Minimize your risk with a job analysis
Avoid potential threats to patient safety by performing a job functional analysis to determine how many FTEs it takes to do a job, same-day surgery managers suggest. "Ask, `What are the things nurses must do? What are the things others can do?'" says Jayne Byrd, BSN, director of surgical services at Rex Healthcare, a corporation of health care providers, including a hospital and freestanding surgery center, based in Raleigh, NC.
Byrd acknowledges that same-day surgery programs with low caseloads find it hard to justify an all-RN staff. "We're at 1,200 cases a month," she says. "Without a high degree of skilled workers with a commitment to teamwork and the ability of all staff to do a variety of things, it wouldn't be possible to pull off." For example, support techs can be jacks-of-all-trades, she says. "They can draw blood, take vital signs, do preps, errands, EKGs, and data entry for lab orders."
Techs are multiskilled at an extremely technical level, she says. "Using them in variety of ways frees nurses to spend more time with patients, do better assessments, and do better pre- and post-op instruction, which I believe only nurses can provide," Byrd says.
With many same-day surgery procedures approaching three hours in length, Byrd's facility is exploring the opportunity to offset the salary burden of using RNs with increased use of technicians. "This is where the job functional analysis comes in," she says. "Do you need someone to scrub on a case for three hours? Maybe it doesn't have to be a nurse."
To perform a job functional analysis, make a task list of jobs the people in your program do, she suggests. Take each line and ask, "Do nurses have to do this job? Can someone else do it?"
Look at your nursing investment per case. For example, there may be a task a nurse must do 1,200 times per month for 10 minutes. Multiply that number by the nursing salary to determine the cost. Determine what cost and what patient acuities need to be handled by nurses or techs.
After performing a job functional analysis, Byrd and her fellow managers determined techs could handle virtually all of the responsibilities of the three-hour cases. "The case mix in a surgery center is the critical piece because if you have short cases, you might find the flexibility of all-RN staff is a real bonus." Having nurses who can scrub and circulate, and who are willing to do either or both, adds to the flexibility of a unit with short cases.
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