Paying staff for hours they don't work is how we incentivize our staff to work more efficiently and to cover our facility on low-volume days. Here's what I mean:

• Pay for eight hours for six hours worked. If staff complete the day's work in less than eight hours, they may go home early - with a guaranteed eight hours of pay - after completing six hours. This is a daily incentive. We're in a very highly unionized locale, and we've remained non-contract and competitive by including this incentive, which is available to all professional staff with no discrimination between full- and part- time nurses. We haven't determined the cost savings, but it stands to reason that incurring the overhead costs of running the center for two extra hours makes this a budget-neutral policy.
• Pay for four hours on unscheduled shifts. We pay nurses for a minimum of four hours if they work an unscheduled shift. Our charge nurses receive an extra $1.75 an hour.
• Pay for four hours on low-need days. These are days when, due to low caseloads, we require staff to stay home but remain available should the schedule change - and we need help.

Lesley Nace
Co-director
Landmark Surgery Center
St. Paul, Minn.
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Do more during pre-admission visit
On the morning of surgery, our extensive preadmission process expedites cases. Before a patient's preadmission visit, we send physicians' orders to our telefax center. During pre-admission, we give patients a pre-op workup, an anesthesiologist consults with them, and we tell them what to expect and what will be expected of them. Plus, nurses collect information for the nursing database, consents are signed and paperwork is completed.

Mary Knapp, RN
Vice President of Clinical Services
Cox Health
Springfield, Mo.
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Fat substitute can clog your scopes
Last year, one of our colonoscopes mysteriously dripped orange liquid after a case. We brushed and brushed, but the scope wouldn't come clean, no matter what we did. I found out that the problem was an indigestible synthetic lipid found in fat-free snack foods containing olestra (Olean). That fat-substitute's residue will cling to the colon even after an extensive bowel prep. It clogs up your suction channel, coats the lens and light guides and is virtually impossible to wipe off. Ruhof makes a lipid detergent called Endozime SLR that helped. Clean your scope first with this detergent to get rid of the fatty debris, thoroughly rinse (it's tough to get off), then follow your usual cleaning protocol. If you get into trouble, you can use Dawn brand dish soap in a pinch to break up the fat globules - but don't overdo it, because Dawn is extremely difficult to rinse off as well. We also now ask our patients to avoid foods containing olestra (Wow snack chips and Fat Free Pringles) for at least a week before colonoscopies.

Irene Hasenbank, RN, BSN
Director of Endoscopy Services
Cotton-O'Neill Endoscopy Center
Topeka, Kan.
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Oil at night, water during the day
I use oil-based hand lotions at night, water-based moisturizers during the day. When used with latex gloves, the oil in the oil-based lotion breaks down the latex, releasing additional allergens.

Deborah Qualey, MD
Anesthesiologist
Rockland, Del.

Contact dermatitis? Pay for allergy testing
Refer staff who develop contact dermatitis to your occupational health department (if you have one) or pay for them to undergo allergy testing (about $500 for the full battery). Don't assume that latex allergy is the cause; latex is just one of many possible allergens in the OR. Soap excreta and the chemical additives in gloves can also cause reactions. Allergy testing is expensive, but it's impractical to furlough an employee long enough to figure out the allergy by elimination.

Joan White, RN
Infection Control Nurse
Cooper Medical Center
Camden, N.J.

Let your surgical conscience be your guide
If you've seen enough literature to defend abandoning a long-standing practice and you're comfortable that your infection rate won't suffer, go for it. But if there's no research to support your decision to abandon a practice, you're playing with fire.

Ellen Smith, RN, BS, CNOR
Director of Surgical Services
Morehead Memorial Hospital
Eden, N.C.
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