The good news/bad news for OR leaders from the 2018 annual OR Manager Salary/Career Survey: Surgical volume continues to increase for many hospitals, but staff turnover and recruitment difficulties remain, creating challenges in meeting that increased volume. Another ongoing challenge is reimbursement changes; more than half of respondents report bundled payments for orthopedics as the top reimbursement trend compared with a year ago.
More survey highlights
Other key findings of the survey include:
Models of care are making only modest inroads. One-third of respondents reported that none of the care model options presented in the survey—such as Enhanced Recovery After Surgery (ERAS), Accountable Care Organizations, and the perioperative surgical home (PSH)—had been implemented or were planned to be implemented in the next 6 months.
The average staff turnover rate (defined as the percentage of staff who have left and been replaced in the past 12 months) was higher this year than last: 13% for RNs (vs 10% in 2017) and 11% for surgical technologists (STs) (vs 8% in 2017).
Difficulty in recruiting RNs and STs continues to be a trend. Two-thirds of leaders noted that, compared to 12 months ago, it’s more difficult to recruit experienced OR nurses (down from 73% in 2017), and more than half (52%) said it’s harder to recruit STs, up from 47% last year.
The number of reported open positions is relatively stable.
Healthcare environment
It has been 4 years since the major provisions of the Patient Protection and Affordable Care Act went into effect. These provisions, along with other changes in healthcare, have created a healthcare environment that benefits many patients, but OR leaders continue to face challenges in terms of volume, reimbursement, and care models.
Nearly half (47%) of respondents reported increased volume over the past 12 months, up slightly from 43% in 2017 and up significantly from 33% in 2014. Back then, 30% reported decreased volume, compared with only 18% this year. This year, more than a third (35%) reported that volume stayed the same in the past 12 months, compared with 36% in 2014.
For the first time, we asked respondents to identify top reimbursement trends. More than half put more bundled payments for orthopedics as number one. (See related article on the cover.) Far behind in the second and third slots were more patients covered by Medicaid (17%) and more patients enrolled in Medicare Advantage plans (15%).
Those numbers are likely to continue increasing as the population ages. By 2030, all Baby Boomers will be older than age 65, according to the US Census Bureau. Those 85 years or older comprise the fastest-growing segment of the total population, and it is expected to double by 2036.New care models have sprung up in response to the new healthcare environment, but they aren’t being widely adopted. ERAS is a case in point: Despite research showing numerous benefits, fewer than half (42%) of respondents are using ERAS or plan to implement it in 6 months. In 2017, 46% reported having ERAS for at least one specialty. The percentage of respondents who have adopted or plan to adopt a PSH is only 14%; in 2017, 32% reported having a PSH.
Staffing stats
The unsettled healthcare environment makes it more important than ever for OR leaders to have the right staff—and the right number of staff—in place.
About a third (35%) of OR leaders have hired more direct care staff in the past year, similar to the 34% reported in 2017. Leaders continue to respond to financial pressures in a similar pattern. For instance, 25% have eliminated open positions (vs 31% in 2017 and 22% in 2016). Other actions include: reduced overtime usage (36% vs 43% in 2017) required staff to take time off without pay (20% vs 24% in 2017 and 16% in 2016) decreased use of agency staff (26% vs 29% in 2017 and 23% in 2016). In all, 20% reported increased use of agency staff, compared with 22% in 2017 and 23% in 2016.
The percentage of open full-time equivalent (FTE) positions for RNs in the past 12 months increased for more than a third (37%) of participants (vs 33% in 2017), and only 17% (vs 20% in 2017) reported a decrease. More than a quarter (27%) had no open positions, 38% had between one and two, and 21% had five or more.
In all, 37% reported an increase in ST open FTE positions, up from 26% in 2017, with 14% reporting a decrease, down from 19% last year. However, a third had no open positions for STs, and 42% had only one to two; half (48%) said the number of open positions was the same.
Looking back to 2014 reveals significant changes. That year, few respondents reported an increase in open positions for RNs (11%) and STs (12%); more than two-thirds (65% for RNs and 64% for STs) reported open positions were the same. Nearly half (42%) were in the enviable position of having no open RN positions.
Staff transitions
Although the average RN turnover rate rose, the percentage of respondents reporting an increased turnover rate over the past year remained relatively stable, although it has been trending downward the past few years (39% in 2016, 35% in 2017, and 32% in 2018). Still, it remains much higher than the 20% in 2014.
Slightly more than a quarter (26%) of participants reported an increased turnover rate for STs, but 63% said it had stayed the same. ST staffing turnover has been stable for the past 4 years, with 59% to 64% reporting no change during that time frame and 21% to 28% reporting an increase.
Recruitment
OR leaders continue to struggle to fill RN positions. Only 6% report that recruiting experienced OR nurses is easier compared with 12 months ago; last year, that figure was 2%. The percentage of participants reporting greater difficulty in recruiting new or inexperienced OR nurses jumped from 16% in 2017 to 25% this year, but this could be a one-time variance—more than half (51%) said that the level of recruiting difficulty stayed the same for this group, similar to the 57% for last year.
When it comes to resumes for new RN hires, 44% of OR leaders require the applicant to have a baccalaureate degree in nursing (BSN), 57% require an associate degree in nursing (ADN), and 9% don’t require a degree. The percentages differ significantly between community and teaching hospitals.
More than two-thirds (67%) of teaching hospitals requiring a BSN, and more than two-thirds (65%) of community hospitals require an ADN. Despite the merits of having a CNOR, only 6% of all respondents require that certification.
More than half (52%) of OR leaders said it was more difficult to recruit STs, up slightly from 47% last year. Only 11% said it was easier, the same as last year.
About the respondents
Consistent with previous surveys, most respondents (64%) work in community hospitals as opposed to teaching hospitals (28%). Of the options provided, the most common job title was director (46%), followed by nurse manager (39%), and administrator/administrative director (6%).
In service to patients
As volume continues to increase in an environment with an aging population, reimbursement changes, and new care models, OR leaders will need all their skills to recruit and retain staff so patients can receive the quality of care they deserve.
All about the business manager
Overall, 35% of OR leaders have a business manager, compared with 38% in 2017, 33% in 2016, and 29% in 2015. Business managers continue to be a much greater force in teaching hospitals (68% report having one) than in community hospitals (only 21% report having one). The teaching hospital percentage is down significantly from 86% last year, but more data are needed before any conclusions can be made about the drop.
Requirements and salary
- The number of OR leaders requiring business managers to have a clinical background keeps falling: 25% in 2017 vs 16% this year.
- Nearly half (47%) of OR leaders require business managers to have a bachelor’s degree; 35% require a master’s degree in business administration.
- Annual salaries of $90,000 to more than $100,000 a year for business managers were cited by 27% of respondents, but 40% said they did not know the current salary of their business manager, so caution should be used when interpreting the results.
Scope of responsibilities
- The number of direct reports for business managers is fairly evenly divided between the categories (see table).
- More than a quarter (27%) have no direct reports, compared with 17% last year, and 12% (up from 10% in 2017) have 10 or more. The mean number of reports for those having 10 or more is 15.
- As expected, the bulk of responsibilities for business managers fall under finances, with financial analysis and reporting topping the list (73%), closely followed by the annual budget (64%) and billing and reimbursement (61%). Interestingly, strategic planning responsibilities continue to decline.
Surgical volume in the past year increased for 40% of respondents to the 2018 annual OR Manager Salary/Career Survey, down slightly from the 48% reported in 2017. This result is intriguing in light of the proliferation of procedures now being performed in ambulatory surgery centers (ASCs). Does this suggest some stabilization is occurring in outpatient surgery?
That might be the case. A significant majority of leaders in ASCs report that turnover and number of open positions for RNs stayed the same compared with 12 months ago, and only 24% reported an increase in the number of specialties in the past year, half of the 48% reported in 2017.
In 2017, RN turnover stayed the same for 59% of respondents; that percentage jumped to 73% this year. The number of open positions stayed fairly stable, with 58% in 2017 reporting the RN open position rate had remained the same, compared with 61% this year.
Recruitment also has stabilized somewhat, with more than a third (39%) of ASC leaders reporting that recruiting experienced RNs was unchanged from 12 months ago, compared with only 26% in 2017. For surgical technologists (STs), the number of respondents reporting no change in recruiting rose from 39% to 51%.
But clouds still hover over the ASC. In all, 22% reported increased RN turnover during the past year; 20% reported increased ST turnover. Open RN positions increased for 26% of OR leaders, and 24% reported an increase in ST open positions. And more than half (56%) find that recruiting experienced RNs is more difficult compared with 12 months ago, although that number is down from 67% in 2017.
Healthcare environment highlight
For the first time, we asked participants about care models and reimbursement trends.
Most (59%) respondents don’t have (and didn’t plan to add in the next 6 months) any of the care models included in the survey, such as joint ventures, Enhanced Recovery After Surgery (ERAS), and Accountable Care Organizations. Of those who selected an option, most chose some form of joint venture (28%), with a joint venture among physicians, management company, and hospital the most common (15%). Despite the proven benefits of ERAS, only 11% said they had implemented it or planned to add it in the next 6 months.
The top three reimbursement trends were: more patients covered by Medicaid (46%), more patients enrolled in Medicare Advantage plans (43%), and more patients covered by Medicare (40%), a trend likely to continue given the aging patient population. Not far behind were fewer patients covered by private insurers (37%) and more bundled payment for orthopedics (30%).
About the ASC
Most respondents (43%) work in physician-owned ASCs, followed by hospital owned (22%), joint venture (20%), and corporate/LCC (14%).
Multispecialty ASCs dominate (71%), and the top three specialties are general orthopedics (77%), general surgery (70%), and ophthalmology (68%). Only 28% reported total joints, and 24% reported spine surgery.
The top specialties among single-specialty ASCs were gastroenterology (30% vs 15% in 2017) and ophthalmology (24% vs 33% in 2017), with orthopedics a distant third at 13%.
More staffing results
Half of ASC leaders reported no open ST positions, and 41% reported no open RN positions, comparable to last year (52% and 44%, respectively). The number of respondents reporting no change in recruiting difficulty for RNs over the past year increased from 26% in 2017 to 39% this year. The “no change” trend was similar for STs (39% in 2017 vs 51% in 2018) and new/inexperienced OR nurses (55% in 2017 vs 56% in 2018).
The most commonly reported staffing changes during the past 12 months were hiring more direct care staff (42%) and reducing overtime (40%).
What’s next?
Although there are some signs that staffing has become more settled, it’s difficult to know if this is an anomaly or a trend. With healthcare changes continuing at a rapid pace, ASC leaders will need to keep a watchful eye on how these changes may affect patient outcomes and profitability.
A steady stream of changes and upheaval, ranging from increased use of bundled payments for reimbursement to the pressure of filling open positions with qualified staff, are affecting OR managers’ ability to be successful. Despite the challenges, more than two-thirds (67%) are satisfied with their jobs or positions, according to the 2018 annual OR Manager Salary/Career Survey. More than half of respondents (55%) don’t plan to retire until 2027 or later, up from the 42% in 2017 who said they planned to retire in 2026 or later.
But the news from the survey isn’t all positive. Significant areas of dissatisfaction remain; for example, fewer than half (46%) of respondents are satisfied with their total compensation. This is not surprising, given that salaries are flat compared to 2017. And although job satisfaction is high, it’s less than the 73% reported for healthcare workers in general. Nearly a quarter (22%) of leaders plan to retire between 2018 and 2022, which could lead to a significant leadership wisdom gap.
For the first time, we asked respondents to identify the most important resource they needed to be more successful as a leader. Most (23%) chose more staff members, but many others were looking for better support from their immediate supervisors. (In all, 21% chose that option, which correlated with the 17% who were unsatisfied with the support provided by their supervisors.) Education related to finances (19%) rounded out the top three needs.
Other highlights from the 2018 survey include:
- About half (49%) reported an annual salary between $100,000 and $149,999, comparable to 48% for that range in 2017.
- The average last raise for respondents was 3.27%, up slightly from 3.07% in 2017, and higher than the 2.1% increase in the consumer price index for 2017.
- OR leaders oversee an average of 88 full-time equivalent (FTE) employees, a sharp drop from 117 last year, but comparable to 95 in 2016 and 94 in 2015.
- OR leaders in teaching hospitals earn more than their community counterparts.
Compensation
Two-thirds of OR leaders earn an annual salary of $100,000 or more, consistent with 69% in 2017 and 66% in 2016. As has been the case in previous surveys, those in teaching hospitals earn more than those in community hospitals. For example, 61% of respondents in community settings earn $100,000 or more, compared to 77% of those in teaching hospitals. And the total compensation package for 54% of OR leaders in community hospitals is $120,000 or more, compared to 67% of teaching hospital respondents. The percentage of the last raise was also higher in teaching hospitals compared with community hospitals (3.96% vs 3.04%).
OR leaders in administrator or administrative director roles earn more than those who are directors or nurse managers, likely reflecting scope of responsibilities. The most commonly reported annual salary range for administrators was $150,000 or more (75% of respondents); for directors, it was $120,000 to $149,999 (32% of respondents); and for nurse managers it was $100,000 to $119,999 (30% of respondents).
That pattern was reflected in overall compensation as well. The highest annual compensation category was more than $200,000 or more for administrators (50%), $150,000 to $174,999 for directors (27%), and $100,000 to $119,999 for nurse managers (25%).
Scope of responsibility
The differences in compensation between community and teaching hospitals can be partly accounted for by differences in scope of responsibility. OR leaders in community hospitals oversee an average of 75 FTE employees (64 clinical and 11 nonclinical) compared to average of 124 (104 clinical and 20 nonclinical) for those in teaching hospitals. Administrators supervise the most employees (average of 170), followed by directors (average of 103), and nurse managers (average of 61).
Scope of the role
Respondents oversee an average of 11 ORs (vs 14 in 2017). In addition to the OR, the most common departments that OR leaders are responsible for are the postanesthesia care unit (PACU, 64%), preoperative unit (58%), outpatient/same-day surgery (54%), central processing (53%), GI/endoscopy (52%), preadmission services (41%), and anesthesia support personnel (40%).
Although these results are similar to those of the last 2 years, significant differences emerge when comparing data from 4 years ago. In 2014, 83% reported having responsibility for the PACU, 72% for central processing, 70% for outpatient/same day surgery, 68% for pre admission services, and 69% for GI/endoscopy. The only two areas that increased in comparison to 2014 are certified registered nurse anesthetists (CRNAs, 11% vs 10%) and materials management for the OR (36% vs 34%), and the increase was slight.
About a fourth of OR leaders (26%) manage an annual operating budget of less than $2.5 million, with 59% having responsibility for operating budgets in the $2.5 million to $49.9 million range. Only 7% manage an annual operating budget of $75 million or more.
Responsibility for the annual capital budget was fairly evenly divided among all categories, with 21% managing a capital budget of less than $250,000. In all, 54% manage a capital budget of less than $1 million per year, and 47% are responsible for a budget of more than $1 million per year.
Profile of a leader
Here is a closer look at you and your colleagues in several areas.
Ingredients for success
Although more staff members, better support from immediate supervisor, and education related to finance were most commonly identified as resources needed to be successful as a leader, 12% chose education related to human resources, and 11% chose more assistant managers. The responses from those who selected “other” included more support from senior management and more support related to data analytics.
Satisfaction
Satisfaction levels were similar to or only slightly lower than those in 2017. This year, we compared some of the satisfaction results with data provided by Burke, Inc, Annual Workforce Perspectives® 2018, from a pool of healthcare workers. These workers are from all different settings and levels, so exact comparisons aren’t possible, but the data provide some interesting perspectives.
OR leaders put patient satisfaction with OR services at the top of the list (82% have a favorable view). The next highest satisfaction percentages were for current job or position (67%), benefits provided (63%, similar to the 62% reported for healthcare workers in general), support provided by the respondent’s boss (62%, the same as healthcare workers), and engagement level of staff (57%).
OR leaders were less satisfied with the engagement level of physicians (only half had a favorable rating), top leadership of the organization (49%, compared with 57% of healthcare workers), and total compensation (46%, much lower than the 58% reported for healthcare workers). The highest unfavorable ratings were for top leadership of the organization (21%), total compensation (17%), and support from the respondent’s boss (also 17%).
Satisfaction based on work setting switched from 2017, when 75% of respondents in community hospitals were satisfied with their job or position, compared to 66% of those in teaching hospitals. This year those percentages were 65% and 72%, respectively. However, as in 2017, OR leaders in teaching hospitals were more satisfied with their benefits: 70% compared with 60% for their community hospital counterparts.
Areas where community hospital respondents reported greater satisfaction than those in teaching hospitals included: patient satisfaction with OR services (84% vs 73%), support provided by respondent’s supervisor (64% vs 60%), and engagement level of staff (58% vs 50%). These findings are comparable to 2017 results. Satisfaction with engagement level of physicians was split evenly between the two settings, whereas last year the percentage was 57% for community hospitals and 50% for teaching hospitals.
Staying on the job
Although more than half of respondents plan to retire in 2027 or later, the numbers differ significantly by work setting—62% for those in community hospitals vs 40% for those in teaching hospitals. In all, 25% of respondents in teaching hospitals plan to retire between 2018 and 2022 (compared with 20% for those in community hospitals), and 35% plan to head for the exit between 2023 and 2026 (compared with 18% of those in community hospitals).
Overall, more than half (60%) of respondents working in teaching hospitals plan to retire by 2026, compared with only 38% in community hospitals, which means leaders in teaching hospitals will need to put succession plans in place to ensure smooth transitions as leaders move into retirement.
Demographics
Overall demographics are listed in the infographic above. The average age of an OR leader is 51.9 years, compared with 55.2 in 2014, and 52.3 in 2009. The average age for nurses overall is 48.8 years, according to the 2015 National Nursing Workforce Survey.
The percentage of OR leaders who have a master’s degree as their highest level of education has decreased in the past few years. In 2014, 47% of respondents held an MS/MSN, MBA, or another master’s degree, compared with 42% in 2016 and 40% this year. Doctoral preparation remains rare, with only 6 respondents having this degree this year. BSN or another baccalaureate degree was reported as the highest degree for 40% of respondents.
Respondents in teaching hospitals were more likely than those in community hospitals to have a master’s degree (51% vs 37%). For community hospitals, 42% of respondents had a BSN or another baccalaureate degree as their highest level of education, compared with 29% in teaching hospitals. Overall, 82% of OR leaders in teaching hospitals reported having a baccalaureate degree or higher, compared with 83% of those in community hospitals.
As expected, the highest degree earned varied depending on title, with 41% of administrators and directors reporting a master’s, compared with 29% of nurse managers. Half of nurse managers had earned a baccalaureate degree.
About two-thirds (64%) of respondents work in a community hospital, and 28% are based in a teaching hospital.
Looking ahead
OR leaders remain satisfied overall with their jobs. Although they will need to continue to enhance their leadership skills to move forward, this satisfaction will help buttress them against the challenges ahead.
Leaders of ambulatory surgery centers (ASCs) are less satisfied than they were a year ago, according to the OR Manager 2018 Salary/Career Survey. In 2017, 83% were satisfied with their current job or position, compared with 77% this year. Other areas where satisfaction dipped by five percentage points or more were benefits provided (69% in 2017 vs 63% in 2018), top leadership of the organization (64% vs 58%), and physician engagement (72% vs 63%).
Lower satisfaction comes at a time when salaries are trending slightly upward. This year, 60% of respondents earned $100,000 or more annually, compared with 54% in 2017 and 53% in 2016.
When asked about the most important resource that is needed to be more successful as a leader, respondents put more staff members (25%) and education related to finance (23%) at the top of the list.
Here are some other survey highlights:
The average raise was 3.63% (higher than the 2.1% increase in the consumer price index for 2017), compared with 3.94% in 2017 and 3.6% in 2014.
Retirement plans will reduce the number of experienced leaders, with 21% planning to retire between 2018 and 2022, and another 30% planning to leave between 2023 and 2026. This means that more than half (51%) of respondents expect to be retired before 2027.
Nearly half (44%) of respondents said they didn’t know the ASC’s annual operating budget. This may be a case where respondents preferred not to disclose the information, even though the survey was confidential.
Money trends
The most frequently reported total annual compensation range was $120,000 to $149,999 (28%). More than half (51%) of respondents earn $120,000 or more, and only 16% earn less than $80,000.
The salary disparity between ASC and hospital leaders narrowed this year, with 43% of hospital respondents earning $120,000 or more, compared to 37% of ASC leaders. In 2017, those percentages were 40% and 29%, respectively. And in the case of total annual compensation, more than half (56%) of hospital leaders earn $120,000 or more, compared with 51% of ASC leaders.
ASC leaders on the job
ASC leaders supervise an average of 37.34 full-time equivalent (FTE) employees (30.38 clinical employees and 6.96 nonclinical employees), compared with 39.83 in 2017, 36.84 in 2016, and 38.6 in 2015. In all, 73% manage one to five ORs, comparable to the 70% reported in 2017. Only 3% manage more than 10 ORs, with an average of 17 for those in that category. Position titles were nearly evenly divided among administrator or administrative director (33%), director (30%), and nurse manager (29%).
A total of 14% of respondents reported an annual operating budget of $5.0 million to $9.9 million; 10% chose the $1.0 million to $1.9 million option. Only 3% reported a budget of $15 million or more, with a range of $17 million to $88 million for those who chose that option. In all, 70% reported no change in the annual operating budget in the past 12 months (vs 59% in 2017), and 23% saw an increase (vs 34% in 2017).
Profile of ASC leaders
Here are more insights about you and your colleagues.
Ingredients for success
In addition to more staff members and education related to finances, ASC leaders identified other resources important for their success as a leader. The same percentage of respondents (16%) chose education related to human resources and better support from their immediate supervisor (interestingly, 11% of respondents have an unfavorable view of support provided by their immediate supervisor). Only 7% chose more assistant managers.
Satisfaction
This year, we compared some of the satisfaction results with data, provided by Burke, Inc, Annual Workforce Perspectives®2018, from a pool of healthcare workers. Workers are from all different settings and levels, so exact comparisons aren’t possible. Overall, however, ASC leaders’ satisfaction is remarkably similar to that of healthcare workers in many areas: current job satisfaction (77% for respondents vs 73% for healthcare workers), total compensation (58% for both), benefits (63% vs 62%), and top leadership (58% vs 57%).
ASC leaders view patient satisfaction with OR services most highly (97% vs 95% in 2017). The only other area that ticked up was support provided by the respondent’s immediate supervisor (from 67% in 2017 to 69% this year; that is lower than the 62% reported for healthcare workers in general). Areas of satisfaction that declined slightly were total compensation (60% in 2017 vs 58% in 2018) and engagement level of staff (75% vs 71%).
Demographics
Overall demographics are listed in the infographic above. The average age of the respondents was 51.7 years, compared with 53.2 years in 2017. That’s still higher than the 48.8 years for nurses reported in the 2015 National Nursing Workforce Survey.
Slightly more ASC leaders hold a master’s degree as their highest level of education (34% this year vs 33% in 2017), a change from the past few years, when more respondents reported a baccalaureate as their highest degree. An associate degree in nursing was the highest earned degree for 20% of respondents, unchanged from 2017.
A trend?
Although satisfaction declined slightly and salary increased slightly, it’s too early to tell if these are trends or a blip on the radar. However, the number of ASC leaders planning to retire before 2026 and the ongoing challenges of meeting the needs of various stakeholders mean that ASC administrators will need to continue their efforts to recruit and retain top leaders.
We asked some top ambulatory surgery center (ASC) leaders, including members of OR Manager’s Editorial Advisory Board, to identify the top challenges ASC leaders are facing. Here are their responses. We believe you will see some of your own challenges reflected in their comments.
Starting new service lines or adding to the existing ones. More procedures are being performed on an outpatient basis, yet the leaders need to ensure safe, effective care in the outpatient setting, and work on costs and outcomes. It is not easy to just move a case traditionally done at the hospital to an ASC.
Meeting patient, physician, and staff expectations. No one can have a great patient experience without physician/provider and employee satisfaction doing well—it takes all three. I like to call this the “triangle” of patient experience. One side is the patient, one side is employees, and the last side is the physicians/providers. If one side is not doing well, the other two will not do well, either.
Competition. ASC leaders need to stay on top of staffing, facility cleanliness, satisfaction, costs, convenient hours, etc because patients and their surgeons have a choice. And that choice may not include the ASC if the carpet in the waiting room was stained last time they visited.
Stewart is director, patient experience, SIU Medicine, Southern Illinois University School of Medicine, Springfield, Illinois.
Declining reimbursements with rising costs. Employee salaries are rising, as employees are hard to find in some cases; supply costs are climbing; pharmaceuticals are unavailable; and, if a center can find the drugs, the costs are exorbitant.
Replacing high-volume physicians who retire, move, or open a competing center. This affects staffing, materials management, and equipment. You need to be honest with the staff about the reduced volume and what you are doing about it.
Staying current with regulations and standards (Centers for Medicare & Medicaid Services [CMS], state, local). Administrators are struggling with this. Many don’t know how to delegate, and they don’t know how to get everything done. Eventually, things are missed, and this affects accreditation and CMS surveys. The key is to delegate, but train the people you delegate to; give them clear expectations and a timeline.
Geier is chief nursing officer, Surgical Information Systems, Alpharetta, Georgia.
Meeting regulatory standards, especially in the areas of Life Safety, including engineering issues related to fire safety and generators. There are not enough engineers who are aware of ASC regulations, and it’s very hard to find someone to ensure we are meeting compliance in regulatory standards (this is especially difficult for centers that have been around for 10 years).
Aging population in nursing and inability to find trained and qualified nurses, especially in the OR. Also, the variety in generations: Baby Boomers’ way of thinking versus the Millennials or Generation X.
Drug shortage and back orders. This results in having to change protocols and use older drugs such as ketamine that staff don’t have experience with, which can lead to patient safety events.
Shimek is senior vice president, clinical operations, United Surgical Partners International, Addison, Texas
Staffing issues. These include covering staff sick calls and needing overtime late in the day when cases run past nurses’ scheduled leave time.
There are numerous other challenges, such as:
- expectations of fast turnover
- constant change in case shift, which affects volume
- educating staff on new procedures
- maintaining high patient satisfaction scores
- meeting budget constraints.
Carpenter is nurse manager, Center for Advanced Medicine Ambulatory Surgery Center, Long Island Jewish Medical Center/Northwell Health System, Lake Success, New York.
Trying to accomplish everything with limited staffing. In the ASC, managers frequently wear many hats—infection control office, safety officer, quality, credentialing, policies, etc. In some facilities, staffing allows for staff nurses to take on and champion these different roles. In others, the business prevents staff nurses from being the champion. How do facilities manage to get it all done? With more procedures becoming outpatient (total joints, spine cases), the unit is very busy. Are ASCs employing two shifts? Day and evening?
Ensuring competency and filling positions. How do managers find the time to ensure competency among staff? Is this done off hours with required attendance? Are ASCs now to the point where they are employing an educator? How are facilities finding qualified staffing? We are expanding services, yet finding qualified staff is very difficult. We are having to rely on travel nurses. Are facilities hiring new graduate nurses? How is training accomplished, especially for OR nurses, who are impossible to find? Are facilities offering sign-on bonuses?
Starting a new service line. When we started doing total joints, it was a very in-depth process and took us over 2 years before we really committed to doing these. A lot of planning went into this. We did site visits, worked closely with the physicians to establish patient selection, and worked on the patient preop routine, patient teaching, etc.
Purchasing the equipment was a huge undertaking—we had to work with the product representatives to bring in instrumentation and implants, etc. We did a walk-through that included all providers, anesthesiologists, the sales representative for the OR table, the representatives for the implants and instruments, physical therapy, and nursing. It has been worth the process, but you really need to be sure you cover all bases.
Quinn is director, Orthopedic Surgery Center, Concord, New Hampshire.
In light of my role in providing support with regulatory compliance, my viewpoint is more limited, but the main trends I see happening are:
- Driving physician and anesthesia provider compliance with policies/standards.
- Time challenges—unable to provide a robust education/training and competency program, conduct the appropriate monitoring, and maintain required documentation.
- Emergency preparedness is a huge issue affecting everyone.
Allison is senior director of regulatory, AMSURG, Nashville, Tennessee.
Cynthia Saver, MS, RN, is president of CLS Development, Inc, Columbia, Maryland, which provides editorial services to healthcare publications.
Data for the OR Manager Salary/Career Survey were collected from March 28 to May 14, 2018. The survey list comprised nurse managers of ASCs who were either OR Manager subscribers or part of an external list. The survey was closed with 161 usable responses. The margin of error is ±5 percentage points at the 95% confidence level. This article features the staffing findings from the survey. Watch for other findings, including compensation and management responsibilities, in the October 2018 issue.
OR Manager thanks those who generously took time to complete this year’s survey. We appreciate your help in gathering this information, which will be useful to your colleagues around the country.
References
Ortman J M, Velkoff V A, Hogan H. An aging nation: The older population in the United States. 2014. https://www.census.gov/prod/2014pubs/p25-1140.pdf.
United States Census Bureau. Older people projected to outnumber children for the first time in US history. 2018. https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html.
