Of all the challenges involved with running an OR, managing the changeability of a level I trauma center can be the most riddled with complex situations. Many plans can help direct a nurse manager on how to construct an on-call program, yet too often, the program doesn't adequately fit departmental needs. So how does a nurse manager begin to accommodate the variability of whatever complex, high-acuity cases may present at any given time?
Establish a core call team
With the changing demographics in the nursing workforce, work-life balance has become more of a priority as it relates to staff satisfaction. To combat these challenges, Lehigh Valley Health Network's Level I Trauma Center in Allentown, Pa. has established a core call team to support the needs of the community, as well as increase staff satisfaction by alleviating the call burden on the perioperative staff.
A well-formulated plan is the key to a successful program. Understanding the limitations put forth by various accrediting bodies, Lehigh Valley's plan considered hours of operation, staffing patterns, and the overall goal of staff satisfaction and recruitment. A comprehensive education plan for these core call team staff members was crucial to the overall success of the program and quality of care delivered.
Ongoing validation of members on an assortment of procedures, including those most seen during emergent or trauma situations, is vital in sustaining an exceptionally diverse core call team. On any given day, as cases on the competency checklist are performed, staff on the core call team are given the autonomy and support needed to select their staffing assignment based on their requirement for continuous proficiency.
As the core call team was constructed, careful consideration was given to the preservation of shared governance, unit needs, and state requirements. Placing the guidelines in policy format, as well as developing a yearly contract outlining the requirements of the core call team, provided clear expectations for the team's individual members. Additional success was found by promoting self-governance and scheduling, which allowed members to have a better work-life balance while committing to quality patient care. Upon careful assessment, a need to establish an additional call team to support cardiac cases was identified. Maintaining the quality and consistency of care delivered to this patient population was paramount.
Financial challenges
When establishing this incentive program, the institution was faced with financial challenges and needed justification for related expenses. Staff turnover versus bonus pay was carefully considered. In addition, creative budget strategies were formulated to encourage and attract joining core team members. The core call team members received the same hourly pay as the rest of the staff plus 1 hour of pay for every 8 hours of call they acquired. If they worked more than 40 hours in a week, they were paid time and a half. The administration created a sliding scale of tiered bonus pay based on a 12-week time period to attract member participation. The core team member would have the ability to increase their overall compensation based on number of call hours taken. For example, a call team member who took 200 to 224 hours in the 12-week time period would receive a $1,200 bonus. Those taking 300 to 324 hours of call received a bonus of $1,931. In total, these paid hours, as well as the additional bonus, would substantially increase a staff person's annual salary. An increase in salary for hours not necessarily worked was enticing.
The perioperative division at Lehigh Valley justified the program costs by pointing out its positive impact on recruitment and retention, its decrease in turnover rate, and the alleviation of the need for agency staff. In addition, this program decreased overtime for the perioperative team.
Achievements
To date, the following accomplishments have been met and sustained: enabled staff recruitment from distances greater than 30 minutes, retention of mature staff who no longer wish to take call, and a sustained vacancy rate of less than 4%. This process can easily be tailored and applied to any organization requiring an on-call program with a little creativity. This establishment promoted teamwork and strengthened the relationship between the staff and management team. Moreover, it provided an opportunity for the perioperative team to administer safe, quality care in the Lehigh Valley and neighboring communities.
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