Cross-trained staffing: The pros and cons
By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
Dallas
Is cross-training in your surgical department a good opportunity or a bad idea? Do you embrace or repel the notion? Not surprisingly, with the shifting paradigm of the delivery of outpatient surgery, it’s a very hot topic for many surgical departments.
It’s common for me to be in several surgical facilities a week. When the issue of "Should the staff be cross-trained or not?" comes up, I hold my breath after I say "Yes," because the reaction can be very strong in either direction. There is a lot of emotion attached to this issue.
Is there commonality between those who want cross-training and those who are opposed to it? There doesn’t appear to be. The reaction stems from the culture of the organization and past expectations of the staff.
If you have always been cross-trained, chances are high you like it and will continue to endorse it; if not, well, it may not be a hill you want to die on.
I should explain my definition of a cross-trained staff. It doesn’t fit the often-accepted description:
• PACU nurses rotate into the operating room and assist the circulating nurse on cases.
• Circulating RNs assist the PACU nurses in the recovery area.
• The receptionist learns how to clean instruments, and the instrument tech knows how to book cases.
• The scrub techs transport the patient with the RN to the floor or PACU.
• The billing staff assist the recovery room staff in providing nourishment to Phase II recovery patients.
• The circulator handles insurance correspondence in the billing office with the billing office staff.
• The recovery room staff change the O2 tanks when necessary.
• The circulator scrubs in on cases periodically.
• The scrub techs pick cases.
• The ENT nurses scrub for the eye cases.
• Everyone is able to properly answer the phone and take messages.
• Everyone learns to fill in for everyone where possible.
A well-designed surgical team doesn’t necessarily mean that everyone is a jack of all trades and a master of none. That concept usually doesn’t work well in a busy surgical department. But we are talking about everyone having a working understanding of each other’s roles. This system is not only good for the department but good for the staff so they can fill in when needed.
PACU nurses work recovery because they want to. Let them! No one should try to change that career choice. But the PACU nurses also need to understand how to circulate and scrub for the facility to be efficient and successful. Rotating departments generally doesn’t work. For example, a recovery room nurse working in the OR on Tuesdays and Thursdays and back into the recovery areas the rest of the days usually is not satisfying to the staff. It can be a bit too much. But they should be able to fill in and assist the other departments when needed. This goes for all the departments. It is just good business to maximize your resources to their fullest.
The cross-trained staff member is much more valuable an employee than one who is not. (It is also a major selling point on personal resumes.) Compare a noncross-trained staff member to an emergency department physician who can treat only one injury in a trauma emergency. There are many other body parts that are important and need to be evaluated and treated. The surgical department is an exciting mixture of parts, and each is as important as the next.
Cross-training staff can be a major hassle — no doubt about it. Who has time for it in a busy surgical department or surgery center? Not many — it doesn’t just happen. It requires sacrifices and planning. Someone has to carefully implement the process. Be thankful it isn’t you. But also be receptive when your department initiates it. They are doing you a favor.
Cross-training brings these advantages:
• provides a better understanding of the overall patient experience;
• expands the individual’s knowledge base;
• provides periodic "change of scenery"
• enables all to appreciate each others’ roles;
• can relieve bottlenecks when staff call in sick or are on vacation;
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Fill in the above blanks when you see the number of benefits you’ll enjoy.
(Earnhart and Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management. Earnhart can be reached at 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: [email protected]. Web site: www.earnhart.com.)
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