Same-Day Surgery Manager

Nurse manager retires, and other quandaries

By Stephen W. Earnhart, MS
Earnhart & Associates
Austin, TX

In this month’s issue, I address some of your most pressing questions, including whether to replace a retiring nurse manager, motivation of long-time staff, use of a urology table for other procedures, whether to have separate staff and physician lounges, use of cell phones, and the most profitable specialty.

Question: The nurse manager of our surgery center is retiring next month after 20 years of great service to our center. We were informed today that the board is not going to replace her but rather have her functions absorbed by the administrator and the business office manager. Can they do that? I always heard that you must have a nurse manager in charge of clinical issues.

Answer: Not only can they, but it sounds like it is a good business decision your board has made. Your nurse manager was hired when you opened 20 years ago and when your administrator was not an RN. With your current RN administrator who was hired seven years ago, it sounds like your current administration can carry her current load and still maintain a credible presence to the clinical staff.

Question: I am finding it increasingly difficult to motivate many of my staff members into being cost- and time-efficient and effective. These are seasoned nurses and have been here for decades. What can I do to fire them up again?

Answer: It sounds like you have tried everything. Call it burnout or whatever you want, but sometimes you just cannot get staff to do what is required of them. It might be best to sit down with them on a one-on-one basis and plan their retirement.

Question: One of our surgeons is pushing us to bring a new urologist into our facility. The cost of the equipment is more than $240,000, and we cannot use the room for any other procedures. The urologist is trying to convince us that the "urology table" can be used for other specialties and it should not be considered just a "uro room." Have you ever heard of a "urology room" being able to be used for other specialties?

Answer: The equipment you are referring to is the split-tail, fixed-imaging operating table. It is for urology use only. While some might have found another use for that table, most of us have not. I believe you are correct in your thoughts that you can only use it for urological procedures.

Question: We are adding an extension to our facility, and the staff wants to separate the surgeon and staff lounges. Administration wants to have only one lounge in the facility. They said it will foster a feeling of closeness between the staff and the surgeons and that is a good idea to keep us all in one room. We think they are just being cheap. What do you think?

Answer: I agree with your administration: Keeping the staff and surgeons in one lounge does promote a greater sense of working together, and it helps to keep communications open.

Question: In one of your columns a few months ago, you said that cell phones should not be allowed in the operating room or the facility. I have young children and a sick mother and I need to be available immediately if they need me.

Answer: I had stated that the best policy is that cell phones stay off during working hours but be used during breaks and meals. You can give the number of the facility to caregivers or your children rather than your cell phone number. Another change you might consider is to leave the number of your workplace in your message should someone call you in an emergency.

Question: What specialty typically makes the most profit in a surgery center? We have a contest going here.

Answer: Based upon my experience: ophthalmology. Did I win?

Feel free to send your questions to me at the e-mail address below. All e-mails are handled as quickly as possible and with 100% anonymity.

(Editor’s note: Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management. Contact Earnhart at 3112 Windsor Road, Suite A-242, Austin, TX 78703. E-mail: Web: