Staff Shortages and Scheduling Strategies
The looming shortage of registered nurses in the U.S. has been well publicized. This shortage has been attributed to a number of different factors, including the retirement of many baby boomer nurses and the need for more health care services as the U.S. population ages. The consequences of this shortage could be greater in the operating room than in any other area of the hospital. “There’s a tsunami of change that’s coming at us,” says ChrysMarie Suby, RN, MS, the president and CEO of the Labor Management Institute. “Right now, we’re watching as the wave approaches the shore. It’s not here yet, but it will be soon.”
Suby cites a number of statistics that should be eye-opening to hospital and OR leaders. For example, about two-thirds of perioperative nurse leaders are over 50 years old and one-fifth are over 60. Also, 37 percent say they plan to retire within the next three years and 65 percent plan to retire by 2022.
In addition, about half of all OR leaders say they are having problems recruiting perioperative nurses – and two-thirds expect to encounter problems over the next five years due to the age of their staff.
The Institute of Medicine’s landmark report “The Future of Nursing” recommended that the number of baccalaureate-prepared nurses in the workforce should be increased to 80 percent, and the population of nurses with doctoral degrees should be doubled. The current nursing workforce falls far short of these goals, the report noted, with only 55 percent of registered nurses prepared at the baccalaureate or graduate degree level.
Finally, the Bureau of Labor Statistics projects a need of 525,000 replacement RNs in the workforce between now and 2022. This is on top of the 527,000 projected new RN job openings during this timeframe.
According to Suby, these statistics should be especially alarming for perioperative leaders because of the lack of perioperative training that most RNs receive in school.
“There aren’t enough new nurses coming into the workforce who are ready to enter the perioperative environment,” she says.
Rachel Le Mahieu, RN, MSN, CNOR, RNFA, the director surgical services at Spring Valley Hospital in Las Vegas, Nevada, concurs.
“There’s a steep learning curve for new nurses entering the OR,” she says. “Technology is advancing so fast that there’s a lot for them to take in, and training new OR nurses is a lengthy process.”
Le Mahieu estimates that it takes between six months and a year for new OR nurses to become comfortable in the job, at least two years for them to become proficient, and about five years for them to become experts.
“It’s getting harder and harder to find qualified perioperative staff because there’s so much for them to learn,” says Le Mahieu. “This is especially true for specialty niche nurses: I’ve had two cardiovascular OR nurse positions open for over a year now.”
A Two-Pronged Strategy
Dealing with current OR staffing challenges and preparing for the challenges that lie ahead requires a two-pronged approach that focuses on: 1) attracting, hiring and retaining qualified perioperative nurses, and 2) scheduling your existing staff to maximize efficiency.
Suby stresses the need to recruit nurses who are coming out of school into the perioperative field.
“Too often, the focus is on critical care and emergency nursing, rather than on perioperative nursing,” she says. “Once new perioperative nurses have been hired, they need to be partnered with experienced OR nurses in formal mentoring programs.”
Le Mahieu believes that solid training and support are essential to getting new perioperative nurses up to speed fast so they can contribute in the OR as quickly as possible.
“It’s important to have a strong perioperative residency program so you can ‘grow your own’ perioperative nurses,” she says.
Creating the right workplace culture and environment is critical to retaining OR nurses once you’ve hired them.
“This includes providing strong support to perioperative nurses in the OR environment,” says Le Mahieu. “For example, they need to know that OR leadership will have their backs if they have to stand up to a physician.”
“If perioperative nurses don’t have the support they need to do their jobs, they’re not going to stay – no matter how well-paid they are,” Le Mahieu adds.
Both Suby and Le Mahieu believe that hospitals should go above and beyond when it comes to perks and other benefits in order to retain perioperative nurses. These perks include things like tuition forgiveness and reimbursement, bonuses for developing new skills, continuing education opportunities, and flexibility in scheduling.
OR Scheduling Strategies
The second prong of a strategy for dealing with staff shortages is scheduling OR staff for maximum efficiency.
“Your scheduling practices should always accommodate your budget for full-time employees,” says Suby. “When the schedule is detached from the budget, staff needs can be inflated by two or three people per shift. This results in unnecessary added expenses and staff floating.”
Most hospitals use block scheduling to allocate staff, facilities and resources on specific days at specific times to surgeons and surgical groups. Surgeons and groups can then schedule their cases accordingly.
“Once you have allocated block time to a surgeon or group, you’ve committed to having your staff and resources available to them at that time,” says Michelle Jackson, the surgical scheduling systems supervisor for the Boise, Idaho campus of the St. Luke’s Health System. “So you should only allocate block time when it can be used effectively. This is especially crucial when you’re dealing with staff shortages.”
Jackson manages scheduling for 60 ORs in six different facilities that handle more than 30,000 cases a year. In 2010, she helped launch an initiative designed to improve blocks utilization at her facility, which had an unmanaged system of block scheduling at the time with no monitoring or systematic approach.
The initiative created a multi-disciplinary block committee comprised of surgeons, perioperative managers and other key OR staff. Committee members were tasked with making decisions about policies governing utilization expectations, how unused block will be released, and what the consequences will be when blocks are not utilized most effectively.
“If surgeons aren’t using their blocks effectively, they’re tying up resources that could be used by other surgeons and groups,” Jackson says. “This is why it’s so important to have a block management system that details procedures holders must follow if they need to make changes to their blocks.”
Since the initiative was started, block utilization at the St. Luke’s Health System campuses where it’s used has increased from the low-70 percent range to the mid-90 percent range, exceeding the average target for all physicians.
Among the keys to this success, notes Jackson, have been obtaining high-level hospital support for block management and building strong partnerships with surgeons. She defines high-level support as the chief of surgery, COO, CFO or even CEO.
“Without this support, the task is impossible,” says Jackson.
She adds that implementing block management was something that was done with the surgeons, not to them.
“We honed in on surgeons who were frustrated with the process when we opened up the scheduling committee,” Jackson says.
Le Mahieu says her hospital has implemented what she calls modified block scheduling so that schedules are adapted to how surgeons are actually using their block.
“We try not to block more than 75 percent of available OR time to save the remaining 25 percent for growth and add-on cases,” she says.
Suby notes that with ORs contributing up to half or more of the typical hospital’s revenue, effective OR scheduling is more critical than ever.
“You need to know your numbers and manage your dollars to make sure your ORs are running at peak efficiency at all times,” she says.