Whether you're the administrator of a hospital outpatient department or a freestanding surgery center, it helps to know how to retain good nurses. Based on my experience in both settings, these four factors are key in whether a nurse shifts from a hospital to an ASC.

Convenient, flexible schedules
A great work schedule is a big carrot ASC administrators can dangle in front of nurses. Shifts may start as early as 5:30 a.m. and not end until the last patient leaves, but there are plenty of plusses in what RNs won't find on their schedules - nights, weekends and call. Secondly, ASCs offer flextime. Nurses can work part-time and a variety of shifts, and cross-trained colleagues and PRNs can cover time they're away.

Some HOPDs are emulating the ASC schedule for full-time nurses. More HOPDs offer flextime and late-shift coverage (something ASCs can't afford as part of their regular staffing). Hospitals also have the vacation-time edge. Five years at the HOPD may earn staff three weeks' vacation; 10 years may get them four. Paid leave in ASCs may be capped at three weeks.

Competitive salary and benefits
Hospitals usually win the salary battle. ASCs try to keep pace, but it's hard to compete with hospital administrations' deeper pockets - often several dollars an hour more.

ASCs may offset this with a benefits plan including profit sharing, a 401K and insurance (the minimum work hours may be 32 hours per week for the employee to qualify).

HOPDs have increasing leeway to offer many of these benefits because more administrations recognize it's good for staff retention. Some hospitals have even lowered the minimum hours you must work to qualify for benefits, including insurance. With skyrocketing premiums (docs aren't the only ones paying through the nose for coverage), insurance is an increasingly significant factor in where an employee decides to work.

Supportive work environment
Many hospitals still have a significant disadvantage in this area. The administration controls your departmental budget, and committees purchase your supplies and capital equipment. Nurses' input, if solicited at all, has little influence on decisions that affect daily work.

In addition, the hospital OPD is often not located on the first floor and staff parking is inconvenient. Rarely is hospital administration truly responsive to these issues, and there is not much a supervisor can do to push them to the fore of administration's agenda.

A well-run ASC offers prospective nurses a host of environment-related benefits the hospital cannot: a family atmosphere, cross training, teamwork in all areas and greater work autonomy, and a much slimmer hierarchy. There are also ancillary benefits such as more convenient parking.

Hospitals, though, are not at a total loss. ASC nurses must be self-motivated problem solvers because their workplace lacks formal departments. If you need support in the hospital, there is a biomedical engineering department for OR equipment, an IT department for your computer and an infection control department to handle post-op infection tracking. Got a mess that needs to be cleaned? House-keeping. Light out in the restroom? Maintenance.

Educational opportunities
ASCs can attract prospective nurses by creating programs where they encourage staff to attend meetings and seminars and, within reason, paying the staffers' attendance fees. Ownership and administrators often encourage staff to join professional organizations and get certified in their specialties.

HOPD administrators' hands are often tied by the budget. They sometimes can finagle money for staff education, but just as often, they cannot. While good meetings and workshops may be available for the hospital RNs, even if the meeting fees are covered, the employees are not paid educational time, unlike in many ASCs.

Is there a perfect place to work?
There's no such thing as the perfect place to work, but your ASC or HOPD can recruit and retain nurses by maximizing your performance in these areas.