late coverage process improvement

[peabozzle]

I work in a very busy 8 OR hospital, as the charge nurse. We had a record breaking year last year, with 10% of our total volume done in December alone. It was killer, with much stress, much teeth gnashing, much grumbling from staff & physicians. I am looking for ways to make the next busy season better. One of the biggest staff complaints is staying late to finish cases when not on call, or not the "late" person. We staffed for call, 2nd & 3rd call; but often would have 5+ rooms still running after "quitting time". We also have some staff on 10 hour shifts that end at 4:30 & some on 12 hour shifts that end at 6:30. We also have quite a few surgeons who have their own "teams" that generally stay until their surgeon's cases are done. I always make a point to ask the staff if they are able/willing to stay, even if they are on a team. Does anyone have any suggestions on how to arrange coverage for later cases in a "fair" manner? What I discovered was myself & one other RN were typically the ones that ended up staying, while the others always had to leave. I really do understand that there has to be a life outside of the OR, but I am looking for a way to make that happen for everyone, not just the ones that don't want to stay late an extra day.

[Rose_Queen, BSN, MSN, RN]

There is a lot of collaboration between anesthesia and the OR charge nurse. It's not just the room staff that leaves- so does anesthesia. Basically, if it's an add-on that will put us over our after-hours anesthesia limits, it doesn't start until something else finishes. As for scheduled cases, we have rooms that have extended block times- surgeons aren't allowed to book cases that are scheduled to finish after 3pm unless it's their turn in one of the late rooms. That helps a lot too- most of our surgeons are either running on time or only a few minutes late, so since the end of shift is 3:30, most people are out on time unless on call. We've got most of the crew willing to stay to finish the current case, but won't stay to start another after that. No one complains in that situation- they actually usually get relieved by the call team before the end of the case. Then again, we get 9 anesthesia locations at 3pm, and have the staff to cover it when we include call people. Sounds like you facility really needs to examine more 10/12 hour people, more call teams, or discussion about not starting cases once it gets to a certain time.

Now, when the call person calls off and no one voluntarily picks up the call shift, then someone ends up being mandated to cover the call- goes in alphabetical order. Doesn't get used that often, but maybe it could be modified for your situation. Although then you run into the risk of bombing staff morale, losing people, and being worse off than you were before.