gellenbeck. "If you don’t see the supply you need, there’s no hospital central supply to call. If you have a code, you handle it without backup from [the intensive care unit] or the emergency department." For these reasons, it’s important to prepare staff to respond quickly and competently to different situations, she says.
"All of my nurses are advanced cardiac life support- and pediatric advanced life support-certified, so they do know they can handle a problem with a patient," Gellenbeck says. While the classes for these certifications are serious, she looks for ways to make other inservice education fun. "We all have to have a yearly inservice on fire safety, but no one says you can’t pass out inexpensive fireman hats and Red Hots [candy] at the meeting," says Gellenbeck.
Her facility also incorporates games into inservices. "Of course, The Price is Right is perfect for meetings at which we discuss cost-savings issues," Gellenbeck says. For cost-related meetings, she uses a combination of clinical items, as well as supplies such as ink cartridges, to show that everyone, not just clinical staff, needs to be aware of the cost of supplies. Employees have an opportunity to guess at the cost of each item and employees who get closest to the real price win small prizes, she explains.
Another key to managing stress is proper nutrition, exercise, and a balance in your life, Hickey says. "We nurses are our own worst patients. We take care of everyone else but ourselves," he says.
In addition to walking as a form of exercise and stress relief, Butler suggests that nurses stay in touch with family and friends. "I moved to Alabama to take this job, leaving friends and family back in New York. I make a point of speaking with them by telephone regularly because contact with family and friends keeps you from making work the only thing in your life," she says.
Gellenbeck agrees and adds, "Be sure you make time for family and friends. After all, a friend once told me You can love your work, but it can’t love you back.’"
For more information about creating a positive work environment, contact:
• Pat Hickey, RN, BSN, MS, CNOR, Director of Performance Improvement, Palmetto Health Richland, Five Richland Medical Park, Columbia, SC 29203. Telephone: (803) 434-4012. E-mail: email@example.com.
• Mary Ann Gellenbeck, RN, CNOR, Facility Administrator, Butler County Surgery Center, 3125 Hamilton Mason Road, Hamilton, OH 45011. Telephone: (513) 894-8888, ext. 2125. Fax: (513) 895-1247. E-mail: firstname.lastname@example.org.
• Lorraine J. Butler, RN, MSA, CNOR, Assistant Vice President of Surgical Services, Brookwood Medical Center, 2010 Brookwood Medical Center Drive, Birmingham, AL 35209. Telephone: (205) 877-1122. E-mail: email@example.com.