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Staffing: No Director of Nursing? No Problem
Spread managerial responsibilities throughout the staff.
Tina Mentz
Publish Date: May 13, 2015   |  Tags:   Staffing
spreading staff responsibilities ALL FOR ONE Spreading responsibilities among the staff removes a heavy burden from one person's shoulders.

It's challenging to find a strong, experienced director of nursing (DON) who can manage all things clinical. Never mind that today's DON must also have a comprehensive understanding of regulatory requirements and know how to operate within a limited budget. The person with leadership savvy and the prerequisite skills isn't always easy to find, and often difficult to afford when you do. And that's OK. By spreading managerial responsibilities throughout the staff, your facility can thrive.

Shared accountability
More and more surgical facilities are opting to staff clinical managers who work collaboratively on infection prevention, safety and regulatory activities. For example, you may have an OR manager who's responsible for the operating room and sterile processing areas, but who also serves as the safety officer and leads environment of care activities. Your center's PACU manager might be responsible for overseeing the pre-admission, pre-op and PACU staffs while also serving as the infection preventionist. They're working managers within their departments, and receive the appropriate education for their additional roles, but the individual tasks that fall under their managerial umbrellas are shared among a team consisting of select multi-disciplinary staff members.

One center I work with shares numerous responsibilities among its clinical managers, including infection prevention efforts, environment of care concerns and facility-wide safety. The PACU manager serves as the infection preventionist and is responsible for developing and reviewing the annual infection prevention and influenza vaccination plans, updating policies and procedures related to infection prevention, creating staff and licensed independent practitioner (LIP) educational tools, investigating reported infections or complications, reviewing audit results and developing action plans or performance improvement plans. She also gets help from other members of the team (see "Infection Preventionists Can Also Manage …").

A Shared Vision of Success

— VESTED INTEREST Staff managers feel responsible for improving patient care and business performance.

Annamarie York, the executive director at Hoffman Estates (Ill.) Surgery Center, implemented the clinical manager model last year. "After our accreditation survey, I realized that one person could not do it all," she says. "We needed to flatten our organization, to get more staff involved in all aspects of patient care and business performance in order to create buy-in to a shared purpose."

The department clinical manager model empowers the main staff, who best understand how things work in their specific areas in order to make smart and effective decisions, according to Ms. York. "The managers more actively engaged individual team members and the result has been a more empowered, positive and cohesive unit," she says. "Overall staff performance has increased because of the commitment to a shared success. The departmental teams are more efficient and make better decisions."

— Tina Mentz

The administrator at the same center also serves as the safety officer, developing and reviewing annual emergency plans and education programs for staff and LIPs. As the safety officer, she reviews audit data and occurrence reports and develops action plans or performance improvement. She, too, passes key responsibilities to staff members (see "Safety Officers Can Also Manage …").

Infection Preventionists Can Also Manage …

  • A pre-op nurse responsible for influenza education and vaccination of all staff members, licensed independent practitioners (LIPs), students and volunteers.
  • The business office staff assisting with the distribution of monthly infection and complication reports, and tabulating preliminary results. The staff also distributes infection prevention education packets to new LIPs and annually to all LIPs, and obtains written acknowledgements of completed education.
  • Individual staff members or clinical managers participating in audit activities for hand hygiene and sterilization logs. Audit results are presented to the infection preventionist, who works with appropriate departments on performance improvement plans.
  • Staff training via a computer-based training (CBT) module that incorporates testing at the end of each education model. The CBT tool tracks all staff education for the year and serves as each staff person's education file.
  • A multi-disciplinary committee that includes the infection preventionist and both staff and managers from various departments who conduct monthly infection prevention and environment of care surveillance. The committee identifies deficiencies, and specific committee members are assigned to take corrective actions.

Safety Officers Can Also Manage …

  • Clinical and non-clinical department managers, who conduct preliminary investigations for all occurrence reports, collect additional data and prepare recommendations for the safety officer to review.
  • A multi-disciplinary committee that oversees environment of care and safety surveillance during infection control rounds.
  • A designated pre-op nurse, who runs fire and disaster drills. The nurse creates drill scenarios, coordinates the event with building management and outside services, runs and evaluates the drill, and prepares an action plan for deficiencies identified.
  • The OR manager, who serves as the surgical energy safety officer and who oversees related education, policies and activities.

Strength in numbers
At a time when surgery centers and surgical departments are asked to do more with less, the clinical manager model combined with empowerment and shared responsibilities of multi-disciplinary teams will continue to grow in popularity and effectiveness. Nowadays, one person cannot do it all. Letting key members of your team manage specific clinical care needs based on their strengths and interests creates a more engaged, high-performing team.