OR Manager March 2023 - 10
STAFFING
BY JUDITH MATHIAS
Maximize your staff: Developing and using successful float teams
loat teams have been a staple
of nurse-staffing plans for many
years, but they have not been
widely used in the operating room.
Utah Valley Hospital, a Level II trauma
F
center in Provo, Utah, and part of the
Intermountain Healthcare system, has
been developing float teams for nearly
2 decades. They honed a method to not
just float nurses and surgical technologists
between the postanesthesia care
unit (PACU), OR, endoscopy, and same
day surgery, but to float between geographically
close hospitals in the system.
With a 15-year successful track record,
this model was adopted by other
hospitals within Intermountain Healthcare
in 2020 to maximize available OR
staff during the COVID-19 pandemic. Intermountain
Healthcare is headquartered
in Salt Lake City, and serves 25 hospitals
and 218 ORs in Utah, Colorado, Idaho,
Kansas, Montana, and Nevada.
Strategies to maximize staff
In 2020, during the
COVID-19 pandemic, Intermountain
Healthcare
leadership challenged
directors in its three
regions to start float
pools at the same time
that they were asked
to decrease their staff
in what they called " off
FTEs who weren't working. We had to
reduce that, " says Douglas.
Managers went to these staff members
and told them they would have to
work 30 hours to get their benefits, and
a lot of them left. By May 2021, the
system was down to 3,045 called-off
hours.
The other challenge-to start float
pools-did not have to start from the
ground up. There was already a strong
process in place.
Paul Brown BSN, RN,
director of surgical services
for the Utah Valley
geographical areas
of Intermountain Healthcare
had started a float
pool about 15 years
earlier. It had started
" drama. " When they float to a facility,
they don't get involved in the politics
and personality clashes that can happen
in a workplace. In addition, the regular
staff are always happy to see them,
and then the next day they are on to
another assignment.
Another thing float staff like is they
get to try all of the different units to see
what is the best fit for them. " It's like a
working interview, " Brown says. There
are some float staff who eventually want
a permanent place to work, and this is a
way for them to try all of the specialties.
Leadership likes
Paul Brown
BSN, RN
as a team of five nurses, and it grew
to a team of 25 to 30 nurses and OR
technologists that were supporting four
hospitals and a surgical center. Presently
there are four float pools in six
geographical areas. Caregivers in the
pool include OR, PACU, same-day surgery,
and endoscopy nurses as well as
surgical technologists. Endoscopy technologists
may also be added to the pool
in the near future.
Mary Anne
Douglas,
MSN, RN
hours. " Off-hour staff were budgeted to
work for a certain amount of hours. If
they weren't needed, they didn't work;
however,
those called-off hours still
counted toward their benefits.
" As a system, we were paying $10
million in benefits to staff who weren't
working their hours, " says Mary Anne
Douglas, MSN, RN, executive nurse director
of surgical operations at Intermountain
Healthcare. " It was great for
the managers and staff to have this
staffing reservoir, but it wasn't great for
our bottom line. " In January 2021, surgical
operations had 53,000 called-off
hours in 1 month. " That's about 25.5
10
OR Manager | March 2023
Staff likes
" One of the things that helped make the
float pool successful for us is that we
support a very small geographical area, "
notes Brown. Recruiting staff for the float
pool also was successful because they
didn't have to take call, work weekends,
or work holidays. The pool also added
variety to their days. Staff may work at
a trauma center one day, an ambulatory
surgery center the next, or a small community
hospital the next. The downside
is that they had to bounce from facility
to facility, have rotating schedules, and
have different start times.
" They are moving a lot, but that is
balanced with other things, " he says.
For example, float staff " really " like
that they don't have to deal with any
The float pool is an actual department
in the system. It has its own manager,
educator, and leadership team. The
leadership team meets every 8 weeks
to develop a schedule that meets the
needs of their departments, and they
coordinate daily to make needed adjustments.
" When
our called-off hours, which
allowed us to overstaff and protect ourselves,
were taken away, it was a big
blow to the way we historically staffed
our units, " says Brown. " Now, with an
organized float pool, managers can
have the confidence to staff at 85% to
90% of their master instead of 110% of
their master. "
Managers don't have to flex up during
busy times or flex down during slow
times. The float pool protects them.
Managers also know that when they get
a float pool staff member, they will have
someone who is instantly helpful. They
have already been oriented, they know
the surgeons, and they know the staff.
Another benefit of the pool is that as
staff float from place to place, they can
look at things objectively and point out
places and people who are doing things
well.
In addition, he says, " because this is
like a working interview, we get to see
how well the float staff mesh with different
teams. Then when it is time to hire,
we can go to them first. "
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