Session: Leadership roundtable panel

Editor's Note

In this wrap-up roundtable discussion, members of the conference planning committee Hazel Boyd, MBA, clinical operations manager at Boston Children’s Hospital; Sheila Stein, MSN, FNP, CNS, CNOR, robotics coordinator at Cayuga Medical Center; and Denise Waslo, MSN, RN, CNOR, CSSM, NE-BC, director of perioperative services at Long Island Jewish Valley Stream, offered their personal perspectives and experiences on the business of managing the surgical suite, tackling challenges with staffing, scheduling, and operating on razor thin margins.

Here are some highlights:

• Staffing

“Our work now requires a lot of flexibility,” said Boyd. “That is something the pandemic changed in our jobs, and that change is here to stay. We have to be flexible with remote work, flex scheduling, and even with patient care.”

Travelers joining their organizations has made for some conflict and frustration among staff, in particular when incoming travel nurses making premium pay are required to shadow long-term staff.

“There’s a sense of betrayal with the loyal staff who stayed,” said Stein, who works at a small community hospital where everyone knows each other. Many nurses who initially stayed left later because of retention bonuses and other incentives that were not offered to them. “It’s wild, to come to work in-person finally and not recognize most of the people there.”

However, they saw some success when it came to rewarding staff and showing them appreciation in creative ways. “Get to know facts about them,” said Waslo. “Stop them to say ‘How are you? How’s your son?’ and show them that you care. These pay rates are not sustainable. Once it dies down, nurses will want a home base.”

• Scheduling

“Our case volume has gone way up,” Boyd said when reflecting on how operations differ from a year ago amid surges and low vaccination rates.

“It’s definitely challenging to staff for elective surgeries right now,” added Stein. “The number of added cases impacts how we run the facility, and our volume fluctuates depending on the staff-to-bed ratio at other community hospitals.”

“It’s the wild west, and there’s no predictability sometimes,” said Waslo. “Our health system invested a lot of money on a joints program 5 years ago. Now joints are going offsite to ASCs [ambulatory surgery centers]. What are we investing to put in its place?”

• Reduced margins

“When has that not been an issue?” joked Stein. The other panelists agree that operating under limited margins has always been par for the course. “We have never had open pockets and been able to get everything we want.”

There has been about a 30% reduction in their capital budgets since the pandemic started, said the panelists. “Where as before we would get maybe 40% of what we asked for, today we get 10%,” Stein added. She explained how certain investments are being seen as side projects and necessary improvements are not being made.

And this proves to be a vicious cycle, the panelists unanimously agreed. “You want to be marketable so you can attract top talent, but surgeons won’t come if you don’t have the right equipment to successfully perform laparoscopy surgery for instance,” said Stein.

“And if patients love their surgeons, they’ll follow them,” Waslo cautioned.

Advanced technology and robotics might not be as much of a draw for nurses or sterile processing staff when it comes to recruiting, but the panelists are still very conscientious of the burden of working with cheap equipment and outdated devices.

“We are trying to retain our people,” said Boyd. “We can’t stop advocating for them and asking for what we need to take care of them.”