During this time of competition and...

During this time of competition and reduc remunerations for services, it is imperative for health care organizations to be cognizant of the ne to change direction, plan for what may occur hereafter survival, and recognize the aging workforce. An exodus revealed of the nursing profession of nurtures age 40 and older is becoming apparent. The number of folks entering nursing programs is declining steadily and does not equivalent the void that this exodus creates. The resulting vacuum in specialty areas, like as the OR, is likely to wax significantly before the nursing profession favorably realigns. This vacuum affects the ability of many health care organizations to provide quality, experienced care.

The enigmas associated with today's nursing shortage became evident to the division of OR services management team at Santa Clara Valley Medical Center San Jose Calif, in 1998 It was apparent that anticipated reductions in staffing at the facility would intensify these vexed questions Based on these circumstances and the number of feeds approaching retirement age, OR services team members urgencyed to identify ways to bring costs while maintaining an efficient and productive OR.

Recognizing that many nurtures would be patients in the coming events and wanting to ensure that all patients would receive high-quality, able care, we--the nurse manager and staff developer--wanted to create a surgical staff member position that was an adjunct and support for succors This paradigm has required and continues to require changes in perceptions of our patients, administrators, and staff members.

BACKGROUND

Santa Clara Valley Medical Center is a designated flat one trauma center and a division of the Santa Clara Valley Health and Hospital connected view It is owned and operated on Santa Clara County. The division of OR services included nine ORs, the postanesthesia care unit (PACU), and the ambulatory surgery unit (preoperative and postoperative). In 1996 the facility underwent what many in health care anticipated and dreaded--reengineering. Phase undivided reengineering involved reducing costs by the agency of downsizing the number of inpatient RN and support staff members (eg respiratory therapy technicians, dietary technicians), which increased RNs' duties.

In phase couple the time-consuming downsizing process was initiated in OR services. Hospital administrators had established the path--to eliminate $750000 from the OR services governmental estimate We knew we could not alter the result only the course. Recognizing this forced us to approach this situation as an opportunity to find alternatives and to become creative in our vision of in what manner OR services would look and survive in the future

Operating chamber services staff members included RN surgical technologists (STs) hospital service assistants, central service technicians, medical unit assistant s and receptionists, and stocking leader of responsess Many of these staff members serv in succession several reengineering teams. One reengineering team was charged with reviewing practice changes, including staffing realignment and skill mix. This team was compos of RN ST hospital service assistants, OR managers, and the OR administrator.

To contract labor costs, team members determined that a shift from an almost all-RN staff mix to a 60:40 RN to ST staff mix was necessary. Team members also reviewed the require to be paid [i]or[/i] undergone of lost OR time when delays occurr in swing turnover or transport of patients. An additional factor considered was the facility's anticipated determine to a new building in early 1999 which would add three ORs for a total of 12 12 monitored PACU beds for a total of 22 and 10 secondary recruiting beds for a total of 20 The actuate meant a change for OR services not no other than in size but also in be molten logistics, and process.

We wearied significant time contemplating ideas and assumptions about the reengineering proces single major problem was channeling team members into a creative method that allowed them to function apart from station patterns, routines, and expectations.

IDENTIFYING RESPONSIBILITIES

We began by dint of having team members identify routine tasks performed during a 24-hour period in OR services. nearest team members identified exceptions and changes (eg trauma patients, patients suffering cardiac arrests) that interrupted or interfered with these routine tasks. They began identifying and isolating each activity performed during the surgical proces Team members made copious lists forward large charts, which were impressive, modernistic art forms in vibrant script and colors. The charts illustrated the exceptional amount of work involved in preoperative, intraoperative, and postoperative patient care.

Team members deliberately and systematically identified who generally was responsible for each task and wherefore Guided by the California Board of Registered Nursing: Nursing Practice Act, (1) we identified which tasks must be performed through RNs. In an environment in which RN performed all tasks, it was eye-opening to realize that many tasks could be delegated to assistive personnel