ASC administrators might notice how difficult it is to fill perioperative nursing jobs. There are competing interests for bachelor’s degree nurses, and perioperative nursing has not been a priority in many schools. One researcher studying this issue has found that this is a problem throughout the surgery center nursing pipeline. Too few new nurses specialize in surgery, which leads to too few nurses who are qualified to climb the management ladder.

“One of the reasons I became interested in this topic was I was seeing within my own facility longer and longer times to fill perioperative staff nurse positions, as well as leader positions,” says Donna Doyle, DNP, RN, CNOR, administrative director for surgery and anesthesia at OhioHealth in Columbus. Doyle has researched surgery nurse training, jobs, and leadership roles and plans to present data at the Association of periOperative Registered Nurses (AORN) Global Surgical Conference & Expo 2018 later this month in New Orleans.

“The first thing impacting the nursing shortage is that many nursing programs no longer have rotations in perioperative nursing,” Doyle says. “So, when nurses graduate, they’re no longer imprinted on working in the perioperative specialty.”

Nursing students rarely complete their education to work in an operating room. But they might be interested if they participated in a surgery suite rotation.

“We think they should put a perioperative rotation in the curriculum for BSN degrees,” Doyle says. “But in reality, they only have so much time, and every specialty believes theirs should be part of that program.”

At the other end of the spectrum, experienced surgery center nurses and nurse leaders are retiring. The average age of perioperative nurses is older than in other specialties. These are the baby boomers, many of whom have been working in surgery centers for 20 years.

“That’s a lot of critical thinking and skill sets walking out the door with them,” Doyle says. “When you talk about the pipeline, and you have all of these folks leaving, and you don’t have a front-end pipeline bringing in those individuals, you have a deficit in that area.”

It’s a domino effect, she says. “If you don’t have a full pipeline, then it can impact your ability to staff your operating room, and it leads to an access issue.”

Access will be a crucial issue in the next decade. It will become a crisis for ASCs if there are not successful succession planning strategies underway.

“Succession planning strategies have to be developed now before the crisis becomes greater and to avert a crisis of phenomenal proportions down the road,” Doyle says. “Perioperative leaders come from the ranks of staff nurses, so it’s imperative that you have a succession plan.”

Doyle suggests ASCs and others use the following strategies to prevent succession problems:

• Develop partnerships with colleges. Doyle approached a professor at a local college, Otterbein University, to develop a perioperative elective so students could rotate within the operating room.

“We’ve had that in place for several years, and it’s been very effective,” Doyle says. “We have hired several individuals from the program.”

The program started with six to eight students, and several were hired after they graduated, she adds.

• Mentor millennials and other new nurses. “Assign a buddy system to help guide them,” Doyle says. “Those mentoring relationships continue long after they finish their orientation.”

New nurses will rely on their mentors to guide them and help them develop. They also benefit from a socialization perspective, Doyle adds.

“Every clinical area has its own culture, and the culture of the operating room is no different,” she notes. “Trying to socialize new nurses into the environment is just as important as teaching them the competencies and skills they need in order to be successful, and this helps to retain them.”

To make the buddy system work, ASCs should pair new nurses with someone who is willing to show them the ropes. The mentor might be someone with at least a few years of experience working in an ASC, Doyle suggests.

• Work to retain millennials and other staff. “Retention is absolutely imperative,” Doyle says. “Millennials want to be involved; they want to contribute, and many times the culture of the operating room is one in which people have a tendency to say, ‘Have you put in your time? You have to pay your dues before you start to contribute.’”

But this won’t work well with new nurses. A better retention strategy is to find out what is important to these new nurses, whether they’re millennials or another generation, she says.

“If you can’t provide what’s important to them, then the likelihood of their finding another place to work is much higher,” Doyle says.

“Perioperative leaders come from the ranks of staff nurses, so it’s imperative that you have a succession plan,” Doyle adds.

• Identify high-performing employees. ASC administrators can find the next leaders among their staff, but only if they know which qualities to identify.

“Look for individuals who have positive attitudes, who are engaged, who are problem-solvers, who communicate and interact well with all team members, including physicians,” Doyle says. “These are the people who, many times, ask to be involved in various committees and initiatives in the department.”

Target these high-performing individuals early and find out if a leadership role would be a good plan and match for them.

“Once you identify your talent, you have to validate whether or not that individual wants to do that,” Doyle says. “You may think this person would be a great manager or team leader, but that may not be what they want to do.”

While there might be employees who perform above average at the skills and tasks of their jobs, they could fall short of leadership potential. One way to screen these individuals is to ask for staff input.

“When people say he or she ‘is a good nurse, but…,’ it might mean the person is a little caustic in approach or may be passive-aggressive,” Doyle says.

Perhaps the potential nurse leader is great, but has a little tardiness issue. It’s up to the administrator to determine if that’s a short-term problem or a long-term trend.

• Help employees develop career growth plans. One of the best ways to do this is to meet with staff members individually to determine what type of career growth they desire and what are their near- and long-term goals, Doyle suggests.

“We develop individual development plans,” she says. “We look at each person’s career growth to identify opportunities for this individual.”

Opportunities might include attending classes or conferences, or becoming a preceptor. Educational sessions could be offered to new employees or students, or some classes might include learning the skills to become a mentor. ASC administrators also must identify opportunities for advancement for these nurses with leadership potential.

“You must do succession planning and development planning with each person,” she says. “You can’t just wait to do it until there is a vacancy and then try to figure out how you’ll fill it.”

Wherever possible, there should be a stair-step progression plan for employees. Career growth planning also helps retain employees.

“When you’re working with employees on individual development, they’re very engaged,” Doyle says. “At our organization, we have year-long classes for new or aspiring leaders.”

The organization has found that when supervisors are engaged with employees in their career planning, the probability of success is much greater, she adds.

• Find out what employees want from the job. Doyle sets up one-on-one, 30-minute meetings with employees to talk about their future development.

“During that meeting, I explain why I’m talking with them, and I give them a little background and straight out ask them where they see themselves,” Doyle says. “Where do you see yourself in a year, five years? Where do you want to be?”

These open-ended conversations have led to Doyle discovering that one nurse, who showed leadership potential, really aspired to be an RN first assistant. She didn’t know how to get started in achieving this goal and was unsure of what it would entail, but Doyle could help her.

“If your organization has tuition reimbursement, then you might encourage some employees to go back to school as part of their development plan,” she says. “So now you are investing, whether it’s sitting and talking with them about their career growth or offering tuition reimbursement.”

Organizations can protect themselves from wasting this kind of benefit by asking employees to sign a form, saying they agree to stay a year after completing the class.

• Provide follow-up. “As a leader, you need to be out there and visible,” Doyle says. “You’re interacting with your staff, and part of that interaction is to just touch base.”

The best practice is to follow up on employees’ individual development plans on a quarterly basis, asking, “How is it going? You said you were going back to school, how is that going? Is there anything else you need from me? How can I help you?” Doyle suggests.

Encouragement goes a long way. It’s important to put this process into perspective. “There is always the reality and what is possible,” Doyle notes. “What I tell managers is to not focus on how it’s always been done, but to look at what are the possibilities and how you can make it work. Sometimes, you just can’t make it work, and you have to consider the business needs of the organization first, but there is a trade-off.”

If one plan won’t work, maybe some other plan that is nearly as desirable will work. When the employee’s desired goals won’t work within an organization, it’s important to be honest and clear about why these won’t work.

“Make sure they know the ‘why’ behind it,” Doyle advises.