Surgery center leaders must develop specific skills to help them navigate the difficult line between collegiality and staff management.

  • Administrators should seek peer support from leaders and administrators at other organizations.
  • An important skill to learn is to communicate better by sharing less and listening to employees’ needs.
  • Flexibility is an important quality in a leader, but it must be exercised within guiding rules and principles.

One of the biggest mistakes a surgery center administrator can make is to talk too much and share too much.

“When they’re upset with an employee, they share it with another team member, which should not happen,” says Beverly Kirchner, BSN, RN, CNOR, CASC, chief compliance officer at SurgeryDirect in Denver.

It is lonely at the top, but that does not excuse administrators who forget the separation between management and staff. “If you’re having a major issue with an employee, you should have another leader in another department that you can go to and work through it,” Kirchner says.

Administrators should look for support from another leader whom they trust, not from the people they supervise. “The hardest part of being an ambulatory surgery center administrator is that you can like your employees and do all sorts of wonderful things for employees, but you can’t be their friend,” Kirchner says. “There’s a fine line between respecting, working with, and being somebody’s friend.”

Kirchner offers these additional examples of administrative best practices:

  • Follow rules and regulations, not emotions.

“You have to connect with your physician owners and stay focused on rules, regulations, and compliance,” Kirchner says. “As the gatekeeper for everything in that facility, it can be very uncomfortable because you have to deliver messages that people don’t like.”

If an administrator lets emotions affect decisions, it can cause major problems down the road. “If you allow too much of your emotions to be shown to your team, even if they understand that you’re human and can make mistakes, they’ll come back and use that against you in the future, if it’s to their benefit,” Kirchner explains.

This also is why leaders should not let their need to be liked or be friends with staff undermine their role as supervisor and administrator.

  • Learn leadership communication skills.

Administrators have to develop new or different communication skills for dealing with the people they supervise. “Share less of yourself. Keep conversations friendly. Listen to their needs,” Kirchner suggests. “But don’t cross the line to become their sympathetic friend.”

  • Form a support team or network.

One way to overcome the loneliness of leadership is to network with other surgery center leaders. “You can go to conferences, network there, and build a team that you can call,” Kirchner explains. “People who are in the same position can discuss things safely with you.”

No administrator can survive alone. Leaders need a team of supportive peers with whom they can discuss problems.

When Kirchner taught an administrative course, she would bring together nurses who planned to be surgery center leaders. She encouraged them to develop friendships and peer mentor relationships. “This was so they had a resource to fall back on,” Kirchner notes.

Another source of leadership support is a professional society or organization. For example, the Ambulatory Surgery Center Association provides information about rules and regulations and offers leadership training.1 “AORN [Association of periOperative Registered Nurses] also provides resources and helps nurses with compliance,” Kirchner says.2

  • Encourage flexibility, but maintain a leadership wall.

There are times when a leader needs to be flexible with scheduling and staffing rules. Other times, an administrator wants to help an employee with a personal issue. But while flexibility is important, the leader should not cross the line between an administrator and a friend. For example, Kirchner recalls the time when a postanesthesia care unit nurse was talking about her 18-month-old daughter’s cough.

“She couldn’t decide whether the cough was the child making funny growling noises or something was wrong, medically,” Kirchner says. “She took off work early, with permission, to have her child seen by a pediatrician. They ended up in the pediatric emergency room. The child’s heart had not developed correctly, and she was dying.”

The child went into cardiac arrest and was kept alive while waiting for a heart transplant. “This is where the line could be crossed, but you need to go in another direction,” Kirchner says. “The administrator can support the team with sympathy and allow employees to do what they want to do for their colleague. But you don’t want to lead that effort.”

The administrator can explain the situation to the physician owners and see if they would like to support the nurse. In this example, they started a fundraising page for the nurse and provided meals for her family.

“The team supported her in all sorts of ways, and the surgery center supported the staff and gave them time to work through this,” Kirchner says. “The leader showed empathy and support, but she did not cross the line and lead the fundraising and [meal donation] efforts.”

Instead, the administrator worked with nurses and involved the surgery center’s board. “She gave them time and space to help with what they were trying to do to help the family,” Kirchner adds. “She kept her support at a leadership level.”

  • Delegate and trust the team.

Administrators can become overwhelmed with their workloads. In a surgery center setting, they can be responsible for compliance, safety, infection prevention, staffing, and other duties. There might be team members to help, but the administrator is the one who is responsible.

“I find that people have a hard time when they first come in as administrators in training their teams to help them with data collection, chart auditing, quality control, infection prevention, and observation,” Kirchner observes. “If they don’t learn how to train teams and do it quickly, then they become overwhelmed and burn themselves out.”

Administrators need to learn to trust their teams and look for the people who they will want to help grow in responsibilities. “Help [teams] grow by giving them stuff of interest, and help them build up their résumé and career,” Kirchner suggests. “Any good leader is helping team members build their résumé for that next job.”

Delegation is important, but also is vital to verify what employees are doing. “Trust, but verify. If you don’t do that, it will get you in trouble,” Kirchner cautions.

In the abstract, surgery center administrators should strive to be leaders who are viewed as transformational. “They have to be thought leaders as well, and they have to be lifelong learners,” Kirchner adds. “Learning is something they have to embrace, or they will never succeed in this world.”


  1. Ambulatory Surgery Center Association. Federal regulations.
  2. Association of periOperative Registered Nurses. AORN Center for Nursing Leadership.