Make certain your staff are prepared, involved

As same-day surgery programs increasingly see American Society of Anesthesiologists III and IV patients, ensure your staff are prepared to take care of such patients, emphasizes Nancy King, RN, CAPA, TQM coordinator at Columbia The Surgery Center in Cleveland. "At our surgery center, every nurse is training to be ACLS certified," she says. But how do you maintain quality patient care when your staffing costs are cut? Cross-training is one answer, managers suggest.

At Trinity Outpatient Center in New Port Richey, FL, RNs in the post anesthesia care unit (PACU) are cross-trained to perform functions in the OR, says Nancy Burden, RN, CAPN, CAPA, director and author of Ambulatory Surgical Nursing (W.B. Saunders, Philadelphia).

They aren’t trained to be the sole circulators, Burden says, but they can operate as the third person and monitor patients for IV conscious sedation and operate pain management equipment. OR nurses help with pre-op phone calls, interviews, and admission of patients.

"Where we’re cautious is in the highly specialized areas of OR circulator role, where you wouldn’t want to leave someone unless absolutely comfortable alone in a room," Burden says. "You wouldn’t want to be an OR nurse who isn’t ACLS qualified as the sole person recovering a general anesthesia patient who’s not awake yet. You have to temper cross-training with making sure you’re using a qualified person for the job."

While cross-training is one effective way to stretch your resources, get your staff involved in committees so they buy in to your efforts, says Terry McLean, RN, CPAN, immediate past president of the Thoroughfare, NJ-based American Society of PeriAnesthesia Nursing and nurse in the post anesthesia care unit at Portland (OR) Veteran Affairs Medical Center. Share your budget with your staff, he adds.

"Look to the staff for some creative solutions," McLean advises. "Ask how can they manage to maintain the quality and the standards and, at the same time, work within the constraints of the budget. If you involve staff nurses and ask for their suggestion, you’ll be surprised at the ideas they come back with."

Another way to involve your nurses is with shared governance, he says.

"That includes working within a budget, figuring out how the budget will be split, staffing issues — essentially the unit manages itself," McLean says.