Today more than ever, you need to be certain you're getting your money's worth for every minute your staff are on the clock. Here are some strategies that have worked for me.

Shift from the morning to afternoon rush hours. Train your nurses to assist in the admission process during the morning influx of patients and have them transition to recovering patients in post-op as that area becomes busier later in the day.

Stagger starts. Schedule staff start times based on the number, type and timing of cases. For example, if 3 surgeries are starting at 7 a.m. and at least 2 of those cases will last an hour, start 2 nurses in pre-op at 6 a.m. to prepare the patients for surgery and stagger the next wave of nurses to arrive at 7 a.m. or later.

Reduce overtime. When scheduling shift start times, work backward from the estimated end of the day to keep the workday to 8 hours and reduce or eliminate staff overtime. If the last patient of the day will likely complete recovery and be discharged at 6 p.m., start the last 2 nurses of the day at 10:30 a.m. This way, they won't be earning overtime when they discharge the last patient, complete the charting and clock out by 6:30 p.m.

Chart as you go. Update patients' records in real time to eliminate allocating paid nursing hours at the end of the day for catching up on charting. Establish a guideline stating that any hours worked at the end of the day, and especially during overtime, should be spent only on direct patient care.

Eliminate loitering and lingering. Make sure staff don't clock in early or linger at the end of their shifts. Have them start and stop when they're scheduled to in order to shave wasted minutes from a paid workday. Most preparation for outpatient surgery can be done in 30 minutes or less. If you're letting OR staffers clock in more than 30 minutes before the start of surgery, all you're paying for is an extra coffee break at the beginning of the day.

Plan breaks. Coordinate breaks to fit the schedule of the charge nurse — who can fill in at the front line — to eliminate bringing on an extra float nurse. If the day's schedule is not terribly busy, the charge nurse may be able to coordinate workflow in the morning in order to give coffee breaks and lunch breaks in the middle of the day. Filling in for staff on break will also let the charge nurse stay connected to happenings in the OR, build relationships with surgeons and get a firsthand look at issues that may need to be addressed.

Phase out full time. Never guarantee your staff will work 8 hours in a day or 40 hours in a week. Let your team know that shifts will be staggered to accommodate fluctuations in the surgical schedule. On slow days, for example, if a series of procedures begin at 7 a.m. followed by a few cases starting at 2 p.m., bring in just enough staff to work a 4-hour shift that covers the morning cases, send them home, then have a separate team work the afternoon cases. This not only maintains salaries within budget, but also spreads the working hours evenly among the staff in order to prevent layoffs or shift cancellations. While some staffers might complain about having their shifts reduced to 4 hours, most would agree that working 4 hours is better than not working at all.

Avoid common pitfalls. Doling out overtime pay makes it nearly impossible to maintain salary costs within a limited budget. Try to anticipate and eliminate potential overtime pitfalls: staff skipping lunch breaks; delayed case start times — which push back the entire day's schedule — because of surgeons who always run late; or early-arriving nurses volunteering to work late-starting cases.