August 15, 2004
New directors often try to resurrect old plans for staffing. Our Ambulatory Surgery Center (ASC) is a small facility with three operating rooms located across a parking lot from the hospital. While belonging to the hospital, we are not part of the main operating room. Therein lies the rub. Each new Director of Surgical Services wants to combine staffing to make the main operating room more efficient. Cross scheduling or combining of staff in both operating rooms is just not a viable option.
Every two to three years the management changes in the main operating room. New "old" ideas are proposed and the arguments begin. Six years ago a new director was successful in accomplishing the combination of staff. As a result, staff from the ASC was put on the call schedule for the main operating room (MOR). We were expected to work in both facilities and take night and weekend call.
Cases scheduled in the MOR are longer and the patients are usually quite ill. Complicated equipment and more invasive patient monitoring are required. Post-op care for MOR patients often includes a stay in the ICU or several days on a surgical floor. ASC patients are usually very healthy and almost always go home the same day. The turnover time in preparing operating rooms for succeeding cases in the ASC is very short, while more time is necessary in the MOR.
The bone of contention is that while surgical nursing is often the same, there are enough differences to create problems and delays in care. Skill levels differ in both facilities and the comfort level for both groups of cross-scheduled nurses is non-existent. The choice to work as an outpatient nurse was consciously made by all of us in the...