1. Combining generations
Like other business sectors, healthcare is learning how to accommodate the collective personality of a new generation of employees.
“Generation Y grew up on computers ? this generation is used to texting and e-mail and using technology,” says Roger Manning, president of Manning Search Group. “The key is to manage the business while recognizing individual generations’ needs. You can’t project traditional models on people who don’t work that way.”
Further, it’s wrong to assume that because Gen Y works differently and values work-life balance more than preceding generations, its members are lazy. In fact, their work style is quite the opposite.
“They just see getting to the outcome differently,” says Mr. Manning. “The hallmark of ASCs is keeping costs down through operational efficiency. Gen Y is all about getting the job done so it can get out of there. It’s a generation that seeks out efficiency; it’s almost as if it’s made for ASCs. If there ever were a negative to the Baby Boomer’s work-work-work mentality, it’s that it assumes everything can be fixed by working harder and longer.”
That’s not to say that older employees aren’t valuable. While the nursing shortage has become increasingly acute across the nation, Baby Boomers have remained the stalwarts of the profession.
“People in their late 50s still have a lot to offer ? they’re not too old,” says Joe Feldman, president of The Spring Group, which runs www.AmbulatorySurgeryCenterCareers.com. As the delaying of retirement becomes more and more commonplace, “age is no longer a factor. [With the shortage,] if you’ve got a strong background and you can produce, no one cares if you’re 60 or 20.”
2. Staffing for flexibility
The key, say the experts, is to find ways to integrate the different generations to your facility’s advantage. As a result, one increasingly popular trend is to hire according to new, more flexible staffing models.
“There’s a trend now to staff just a tad below what you really want in terms of FTEs, then supplement with PRN staff,” says Mr. Manning. “Most of the center managers we work with talk about getting a good, strong PRN pool. That’s just good business economics. If your census kind of leans on you, instead of having too many FTES, just rely on PRN staff.”
Because the surgery business is greatly skewed toward early mornings, everyone wants to leave by early afternoon, explains Mr. Manning. That often leaves an ASC sitting idle in the afternoon, when it could be generating more income. If you want to bring in physicians to fill those blocks of time, a larger PRN staff can fill in, preventing your having to pay overtime for FTEs. Alternately, if physicians want to close one day a week or run a few half-days per week (common in smaller facilities), you might run into problems with Baby Boomers who want guaranteed full-time work.
“The PRN pool is filled with younger employees ? Gen X and Gen Y want to work, but they’re OK with being called off, whereas more experienced individuals have the attitude that they want the hours they expect,” says Mr. Manning. “They’re more rigid; if you don’t have full census, you still have to pay them. Gens X and Y want more flexibility, and a staffing model where you are just below what you need plays right into that.”
The hourly rate for PRN staff will be about one-quarter more than that for FTEs, but if you calculate the cost of benefits, off-days and holidays, and paying FTEs on low-census days, “the cost of the FTE is actually more than what you’re paying with the 25 percent markup,” says Mr. Manning.
There’s no percentage of FTEs to PRNs that is the perfect breakdown, but it’s recommended that you “keep it to one FTE below what’s comfortable, then supplement the rest,” says Mr. Manning. “If you do that, you’ll always be using someone from the PRN pool, and can further supplement if the census increases. If the census drops, you call off the PRN and you’re already down one FTE, so it’s very cost-effective to run the center that day.”
Which brings up another point: Having enough work to keep RN staff amply busy is key to developing a strong PRN pool. However, if you find yourself using more than two or three PRNs each day, you should track your case volumes to determine whether an increase there warrants adding another FTE.
3. Hiring for cross-trained skills
It’s not just the overall staffing model that needs to be flexible; it’s the individuals as well.
“One of the best ways to keep staffing costs down is through cross-training,” says Mr. Manning. “RNs need to be trained to work in materials management as well, or PACU nurses as OR nurses and OR nurses to cross over to PACU. There’s also cross-training in some of the non-clinical positions; maybe a surgical tech has to fill in at the front desk. It’s being done at all levels.”
Expecting staff to specialize in two or three areas can eliminate separate full- or part-time positions, which cuts down on staffing expenses, he says. Further, you should look to make the most of supplemental clinical staff, says Mr. Manning: “For example, while AORN guidelines or staffing suggestions may say there should be two people manning the PACU, it doesn’t say that they both have to be RNs. That second person could be an LPN or nurse’s aide ? both can effectively supplement the RN, but they cost less.”
