We've all had it happen. After doing careful interviews and diligent background checks to find the person who is the right fit for your facility, you still hire employees who don't work out. If you haven't yet hired someone like this, chances are you soon will. But hiring a miscast is not as bad as it may seem. As you'll see, with a little ingenuity and imagination, you can find roles for these employees.

Finding a fit
The nurse who comes to an ASC from the hospital may prefer to work alone and may not think to lend a hand when her "own" area is slow. Or perhaps the tech whose gregarious personality was an asset during an interview is now getting complaints from your docs, because her constant chatter is a distraction during such "quiet" cases as cataracts. You need to re-assign these employees in a way that makes them productive in other capacities at the facility.

• The "territorial" nurse may find a niche working away from the OR, doing pre-op interviews and working one-on-one with patients and family members.
• The "chatty" tech may be fine working cases where the environment need not be quiet during the procedure.

Knowing when to say when
Not every employee is salvageable. You can't, for example, get someone who works at one (slow) pace to be a good fit if your facility does a lot of short ENT cases. No matter what you do, the employee will slow you down, because there is a lot of equipment to set up and everybody needs to work briskly to ensure rapid turnover and to keep the OR schedule on course.

At other times, no matter how hard you work on personality clashes, scheduling conflicts and training, the employee still does not fit in at your facility. It may be time to help this person move on to a place where the fit may be better. At least you made every effort to make it work.

Bridging the generation gap at work
Nurses from different generations have markedly different work ethics. All you can do is assign staff to areas that match their work ethic and minimize discord. For example:

• Older nurses. Give the World War II-era nurses a break from having to do unpopular, "heavy" assignments, such as moving around the heavy equipment for ophthalmic cases. Leave the heavy work to the younger staffers and put older nurses in areas that require diligence and concentration.
• Baby Boomers. Nurses in their 30s and 40s may find flextime helpful if they have elderly parents or a child to tend to early in the morning or in the afternoon. Perhaps you can work out an arrangement where they work 8 a.m. to 2 p.m., for shorter blocks of time, and/or in the PACU during peak hours.
• Generation X. Schedule those staffers in their 20s who prefer to sleep late to cover a later shift. Do they prefer to leave early? Put them on the early shift and let them leave when work is slowing down.