From Hospital to Endoscopy Center

What is the scariest thing you have ever done? Some say getting married, some having children, but for me, it was a major career change. I had been working in a hospital setting for 22 years when the opportunity to become a director of nursing at a free-standing endoscopy center was brought to my attention. I had management experience from working in the newborn nursery and labor and delivery unit, had worked many hours in the emergency department, helped in special procedures, and I even had some pediatric experience. I guess the one thing that made me feel somewhat comfortable was the fact that I had been in the GI lab for nine years and had my certification as a GI nurse. I had my doubts about how to get started, but quickly found out that networking would be my best friend.

It was November 2000 when my nurse manager, Terry, got a call from the Gastroenterology Associates of North Mississippi. They were searching for a director of nursing for a free-standing endoscopy center that was being built. Terry declined the offer, but told the office manager, Gerald, that I might be interested. After speaking with Gerald and arranging an interview, I knew my life was about to change. First, there was the primary interview with a physician, the office manager and a consultant. Then came secondary interviews with more doctors. I had not interviewed for a job in years, so these experiences were scary.

When I was hired, our building was just a slab of concrete that eventually grew into a two procedure room center with four admission bays and five recovery bays. The building consists of the physicians' offices, the Gastroenterology Associates of North Mississippi, and our section, the Endoscopy Center of North Mississippi, LLC. Our first step was to read and revise the policy and procedure manuals. My doctors had a consultant who developed the manuals in the initial phase of their planning, but I had to read and correct all the manuals given me. Then there was the task of finding the right group from whom to purchase miscellaneous supplies. Meeting and dealing with various personalities was sometimes a strain on the nerves, but in the end, I found the group with the best deals. Being an endonurse gave me insight into which endoscopy companies I needed to contact and work with. Never stop looking for a way to cut costs, maintain safety, find educational opportunities for your staff and yourself and ways to be more efficient, always keeping the patient as our main focus.

Things were looking up for us. The doctors had the lease agreement with Olympus for equipment before I started, the manuals were completed, vendors were selected, and now it was time for the nurses. My physicians already had in mind the people they wanted. You can say we got the "cream of the crop" from the hospital lab. Lisa, my receptionist, came first. She helped me choose the type of charts we would use. Phyllis and Susan, my RNs, came next. Together, the nurses and I developed our nurse's notes physician orders, procedure notes, and follow-up forms. When we were allowed in the building to set up, Phyllis and Susan set the rooms up as they felt would be most efficient. Having been part of a GI lab, they knew what would work and what would not. As we grow, I think we'll keep the same setup.

Finding the right dictation station for the physicians was another hard task. I talked with representatives, viewed and played with software from several companies, and researched companies over the Internet. Dr. Webb found the company we now use when at DDW. We have a point-and-click system that takes the doctors three to five minutes to write their reports. This system allows the physician to add the information he uses on a regular basis to his report, and I must say that we have had great results from this company.

Having an experienced staff made our start an easy one. Before we went through Medicare certification, we were told that we could only do four procedures. After that, there was a wait and see period for their approval. Not being able to do any further cases until we were Medicare-certified, my nurses went back to working at the hospital on an as-needed basis. Once approved, the procedures started increasing. We have been in our center now for 18 months and already have seen 2,780 patients -- some of them more than once!

Finding a tech was probably my most difficult task. I interviewed at least 50 people who did not even know what they were applying for. Some people became a little squeamish when I described the procedures. Only a few had backgrounds in the medical field. In the end, we hired Hazel, an LPN, also from the hospital GI lab. My staff was now complete. Our plan was to have Hazel and an RN in each procedure room.

Our day begins with the first patients arriving at 8 a.m. Phyllis, Susan and I get the patients ready for their procedures. Once the first procedure is complete, I become the recovery nurse. Phyllis or Susan, whoever is not in a procedure, goes to the admission area to prepare the next patients as they arrive. When times are tough, Lisa helps bring patients to the admission area and even transports patients to the rooms, if needed. When patient census is low, I manage to be out of staffing to work on the numbers, benchmarking, ordering and whatever else may come across my desk. We are a small group of women, a great team and a family.

Besides my responsibilities as director of nursing, I help the clinic nurses with Remicade infusions. This too was a new learning experience for me, and has been beneficial. It has helped me understand more about the patients we treat, their disease and how this medication has improved their lives. These patients appreciate the care given them by our physicians and nurses, and are also beneficial in teaching a new patient about their experiences.

Being a part of SGNA has also helped with networking. I have met many new friends via the Internet through SGNA who have helped me with benchmarking, forms, educational opportunities and mental support. Going to the local and national meetings has also helped me learn from my peers -- what trials and tribulations that they encountered in the beginning. Because of my networking with others through SGNA, I was a part of an educational lecture group at the SGNA national meeting in Phoenix. This session was specifically for the ambulatory setting. Therefore, I encourage each new manager I meet to get involved with SGNA, to be active on the local and state levels, and possibly nationally. Your resource can be one of your fellow SGNA members.

Diane Moore, RN, CGRN, has been the director of nursing for the freestanding Endoscopy Center in Oxford, Miss., for 18 months. She began GI nursing in 1993 and became a CGRN in 1999. She can be reached at: dmoore@vista-express.com.