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Putting New Hires Through The Proper Paces
Stephanie Wasek
Publish Date: October 10, 2007   |  Tags:   Staffing

Vital Stats
Director: Jane Hensley, RN
Medical Director: John Kenney, MD
Types of surgeries: General, GYN, GU, ENT, orthopedics, podiatry, ophthalmology, cosmetic/plastic, pain management
Staff: 28 - 2 scrub techs, 8 OR RNs, 1 admissions LVN, 7 pre-/post-op RNs, 2 unit assistants, 2 central service, 1 director, 2 anesthesiologists (including medical director), 3 CRNAs
ORs: 3
Operating surgeons (all employed by the center): 20
Monthly case volume: 200
Years in operation: 7
Ownership: Scott and White Memorial Foundation, a not-for-profit organization that owns the flagship Scott and White Hospital in Temple, Texas, as well as clinics throughout the state.

Like many facilities, Scott and White Ambulatory Surgery Center in Coll-ege Station, Texas, has been hit hard by the nursing shortage. But how they've responded is uncommon. And, you may decide, worth emulating.

Nursing students at nearby Blinn College in Bryan must complete a preceptorship at the surgery center during their final semester to graduate. "If one of the students works out well and we have an opening," says Director Jane Hensley, RN, "I usually offer her a job."

Here's how the preceptorship works. Senior students trail a mentor RN several days a week for three to four weeks, helping the RN in the OR or in the pre-/post-op area. "Then they write a term paper," says Ms. Hensley, "and get the necessary credit."

And Scott and White gets to groom prospective staff members, a major coup when you consider that the demand for nurses in this part of Texas far exceeds the supply. The surgery center is 90 miles from the system's flagship facility, Scott and White Hospital. A lot closer to home are the two community hospitals and specialty hospital with which it competes for staffing in the Bryan-College Station area, population 157,000. Ms. Hensley has hired two interns since Scott and White began its agreement with Blinn College in 1998.

ASC boot camp
Ms. Hensley also has started an on-the-job clinical training program for both the RNs and scrub techs Scott and White hires. The program's aim is to train staff specifically for the ambulatory setting. So far, six of Scott and White's OR nurses and two of its scrub techs have been through the orientation.

Helping Our in a Pinch

Although Scott and White Ambulatory Surgery Center is about 90 miles from the system's flagship facility, Scott and White Hospital, it's not out of the loop. There are 17 regional clinics, one of which the surgery center is attached to.

The clinic includes primary care physicians' offices, specialty physicians' offices, an occupational medicine department (for workers' compensation cases) and an urgent care department (for minor emergencies), which means surgeons are always nearby.

"We'll end up doing maybe 10 add-on cases a month" because docs are able to shuttle appointments across the hall or up a flight of stairs if minor procedures are needed quickly, says Jane Hensley, RN, the director at Scott and White. "We also will get add-ons - we've had appendectomies and the removal of a nail from a nail-gun accident - from the urgent-care department, and we'll be able to quickly call a surgeon in to do those."

If the urgent care department gets a case it can't fully take care of, such as a patient with chest pains, or Scott and White needs to admit a patient post-op, the center has an amiable relationship with St. Joseph's Hospital and Health Center across town.

"We have a transfer agreement with St. Joe's, but they have also called on us on occasion to borrow supplies," says Ms. Hensley. "It's a very friendly working relationship."

- Stephanie Wasek

New hires start the six-month program in central service processing, learning about the instruments, the sets they go in and how to clean and sterilize them, says Ms. Hensley. From there, they'll work in the OR, learning about and handling basic instruments. The trainees start with general surgery and move through each of Scott and White's nine specialties as they attain proficiency. To become proficient in each specialty, trainees are progressively integrated to the OR team, says Ms. Hensley. Here's how.

  • A trainee begins by observing cases her that mentor RN works on.
  • After several cases, she will scrub in, working on a limited basis and under the veteran RN's supervision.
  • Several cases later, she'll scrub in for and work on simpler cases, such as a breast biopsy, while the mentor RN observes (but doesn't scrub in).
  • Finally, she is allowed to work cases on her own.

The facility developed an orientation checklist that covers procedures and proper use of equipment. During the training period, the new employee and her mentor check off areas as they are completed; the mentor often gives the new employee a daily report on how she did and where she can improve. This is all documented and, after about six months, the trainee RN is in the regular rotation.

"It has helped with the nursing shortage," says Ms. Hensley. "It just grew out of facing the issue of trying to hire and not being able to get people. It's worked out really well. I have a great group of doctors who are willing to help train nurses, too. There are some days where a surgeon may say, 'We're going to have a difficult case, can we not have a trainee?' And we will accommodate that, but it's very rare."

- Stephanie Wasek