Surgery centers, like most healthcare organizations, have to deal with staff burnout and stress. But there are healthy strategies that help staff deal with work stress, and there institutional policies that might reduce burnout.
For instance, it’s important to cross train staff and vary schedules with both fulltime and part-time nurses, says Kristine Kilgore, RN, BSN, administrative director at Surgical Care Center of Michigan, an ophthalmology center in Grand Rapids, MI. Kilgore recently spoke about staff burnout at the Becker’s ASC 23rd annual meeting, held Oct. 27-29, in Chicago.
“I have a good mix of fulltime and part-time,” Kilgore says. “On lighter days, I say to the fulltime staff, ‘Would you like to go home early today?’”
Part-time nurses are very happy because they won’t lose hours and the fulltime nurses often are thrilled to be able to leave early, she says. “One person told me, ‘You wouldn’t believe what I got done! I got the house cleaned and I made a full dinner for the family.’”
Kilgore doesn’t worry about whether the fulltime employee’s hours dip below fulltime hours, and she doesn’t make them use their vacation time. Instead, she sees this as a positive for her, as well as for them.
“I look at it that they are helping me out by going home early,” she explains.
Another strategy is to focus on wellness and holistic solutions to stress, notes Adrienne Schultz, RN, HN-BC, assistant vice president, patient care services, Cancer Treatment Centers of America in Zion, IL. The organization, which sees 5,000 patients annually, has a 73-bed inpatient facility, as well as outpatient services, ambulatory surgery and clinics. Schultz also spoke about stress at the Becker’s ASC 23rd annual meeting. (See story on creating a “renewal room,” in this issue.)
“One of the most exciting things we’ve done is an initiative to support holistic nursing,” Schultz says. “I’m a board certified holistic nurse, so we’ve sponsored cohorts of nurses – about 20 at a time – to undergo training in holistic nursing.”
The benefits of this additional training are huge, she says. “It benefits both patients and stakeholders.”
The Cancer Treatment Centers of America will have had four cohorts of nurses going through holistic nursing training by the end of this month. The organization has dedicated resources to the training because it fits in well with its vision. Holistic nursing can benefit both the nurses, who learn more about self-care, and patients, Schultz says.
Physician burnout also can be an issue for ambulatory surgery centers, although not every site has this worry, Kilgore notes.
“For our organization, physician burnout is not as much of an issue because the physicians are owners of the company,” she explains. “So they set the agenda and the pace. They determine how many cases they can do in a half day.”
Kilgore is more concerned about the staff: “Last week we had a physician in the morning do 16 cases, and then a physician came in the afternoon to do 22 cases. They might think 22 cases is not that big of a deal, but for the staff it’s 16 plus 22.”
Full schedules and a fast pace can contribute to stress and burnout, but there are ways to buffer staff from their impact. Kilgore and Schultz offer these ideas for reducing staff stress:
- Make sure new employees can handle the workload: Everyone hired at the Surgical Care Center of Michigan is trained based on what they need given their own experience and education, Kilgore says.
“I tailor it to what the person needs,” she says. “I start with pre-op because it’s the most consistent, depending on the doctor, and the last part is circulating because it’s the hardest thing to learn and you need to learn each doctor’s preferences.”
One critical step in hiring new staff is to have them spend a day job-shadowing, Kilgore says.
“This is to make sure they’re even interested in the work,” she explains. “They come in for a half day and shadow a nurse to see pre-op, circulating, and recovery.”
The goal is to make sure the job is a right fit for that particular nurse. “This is a fast-pace environment, and it’s not for everyone.”
- Offer access to wellness activities: Larger organizations can provide employee assistance programs, along with wellness activities, including gym membership discounts and staff exercise sessions, Schultz says.
“We have exercise sessions that people can sign up for and that are available at all different times to accommodate all of our stakeholders,” Schultz says. “We also have an onsite yoga room that people can go to during their lunch time, and there are open, instructor-led sessions.”
- Cross-train nurses: Registered nurses at the Surgical Care Center of Michigan are trained to work in each area of the surgery center.
“They can work in the pre-op area, take care of patients to get them ready, and they also can circulate and also recover patients,” Kilgore says. “I make sure they go to each area throughout the month.”
A nurse might work in the pre-op area for one week and then work in the recover area.
“They are learning ophthalmology, one specialty,” Kilgore notes. “They are not having to learn 20 different specialties.”
- Stagger shifts and include nurses for the breaks: “The pre-op nurses are staggered, starting at 6:30 a.m., 6:45, 7, 7:15 – every 15 minutes, depending on how many nurses I need,” she says. “It’s usually three to five people.”
At 7, the circulators start to arrive, and the nurses in recovery arrive at 8 or 8:30 a.m. The surgeons start at 8 a.m., except on the busiest of mornings when they’ll begin at 7 or 7:30, Kilgore says.
“The surgeons have a four-hour block and go until noon, and the afternoon surgeon starts at 12:30 p.m.,” she says. “Then I bring in a nurse that does all the breaks for the nursing staff, and I have an extra scrub tech to turn rooms over.”
The biggest challenge is finding a good scrub tech, Kilgore says. “It takes a long time to train a good scrub tech.”
The last staff will arrive at 8:30 or 9 a.m. and be one of the recovery people, relieving the last late person and following up on the last patients, she adds.
- Attend to employees’ emotional health: At the Cancer Treatment Centers of America, employees can attend a panel session to discuss an issue that concerns them, Schultz says.
“About once a month, our folks come to speak on a panel about a particular instance or issue they need to share with others,” she explains. “This is multidisciplinary with nurses, physicians, pharmacists, and others who want to debrief or talk about something very personal for them or to share how they handled it.”
For instance, one session involved a long-term patient who had died. Some employees had gotten very close to the patient and wanted to share their feelings about the loss, Schultz says.
“We have one topic per event, and usually different people can share at the event,” she adds.
The sessions are held in a large meeting room, which sometimes has standing room only. Attendees can bring their lunch with them, as the meeting takes place at lunch time.
“People want to share,” Schultz says. “They want that ability to garner input and support from their co-workers.”
- Create nice surprises: “The day the physician had 22 patients, starting at 12:30, he said ‘I’d like to get a treat for the nurses in the afternoon – I know it’s going to be a long day,’” Kilgore says. “Those little things are huge, and it comes from me or the surgeons.”
Other nice surprises will be a catered lunch for staff after a particularly busy week or month, she says.
“I try to acknowledge everyone,” she says. “I’ll do a nurses’ week and bring in lunch or breakfast.”
- Recognize employees: “Our company does an employee recognition day – usually on a Friday in June,” Kilgore says. “We feel it’s important to recognize every employee, so we close the surgery center early.”
After closing the center at noon on a Friday, all surgery center employees head across the street to a botanical garden called the Frederik Meijer Gardens. They have a holiday luncheon. Employees from the surgery center are joined by staff from the company’s various clinics, as well.
“We have over 300 employees, and it’s fun because everyone gets to see everyone,” Kilgore says. “Also, we have fun activities planned that change each year.”
For example, one activity was a game show led by the management team.
- Keep staff aware of how they’re doing: Merit reviews typically occur at the end of the year, but these reviews should not have any surprises for employees, Kilgore says.
“Hopefully, if there are issues, you are not waiting until the year end to go over them,” she explains. “If something is identified by a staff member or an anesthesia provider or a physician, I try to raise it when it occurs so at the review time it’s not a surprise.”
Giving employees real-time assessment makes it easier to discuss issues with them at the annual review. “You know their strengths and weaknesses,” Kilgore says.
“I always ask employees what their goals are for the next year,” she adds. “I ask, ‘What do you want to accomplish in a year,’ and sometimes you find out interesting things from them.’”
- Take employees’ suggestions seriously: Kilgore learned when talking with nurses during one evaluation that they wanted to be trained to use one new surgical device. It was a laser that required a certified trainer to come in and show staff how to use it, and couple of nurses said that the next time there was a class, they’d like to have the trainer train four nurses at a time, she recalls.
“I had no idea they were even interested,” she says. “What I’ve learned over time is to listen to my staff. People might think they’re just complaining, and there is some complaining, but sometimes you pick up little pearls that could work.”
Listening to staff also can prevent misunderstandings. For example, Kilgore brought in an ancillary employee to help the RNs. The idea was to ease some of their burden, but some nurses were worried that they were going to be replaced by LPNs.
“I said, ‘No, I’ve listened to what you say, and you need help, so I’m bringing in someone to help you,’” she says. “It’s a balancing act.”
