Cross-training programs offer scheduling flexibility
One of the most difficult aspects of managing a same-day surgery program is making sure you have the right number of staff members to handle each day’s schedule. Unfortunately, last-minute emergencies and staff illnesses often mean the manager scrubs for cases on days the program is short-staffed. While many managers long for the day they can be cloned to handle the administrative work as well as the substitution for missing staff, some managers have turned to cross-training as a way to increase staff availability.
Managers and staff benefit from cross-training, says Patricia B. Guy, RN, CNOR, operating room supervisor of SurgiCare of Jacksonville (NC).
"I benefit from the extra people I can assign to the different areas of the surgery center, and my staff benefits by being able to work a full 40-hour week even if their area has some slow days," says Guy.
She is able to keep overtime to a minimum by sending employees approaching the overtime limit home and substituting other nurses who haven’t had as many hours due to shortened surgery schedules. "I can use my nurses in the areas that are the busiest," says Guy. "If we slow down in the operating room or the post-anesthesia care unit [PACU] in the early afternoon, those nurses can help in the pre-op area, which is usually busy all day," she adds. The pre-op area handles patients the day of surgery, plus testing and admission sometimes days prior to surgery.
Nurses improve their marketability
Another benefit to the nurses is their own increased skill level, says Guy. "We are located in a military town, so many of my nurses transfer in and out with their spouses. By learning other areas, they increase their chances of finding a job in the next city," she adds.
Cross-training is a requirement for each RN Guy hires. Nurses are hired for a particular position in PACU or pre-op but subsequently are trained in the other area as well.
"If a nurse is hired to work in PACU, he or she spends the first two to six weeks in the PACU to orient to our facility. Then the nurse works two weeks in pre-op and returns to PACU. After one or two weeks, the nurse returns to pre-op to make sure the information is retained," explains Guy.
While there are guidelines as to length of time in each area, Guy says the training is individualized so that time frames may be shortened or lengthened as needed.
Cross-training into the operating room is more difficult. "A nurse really needs two full months of training to work in the OR, and I don’t have the capability to train for that length of time," says Guy. OR nurses are cross-trained to work in the PACU and pre-op areas, but it is rare to train PACU and pre-op nurses with no previous OR experience to work in the OR, she adds.
Train employees to work two locations
Sharon Tolhurst, RN, MBA, CNOR, administrative director at Cape Surgery Center in Sarasota, FL, took advantage of her facility’s affiliation with a nearby hospital to cross-train employees from different locations.
"Our program doesn’t teach new skills," explains Tolhurst. "We train nurses to work at either the freestanding day-surgery center or the hospital-based day-surgery program."
Because Tolhurst’s facility is owned by a hospital, she and the manager of the hospital-based surgery program agreed to allow employees to work in the PACU and OR of both facilities.
"Each nurse or surgical tech who is cross-trained is assigned a preceptor who familiarizes them with our center’s supplies, equipment, and procedures," explains Tolhurst.
Preceptors are experienced nurses on staff, and they handle this responsibility as part of their normal job. "We do have some employees who don’t have the experience to work in a hospital operating room, and there are some hospital employees who don’t like to work in our center, so the program is voluntary," Tolhurst adds.
Because the freestanding center handles cataract procedures, a surgery not performed in the hospital, cross-trained nurses from the hospital do not work cataract cases, says Tolhurst. "Our physicians are generally happy to see familiar faces at both places, but our ophthalmologists have a set routine and their instruments are very different from other surgical instruments, so we have a designated cataract team composed of employees who have worked with these physicians for a while," she adds.
The five surgery center employees and 10 hospital employees who are cross-trained for either location enjoy the change of pace and the opportunity to adds hours to their paycheck, says Tolhurst.
"If my center is really busy, I can check with the hospital program to see if they are slow and have any employees they plan to send home early. At the same time, many cross-trained employees who find out they may be asked to go home early take the initiative to call to see if they are needed in the other location," says Tolhurst. "This program wasn’t designed to give employees overtime, but it does help cross-trained employees work a full 40 hours each week," she adds.
Paychecks are not a problem since both facilities are on the same payroll system. Employees simply change the department code when clocking in at a location that is not their primary location, she adds.
The voluntary system at Cape Surgery and the required training at SurgiCare work well for the two programs, say Tolhurst and Guy. The key to success is clearly defining the program and letting employees know what to expect, they say.
Guy also suggests that managers demonstrate their support of cross-training by willingly helping out in different areas. "I like working in some areas better than others, but I go from area to area during the day to offer help," she says. "Any nurse who is apprehensive about cross-training can look at me and say if that old dog can learn new tricks, so can I.’"
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