Small inpatient surgical center question---(afraid to ask in interview!)

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Specializes in NICU, Peds, Med-Surg.

Hi....I have an interview to work at a busy (mostly) outpatient surgical center that has ten beds for overnight patients

(this particular position is for overnights).

I have MANY questions to ask in my interview, but this is one I'm afraid will sound dumb......If they only have TEN beds,

let's say that day, only TWO patients have to stay overnight.........

wouldn't it be cheaper to just send those patients to a big hospital? And how do these places staff, I wonder?

I can't imagine them letting just ONE nurse stay with two patients----but maybe they do???

My friend recently had a hysterectomy at one of these small places and stayed one night---she said she was

the ONLY patient and there was just ONE nurse with her---and the nurse told her she was with an agency.

. All I could think of was "what if she had coded/

hemorrhaged?".....well---of course the nurse would start things, then call EMS? But how effective is ACLS

when you're alone? She is SURE the nurse said she was alone there---that seems hard to imagine!

I can totally see for this job I applied for, they "PREFER" ICU experience---(which I don't have).

Also, when my friend stayed at this tiny surgical center, there was a HUGE

hospital right across the street---so, aside from this potential job, I'm also just curious why they didn't just

send my friend there----hence, saving the cost of paying the high fee of an agency nurse to care for ONE patient?

I just don't get it.....

I'm starting to get NERVOUS (hence, my user name :D ) about this interview and don't want to sound like an

idiot.....thanks in advance!

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Specializes in L&D, PACU.

I worked at one of those small surgical centers, as the night nurse. Usually I had one patient overnight, at the most two. I was usually the only RN there, but there was always someone else there trained in CPR. They slept in the next room and were available throughout the night for problems. There were a couple of times I had to transfer a patient in the night to the hospital for complications we were not set up to handle.

No, it isn't cheaper to transfer the patient to the hospital for th night. For one thing...think of the patient. Fresh out of surgery and have to get hauled to the hospital? For the patient it is much cheaper to spend the night in the surgical center. Most surgery centers charge a fraction of what the hospital would pay. (seriously...a fraction!!!) It isn't just the cost of the nurse...it's the cost of the overhead. Hospitals are big expensive places to run, and the cost gets spread out over all the patients. The surgery center charges the patient differently if it is just a day stay or an overnight, so it costs the surgery center nothing...the cost is paid by the patient. Plus it attracts doctors to the center that otherwise might not bring their patients to the center. (the centers are there to make a profit...and to do so they MUST have surgeons use them)

So for the patient it's a great deal. It's cheaper by far than the hospital, and even though insurance is paying usually, the copay is much lower. Sometimes we did plastic surgery that was all self pay, or others that were self pay, and we saved them bundles. Plus, they got great one on one care. Surgical recovery at a hospital isn't nearly as attentive as I could be. Our overnights stayed in the PACU so I was in the room the entire night with them.

It's a fun job. I moved to days for family reasons, but sometimes miss my overnights. In the middle of the night when anesthesia had worn out, often the patient would talk. It was a great time to employ some of the nursing skills you might not get to use during a busy day shift, such as therapeutic communication.

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Specializes in NICU, Peds, Med-Surg.

Thank you, Halinja!! You answered ALL my questions soo well! I had no idea about any of these things!!! It ALL makes

MUCH more sense now!

I think I would LOVE this job----I wonder if they'll hire me??? I'm sooo excited! :nurse:

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Surgery centers would likely have one RN and one aide if only 2 patients spend the night. Insurance and other financial reasons are why they wouldn't transfer a patient to an acute hospital.

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is your question the cost? or the concern for the pt?

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Specializes in Med/Surg, Ortho, ASC.

By definition, an ambulatory surgery center is certified to provide care for only 23 hours and 59 minutes. They can only accept surgeries with pre-op through recovery times that fit within that timeframe. It is against their certification to allow a surgery to be performed in their facility when the outcome is a certain transfer to the hospital.

Regarding overnight staff: My facility never staffs less than 2 RN's overnight. I couldn't be comfortable with less than that.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Overnight patients do not usually have complications, but if they do, I can see why they want someone with an intensive care background.

We have an overnight area in my hospital and the nurses who work there don't have that kind of experience and often panic. They are not new nurses either.

As for why they do not just stay at a hospital, it is always about the $$. You have to ascertain the safety of keeping these patients in your area. Create a good rapport with your anesthesia provider so that you are aware of the type of patient population that might cause you trouble, i.e. people with sleep apnea, chronic or recreational drug users that might require more post-op pain management than you are comfortable with (Those types of patients don't belong with you, but some fall through the crack. DON'T assume you will ALWAYS have perfect people--you should-but you never know!)

Be very, very good with emergency BLS treatment, airways management, etc., YOU are the only bridge to the safety of a patient and I, if I were the patient, would want to know that you can handle WHATEVER comes your way.

Oh, and if you can, ask if you can be sent to a Critical Care Course so you have an idea of what you might have to do.

Good luck, be humble, be safe.

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Specializes in NICU, Peds, Med-Surg.

Thank you to everyone that answered.....as I said, I do NOT have ICU or PACU experience, and a patient going

"bad" does frighten me!

JoPACURN---thank you for the advice on taking a Critical Care course...great idea!!!:yeah: I LOVE

to learn, and I've been brushing up and reading A LOT about post-op nursing! I feel like this is more

of a "PACU" type job, so I BETTER know what to do! One of my other questions

at the interview will be how long do I orient!!! I have found at most interviews, they usually say "you can

orient as long as you feel you need to"....I hope this is the case!

If they hire me, I am somewhat scared, ( I think that's a good thing!) but also excited to learn something new!!!

Part of me was thinking maybe this is too much for me, but IF they hire me, I will do my BEST and maybe I will

LOVE it.......but of course, I would never want a patient to have bad outcomes because of my lack of

experience......!!!

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Nervous, I don't think your questions are bad ones at all. :twocents: I wouldn't be afraid to ask them.

As to the economics, many surgery centers are privately owned, so financial information isn't available. Therefore, you can't be expected to find a definitive answer to that question on your own.

The questions about Pt care after hours are also very relevant to your job, and you should have answers to them. For one thing, what's the average response time of EMS to the facility? How many times in the past year has EMS been required? What other immediate resources do you have available for a Pt crisis? Those are questions that deal with the quality of care, and also your job expectations and satisfaction, not to speak of your license.

Asking thoughtful, indeed challenging questions shows you've given some cogitation time to the interview, and that's a plus to an interviewer. If they're defensive or obfuscatory, then run the other way.

Several posters have given you some good info here, based on their experience and knowledge. That'll give you a reference point for the answers you get if you ask similar questions, and also provide the ability to ask follow-up questions as needed.

Best of luck in your interview, and let us know how it goes. :wink2:

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