Is your same-day surgery program short on nurses? Start recruiting from the ED

ED nurses do it all quickly, safely, and efficiently’

The nursing shortage continues — there was an RN vacancy rate of 8.4% at hospitals in 2003 — and there’s no relief in sight.1 Thus, managers are getting creative in their hiring, and they’re finding that emergency department (ED) nurses have skills that adapt well to outpatient surgery performed in hospitals and freestanding centers.

ED nurses typically work in areas other than the operating room. "We have been successful in using these nurses in preop and PACU [post-anesthesia care unit], as they typically have excellent assessment and monitoring skills," says Arthur E. Casey, CASC, senior vice president of surgery operations of the western region of HealthSouth in San Diego. HealthSouth has used about a dozen ED nurses in outpatient surgery, Casey says.

The ED mindset works very well in the ambulatory surgery PACU setting, says Denise Cheek, RN, administrator of Calumet Surgery Center in Munster, IN. "They are very strong in multitasking, assessment skills, and patient and family teaching, and of course they do it all quickly, safely, and efficiently," Cheek says. Calumet is using five ED nurses in its PACU; three are full time, and two are per diem. One of the full-time nurses has previous OR experience and is cross-training in that area, Cheek says.

The outpatient surgery area is a throughput area, just like the ED, says Brigid Bohl, RN, MS, CNS, staff nurse and consultant in Columbus, OH. Bohl has a background as an ED nurse and ED/operating room educator and works for a freestanding, independent ambulatory surgery center (ASC) and a hospital-affiliated ASC.

There are times when both the ED and the ASC are inundated with tasks to accomplish for patients; at other times, the ED and ASC are very manageable, Bohl says.

The advantage of hiring ED nurses is that they have comprehensive experience and abilities, she says.

"That’s not to diminish outpatient surgery, which is a specialty all its own, but having been in critical care, there are skills you use on a daily basis in the ED and critical care area," Bohl says. "If you’re in nursing long enough, you come up against at least one of any given scenario, so you have an educated background to draw upon."

ED nurses offer other advantages, says Thomas J. Mallon, CEO of Regent Surgical Health, a Westchester, IL-based buyer, developer, and manager of surgery centers and surgical hospitals.

"They multitask better than ICU nurses," Mallon says. And good attitudes prevail, he says. "They appreciate the schedule of day work with no call."

One downside of hiring ED nurses is that they are accustomed to higher salaries with shift differentials, Cheek says. Also, the outpatient surgery program may be unable to give them the number of hours that they would like to make up for the lost wages, she says.

Another downside is "blending" them with the already experienced outpatient surgery staff, who may not believe in their potential, Cheek says.

Three tips to make it work

To hire ED nurses successfully, consider these suggestions from your peers:

  • Hire current ED nurses.

Cheek ran an ad in the ED help wanted section of the newspaper and added a headline that said, "Looking for a change?"

"I believe that the situation worked especially well for us because we are only hiring per diem staff, which is a higher pay scale, and we — and they — can try before we buy," she says.

The nurses Cheek hired initially kept their positions in the ED and worked hours at the ASC that fit into their schedules, she says. "Once they were working here, they loved it and couldn’t wait for an opening so they could join our full-time staff," she says. "By that time, they are orientated and ready to start full-time hours immediately after giving their two weeks’ notice — and willing to take the pay cut."

  • "Sell" ambulatory surgery’s advantages.

Some ED nurses are looking to make a move to a more "comfortable" place in nursing, Bohl says.

"We still provide a tremendous service to patients and to the administrators and organizations we work for, and we still use our skills," she says of ED nurses who move to outpatient surgery. "We’re not ready to stop, but we’re ready to stop doing nights and weekends because we’ve been doing it for 30 years."

You may find ED nurses who are at the point where they want to focus on a higher-quality family life, Bohl points out.

Explain to ED nurses that the trade-off for lower salary is greater involvement in the process of care, including decision-making, patient care, and process improvement, she suggests.

"At some point," Bohl says, "the time comes to make a decision: Do I stay in a high-volume, high-tension, lower-involvement area, or do I look around for something equally productive but offering more ability to be involved in the humanistic and quality perspective of nursing?"

ED nurses are interested in self-governance, Bohl says. Also, they are interested in self-scheduling and, if feasible, a menu of options for benefits, she says.

"One particular benefit package doesn’t seem to fit every nurse," she says.

  • Blend ED nurses with staff throughout the facility.

Putting all the ED nurses in one area, such as phase one PACU, may not be the best strategy, says Cheek, who adds that she learned this lesson the hard way.

The ED nurses initially were working per diem, and because they were coming in during the busiest periods of the day, initially they all worked in phase one recovery, she says.

"In the beginning, there was division in the entire area," Cheek says. Battle lines were drawn between nurses who had been at the facility for an extended time and the new hires, she says.

"We realized we were creating a monster by not having them work in all areas," Cheek says.

Once the ED nurses were working throughout the facility, tensions eased, she says.

HealthSouth has put some ED nurses through its OR training program and used them in that area, Casey says. No matter what you do, Bohl advises keeping your options open.

"Everyone has tremendous skills, and in the economy and environment we have now, and the environment of care, every set of hands is needed," she says.


1. American Hospital Association. 2004 AHA Survey of Hospital Leaders. Chicago; 2004.


For more information on hiring emergency department nurses to work in outpatient surgery, contact:

  • Brigid Bohl, RN, MS, CNS, Staff Nurse and Consultant, Columbus, OH. E-mail:
  • Denise Cheek, RN, Administrator, Calumet Surgery Center, 7847 Calumet Ave., Munster, IN 46321. Telephone: (219) 836-5102. Fax: (219) 836-4496. E-mail: