2012 Salary Survey Results: Growing trend in outpatient surgery: Requirement for nurses to have their BSN
2012 Salary Survey Results
Growing trend in outpatient surgery: Requirement for nurses to have their BSN
With outpatient surgery becoming increasingly complex, in terms of technology and patients, there is a growing trend toward requiring nurses to have their bachelor's of science in nursing (BSN) degree.
At press time, New York and New Jersey were debating "BSN in 10" bills that would require RNs in those states to obtain their BSN within 10 years. This trend is supported by a 2011 Institute of Medicine (IOM) report that called for nurses to achieve "higher levels of education."1
"Although a BSN education is not a panacea for all that is expected of nurses in the future, it does, relative to other educational pathways, introduce students to a wider range of competencies in such arenas as health policy and health care financing, community and public health, leadership, quality improvement, and systems thinking," the report said. The advantage of having more nurses with BSNs is that they will be better able to handle healthcare demands as they evolve, the IOM said. Research indicates that staffing models with nurses who have higher educational preparation, such as BSN vs. ADN or diploma, have better outcomes.2
A BSN will pave the path for nurses to achieve master's and doctoral degrees, which are necessary for nurses to serve as primary care providers, nurse researchers, and nurse faculty, the 2011 IOM report says. "The committee recommends that the proportion of nurses with baccalaureate degrees be increased to 80% by 2020," the IOM said.
According to the results of the 2012 Same-Day Surgery Salary Survey, 30.6% of all respondents (nurses and non-nurses) have a BSN. This number compares with 28.6% who have an ADN and 18.4% who have a 3-year diploma. (See graphic, "What is your highest degree?" Below.) The survey was sent to 709 readers in September 2012. There were 49 respondents, for a 7% response rate.
Annette Ross Svagerko, RN, CNOR, OR nurse manager at Nationwide Children's Surgery Centers in Columbus, OH, recently returned to school to complete her BSN. Ross Svagerko says she now appreciates the need for nurses to have a "professional degree."
"In the fast pace of the surgery center, I think it is even more important to have a strong knowledge base and every advantage possible to provide expert care to the patient," she says. "Critical thinking skills are honed in a BSN program, and we have to have those skills at the tip of our fingers in the ambulatory surgery setting."
Since her centers have become a part of the hospital, they follow that facility's employment initiatives, which include preference for a BSN. "An RN may be hired, with the expectation that they will obtain their BSN within five years of hire," Ross Svagerko says.
It simply makes senses that if surgery centers are using the best technology and equipment, the nurses operating those equipment should have a higher nursing degree, says Arthur E. Casey, CASC, senior vice president of business development at Houston TX-based Outpatient Healthcare Strategies, a Consulting Management Services Firm focusing primarily on Hospital Perioperative Services, HOPDs, and Ambulatory Surgery Centers.
"Nursing is evolving into its own discipline with its own theory in science," Casey says. "With ongoing ever-changing health systems, our nurses must keep up."
Midlands (TX) Memorial Hospital is a good example of this trend. The hospital hires nurses with the understanding that they complete their BSN within five years of their start date, according to Marcy Madrid, director, marketing and media relations. All currently employed RNs have the same timeframe expectation, with an understanding that those in different life stages might need additional flexibility and need to be on an education plan to obtain their BSN in an appropriate amount of time, Madrid says. The goal is for 80% of the staff to have BSNs by 2020, she says.
Don't look at the BSN as the only criteria of a good nurse, however, says Stuart Katz, MBA, FACHE, director and orthopaedic service line administrator of TMC Orthopaedic Outpatient Surgery Center, Tucson, AZ. " the proof of the education is in the bedside manner of the nurse and how she performs with the patients and other customers," Katz says. "You can be well-read and not be a good nurse. The BSN degree does not imply competency." (For information on how to recruit and retain staff, see story, below.)
References
- Institute of Medicine of the National Academies. The Future of Nursing: Focus on Education. Jan. 26, 2011. Accessed at http://bit.ly/rmtQMU.
- Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press; 2010. n
Tips for recruiting and retaining staff As managers and staff near retirement age, it becomes critically important to be able to recruit and retain employees. (See results of the question, "How long have you worked in healthcare" from the Same-Day Surgery Salary Survey, below.) At Nationwide Children's Surgery Centers in Columbus, OH, the mean age of the staff is 35 years. "We have been fortunate that we have been able to recruit and retain young nurses who thrive in the self-directed outpatient surgery environment," says Annette Ross Svagerko, RN, CNOR, OR nurse manager. To what does she attribute successful retention of staff? "Among the staff, we have discussed this many times, and it supports the research that shows that a sense of purposefulness and empowerment causes the staff to remain," Ross Svagerko says. For example, administrative support has been critically important for "evidence-based practice from the bottom up," she says. "Allowing nurses to practice their profession is the key to keeping a stable work force," Ross Svagerko says. "Doing things 'just so the look consistent to Joint Commission' is a really poor way to practice." She encouraged her staff to set up their environment as they wished, as long as it was within guidelines from the American Society of PeriAnesthesia Nurses (ASPAN) and Association of periOperative Registered Nurses (AORN), as well as The Joint Commission and state/federal mandates. "This gave the staff a sense of responsibility and ownership for their area," Ross Svagerko says. Her facility also put in a bonus structure when the first surgery center (SC) opened. "The staff is paid less than the in-house nurses but have an opportunity to earn a bonus based upon the criteria established by the SC management staff," Ross Svagerko says. The bonus criteria includes compliance with standards from The Joint Commission such as medical record audits, satisfaction survey results for staff and patients, time-out audits, site verification audits, quality controls on refrigerators, and on-time starts. Also included are items such as education coordination for staff, environment of care rounds, federal privacy law compliance, magnet redesignation projects. The criteria are re-evaluated quarterly, and the bonuses are based upon achieving the criteria. In addition to bonuses, there are other benefits that prove useful in recruiting and retention, according to Arthur E. Casey, CASC, senior vice president of business development at Houston, TX-based Outpatient Healthcare Strategies. Casey says they include not having to work weekends and holidays; slightly higher wages; enough paid time off (PTO) to keep applicants at their seniority level or close to it from the job they are leaving; annual evaluations with the possibility of salary increases; and medical, dental, and vision coverage premiums close to the rate they would have to pay at a hospital. Another recruitment tip is to put a dollar amount on the benefits you offer, suggests Stuart Katz, MBA, FACHE, director of TMC Orthopaedic Outpatient Surgery Center, Orthopaedic Service Line Administrator, Tucson, AZ. "The most beneficial is we have been able to identify the employee benefits to the staff and what they mean in terms of dollars to them rather than just what their hourly rate is," Katz says. "There are places in town where the hourly rate is a little higher, but our benefit package, when taken in terms of dollars, added to the hourly rate exceeds the packages available elsewhere." How can you prepare to fill spots of managers who are retiring? Consider having staff fill in for the OR supervisor when that person is out, Katz suggests. "This gives the staff the opportunity to see what it is like to be in charge and deal with the day-to-day problems of running a department," Katz says. Source For more information about outpatient surgery staffing and other issues, contact:
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