salary/career survey or managers report high job asc ......2003/10/05 · from the unnecessary...

October 2003 Vol 19, No 10

The monthly publication for OR decision makers

In this issueManager of Year is leader inOR, community . . . . . . . . . . . . . . . . .5

Jury awards fired OR director $4 million . . . . . . . . . . . . . . . . . . . . . .7

SALARY/CAREER SURVEY.Skill mix in OR remains stable . . . .13

SALARY/CAREER SURVEY.Strong teams are reason to celebrate . . . . . . . . . . . . . . . . . . . .14

SALARY/CAREER SURVEY.Nearly half have computersin each OR . . . . . . . . . . . . . . . . . . . . .15

SALARY/CAREER SURVEY.How satisfied are you withyour position? . . . . . . . . . . . . . . . . . .16

FUTURE OF SURGERY.Big growth forecast for surgery by 2020 . . . . . . . . . . . . . . . .18

RECRUITMENT & RETENTION.Self-scheduling an aid to staffretention . . . . . . . . . . . . . . . . . . . . . .22

WORKPLACE . . . . . . . . . . . . . . . . .26

AMBULATORY SURGERY.More ASC managers receive salary hike . . . . . . . . . . . . . . . . . . . . .27

AMBULATORY SURGERY.Building an ASC team from theground up . . . . . . . . . . . . . . . . . . . . .32

CMS loosens emergency treatment rule . . . . . . . . . . . . . . . . . .36

HEALTH POLICY & POLITICS . .38

AT A GLANCE . . . . . . . . . . . . . . . . .40

ASC section on page 27.

Even with the stresses of managingsurgery departments, the atmos-phere in most ORs is upbeat.

Nearly all of those responding tothis year�s OR Manager Salary/CareerSurvey report good working relation-ships with their physicians. And nineout of ten say their staff works togetheras a cohesive team. This is the first yearthe survey asked managers and direc-tors about their job satisfaction.

If they were to receive an award fortheir OR�s achievements this year, mostwould turn around and give the awardto their staffs, crediting them for teamspirit, accountability, and willingnessto help out when needed.

Salaries top $80,000Salaries for managers and directors

now average over $80,000 a year. Theaverage raise was 4.6%. Raises have out-paced inflation for the past 5 years andcompare favorably with those for man-agers and executives nationally (chart).

The average age of directors hasedged above 50, reflecting the aging ofthe RN population. Five years ago theaverage age was 47.

Purchasing power increasesPurchasing power jumped this

year�with more than two thirds ofmanagers and directors saying theygained influence. That may be becausegroup purchasing reforms are return-ing more decision making to clinicians.

OR Manager�s 13th annual Salary/Career Survey of hospitals was mailed inMay to 1,197 OR Manager subscriberswith management titles in hospitals, witha return rate of 37%. The survey has a 95%confidence level with a margin of error of4.75%. A separate survey was conductedfor ambulatory surgery centers.

RaisesThe vast majority of managers and

directors�87%�received a salaryincrease this year. Those in medium-and large-sized OR departments werea little more likely to receive a payboost than those in small ORs:

Those receiving raisesby size of department1 to 5 ORs 84%6 to 9 ORs 88%10+ ORs 88%

Raises varied little by region. Thosein teaching institutions got slightlyhigher increases (5.2%) than those incommunity hospitals (4.4%).

Those titled �director� received rais-es that were slightly higher (4.7%) thanthose titled �nurse manager.�

Raises for managers and directors raneven with those for staff nurses of alldisciplines. The average staff nurse�s

OR managers report high jobsatisfaction despite pressure

Salary/Career Survey

Continued on page 8

Profile of the typicalhospital OR director

The typical manager of a hospitalOR in the OR Manager Salary/Career Survey:

• Earns an annual base salary of$81,694

• Received a raise of 4.6% of basesalary

• Holds the title of director of sur-gical services

• Works in a community non-teaching hospital (78%) with anaverage of 10 staffed ORs

• Reports to the nursing adminis-tration (73%).

2

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2

Please see the ad for MEDLINE INDUSTRIESin the OR Manager print version.

As their shift draws to a close, thetwo nurses meet in the loungeto change from their scrubs into

street clothes. �Boy, today was tough. I hope there

aren�t too many like that,� commentsMary.

�Mine wasn�t exactly a piece of cake,�commiserated Susie.

�Say, did you see that show the othernight, �Nip/Tuck�?� It is about cosmeticsurgery, and it is supposed to be funny,but I guess I see enough of that duringthe day,� Mary added.

�We probably see enough to script amade-for-TV movie,� Susie suggests.

Mary pauses a moment. �I�ve got anidea. What if we had surgeons who do alot of unnecessary heart surgery on healthypatients because they wanted to make a lotof money. We could use the plot to showpeople how profit drives the health caresystem�in the wrong direction�andwhat can happen when it does.�

Susie quickly gets caught up in theplot. �And of course, we need the whis-tle blowers�among them a handsomeyoung internist who goes to administra-tion to complain that the cardiac surgeonis doing too many procedures . . . proce-dures he thinks aren�t necessary. He istold to mind his own business.�

�But, of course, the administrationdoesn�t pay any attention to the docswho complain because they need to sat-isfy their investors who want to seegrowth in cardiac care so they will makemore money. And senior officials of thecompany that owns the hospital keeppressuring the administrators for largerand larger profits,� continues Mary.

�The part about the patients will be piti-ful,� muses Susie. �They suffer terriblyfrom the unnecessary surgery. Like Mrs W,who has emergency bypass surgery. Sheused to go dancing with her husband andtake long driving trips. Now she can nolonger write or walk steadily. Her husbandhad to quit his job to take care of her.�

�That�s so sad.� Susie goes on,�Another patient is told she has severecoronary disease and needs immediatesurgery. But after her surgery, her cardi-ologist reviews her chart and finds noevidence of serious heart problems.�

�We will need a hero!� both exclaimtogether.

�I�ve got it,� says Mary excitedly.

�Enter a Roman Catholic priest whodecided to have a cardiac stress test atthe hospital. Although he passes the test,the surgeon suggests a trip to thecatheterization lab. While he is still onthe table, the surgeon tells him he needsan emergency triple bypass.

�Leery, the priest consults an accoun-tant friend who persuades him to cometo another hospital for the surgery. Whenhe arrives, the cardiologist asks, �Excuseme, but what are we bypassing?��

�What happens next?� asks Susie. �The priest and the accountant meet

with hospital officials, but when the offi-cials don�t seem concerned, the accoun-tant contacts the Federal Bureau ofInvestigation.

�And, ta da . . . four months later, fed-eral agents raid the hospital.

�After all is said and done, the hospi-tal owner agrees to pay $54 million to thegovernment for billing federal healthprograms for unnecessary care, onlyslightly less than the $55.7 million in out-lier payments it received in 2002.

�So what do you think?� asks Mary,�Would that work as a plot?�

�Nah, it�s too weird,� replied Susie.�It could never happen. Nobody wouldbelieve it. Besides, you need lots of sexand violence for anything on TV. Wewould have to make up some steamyOR scenes.�

She slips into her leather jacket, �Seeyou tomorrow. Hope we both have aneasier day.�

Sometimes fact is stranger than fic-tion.* ❖

�Elinor S. Schrader

*Thanks to the New York Times Aug 12article, �How one hospital benefited on ques-tionable operations,� for the facts aboutRedding Medical Center in Redding, Calif.Redding Medical Center is owned by Tenet.

3October 2003

October 2003 Vol 19, No 10OR Manager is a monthly publication forpersonnel in decision-making positions inthe operating room.

Elinor S. Schrader: PublisherPatricia Patterson: EditorJudith M. Mathias, RN, MA:

Clinical editorBillie Fernsebner, RN, MSN:

Consulting editorJanet K. Schultz, RN, MSN:

Consulting editorKathy Shaneberger, RN, MSN, CNOR:

Consulting editorOR Manager (USPS 743-010), (ISSN

8756-8047) is published monthly by ORManager, Inc, 1807 Second St, Suite 61,Santa Fe, NM 87505-3499. Periodicalspostage paid at Santa Fe, NM and addi-tional post offices. POSTMASTER: Sendaddress changes to OR Manager, PO Box5303, Santa Fe, NM 87502-5303.

OR Manager is indexed in the CumulativeIndex to Nursing and Allied HealthLiterature, the Hospital Literature Index, andthe National Library of Medicine�s HealthPlanning and Administration Database.

Copyright © 2003 OR Manager, Inc. All rightsreserved. No part of this publication may bereproduced without written permission.

Subscription rates: $86 per year. Canadian,$98. Foreign, $108. Single issues $10.Address subscription requests to PO Box5303, Santa Fe, NM 87502-5303. Tele:800/442-9918 or 505/982-0510. Web site:www.ormanager.com

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Advertising Manager: Anthony J. Jannetti,Inc, East Holly Ave/Box 56, Pitman, NJ08071. Telephone: 856/256-2300; Fax:856/589-7463. John R. Schmus, nationaladvertising manager. [email protected]


UpcomingSurgery and ambulancediversion

What does elective surgery have todo with ambulance diversion? A lot.Some hospitals are taking action.

Bargaining with anesthesiagroups

The shortage is easing, but negotiat-ing will still be tough. Read advice fromexperts.

Managing bariatric surgery riskWhat you need to know about the

medical-legal risks.

OR Manager Vol 19, No 10

Editorial

“Excuse me, butwhat are webypassing?

“

4

Please see the ad for KIMBERLY-CLARK CORPORATIONin the OR Manager print version.

Awoman who sees no barriers. Aperson who brings energy intoany room she enters. A leader

not only in the hospital but in her com-munity.

That�s how colleagues see RitaBorden, RN, BSN, the 2003 OR Man-ager of the Year.

Borden was recognized at theManaging Today�s OR Suite conferenceSept 17 to 19 in San Diego.

Borden is executive director of surgicalservices for Sun Health based in Sun City,Ariz, which includes W.O. Boswell andDel E. Webb Memorial Hospitals.

During her tenure, she has overseensurgical services� growth from five ORsand 13 staff members to 22 ORs and 235employees. She is responsible for thedepartments of surgery, postanesthesiacare, cardiac care, outpatient surgery, IV

therapy, endoscopy, and dialysis inboth facilities.

Borden�s nominating letters citedmany accomplishments�leading Sun

Health�s Heart Center, named as one ofthe nation�s Top 100 cardiac programs forthe second year in a row; increasing surgi-cal volume at Del E. Webb by 20%; lower-ing costs in orthopedics; and building acareer ladder for surgical technologists(STs), among others.

She has worked to address gaps in thesurgical schedule that enabled the systemto recruit new anesthesiologists during anationwide shortage.

�We do what we need to do to makeour facility attractive to physicians,�Borden commented for a profile in theJanuary 2003 OR Manager.

She has helped create an environmentthat retains nurses, with a turnover ratelower than the national average. Thetraining program she developed for STs,the only one in the state, draws from thecentral service department and givestechs a career advancement path.

A family unitOf all her achievements, she treasures

a close relationship with her leaders andstaff.

�Rita organizes fun events for her staffand families,� writes Rita Mathis, RN,BSN, a staff nurse in the OR. �She hasinstilled good rapport among her staff,and we all feel like a family unit and workwell together.�

JoAnne M. Andrews, RN, manager ofsame-day surgery at Boswell adds, �Sheknows every staff member and their fami-lies. She recognizes little and big accom-plishments with praise, a hug, and giftcertificates.

�I value going to work every day. Atthe end of the day, I feel I was part of acaring and competent team. Rita is theenergy behind all of this.�

Borden is also a leader in her commu-nity.

In August 2002, she was recognizedwith the Health Care Hero Award fromthe Arizona Business Journal, one of eighthonorees selected from 100 nominees.

Along with family members, she isdedicated to causes, including the CysticFibrosis Foundation and the ArthritisFoundation. After her 16-year-old grand-daughter, Brittany, died of cystic fibrosislast year, Borden and her daughter orga-nized a charity golf tournament thatraised $125,000. The money was used tobuild an outdoor stage at PhoenixChildren�s Hospital to honor Brittany�sinterest in acting. ❖

Manager of Year is leader in OR, community

5OR Manager Vol 19, No 10October 2003

Gail Avigne, RN, BA, CNORNurse managerShands Hospital at the University of Florida, Gainesville

Mark E. Bruley, EITVice president of accident & forensicinvestigation, ECRIPlymouth Meeting, Pa

Judith Canfield, RNC, MNA, MBAAssociate administrator of surgical servicesUniversity of Washington MedicalCenter, Seattle, Wash

Michele Chotkowski, RN, MSHADirector, perioperative servicesCentral DuPage Hospital/CentralDuPage HealthWinfield, Ill

DeNene G. Cofield, RN, BSN, CNORDirector of surgical servicesMedical Center EastBirmingham, Ala

Larry Creech, RN, MBA, CDTVice president, perioperative servicesClarian Health SystemIndianapolis, Ind

Cheryl Dendy, RNAdministrative director, AmbulatorySatellites, St John Hospital and MedicalCenter, Detroit

Franklin Dexter, MD, PhDAssociate professorDepartment of AnesthesiaUniversity of Iowa, Iowa City

Aileen Killen, RN, PhD, CNORDirector of nursing, perioperative servicesMemorial Sloan-Kettering Cancer CenterNew York City

Robert V. Rege, MDProfessor and chairmanDepartment of SurgeryUT Southwestern Medical CenterDallas, Tex

Marimargaret Reichert, RN, MAAdministrator, Surgical Care CenterSouthwest General Health CenterMiddleburg Heights, Ohio

Kathy E. Shaneberger, RN, MSN, CNORDirector, perioperative services andortho/neuro service lineMercy General Health PartnersMuskegon, Mich

Shelly Schwedhelm, RN, BSNDirector, perioperative servicesNebraska Health System, Omaha

Sallie Walker, RN, BA, CGRNBaptist Physicians Surgery CenterLexington, Ky

Allen WarrenBusiness manager, surgical servicesMission St Joseph�s HospitalAsheville, NC

Anny Yeung, RN, MPA, CNOR, CNAAAssistant vice president for perioperative services & associate hospital directorSUNY Downstate Medical CenterNew York City

Advisory Board

Rita Borden, RN, BSN

6

Please see the ad for OLYMPUS ENDOSCOPYin the OR Manager print version.

Afederal court jury awarded aformer OR director $4 millionon Sept 2 after finding she was

fired for trying to enforce a hospital�ssexual harassment policies.

The award to Stephanie Denning-hoff, former OR director at Bon SecoursDePaul Medical Center in Norfolk, Va,is expected to be reduced to $300,000plus pay because of a federal cap ondamages in civil rights cases.

Denninghoff said she was fired afterresponding to complaints from employ-ees about a staff nurse�s �sexuallycharged� conduct, according to courtpapers filed by the Equal EmploymentOpportunity Commission (EEOC).

Denninghoff said she took steps toaddress the complaints, including seek-ing the advice of the Human ResourcesDepartment, conducting sexual harass-ment training for the staff, and counsel-ing the nurse with HR�s involvement.

The staff nurse then complained tophysicians and administrators abouther treatment, according to the EEOC.As a result, a prominent physiciandecided to move most of his cases toanother hospital. He said he wouldreturn only if the hospital firedDenninghoff, which it did, the EEOC�sfilings stated.

Denninghoff then filed a complaintwith the EEOC.

The award is believed to be the high-est for an employment discriminationcase in a federal court in Virginia,according to Amy Garber, the attorneywho argued the case for the EEOC.

The hospital said it would ask thejudge to set the entire verdict aside.

�The jury�s verdict is so extreme asto be out of keeping with reality,� thehospital�s attorney, William E. Rachels,Jr, told the local newspaper, theVirginian-Pilot.

A call to the hospital by OR Managerwas not returned by press time.

What made the case compelling wasthat Denninghoff had taken the propersteps and involved HR, Garber said. �Ithink the jury responded to a managerwho was playing by the rules and anemployee who didn�t think the rulesapplied to her.�

Complaints about a nurse’sbehavior

Denninghoff spoke about the case inan interview with OR Manager. The

incidents took place while she was ORdirector at Bon Secours DePaul fromJune 21, 2000, until her firing on Aug29, 2001. She supervised about 100employees and six staffed ORs.

In December 2000, Denninghoff saidshe started receiving complaints aboutan OR staff nurse from nurse anes-thetists who worked with the nurse inthe OR. She said she did not witness theincidents personally.

Complaints concerned behaviorbetween the staff nurse and physicianssuch as hugging, kissing, and carryingher from room to room.

�It was more than friendly behav-ior,� Denninghoff said.

In response, Denninghoff said sheworked with the HR department toprovide sexual harassment training forthe entire department, �hoping every-one would get the idea of what wasappropriate behavior.�

Complaints died down for 2 months,then resurfaced.

This time, HR recommended coun-seling for the nurse. The counselingwas conducted by an HR person,Denninghoff, and a nurse manageraway from the department. They toldthe nurse about the complaints andasked her to change her behavior.

The nurse objected to being coun-seled and �made her objections knownboth to colleagues and physicians� inthe OR, according to the EEOC papers.

After a series of communicationsbetween the staff nurse, physicians, andthe hospital administrator, the adminis-trator apologized to the staff nurse forthe counseling and said Denninghoffhad been counseled about it, accordingto the EEOC. Nevertheless, the staffnurse resigned.

A prominent physician, a gynecolog-ic oncologist, protested her treatmentand said he was taking his business to

another hospital. His loss was �keenlyfelt by the hospital, which made signifi-cant efforts to retain his business,�according to the EEOC.

Administrators went to his office toask him what it would take for him toreturn. He replied he would return afterthe hospital fired Denninghoff. Within afew weeks, she was fired. She was toldshe had mishandled two issues�thenurse�s counseling and one other. Thehospital later tried to claim Denning-hoff was fired for other reasons, thoughher personnel record had only praisefor her performance, according to theEEOC.

Six days after Denninghoff left, thestaff nurse, who had threatened to suethe hospital for falsely accusing her ofsexual harassment, returned to work atthe hospital.

Asked why she decided to go to theEEOC, Denninghoff said, �The mainthing was the fact that I knew I hadbeen protecting the rights of the nurseswho had the courage to bring theircomplaints to me.

�I also knew I had followed the hos-pital�s policy. In my mind, I hadn�tdone anything wrong.

�The bottom line is that a jury of mypeers saw the same thing I saw and thesame thing the EEOC saw. It sends amessage to the hospital that they needto get back to their basic values.�

Garber said it is �relatively rare� forthe EEOC to take a case to court. Inmost cases, the agency can�t determinethere was a violation and tells individu-als they can decide whether to sue ontheir own. When a violation is found, itis usually settled without a trial. In thiscase, the EEOC thought the facts wereclear enough to litigate, Garber said.

The EEOC (www.eeoc.gov) is a fed-eral agency that enforces civil rightslaws. ❖


Jury awards fired OR director $4 million

“I knew I hadfollowed the

hospital’s policy.

“

Have an idea?Do you have a topic you’d like to see

covered in OR Manager?Have you completed a project youthink would be of help to others?

We’d be glad to consider your suggestions. Please e-mail Editor

Pat Patterson at [email protected]

8 OR Manager Vol 19, No 10 October 2003

raise nationally was 4.6%, according tothe Hospital and Healthcare Compen-sation Service (www.hhcsinc.com). Staffnurse raises dropped back from lastyear, when the average was 8.7%.

Annual salariesAverage annual salaries for OR man-

agers and directors rose only slightly to$81,694 from $81,655 in 2002.

Those with the title �director� earnedan average of $85,165, while those withthe title �nurse manager� earned anaverage of $68,032.

Who’s making the most?Those in the West have the highest

salaries, averaging $89,189, almost$8,000 higher than the national average.

The highest pay is earned by thosein teaching hospitals, managing 10 or

more operating rooms, and havingmulticampus responsibilities.

Manager bonuses andincentives

The percentage eligible for a bonus,40%, is similar to last year�s 43% buthigher than the 34% reported 5 yearsago.

Bonuses are most popular in the

West (52%) and least popular in theEast (28%). Large- and medium-sizeddepartments are far more likely to offeran incentive than small ones:

Those receiving bonusesby size of OR

1 to 5 ORs 29%6 to 9 ORs 42%10+ ORs 47%

The average bonus is 8.5% of basesalary, with 42% receiving more than 8%.

Bonuses are far more common forthose with the title �director� (44%)than �nurse manager� (31%). The aver-age bonus for a director is 9.2% of basesalary; the average for nurse managersis 6.2%.

BenefitsMost benefits have remained stable,

with the exception of health insurance.Many respondents wrote in that theyhad seen an increase in their copaysand deductibles this year. This is part ofa national trend as many employerstrim health benefits in the face of risingpremium costs.

A few commented that eye-care ben-efits had been dropped, while otherssaid eye and dental benefits had beenadded.

Tuition is one benefit that hasimproved. With the nursing shortage,more organizations are boosting tuition


Hospital respondents to surveyRegion Distribution Response

East 176 (15%) 16%South 406 (34%) 26%Central 363 (30%) 32%West 255 (21%) 21%

Continued from page 1

Average annual salary by region

West$89,189

South$80,260

Central$78,199

East$80,352

Continued on page 10

1%

2%

3%

4%

5%

6%Consumer price index (CPI-U)

1999 2000 2001 2002 2003

All executives and managers

OR managers

Note: CPI-U is seasonally adjusted for June 2003.

Source: OR Manager, Inc; U S Department of Labor, Employment Cost Index, Wagesand Salaries, July 31, 2003.

How OR leaders’raises compare

9

Please see the ad for BOVIE MEDICAL

in the OR Manager print version.

assistance as part of their strategy toattract and retain nurses.

Benefits 2003 2000 1998Health insurance 99% 99% 98%Dependent health

insurance 76% 81% 69%Life insurance 94% 97% 94%Retirement plan 92% 93% 91%Dental insurance 93% 94% 89%Disability ins 81% 86% 83%Paid time off 99% � �Tuition reimb 90% 86% 81%Eye care 60% 54% 47%

About your organizationMore than three quarters of respon-

dents (78%) are from community hospi-tals, with 20% from teaching institutionsand the rest from other types of hospitals.

Respondents are more likely to beemployed by a freestanding hospital(54%) than one that is part of a healthcare system (42%).

About your roleTitle and work area. The most com-

mon title for respondents is director(71%), followed by manager or nursemanager (26%).

Most (62%) refer to their work area as�surgical services.� The term �periopera-tive services� has gradually grown inpopularity, with 20% using it this yearcompared with 12% in 1998. As in pastyears, this title is more common in theEast (25%) than in other regions.

Reporting structure. As in pastyears, respondents are much more like-ly to report to the nursing administra-tion (73%) than to the hospital adminis-tration (21%) or any other entity. Lessthan 1% (N=2) report to an OR medicaldirector, a percentage that also hasremained stable over the years.

Managing beyond the OR. Nearlyall of the survey respondents (90%)have a role that extends beyond theoperating room.

The largest group (79%) managesthe OR plus other departments in thesame hospital. These managers anddirectors head an average of:� five departments�with 4% (N=13)

having ten or more units

� 10 ORs

� 72 clinical and 19 nonclinical FTEs.They are responsible for an average

annual budget of $11.3 million.For 11% (N=51) of respondents, the

role extends beyond the hospital tomultiple facilities. Those with multi-siteresponsibilities oversee an average of:� nine departments

� 16 ORs

� 121 clinical and 27 nonclinical FTEs.The average budget they manage is

$18.7 million.Compared with 10 years ago, man-

agers and directors are much more like-ly to have responsibility for the centralservice area�71% versus 40% in 1993�




To whom do you report?Other6%OR medical

director<1%

Hospitaladmin21%

Nursing admin73%

Who reports torespondents?

2003 1998Postanesthesia 88% 90%Outpatient surgery 78% 79%Central service 71% --GI/endoscopy 65% 54%Anesthesia support 59% --Preadmission 55% 49%Perfusion services 16% --Materials management 8% --Inpatient units 5% --Cardiac cath lab 4% 6%Emergency/trauma 2% 2%ICU 2% --


Average annual salary by scope of role

0

$20,000

$40,000

$60,000

$80,000

$100,000

Multiplesites

(N=50)

$92,256

OR+otherdepts

(N=347)

$80,806

OR only(N=41)

$76,334

Average annual salary by number of ORs

0

$20,000

$40,000

$60,000

$80,000

$100,000

10+ OR (N=174)

6-9 ORs(N=111)

1-5 ORs(N=41)

$92,197

$80,406

$70,074

Average annual salary by facility type

0

$20,000

$40,000

$60,000

$80,000

$100,000

Teaching(N=86)

$86,114

Community(N=341)

$80,195

11

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and the GI/endoscopy unit�65% ver-sus 44% a decade ago.

More than half (59%) manage anes-thesia support functions, and a fewhave responsibility for inpatient units,the cardiac cath lab, emergency/traumaservices, and intensive care units.

Respondents, primarily from smallfacilities, wrote in that their scopeincludes a wide variety of other units,ranging from the pain clinic to the der-matology clinic. Also mentioned wereobstetrics, infection control, radiology,ambulatory clinics, dialysis, PRN andtemporary staff, and employee health.

Purchasing powerOR managers and directors could be

regaining some of their purchasingclout.

More than two thirds�68%�saytheir purchasing role increased in thepast year. That is the largest increasereported since this question was firstasked in 1999. It is much higher thanthe 24% who said their involvementhad risen last year.

Also up is the number who say theyare the primary decision maker�41%compared with 35% in 1999. Leaders ofsmall ORs (1 to 5 rooms) are most likelyto be the primary decision maker (55%).There was little difference by title.

One possible reason for the shift isgroup purchasing reforms in the pastyear. As Congress has put more pres-sure on group purchasing organiza-tions, they are reforming practices suchas bundled contracts with unrelateditems and sole-source agreements.GPOs say they are increasing theamount of clinician input. (SeeSeptember OR Manager.)

About the operating roomNumber of ORs. Those with the title

�director� manage an average of 11ORs, while those with the title �manag-er� are responsible for an average of 7

ORs. They report an average annualsurgical case volume of 7,695.

Surgical volumes. The majority,55%, saw their surgical volumes rise inthe past year; 27% said volumesremained about the same; and 18%reported a decline. The average volumeincrease was 10%.




Has surgical volumeincreased?

No change27%

Decreased18%

Increased55%

What is the OR’s overallannual budget?1-5 ORs 6-9 ORs 10+ ORs

$4.1 $9.3 $19.2million million million

How many clinical FTEs are under your span of control?

By facility type By number of ORs By title

Community Teaching 1-5 6-9 10+ Director Manager

Clinical 65 118 28 56 132 83 38

Nonclinical 16 32 5 12 37 21 9

About youHighest degree

Associate12%

Diploma13%

Bachelor’s36%

Master’s39%

Master’s12%Associate

19%

Diploma26%

Bachelor’s43%

Managers

Directors

Average age increasing

2003: 502001: 491998: 47

What do you call yourwork area?

Other6%

Periopnursing

20%

Operatingroom 12%

Surgical services62%

Managing multiple sites

How many sites do you manage?

Director Manager

OR only within one hospital 7% 25%

OR & other depts within one hospital 80% 72%

OR only at multiple sites <1% --

OR & other depts at multiple sites 13% 3%


OR budget. Those with the title�director� manage an average annualbudget of $15.9 million. For those with thetitle �nurse manager,� the average annualbudget they oversee is $11.8 million.

About youAge, gender. The average age of

managers and directors is creeping up.The average age in this year�s survey is50, compared with 47 in 1998.

Consistent with past years, 88% ofrespondents are female, and 12% aremale. Less than 1% (N=4) are not RNs.

Education. The level of educationcontinues to rise. This year, for thosewith the title �director,� more have amaster�s degree than a bachelor�s only.The most common master �s is anMS/MSN (50%), followed by an MBA(38%) or another master�s (12%).

For those with the title �nurse man-ager,� the most common degree is abachelor �s, followed by a diploma,associate degree, and master�s.

Most respondents�71% of directorsand 54% of managers�say theiremployer requires a specific degree fortheir position. For directors, 58% saytheir position calls for a bachelor�s and39% for a master�s. When a degree isspecified for nurse managers, almostalways (92%) it is a bachelor�s; only 3%mandate a master�s. ❖

The OR Manager Salary/Career Survey iscoordinated by Billie Fernsebner, RN, MSN.


The skill mix in the operating room, atroughly 60:40, continues to see little change.

The ratio of RNs to surgical technologists(STs) has held steady since OR Manager begancollecting this data in 1995.

A small number of hospital respondents tothis year�s Salary/Career Survey, 6% (N=26),continue to have a staff that is 90% or moreRNs. Most (N=21) are small facilities with fiveor fewer ORs.

Only 1% (N=6) of respondents allow STs tocirculate with an RN immediately available, which means outside the operat-ing room but in the immediate area. These were evenly split by size of facility;five were community hospitals, and one was a teaching institution.

Ambulatory surgery centers. The skill mix for ASCs is very similar to that ofhospitals: 65:35. Like hospitals, most ASCs (86%) do not report STs circulating.A few, 8% (N=12) have STs circulating with an RN in the same room, and 6%(N=8) allow STs to circulate with an RN immediately available.

Skill mix in OR remains stable

Ratio of RNs to surgical techs

2003: 64:362001: 62:361999: 65:351997: 66:331995: 69:31

Do surgical techs circulate?2003 1998

Yes, RNavailable

1%Yes, RNin room

8%

No91%

On theirown1%

Yes, RNavailable

3%

Yes, RNin room

15%

NoNo81%81%

What is your role inpurchasing decisions?

Committeemember

42%

Advisory17%

Primarydecision maker

41%

Thank youOR Manager thanks its subscribers who

generously took time to complete thisyear’s survey.

We appreciate your part in gatheringthis information, which will be useful toyour colleagues around the country.

Do you have an OR business manager?

No80%

Yes20%

By number of ORs

1+ ORs 6-9 ORs 10+ ORs5% 13% 37%

By facility type

Community Teaching15% 36%



Despite constant pressure to savemoney, improve safety, andrespond to staffing challenges,

OR managers and directors find muchto celebrate.

The Salary/Career Survey asked, �Ifyour OR were to receive the �goldenscalpel� award this year for an accom-plishment, what would it be for?�

Most often mentioned�a cohesivestaff and good results with recruitmentand retention despite a shortage ofexperienced perioperative personnel.

These managers said staff team-work plus stable staffing enabledthem to carry out successful perfor-mance improvement and patient safe-ty projects.

Kudos to hard-working staff

More than any other thing, managerscount a close working relationship withtheir staffs as their greatest achievement.Here�s a sampling of their comments:

�I have never worked with such acohesive staff. When a case finishes,they call out, and everyone free actuallygoes and helps with turnover, and theydon�t complain. They are all wellversed in their experience, and all havea pleasant personality.�

�Manager who took a new position ina four-room OR in Nevada

�The surgical services teams are whatmakes these departments work. I don�tknow how or why, but the staff in mydepartments work cohesively and posi-tively together for the benefit of thepatient. Their goals are good dayswhere everything clicks, and patientsand surgeons are happy.�

�A competing ASC opened in the fallof 2001. My staff have struggled toovercome the anger associated withthis, as the same physicians utilize thehospital for inpatient procedures. It hasbeen a tough 18 months, but they haveestablished a good working rapportwith the docs.�

�We went from 50% travelers to zero.The staff became involved in teamdevelopment and a blame-free problem

solution process. Staff was involved inpromotion of a safety-first environmentfor patient, staff, and physicians.�

�My staff should receive a goldenscalpel award for living the GoldenRule. They treat each patient as aunique individual. In the last 12months, they innovated staffing nearlyevery day to provide the same highlevel of care during prolonged staffabsences due to family illness andemergencies.

�Manager of five-room OR and otherdepartments in rural Iowa

�My staff is cross-trained to work allareas. On any given day, an RN maycirculate cases, scrub, work in thePACU, or do preop teaching and helpin the same-day surgery area. We are afamily and work together and supportone another.�

�Manager of five-room OR inMississippi

�The staff is a great team, account-able for what is needed in our depart-ment. They will work through lunch tokeep cases going and not complain.When asked, they will always be thereto help patients and MDs.�

�Director of four-room OR in ruralFlorida

�Developed a scheduling committee(staff only) including RNs of variousseniority and STs. Rocky start. Directorwas only involved in providing numberof staff needed for each shift. Staff [now]much more willing to cover off shiftswith set schedule. Open-heart calldecreased by 2 FTEs. Staff now loveschedule and will cover even the Sun-day shifts. Zero turnover in past year.�

�Manager of 16-room OR in WestVirginia

�Sterile processing remodel forcedus to process instrument trays in ORsubsterile areas. That increased posi-tive communication between OR andCS staff.�

Recruiting, retaining staff

Many reported their success inattracting and preparing new RNs who

did not have previous experience insurgery:

�Our retention of staff is remarkable.In my 10 1/2 years, only one person leftbecause she didn�t like it, and she askedto come back several months later.Being the manager here is easierbecause of the truly compassionatestaff. It is more like a family. Our case-load has increased dramatically, andeveryone adjusts by helping eachother.�

�Manager of four-OR ambulatorysurgery center

�We have offered the Periop 101course [by the Association ofperiOperative Registered Nurses]through a consortium in the state ofAlaska. Twelve hospitals are participat-ing. We were the first to graduate anurse who had no OR experience. Shewas up and running in six months tak-ing independent call. We can�t wait forthe next opportunity.�

�Manager of three-room OR in ruralAlaska

�Community reputation for fairwork environment attracts personnel.Serve as site for university BSN seniormanagement students 8 hours perweek for 6 weeks. Staff is active towardimproving relations with high schoolshadow program and students on site.�

�We receive a golden scalpel awardalmost every time we receive a patient(satisfaction) survey. The patients arevery complimentary, stating that ourstaff makes them feel comfortable andat ease; that the staff is caring and kind,friendly, professional, cheerful, infor-mative, organized, and that we work

Strong teams are reason to celebrate



Nearly half have computers in each OR

Yes, by size of ASC

Is there a computer in each OR?

Hospitals

No54%

Yes46%

ASCs

No87%

Yes13%

Yes, by size of OR

1+ ORs 6-9 ORs 10+ ORs34% 45% 57%

< 5 ORs 5+ ORs13% 10%

(N=10) (N=6)

Computers in each ORare used for:

Hospital ASC

Inventory control 29% 39%

Patient charges 48% 50%

Intraop documentation 72% 61%

Other 32% 39%

Automation in surgical services hasarrived.

All but two respondents in this year�shospital Salary/Career Survey have acomputerized management informationsystem (IS) for their departments. Thetwo that do not are both small facilitieswith five or fewer ORs.

Also up sharply are those with com-puters in each operating room, 46% thisyear compared with 28% in 1998.

Though computers are more widelyused, the majority of hospital ORs�53%�don�t have a dedicated informa-tion specialist to support their systems.

For the 47% who do, most (75%) havea specialist within their own departmentrather than in the IS department.

Application of automation extendsbeyond the usual functions of charges,documentation, and inventory control.Among other uses are digital imaging,laboratory data, order entry, immediatepostoperative notes for physicians, andpolicy and procedure manuals.

Automation use also has taken a bigjump in ambulatory surgery centers,with 88% having information systemsthis year compared with 66% in 1998.

Most haven�t yet extended its use toeach operating room, however.

well as a team. The RNs are very wellqualified. We do ENT, cataracts, andretinal procedures. Most of our staffhave been here for 8 to15 years.

�Manager of ambulatory surgerycenter

�This is our tenth year for a summerextern program. Three students in theirjunior year spend 10 weeks learningbasics of OR nursing. The intent is tohave three available full-time RNs eachyear from our school of nursing.

�Director of 15-room OR inPennsylvania

�We are fully staffed. Our focus hasshifted from recruitment and retentionto retention and attraction. We haveworked with the medical staff to com-ply with the National Patient SafetyGoals. We have increased our volume16% in the past year. We celebrateoften, and the staff are quick to applaudexceptional work. Life is good.�

Improving patient safety

With national initiatives, patientsafety projects have been high priori-ties. Examples of what ORs haveaccomplished:

�Labeling of medications on sterilefield, establishing ways to determinecorrect site, documentation of nearmisses, and follow-up with staff to dis-cuss ways to correct for near misses.�

�Manager of three-room OR in ruralIllinois

�Learning the six safety goals issuedby JCAHO. The staff all adjusted verywell and handled obstinate physicianswith tact and professionalism.�

�Within 1 month, we achieved 100%compliance with surgeons and nursesmarking and ID-ing the patient�s site.�

Futureconferences

Future dates for conferencesoffered by OR Manager, Inc:

Managing Today’s OR Suite

Oct 6 to 8, 2004Hyatt Regency Chicago

Oct 12 to 14, 2005Manchester Grand Hyatt

San Diego

OR BusinessManagement

May 12 to 14, 2004Hyatt Regency Downtown

Albuquerque, NM



Running a surgical suite is adifficult job but also a satis-fying one, judging from

responses to the OR ManagerSalary/Career Survey.

The overwhelming majority ofmanagers say they are satisfiedwith their support and communi-cation from senior management.

Though in the past, managershave counted among their chal-lenges friction with physicians andstaffs who were reluctant tochange, in this survey they report ahigh level of satisfaction with theirprofessional relationships. Nearlyall managers say they have a posi-tive relationship with their MDs.And nine out of ten say they have acohesive staff.

Though budgets for educationhave been cut in recent years, mostfeel they have adequate opportuni-ties for continuing education.Satisfaction on this issue was a lit-tle lower for ambulatory surgerycenters.

Satisfaction dipped in twoareas�pay and recognition. Aslimmer majority thinks their payis in line with their responsibilities,and many would like to see morerecognition for what they achieve.

OR directors� satisfaction withpay is on a par with that of chiefnurse executives across the coun-try; 60% thought their pay was fairand equitable in a survey byrecruiters Witt/Kieffer.

This is the first year the surveyhas asked about managers� satis-faction.

How satisfied are you with your position? . . . you receive adequate

support from uppermanagement?

Hospitals ASCsYes 84% Yes 85%No 16% No 15%

. . . you receive adequatecommunication from your

administration?


. . . you have a positiverelationship with your

physicians?

Hospitals ASCsYes 98% Yes 99% No 2% No 1%

. . . your staff workstogether as a cohesive

team?


. . . you have adequateopportunities for

continuing education?


. . . your salary structure iscommensurate with your

position?Hospitals ASCsYes 56% Yes 61%No 44% No 39%

. . . you receive adequaterecognition for your

achievements?


Do you believe...

OR Benchmarks plansstudy of gastric bypass

With bariatric procedures growingannually, facilities are interested in mea-suring their costs. OR Benchmarks is con-ducting a special study of the laparoscop-ic gastric bypass procedure.

Some 80,000 bariatric procedures wereperformed last year, and the number isexpected to climb to 120,000 this year.The number of people eligible for theprocedure is expected to grow by 10% to12% per year.

Insurance plans are often reluctant topay for this procedure. Facilities thatknow their costs will be able to calculatetheir return on investment and will be ina stronger negotiating position with pay-ers.

OR Benchmarks�s procedure studiesinclude direct costs for supplies, anesthe-sia, and labor. Case times are included forthe procedure as well as for prep, induc-tion, and turnover times. Facilities� costswill be compared with like facilities.Differences in costs are analyzed to pointout opportunities for cost savings.

The fee to participate is $1,500. To reg-ister on-line, go to www.orbenchmarks.com or for more information, call JudyDahle, RN, MS, director of OR Bench-marks, at 877/877-4031. ❖

Boomers busting for bionics

New vanity procedures for agingbaby boomers range from shoulderrepairs to knee-cartilage-cell transplants,according to the Aug 22 Wall StreetJournal.

Helping spur the movement are newprocedures with shorter recovery times,plus the fact that insurance companiespay for many of these procedures.Experts say this helps explain a jump inorthopedic surgery.

Oxford Health Plans reports a 63%rise in arthroscopic shoulder surgeries inmiddle-aged patients in the past 3 years.Knee replacements doubled in the 38- to56-year-old age group from 1996 to 2001.

Hospitals and manufacturers arepumping these procedures with TV, printcampaigns, and pop-up ads on the web.

Lost in much of the advertising, how-ever, is the fact that these procedures mayinvolve painful recoveries, and boomersdon�t recover as easily as they did in their20s. ❖

�www.wsj.com. Subscription required.

17

Please see the ad for TRUMPF MEDICAL INC.


The over-65 population will swellby 53% by 2020. Who will per-form their surgery?

Not only will perioperative RNs bein short supply. Surgeons could also bescarce.

A new study from UCLA finds thedemand for some types of surgerycould increase by nearly 50% in thenext 20 years.

Cataract procedures will see thebiggest growth�47%�followed bycardiothoracic surgery, expected to riseby 42%.

Growth also is forecast for urology(35%), orthopedics, and neurosurgery(both 28%). General surgery willincrease by 31%.

The only specialty that won�t keeppace with the population growth is ear,nose, and throat because a large shareof those procedures are performed inpatients under 15.

Enough surgeons?�We may wake up and find our-

selves without enough surgeons to pro-vide surgical care,� says David A.Etzioni, MD, a general surgeon atUCLA and lead author of the study.

He and his colleagues conducted thestudy by obtaining government data onage-specific rates of procedures in 1996,calculating the amount of surgical workinvolved, and combining that with pop-ulation forecasts to predict the futureuse of surgical services.

Basically, he says, �We took a snap-shot in time to ask what would happenif services are provided at the same ratethey are now.�

This approach has some limitationsbecause it assumes the demand forsurgery will remain constant. Thiscould change with new technology andmore noninvasive therapy, though henotes that hasn�t happened yet.

�There is the misguided notion thatmedical therapies are going to make theOR a dinosaur,� Dr Etzioni says. �Butas a result of increasing technology,we�re seeing more procedures, some ofwhich are minimally invasive.�

But trends in the physician work-force have been notoriously hard topredict. In the 1980s, a report projectedthere would a surplus of 145,000 physi-

cians. A follow-up report in 1991 con-flicted with the earlier findings andforecasted the need would grow in cer-tain areas.

Technology has an influence.Coronary artery bypass surgery hasfallen by more than 20% while cardiacstent procedures have doubled.

Predicting need difficultAny attempt to predict the need for

physicians is difficult, Richard Cooper,MD, another labor force researcher atthe Medical College of Wisconsin�sHealth Policy Institute in Milwaukee,

told American Medical News (Aug 25).�You just can�t extrapolate a lot from

surveys that way,� Dr Cooper said.�Who knows what will happen nextyear, let alone in 10 years? It�s a givenan aging population will need morehips and knees and things. You onlyknow they�ll need more, but you don�tknow what it will be.�

On the other hand, Dr Etzioni notesthat other recent analyses, includingone by Dr Cooper, also project a short-age of physicians, particularly special-ists, within the next 20 years.


Future of surgery

Big growth forecast for surgery by 2020Surgeons’ workload could rise by 2020

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

2001 2010

Year

% I

ncr

ease

(re

lati

ve t

o 2

001)

2020

Neurosurgery

Cardiothoracic

General surgery*

US population

Urology

Orthopedics

Otolaryngology

Ophthalmology

*Category includes vascular, breast, hernia, abdominal, gastrointestinal, and pediatricprocedures.

Source: Etzioni, DA, et al. Annals of Surgery. August 2003;238:170-177. Reprinted with permission.


19

Please see the ad for ADVANCED STERILIZATION PRODUCTS


Doing more with fewersurgeons

Assuming demand for surgery rises,an important question will be how tohelp surgeons get more done.

�I think we�ll see change occurringon several fronts,� Dr Etzioni told ORManager.

�One solution is to train more sur-geons. But that usually takes a decade.Even if we start when the shortagebegins, we�ll be behind.�

Two other possibilities are to asksurgeons to work harder and for surgi-cal facilities to make better use of theirtime.

Will surgeons work harder?But will surgeons be inclined to

work harder when malpractice premi-ums are rising and reimbursement isfalling? In fact, the opposite seems to behappening, with some surgeons cuttingback on their practices or retiring early.

�We didn�t do research on that,� DrEtzioni says. �But the implication isthat if health care doesn�t treat surgeonswell, they will vote with their feet.�Physicians are leaving states thathaven�t taken action to curb malprac-tice rates, for instance.

�Surgeons will be in demand. It isgoing to be up to states, hospitals, andhealth care systems to make them wel-come,� he says.

Other possible strategies are reliev-ing the paperwork burden and havingORs function more efficiently.

�Any surgeon and hospital couldidentify things surgeons don�t have tobe doing,� he says. �That doesn�t meanabsolving them of all nonproceduralwork but making it so they can focusmore on procedures.�

Some of the work might be divertedto other providers like physicians�assistants and advanced practice nurs-es, he suggests.

�We might be seeing this in carebefore and after surgery,� he says. �Wemight also see it in some of the lessintense areas. For example, you mighthave prolonged skin closures per-formed by nurse practitioners or PAs.�

That, of course, raises the questionabout whether there will be enoughnurses and PAs to take on these roles.

Getting a lifeAnother trend that could affect the

supply of surgeons is younger peoples�wish for more control over their lives.

Medical students are paying moreattention to issues like the amount ofcall and time for families when theychoose a specialty. A new study led byE. Ray Dorsey, MD, MBA, published inJAMA found a strong associationbetween specialties chosen by medicalschool seniors and controllable lifestyle.

There was a significant shift from1996 to 2002, with the number of stu-dents ranking surgery as their firstchoice declining from 10.4% to 7.6%.Interest in anesthesiology, which is per-ceived to have a more controllablelifestyle, rose from 1.2% to 6.4%.

Another report found the percentageof senior students who thought generalsurgeons have �inadequate control overtheir time� rose from 67% to 92% from1997 to 2001.

�The students say they don�t want towork the long hours of my generation,�comments Kirby Bland, MD, FACS, ofthe University of Alabama, Birming-ham, who studies the general surgeryworkforce.

�They see their colleagues in the ERwith a 4-year residency without thesame number of hours and the guaran-tee that when they�re off, they�re off.�

New limits in residents� work hoursby the Accreditation Council for Grad-uate Medical Education, which tookeffect July 1, have helped a bit. Generalsurgery filled 99% of its residency slotsthis year, with 83% of those from theUS, compared with 75% in 2002.

But medical students are looking farbeyond residency to consider whatkind of a life they want to live. ❖

ReferencesDorsey E R, Jarjoura D, Rutecki G W.

Influence of controllable lifestyle onrecent trends in specialty choice by USmedical students. JAMA. Sept 3,2003;290:1173-1178.

Etzioni D A, Liu J H, Maggard M A, et al.The aging population and its impacton the surgical workforce. AnnSurg.August 2003;238:170-177.


Future of surgery


Call for abstracts:Share your successes

Have you developed a new pro-gram to retain perioperative staffor led a successful cost manage-

ment effort? Perhaps you have found creative

ways to foster leadership in your staff ordevelop a culture of patient safety.

Or you might have heard a dynamicspeaker you think your colleagues wouldbenefit from hearing.

Share your ideas and successes withthe planning committee for the Man-aging Today�s OR Suite 2004 conference.The committee is inviting proposals forthe conference to be held Oct 6 to 8, 2004,at the Hyatt Regency Chicago.

Send a proposal of about 500 wordsdescribing the session you wish to present.

Provide enough information to givethe committee a good understanding ofthe content.

Sessions are 1 1/2 hours long andfocus on practical topics related to man-agement of surgical services, such asachieving greater efficiency, managementof information, leading and developingstaff, and keeping costs under control.

The keynote address and general ses-sions feature nationally known speakerswho have important messages for surgi-cal services directors. If you wish to sug-gest a general session speaker, pleaseobtain as much information about theperson as you can, such as the speaker�stitle, organization, address, and phonenumber.

The deadline for proposals and sug-gestions is Nov 1.

OR Business ManagementConference

Proposals are also invited for thefifth annual OR Business ManagementConference to be held May 12 to 14,2004, at the Hyatt Regency Downtownin Albuquerque, NM.

Covered are topics such as financialmanagement, materials and technologymanagement, automation, and ORdesign and construction. ❖

Please fax or e-mail proposals by Nov 1to Billie Fernsebner, RN, MSN, educationspecialist, OR Manager, Inc, at 303/442-5960 or bfernsebner@ ormanager.com

If you have questions, call her at303/442-1661.

21

Please see the ad for CENSIS TECHNOLOGIES INC.in the OR Manager print version.

Self-scheduling is a strategy ORmanagers say is making a real dif-ference in recruitment and reten-

tion.Not only does it save management

time, but it also provides OR staff theopportunity to be autonomous and con-trol their work schedules.

OR managers and directors find thatthe accountability and responsibilityfostered by self-scheduling lead toimproved job satisfaction and profes-sional growth. Unscheduled absencesand individual requests for changesafter posting of the schedule decreasesharply.

Respect for staff needs Self-scheduling attracts staff and

shows respect for needs of staff, saysTrish Barber, RN, clinical coordinator atShands Hospital at the University ofFlorida, Gainesville.

As evidence, Barber says, the Shandsoperating room suite is fully staffedand does not have any travelers.

�Self-scheduling makes the employ-ees happy, and happy employees do abetter job for me and are more likely tobe here every day,� says Barber.

Shands has worked hard to get awayfrom rigid policies that expected thestaff to accept whatever schedule wasgiven to them.

�The staff have total control overtheir schedules. They, not me, choosethe times and days they will work,�says Barber.

�It is impossible for staff to plantheir busy lives around rigid schedules.We realize people have a life outsidethe OR, and they shouldn�t have tochoose between work and home.�

When staff are given the responsibil-ity to schedule their days and call, theylearn to respect the needs of others andwork together as a team.

The staff make the schedule out for 2months at a time. They also make theirown daily assignments in their special-ty teams. Each specialty team has a leadRN and a lead surgical technologist.The teams decide which technologistsand which nurses will work with whichsurgeons each day.

�They work it out however theywant. As long as it is covered, it doesn�t

matter to me,� says Barber.The staff rarely present a schedule to

Barber with an empty slot because theyknow she will have to put someone ofher choosing in the slot. They know it isbetter to work it out among themselves,she says.

A cardiac team self-schedulesThe staff�s willingness to compro-

mise, backed with a �ding list,� is keyto a successful self-scheduling programat Inova Fairfax Hospital in FallsChurch, Va. The 30-member cardiacteam began doing its own schedulingas part of the hospital�s effort to pro-mote self-governance by the nursingstaff. One member became the schedul-ing go-to person, which was neededbecause the team is scheduled using acomputer program.

The cardiac team has policies thataddress how vacations are assigned,when requests are due, and how senior-ity is used to determine who works atwhat time.

The cardiac team consists of all RNswith two surgical technologists. Twolevels of RN first assistants (RNFAs)also are on the team. The more experi-enced RNFAs harvest the saphenousvein and radial artery, whereas theother RNFAs suture and assist the sur-geon. Both levels must be accounted forin the schedule.

�The tricky part is in making surewe have the right complement of peo-ple,� says the scheduling go-to person,Mary Dellinger, RN, CRNFA.

The staffing guideline says the ORwill run four rooms at 6 am, and thestaffing pattern will consist of a scrubperson, a circulator, and two RNFAs,one of whom must be more experi-

enced. Four staff members are on calleach night. The schedule must also con-sider those who work 8-, 10-, or 12-hourshifts.

What works well is for each memberto choose a night as his or her callnight. The 10- and 12-hour staff arescheduled to be off following theirnight of call in order not to disrupt thestaffing for the next day if they mustwork all night. Who gets which callnight and the day off is determined byseniority. As new people join the team,the call nights might need to be adjust-ed to maintain the right complement ofstaff.

�The worst part of self-scheduling isthat people get attached to their callnights and don�t want to move,� saysDellinger. �However, everyone knowswe have to have the competency levelsand shifts evenly distributed, and wehave to assign ourselves, so we work itout.�

Three people are allowed to be onvacation at a time. To use their seniori-ty, staff must submit their vacationrequests by certain posted dates. Afterthat, requests are taken by date submit-ted. The staff sign up for the weekendsthey would prefer to work. Using analphabetical list, weekends are rotatedaccording to the staff�s preferences andto maintain the proper complement.

For holidays, the staff is divided intoseven groups, each with the propercomplement of staff. The staff take oneholiday each year and rotate throughthe holiday groups; ie, they work onThanksgiving once every 7 years. Thosewho worked the holiday the previousyear get priority for vacation duringthat holiday the next year. As staff comeand go, the groups are adjusted tomaintain the right mix of staff.

When a call night is not filled orsomeone who is on call is sick,Dellinger uses a rotation list, nick-named the �ding list.� The person atthe top of the list gets �dinged� to takethe call. That person can take the call orwork out a deal with another staffmember. Once that person takes thecall, he or she goes to the bottom of thelist. This saves time in trying to arrange


Recruitment and Retention

Self-scheduling an aid to staff retention

“Self-schedulingattracts staff andshows respect for

their needs.

“


23

STERIS CORPORATION

for call coverage. The staff know whatthe back-up plan is, and everyone takesa turn.

Creating a new culture When Cheryl Dendy, RN, helped

open St John Surgery Center in St ClairShores, Mich, she wanted to create adifferent work environment.

�It was very important to us that wecreate a terrific work culture�reallygiving people an opportunity to beaccountable. Self-scheduling was a wayto do this,� she says.

The staff work out schedulingamong themselves using their ownguidelines that address how many peo-ple can be off at any given time as wellas contingent staffing and how theywill be utilized.

When the staff finish the schedule,they turn it over to the OR manager forher �blessing,� says Dendy, who isadministrative director of ambulatorysatellites for the St John system.

If the staff are unsuccessful in fillingany shifts, they know the manager willfill in the gaps, so they are not apt toput a schedule on her desk that is notcomplete.

A staff person who oversees sched-uling is rotated every 3 months.

Dendy sees self-scheduling as agood recruitment and retention toolbecause everybody has a chance forinput with little interference by man-agement. When people are told theycan schedule their own time, it givesthem a whole new outlook on work,she adds.

Meeting productivity targets As part of self-scheduling, the St

John staff must meet targets for thenumber of worked hours per case usingthe center�s productivity tool. They fig-ure out exactly how many hours theycan staff on a given number of cases,maintaining between 95% and 110%productivity.

The staff have learned how to calcu-late the number of worked hours theycan schedule based on volume, whichmay change every day, says Dendy.

Right now, the target for workedhours per case is 12.12 (includes thenurse anesthetists), based on 22 casesand upward. The OR component needs

to stay at 3.45 worked hours per case.�We divide the number of cases by

the number of staff to come up with thehours that we actually work per case,�says St John Surgery Center managerJoanna Rabaut, RN.

�It has been a huge buy-in for thestaff,� Dendy adds. �They are learningto become more accountable, whichhelps all of us to be accountable tothose targets.�

An inclusive plan Central DuPage Hospital in

Winfield, Ill, formed an OR staffingcommittee to oversee staff schedulingfor its 22 ORs. The committee has fivemembers who are rotated alphabetical-ly every 2 years.

The staffing committee is not exclu-sive but inclusive, notes Joe Bonura,RN, BSN, past committee member andOR staff educator.

Members include surgical technolo-gists, charge nurses, 12-hour staff,evening shift staff, and perioperativecare technicians. All staff are represent-ed, and committee members under-stand every shift and role, giving every-one a voice.

�It is the whole community settingrules and setting responsibilities foreverybody,� says the director of periop-erative services, Michelle Chotkowski,RN, BSN, MSHA.

�The system works because peopleare informed,� adds committee memberLee Barnes, RN. �The staffing commit-tee was formed because the staff feltthey needed some representation. Itworks because people know the rules.They know they have to sign up forcall. They know they are responsible fora certain number of hours of call, andeveryone has to take their turn.�

The committee has a book in whichthey keep track of how much paid time

off staff members have coming. Therealso is a request book in which staffwrite their requests for time off and callrequests during a 6-month period.

The committee has determined thatfive staff members can be off per day.At least the first three or four staff onthe list can have the day off; the othertwo slots are reserved for anyone whomay have worked a Saturday andwants a day back, says Julianne Davis,RN, BSN, charge nurse of the neuro ser-vice and staffing committee member.

Covering specialty callBecause the OR staff is divided into

teams, the staffing committee also hasto look at how many staff from a certainteam have asked for time off. The teamconcept also affects call because call isdivided into specialty call and first call.For example, if an emergency cranioto-my case comes in, the neuro team mem-ber on call would be called in to scrub,and the first-call nurse would be calledin to circulate.

As the staffing committee gives daysoff, they also look at the specific ser-vices to see if there are, for example,enough orthopedic members scheduledto run the orthopedic rooms for the spe-cific day.

DuPage also has an in-house reg-istry, so if someone needs a day off thatcan�t be provided for by the OR staff,the person can arrange with a registrynurse to work. It is the staff nurses�responsibility to find a replacement.

Christmas and Thanksgiving areassigned differently. Call on these daysis assigned by seniority in conjunctionwith a lottery system. Names aredrawn, then assigned days off accord-ing to seniority so the same personsdon�t get the same holidays off everyyear. Because many of the staff havebeen in the OR more than 30 years,�someone almost has to expire so therest of us can move up on the senioritylist and get the holidays off,� jokesBonura.

If a call slot can�t be filled, and noone will volunteer, the committee looksback at the previous month to see whotook the least amount of call. That per-son will be assigned to take the call. ❖

�Judith M. Mathias, RN, MA



“When people canschedule their owntime, it gives them

a new outlook.

“


25

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California’s nursing schoolshampered by state’s budgetcrisis

Hampered by a state budget crisis,California�s community colleges are hav-ing trouble hiring enough faculty fornursing programs. That is keeping thecolleges from enrolling more nursing stu-dents to help meet demands of the state�smandatory staffing standards, whichtake effect in January, the Aug 28 WallStreet Journal reports. In the meantime,hospitals are recruiting nurses from thePhilippines, Australia, and New Zea-land.

Community colleges prepare almosttwo thirds of California�s nurses.

�www.wsj.com. Subscription required.

Foreign nurses must meet newrequirements

Foreign nurses and other health careworkers seeking temporary admission tothe US will have to comply with newcertification requirements in a final rulefrom the Department of Homeland

Security (DHS). Workers entering the UShealth care system after Sept 23 mustpresent a certificate from an approvedindependent credentialing organization.

For 1 year after publication of thefinal rule, DHS will approve applicationsfor change of status or extension of stayfor nonimmigrant health care workers tohelp ensure the rule does not disruptcare.�Federal Register, July 29, 2003, p 43901.

Health care management stilldominated by white males

Despite efforts to promote racial andgender diversity, health care manage-ment continues to be an old boys� net-work, according to a study by the Amer-ican College of Healthcare Executives.

The survey of 1,621 healthcare execu-tives in 2002 showed the industry actual-ly slid backward in promoting womenand minorities compared with previousstudies in 1992 and 1997. White femalesmade some gains, with some 40% hold-ing the titles of CEO, COO, or senior vice

president�up from 35% in 1997. In 2002,44% of black males responding wereCEOs, COOs, or senior vice presidents�compared with 43% in 1997.

�Modern Healthcare, August 11, 2003,p 6 +.

Physician compensationincreases slightly or not at all

Physicians� pay was up slightly in2002, though some specialties experi-enced decreases. Primary care physi-cians had a 2.8% median increase, andspecialists had a 4.3% median increase.But invasive and noninvasive cardiolo-gists reported decreases of 6.2% and3.9%, respectively in a survey by theMedical Group Management Associ-ation (MGMA) of Englewood, Colo.

Pay is stagnant or declining thoughdemands on practices are growing.Factors affecting compensation areincreasing practice costs, especially labor,drugs, supplies, and malpractice insur-ance, coupled with cuts in reimburse-ment.

�www.mgma.com


Workplace

House Ad:

Please place here the PDF file:

CDROMad.pdf

included with the OR Manager filesfrom Karen Gerhardt


Raises for ambulatory surgery cen-ter (ASC) managers droppedback this year after outpacing

raises for hospital-based OR managersfor 2 years.

The average raise was 3.9% this year,compared with 6% in 2002 and 6.5% in2001. Hospital OR leaders averaged4.6%.

But more ASC managers received asalary boost this year�86%�comparedwith 78% last year.

The annual base salary of $73,213 isnot as high as the $81,694 average forhospital-based OR directors. But forsmaller facilities, the salaries are aboutthe same. An ASC manager overseeingfewer than five ORs earns an average of$69,715, while a hospital-based ORmanager responsible for an equivalent-sized department makes $70,074.

The 13th annual OR Manager Sal-ary/Career Survey polled 607 ASCmanagers of centers performing generalsurgery. The list included OR Managersubscribers. In all, 150 responses werereceived, for a return rate of 26%.

Location of ASCsEast Central South West

Urban 37% 34% 46% 60%Suburban 63% 44% 37% 24%Rural � 22% 17% 17%

What ASC managers earnAnnual salaries. Managers in the

East and West had the highest salaries,with those in the South lagging. Pay injoint-venture and hospital-owned cen-ters is higher than that in physician-owned centers.

Raises. The South and Central stateswere most generous with raises, with88% of managers in both regions receiv-ing a pay increase. That compares with84% in the West and 79% in the East.All respondents from hospital-ownedcenters got a pay boost, compared with85% of those in joint ventures and 82%in physician-owned facilities.

The biggest raises�4.6%�werereported by leaders from joint-venturefacilities. Hospital-owned centers grant-ed an average of 3.1% and physician-owned facilities an average of 3.4%

Incentive bonuses. Surgery centerleaders are more likely than their hospi-tal counterparts to be eligible for incen-tives like profit sharing. More thanhalf�55%�qualify for such a plan,while 40% of hospital OR leaders do.

Incentives are much more commonin physician-owned centers (60%) andjoint-venture facilities (59%) than inhospital-owned ASCs (36%).

The average bonus paid was 9.7% of

base salary, with 30% of managersreceiving more than 10%.

BenefitsBenefits packages for ASC leaders

have improved substantially in the past5 years. They are much more likely toreceive most kinds of insurance as wellas tuition reimbursement. Like manyworkers, though, several wrote thatthey have seen their insurance costs riseas employers shift more of the cost ofswelling insurance premiums to theiremployees.

ASC benefits are leaner than whathospitals offer. Except for health insur-ance, all benefits included in the surveyare less common in ASCs. The biggestgap is for tuition reimbursement,offered by 54% of ASCs and 90% of hos-pitals.

More ASC managers receive salary hike

Gwendolyn Grothouse, RNAdministrative directorApple Hill Surgical CenterYork, Pa

Barbara Harmer, RN, BSN, MHASenior consultantHealthCare Consultants, IncCelebration, Fla

Jerry Henderson, RN, BS, CNOR, CASCExecutive directorThe SurgiCenter of BaltimoreOwings Mills, Md

Diana Procuniar, RN, BA, CNORNursing administratorWinter Haven Ambulatory Surgical

CenterWinter Haven, Fla

Donna Gelardi-Slosburg, RN, BSN, CASCNational surgery specialistHealthSouthSt Petersburg, Fla

Rhonda Tubbe, RN, CASC, CNORAdministratorThe Surgery Center of NacogdochesNacogdoches, Tex

Ambulatory Surgery Advisory Board


Profile of the typical ASC manager

The typical manager of an ambula-tory surgical center in the ORManager Salary/Career Survey:

• Earns $73,213 in annual basesalary

• Received a raise in the past yearaveraging 3.9% of base salary

• Holds the title of director (39%),nurse administrator (25%), ornurse manager (24%)

• Works in a joint venture (41%)or physician-owned (34%) facili-ty in an urban (46%) or subur-ban (39%) locale.

Respondents to ASC surveyRegion Distribution Response

East 60 (10%) 13%South 204 (34%) 7%Central 149 (25%) 28%West 184 (30%) 29%


Benefits for ASC managers2003 1998

Health insurance 98% 95%Dependent health ins 65% 40%Dental insurance 84% 61%Life insurance 81% 74%Disability insurance 75% 55%Paid time off 99% 97%Tuition reimbursement 54% 42%Retirement plan 75% �Eye care 48% 43%

About the ASCJoint-venture and physician-owned

facilities dominated the survey, with41% and 34% of responses respectively.Hospital-owned centers made up 15%of respondents, with others accountingfor 11%.

Most of the hospital-owned centershave five or more operating rooms,while most owned by physicians havefewer than five ORs.

Ownership by number of ORs <5 ORs 5+ ORs

Hospital 38% 62%Physician 77% 23%Joint venture 47% 53%

About four in ten (43%) respondentswork in a facility that is part of a healthcare system.

Number of ORs, volume. On aver-age, managers oversee six operatingrooms. The average annual surgicalcase volume is 4,718.

Recovery care capability. A third offacilities (33%) say their ASC provides23-hour recovery, up from 24% in 2002.This was more common for facilities inthe West (47%) and Central region(34%) than in the South (28%) and theEast (16%).

Whether 23-hour care is offeredvaries little with facility ownership;physician-owned centers are about aslikely to offer the service as hospital-owned and joint-venture facilities.

Currently, Medicare limits payment

in ASCs to procedures that are expectedto have a postoperative stay of less than4 hours, which has limited the growthof extended recovery care in the ambu-latory setting.

About your roleTitles. The most common title held

by leaders in this year�s survey is direc-tor (38%), followed by administrator(25%), and nurse manager (24%).

The nurse manager title was mostcommon in hospital-based centers,while administrator was more commonin physician-owned and joint-venturefacilities.

Titles by ownershipHosp Physician Jt vent

Administrator 5% 31% 28%Director 32% 39% 38%Manager 50% 20% 18%

Among other titles mentioned wereclinical director of surgical services, ORcoordinator, executive director, andsurgery supervisor.

Reporting. More than half ofrespondents (51%) report to the admin-istrator, with 21% reporting to theboard of directors. Far fewer report to

the medical director (13%), or the cor-porate office (5%), or some other office(11%).

Scope of role. Nearly all of the par-ticipants (94%) manage in a single facil-ity, either overseeing the ORs only(49%) or the ORs and other areas (45%).Of the eight who manage at multiplesites, four are employed by a hospital

AmbulatorySurgery



Average annual salary by number of ORs

0

$20,000

$40,000

$60,000

$80,000

5+ ORs

$78,702

<5 ORs

$69,715

Average annual salary by region

West$75,866

South$70,175

Central$73,174

East$74,476


29

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system, three by joint ventures, and oneby physicians.

Purchasing powerASC leaders are influential in pur-

chasing decisions for their facilities.Nearly all�99%�have a say in theselection and purchase of capital equip-ment and OR supplies/equipment.

In all, 40% are the primary decisionmaker. That is the most likely in physi-cian-owned (42%) and joint-venturefacilities (38%) and less likely in hospi-tal-owned facilities (29%).

For 34%, their role is as a member ofa decision committee, and 26% act in anadvisory capacity.

Three quarters (74%) saw no changein their purchasing involvement in thepast year.

About youAge and gender. Like RNs in gener-

al, the age of ASC managers is creepingup, averaging 48 this year comparedwith 47 in 2002. Some 41% are over 50.

Most of the managers (87%) arefemale.

RN status. Nearly all ASC managersare RNs, with just 5% (7) holding othercredentials. Six of the seven with anoth-er credential are male.

Education. The majority of ASCleaders (59%) hold a bachelor�s degree

or higher. An associate degree is heldby 25% and a diploma by 16%.

In all, 44% say their ASC requires aspecific degree for their position. This ismore common in hospital-owned centers(64%) than in those owned by physicians(40%) or joint ventures (46%).

When a degree is required, it is mostlikely to be a bachelor �s (64%), withfewer (15%) specifying a master�s. Jointventures were more apt than othertypes of centers to require a master�s,with 20% asking for that degree. ❖


AmbulatorySurgery


Highest degreecompleted

Other<1%

Diploma16%

Associate25%

Master’s24%

Bachelor’s34%

Average annual salary by specialty

Single specialty $74,501Multispecialty $71,489

Average annual salary by ownership

Hospital-owned $74,822Physician-owned $66,933Joint venture $74,743

Lobbying heavy on surgical hospitals


Lobbying on surgical hospitals hasbeen intense as a House and Sen-ate conference committee weighs

whether to take steps to curb the grow-ing industry.

The House and Senate passed differ-ing amendments on freestanding surgi-cal hospitals in their versions of theMedicare bill to create a prescriptiondrug benefit.

The House bill simply calls for astudy. But the Senate bill includes anamendment from Sen John Breaux (D-La) that would narrow the type ofphysician investments that would beprotected under the Stark law.

The American Surgical HospitalAssociation has been lobbying againstthe curbs. Meanwhile, a newly formedCoalition of Full-Service CommunityHospitals has hired a Washington lawfirm to lobby on behalf of acute-carehospitals in 13 states.

It was not clear in mid-Septemberwhich side will win out.

Caught off guard�Our Washington sources indicate the

Breaux amendment caught many legisla-tors in both House and Senate offguard,� says attorney Lorin Patterson ofShook Hardy & Bacon, Kansas City,adding that both houses have been strug-gling to understand the complex issues.

Specialty hospitals, which usuallyhave physicians as owners and

investors, argue that they provide effi-cient, cost-effective care both forpatients and physicians. Communityhospitals maintain these are �boutiquehospitals� that siphon off the best pay-ing cases and leave them with lessmoney to support services and patientsthat are less well insured.

The Stark law in general prohibitsphysicians from referring Medicare andMedicaid patients to providers in whichthey have a financial interest. But theStark law has a �whole hospital excep-tion� that allows physicians who investin a whole hospital to refer patients tothat facility.

The Breaux amendment wouldexclude hospitals that focus on one spe-cialty such as cardiac care or orthope-dics from the whole hospital exception.

A lot of interpretation will be neededif the Breaux amendment passes,Patterson says, because it could give thegovernment a lot of latitude in enforce-ment.

There also are questions about a�grandfathering� clause that wouldprotect surgical hospitals currentlyunder development from being coveredby the amendment.

Meanwhile, state bills to regulatesurgical hospitals in Ohio and Indianahave died in committee, Pattersonreports. ❖

31

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Ateam that works well together iskey to making any surgical facil-ity successful.

Teamwork helps keep cases movingand aids the type of communicationthat supports good customer serviceand patient safety.

Teamwork also boosts recruitmentand retention. Staff who feel part of ateam are more likely to stay, and attract-ing new employees is easier if a facilityhas a reputation for high morale.

But what if teamwork isn�t what itshould be? How do you go about creat-ing a team-based environment?

Donna Quinn, RN, MBA, CPAN,CAPA, found herself in that positionwhen she became director of the Ortho-paedic Surgery Center in Concord, NH.

It�s been a 3-year transition thatinvolved an almost complete turnoverof staff and required use of agency per-sonnel for 3 months.

Now, she wrote in response to thisyear�s Salary/Career Survey: �We havea great staff, and everyone workstogether.�

In a phone interview, Quinn talkedabout how she turned the situationaround.

Setting expectationsWhen Quinn was hired by the cen-

ter, she found each of the groups�nurses and physicians�had its ownagenda.

There was friction, for example, aboutnurses staying late for cases that ran past5 pm. It had been taken for granted thatthe staff would stay late, no questionsasked. The staff was not consulted overwho would stay when cases ran over,which caused conflicts with their familyand other commitments.

And not everyone was observingcommon courtesy and decorum withpatients and coworkers.

In making the transition, Quinndrew on her 20 years of managementexperience. Her philosophy combines

two basic concepts:� setting clear expectations

� treating employees as she wouldwant to be treated. Though some facilities have written

codes of conduct that employees areexpected to sign and follow, Quinndoesn�t use a formal document.

She relies on professionalism to setthe tone.

�It means setting behavioral expec-tations,� she says. �We are a business,and we need to act accordingly. Therealso is an expectation that you willwork well with your coworkers.�

When employees don�t meet expec-tations, she attempts to deal with thesituation openly and fairly.

�For example, if an employee is call-ing in sick often, you as a manager haveto address that. The other employeesare watching.�

The same is true for physicians whoact inappropriately.

�You need to sit down and talk withthem,� she says. �The staff is watching,and they know you are going to bat forthem.�

After she set expectations and con-tinued to reinforce them, three ORnurses left, which was a large percent-age of the staff. They were replacedtemporarily with agency staff as shefocused on rebuilding.

Hire for fitIn selecting new employees, Quinn

follows a business maxim used by thecenter�s affiliated hospital: �Hire for fit,train for skill.� That means first seekingcandidates who have the right blend ofenergy and a positive attitude. Thetechnical skills can be taught.

�If people come in with the attitude,�It�s just a job,� they won�t last,� saysQuinn. They need to have a willingnessto do what it takes to serve the organi-zation and physicians.

She assesses an applicant�s �fit� byasking open-ended questions:� Tell me about a conflict you�ve had

with a coworker and how youresolved it.

� Tell me about a conflict with a physi-cian and how you resolved that.

� How would your previous bossdescribe you?

� How would your peers describeyou, in addition to your clinicalskills?

� How would you handle a strongcoworker who is opinionated?�People are amazing in what they

will tell you,� she laughs. �When theysay in response to the questions on con-flict, �I was right, and they were wrong,�or �I avoid conflict,� that tells you some-thing.�

She also relies on her informal net-work of nurse colleagues for off-the-cuff references. In the small community,most know each other.

Flexibility builds moraleQuinn balances firm expectations

with the second basic concept�to treatemployees as she would want to betreated.

She has never forgotten the com-ment of one nursing director sheworked for: �Your first responsibility isto the hospital, not to your home orfamily.�

That approach doesn�t work withthe younger employees, she notes.


AmbulatorySurgery


“She helps staffblend work and

their personal lives.

“

Building an ASC team from the ground up


33

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Instead, she helps the staff balancetheir work and personal lives. The typi-cal workweek at the center is four 9-hour shifts, which is considered fulltime, which enables employees to havelong weekends.

Arrangements are made for staffwho have family or school needs.

�If an employee can�t get to workuntil 8:15 because she needs to get herchildren on the school bus, we willwork with that,� she says. �If they needto attend a school function in the mid-dle of the day, we let them.�

On occasion, the surgical schedule isadjusted to accommodate an employee.When one of the surgical technologistscouldn�t arrive until 7:30 am because ofa day care issue, the schedule wasswitched to perform a knee arthroscopy

case, which requires one tech, before ananterior cruciate ligament repair, whichrequires two.

This flexibility �in itself is betterthan any financial reward,� she says,�and a happy staff is more productive.�

A per diem pool helps fill in thestaffing gaps. Per diem nurses earn $3an hour more than base pay and maywork at several facilities in the commu-nity.

Bonuses recognize successThe center has started building in

financial incentives to reward staff formeeting objectives. Last year for thefirst time, employees received a bonusin January in recognition of a successfulyear. The center is developing a bonussystem that will pay bonuses based onquality indicators. The following indi-cators are tracked and posted eachmonth:

� supply expenses per month

� total operating expenses per month

� turnover time

� patient satisfaction

� physician satisfaction

� physician start time.

How the results will be linked withrewards is still under discussion. ButQuinn has found the staff already waitsfor the new charts to be posted.

When the center needs to recruitstaff, it won�t have trouble recruiting.

�I have a list of people waiting to getin,� Quinn says. ❖

AmbulatorySurgery


CoreCurriculum

forPerioperativeNursing

Now in its fourth edition, the classic reference,Core Curriculum for Perioperative Nursing, hasguided the orientation of thousands of OR nursessince it was first published in 1991.

This respected guide has been updated toreflect changing practice.

The book includes basic competencies forexpected performance, lesson plans for classroomactivities, outlines for clinical focus days, and performance checklists. The extensive referenceshave also been updated.

As hospitals and ambulatory facilities face anincreasing shortage of nurses, many are hiringnurses without OR experience and providing on-site training. This book is the perfect guide forsuch training.

The book can be used for orientation of nurseswho are experienced in perioperative nursing aswell as those who are new to this specialty.

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NewThe ORManagement SeriesA collection of articles from recent OR Managers

All modules now available• Patient Safety

• OR Design and Construction

• Recruitment and Retention

• Scheduling Surgery, Staffing, and Efficiency

• Infection Control and Sterilization

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Individual modules $45Shipping and handling $7.95

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CMS loosens emergency treatment rule

The Centers for Medicare andMedicaid Services (CMS) is revis-ing its controversial emergency

treatment rule to make it less onerous forhospitals.

The new regulation for the Emer-gency Medical Treatment and Labor Act(EMTALA) was published in the Sept 9Federal Register and is effective Nov 10.

CMS Administrator Tom Scully saidthe revised regulation �carries outEMTALA in a common sense and effec-tive way to ensure that people who cometo hospitals seeking emergency care arepromptly screened and stabilized.�

Rule revisionsAmong the changes in the reg:

� Hospitals will have discretion in orga-nizing on-call lists for physicians.Physicians will be able to be on call atmore than one facility at a time. Theyalso will be able to schedule electivesurgery and other procedures duringtheir on-call time.This may make it easier for hospitals

to get more physicians to take call.Physicians have resisted call because,despite the EMTALA requirement, theyoften receive no payment for the manyemergency patients who are uninsured.They also say emergency care leavesthem open to more lawsuits at a timewhen malpractice premiums are sky-rocketing.� Off-campus departments will be able

to care for emergency patients with-out moving them to the main campusif that will be best for the patient.

� EMTALA will not apply to off-cam-pus clinics that do not routinely pro-vide emergency services. The ruleswill apply to off-campus sites only ifthey are specifically licensed as anemergency facility, are held out to thepublic as a place that provides emer-gency care, or if emergency casesaccounted for at least one-third of allof their outpatient visits in the pastyear. The old rule applied to all hospi-tal departments, including those noton the main hospital campus.

� EMTALA does not apply to inpa-tients, including those who have beenadmitted through the emergencydepartment.EMTALA was passed in 1986 to

address the issue of hospitals dumpingpatients who are uninsured. The lawrequires a hospital to provide medicalscreening to any person who comes tothe hospital emergency department andrequests treatment or an exam. If the caseis an emergency, the hospital must eitherstabilize the patient or transfer thepatient to another facility.

Hospitals that violate EMTALA canbe dropped from the Medicare programand fined up to $50,000 per violation.

The American Hospital Associationsaid it �welcomed the helpful and practi-cal guidance� and supported CMS�sefforts �to remove barriers to the efficientoperation of emergency departments.�

But critics said the revisions mightmake it more difficult for patients to getspecialized care when they have anemergency. ❖

The OR Management Series

A compilation of articles

from OR Manager

Patient Safety


A compilation of articles from OR Manager

OR Design & ConstructionThe OR Management Series





Scheduling Surgery, Staffing, and Efficiency The OR Management Series


Infection Control and Sterilization

37

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Health Policy & PoliticsSenators support $50 millionfor nurse funding

The US Senate voted Sept 10 to add$50 million in funding for the NurseReinvestment Act for fiscal 2004. TheHouse previously voted for flat fund-ing�a $0 increase. A House-Senate con-ference committee will have to resolvethe difference.

The original Senate amendmentoffered by Sen Barbara Mikulski (D-Md)and Sen Susan Collins (R-Me) wouldhave increased funds by $63 million.That would have brought funding fornursing workforce development to $175million, the amount the AmericanNurses Association recommends.

�www.capitolupdate.org�www.hospitalconnect.com

Senate Finance to investigateTenet

Senate Finance Committee chairmanCharles Grassley (R-Iowa) sent a harshlyworded letter to Tenet in earlySeptember requesting documents.

Among other things, the committeeasked for information on allegations ofunnecessary heart surgery at Tenet�sRedding Medical Center in California.

�In the annals of corporate fraud,Tenet more than holds its own amongthe worst corporate wrongdoers,� saidthe letter, quoted in the Sept 8 Wall StreetJournal.

Tenet has been faced with a series ofgovernment investigations since last fall.Jeffrey Barbakow, its previously praisedCEO, resigned in May. Tenet�s reorga-nized board in September was consider-ing whom to appoint as a replacement.

�www.wsj.com. A subscription is required.

Smallpox vaccine compensationrule published

In an interim final rule, theDepartment of Health and HumanServices outlined its policy for paying forinjuries from smallpox vaccination. Therule lists the vaccine-related injuries thatwill be covered and the timeframes formaking claims. Comments are due by

Oct 27. The notice is in the Aug 27 FederalRegister under the Health Resources andServices Administration.

�Federal Register.http://www.gpoaccess.gov/fr/index.html

Senate passes measureopposing new overtime rules

The Senate voted Sept 10 to opposethe White House�s plan to revamp over-time pay rules. Opponents say the ruleswould weaken workers� rights to over-time pay. The vote was largely alongparty lines. Since the House endorsed themeasure earlier this year, differences willhave to be worked out in a conferencecommittee. Ten nursing organizations,including the Association of peri-Operative Registered Nurses, wrote thelabor department June 30 asking for therule�s comment period to be extended.The groups are concerned the revisionswould hurt efforts to recruit RNs.

The proposed rule was in the June 23Federal Register.

�www.dol.gov/opa/media/press/esa

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At a Glance


Periodicals

Peaks and valleys in scheduledsurgery strain ICUs more thanemergencies

Contrary to popular belief, variabilityin scheduled surgery strains hospitalcapacity more than the random variationof emergencies, a new study shows. Oneresult is wide swings in demand for ICUbeds that in high-capacity hospitalsmean patients get shunted to otherdepartments such as the PACU or arerefused admission altogether. Smoothingscheduled cases might be a better alter-native to increasing hospital capacitythan the usual remedies of rationing careor adding more staff and beds, suggestthe researchers led by M.L. McManus,MD, of Harvard Medical School.

�McManus M L et al. Anesthesiology.June 2003;98:1491-1496.

http://www.anesthesiology.org

Medicare to cover lungreduction surgery

The Centers for Medicare andMedicaid Services (CMS) has announcedit will pay for lung volume reductionsurgery (LVRS) for patients with severeemphysema who meet criteria outlinedby the National Emphysema TreatmentTrial (NETT).

LVRS is designed to improve lungfunction by removing diseased portionsof the lung to provide space for remain-ing healthy tissue.

Medicare decided to provide the cov-erage after the NETT�a 5 year, multi-center, randomized study�providednew evidence of the procedure�s safety,

and cost-effectiveness in certain patients. Hospitals need to be accredited for

LVRS to receive Medicare reimbursement. �www.cms.hhs.gov

�www.jcaho.org

FDA approves new type ofsterilizer

The Food and Drug Administrationon Sept 3 authorized marketing in theUS of a new ozone sterilizer and chemi-cal indicator made by the Canadian com-pany TSO3.

The company says the new 4.3 cu ftsterilizer is designed for sterilization ofinstruments that are not heat resistant,particularly those made of polymers. Theprocess uses medical grade oxygen andwater with only oxygen and water vaporas byproducts.

The TSO3 sterilizer will be distributedin the US by Skytron.

�www.tso3.com�www.skytron.us

Why do CABG patients getreadmitted?

The most common causes for read-mission to the hospital within 30 daysafter coronary artery bypass graft(CABG) are postsurgical infection (28%)and heart failure (16%). In all, 13% ofpatients were readmitted in a study of allpatients who had CABG in New YorkState during 1999. Eleven factors wereindependently associated with higherreadmission rates: older age, female sex,African-American race, greater body sur-face area, previous myocardial infarction

within 1 week, and six comorbidities. After correcting for these, four

provider-related factors also were relatedto higher readmission rates: annual sur-geon CABG volume of less than 100, ahospital with a high mortality rate, dis-charge to a nursing home or rehab facili-ty, and length of stay during CABGadmission of 5 or more days.

�Hannan E L et al. JAMA. Aug 13, 2003;290:773-780. www.jama.com

Canadian health care systemoffers cost savings

The US spends three times as muchper patient as Canada processing paper-work, a study from Harvard MedicalSchool finds. This partly owes to wran-gling over who is going to pay the bill,according to press reports.

The Harvard researchers found sav-ings from a national health-insurancesystem like Canada�s would be enoughto provide health insurance for the 41million Americans who lack coverage.

The study estimated Americans spent$294.3 billion, or more than $1,000 perpatient, on health care administration in1999. That compared with $307 perpatient in Canada.

Another opinion, offered by HenryAaron of the Brookings Institution, notedthe US costs cited in the study could beexaggerated by 24%, and the researchdoesn�t consider labor and other costs,which are higher in the U S.

�Woolhandler S et al. N Engl J Med. Aug21, 2003;349:768-775. Accompanying edito-

rial, 801-803.

salary/career survey or managers report high job asc ......2003/10/05 · from the unnecessary...

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