Many teams still feel challenged by the shortages of the last several years. Finding and retaining staff has become a topic of many presentations over the last few conference rounds.

I experienced first-hand, the constant training of new team members while seeing existing team members become exhausted from the increased expectations of mentoring.

From this experience, we’ve learned new ways to implement and provide training to our team. Our new process has been met with success and has solidified our need to ensure a seamless onboarding, orientation, and training program.

The Past

Many of us in the ASC industry have experienced “trial by fire” at one stage in our careers or had been raised on the saying; “see one, teach one, do one.” Now more than ever, that mentality or circumstance can no longer tolerated. It is not only a stressful way to learn but can also create safety issues for the
team and patient.

I can remember one of my first positions as a circulating RN, they had me circulating surgical cases on my second day of work without having any prior experience in the operating room. The center had been short-staffed, and my trainer called out. Of course, at the time, I was a very new nurse and didn’t have any idea as to the implications had I made a mistake, or the patient suffered a bad outcome. I made it through and though the trainer came back the next day, it was sort of like I was already off my orientation at that point. It was an experience I never forgot. Despite that experience, I remained in the ASC Industry. However, that retention may not be the case if this occurred today.

Ongoing Issues

For nurses, learning about perioperative nursing in college was nearly non-existent. At most, some programs have four days of exposure to the operating room, while other programs have no exposure. This coupled with the ramifications of COVID where many seasoned perioperative staff and leaders left the industry, the pre-existing nursing shortage, and the baby boomer generation retiring in droves, our pool of experienced professionals has become even more limited.

From a business perspective, roles within the surgery center such as the administrator or nurse manager are pivotal and come with significant costs when the center experiences turnover. When those roles become vacant it is estimated that replacing nurse managers can cost 60% of their salary in man-hours for recruitment, agency, lost production, orientation, and patient satisfaction 11, and the recruitment expenses themselves can range from 8%-15% of the vacant position’s salary.

Due to this expense, we are seeing these roles filled in one of two ways. First, they fill with other employees from within the organization. Often, this move does not take into consideration the employee’s experience and/or ability to make the successful change to the new role as there was no succession plan in place.

If the ASC does not hire from within, the other pool from which to choose new leaders may be from the hospital environment. This provides the center with its own set of challenges whereby the new ASC administrator must cross the bridge successfully from a non-profit way of thinking to the for-profit model. It can be done, but only with the right training and commitment to change from the new employee. The hospital environment tends to have deeper pockets than those who work in the ASC environment. Of course, you already understand that very well.

Present Day Solutions

Organizations need to rethink how they handle new employees. Having a solid onboarding, orientation, and training plan and process is paramount for ensuring that the new employee stays and becomes invested in your center.

As an ASC, we are required to have an orientation checklist to be completed within 30 days. That is the easy part. But do you have a solid onboarding and training plan? I know our centers do for surgical techs and SPD staff, but what about leadership? Do you have an onboarding and training plan for your administrator? What about your nurse manager? With these being significant roles within an organization, they should be considered.

As an administrator or nurse manager, it would be ideal to write out your daily tasks, and responsibilities with all pertinent usernames, logins, due dates for reporting, state obligations, etc. This will serve to help your successor with the transition and ultimately the ASC.

Consider creating a plan for a 90-day training period for the administrator and delineate who would assist with this. Do the same for the nurse manager and each role that nursing plays within the organization. Our surgical techs and SPD personnel follow a comprehensive training plan and orientation that ensures nothing gets missed. Create a plan using a similar format for

Encourage your ASC to partner with a compliance consultant and to join their local ambulatory surgery center association as well as ASCA on the national level.

Doing so will provide new leaders with all the tools to make their transition successful. Especially for those new to the leadership role. Being responsible on these levels requires specialized knowledge of accreditation, state regulations, and CMS. Leaders also need leadership, teamwork, and communication training. This education being provided as part of their foundation will help with retention and their ability to provide for a healthy work environment.

Affordable Leadership Training

Custom Surgical Consultants strive to empower leadership and have taken our 20+ years of specific ASC consulting and ASC leadership experience and crafted an ASC Leadership Academy. The leadership academy is fully mentored and provides new leaders with the tools they need to be successful.

Visit for more information. For over 20 years, we have trained hundreds of administrators and nurse managers to take on these roles successfully. This training can be done virtually (something we all learned through COVID) with a comprehensive curriculum and real-world experience and knowledge taught by experts in the industry. The courses are fully interactive and fun. We want this to be an immersive experience.

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