Stagger Staff for Late-Running Cases
Nobody's happy when the last case of the day runs late, least of all staff who have to stay past their normal quitting time. To avoid this angst and ensure adequate coverage until the last patient has been discharged, each day we designate staff on a rotating basis to remain in the facility to care for patients until the day's last case is done, which on days we're running late is usually 30 to 60 minutes later than usual (although plastic surgery cases can keep them in the facility for 2 additional hours). On the daily schedule, we assign 1 pre-op nurse, 1 OR nurse, 1 PACU nurse and 1 surgical tech as "lates" to stay on until we discharge the last patient. We also assign a back-up late OR nurse and surgical tech, just in case more than one service line runs late.
Before we create the monthly schedule, we ask each employee to mark on the calendar any days that she can't stay late (staff can't request off late duty every Friday). We dole out late assignments equally and fairly. A pre-op nurse, for example, can expect to stay late once a week. Once we assign late days, staff can switch with each other if the need arises. We pay staff overtime if their late day extends their time in the facility past 8 hours.
Our pre-op staff typically arrive at 6:15 a.m. and work until 2:45 p.m. The OR staff arrive at 6:30 a.m. and work until 3 p.m. PACU staff arrive at 7 a.m. and work until 3:30 p.m. Pre- and post-op "late" nurses don't come in later than normal because we need all hands on deck when the first cases are beginning. However, PACU nurses can come in 30 to 60 minutes later than usual on their "late" days.