EXECUTIVE SUMMARY

When surgery centers hire new staff, administrators should take time to provide a thorough orientation. Rushing through the onboarding process can lead to major headaches.

• Follow accreditation standards for orientation and training.

• Identify the best employees who could serve as mentors or preceptors for new staff.

• Make at least some of the training job-specific.


Too often, surgery centers hire new staff hurriedly, trying to keep the fast-paced workflow moving without interruption. This is a mistake, according to Ann Geier, MS, RN, CNOR, CASC, chief nursing officer at Surgical Information Systems (SIS) of Alpharetta, GA.

“When they do hire people, they need them right away, so they cut corners,” Geier says. “To me, that’s a big issue because when people get hired, their orientation is very sketchy, and it doesn’t meet the criteria for orientation. It’s a mess.”

Geier often speaks with ASC staff, asking, “How many of you received a thorough orientation?” Usually, no one answers affirmatively. “Nobody got a thorough orientation, and they find themselves in a job they can’t handle, and they’re scrounging for help,” Geier says.

Couple this deficit with the fact that managers often do not hire “smart,” and there can be major problems down the road.

“You have an opening and you’re nervous about not having anyone to fill that role,” she says. “Your staff is stressed out, and you feel like anybody can do this job, so you hire anybody.”

A better solution is to buy some time by hiring a temporary worker from a staffing agency. Then, find the right person and take time to train the right person. This means ASCs should vet new prospective employees thoroughly, including making sure they’ll fit in with the ASC’s culture and conducting background checks, Geier recommends.

“One surgery center in California had been looking for a director for a year, and they finally found somebody with great references,” Geier recalls. “I offered to help them out and found that the person had embezzled in a previous life, but the charges were dropped because she repaid the money.”

This is an extreme example of how inadequate vetting could go awry. Here are Geier’s suggestions for how ASCs can improve their new staff onboarding process:

• Prioritize orientation. The Accreditation Association for Ambulatory Health Care (AAAHC) has set a standard of providing staff orientation within 30 days for new employees. ASCs that are accredited by the AAAHC should include that written timeline into their policies, Geier says.

“Often, when I go into centers for an AAAHC survey, they have not even started their orientation checklist, or they haven’t finished it within 30 days,” Geier says.

Besides meeting accrediting rules, holding a timely orientation can positively affect teamwork, new employee buy-in, patient safety, and quality of care. Orientation is more than giving staff the policy and procedure manual to read, accompanied by a tour of the center and one day with a mentor, Geier notes. In fact, it should include several specific tasks and procedures, and ASCs could create an employee orientation checklist to ensure all are adequately met. (See sample items from employee orientation checklist in this issue.)

“Orientation needs to be done right for every employee,” Geier adds.

• Provide job-specific orientation and training. Surgery centers that are owned by a health system might let the HR department handle the orientation. This might not be adequate, as it could be too general and not specific to particular roles.

“I suggest the HR department and ASC work together on training,” Geier says.

HR departments can handle new staff records, but leave some specific training details to the surgery center. Here are some items that should be on every orientation/staff training list:

Infection control plan: Cover infection control plans and policies, sharps injury prevention, medication administration, if applicable, and biohazardous waste management;

Fire safety: Orientation would include identifying fire exits, extinguishers, pull boxes, medical gas shut-off valves, and the location of personal protective equipment;

Evacuation and emergency management plans: Orientation would include showing new staff the building’s access and entry codes, when applicable, and review of the internal disaster plan, bomb threats, emergency preparedness plans, CPR protocols, and violence in the workplace plan.

Here are some job-specific items to include:

- take each job description and design competencies for each task outlined on it;

- review new hire’s job description with new employee;

- provide a job-specific competency test or tests: If an employee will use a glucometer, then one competency would involve demonstrating use of a glucometer.

• Select the best mentors to work with new staff. Sometimes, the best worker can be the worst mentor. It takes knowledge of each employee’s skill set and attitude to select people to mentor new employees.

“You will have some people who love to teach and others who are great at what they do, but don’t give them a new employee, because they don’t like teaching, and they won’t help the newbie,” Geier says.

For example, when Geier oversaw a hospital’s surgical department, the best ortho nurse on staff, the one who was loved by doctors, appeared to be the ideal person to train new staff. “So when I got new employees, I put them with her to train, but she wouldn’t talk to them or help them,” she says. “I think she was threatened, afraid they’d take her job.”

In another hospital, Geier worked with a nurse who talked nonstop and was thought of as a “goofy” employee. But every new employee paired with her would come back and say, “I learned so much from her, and she’s fabulous,” Geier recalls. “Now, she’s an educator for a large health system.”

ASC administrators might look for potential preceptors in employees who both like to teach and are effective in verbal communication. One way for a surgery center administrator to determine who would work best as a preceptor for new employees is to walk the floor, observe staff in action, and watch for these indicators of how they might perform in the role:

- Does the staff member have any bad habits or take shortcuts in work? If so, then the new employee likely would pick up those same bad habits, if that person was the preceptor.

- Who is the go-to person in the office or on the floor? Employees who are eager to help also might be willing to assist with new staff.

Preceptors also need some training, including instruction in how to conduct the following tasks:

- act as a liaison between physicians, staff, and the new employee;

- provide constructive criticism and fair evaluations to the new staff member;

- follow rules, policies, and standards precisely as expected;

- maintain an open-door policy for new employees to contact them with any concerns, ideas, and feedback.

• Follow-up on the orientation. Even after a thorough orientation, new staff training can continue with follow-up. For instance, managers should review the orientation checklist with employees regularly and complete any missing items. At 90 days, evaluate progress with the new employee’s supervisor.