A few months ago I was interviewing applicants for a staff nurse position in my ambulatory surgery center. I had the pleasure of meeting nineteen wonderful candidates, all of whom had extremely impressive credentials. One applicant, however, made a particular impression on me. When I asked her why she wanted to work in outpatient surgery, she didn't mention "perks" such as not being on call and having holidays and weekends off. Rather, she told me that she wanted to cross-train in multiple areas, work in an environment that encouraged camaraderie and information-sharing, and be a part of a strong team. Those three things summed up for me what I believe are the three primary strengths of ambulatory surgery centers. It also led me to think about how we've tried to enhance these attributes in our center.

At our facility, we start cross-training new nurses from their first day on the job. First, we assign them to a preceptor, who customizes an orientation program especially for them, focusing on sharpening the skills they have and helping them acquire new ones. The preceptor then mentors them through every stage of the orientation process. For the first few months, our new nurses rotate through all the possible areas where they may be assigned. They master a range of duties, which may include preoperative assessment and teaching, preparing patients in the holding area, circulating the OR case, monitoring local sedation patients, caring for patients in Phase I PACU, and discharging patients home from Phase II. They meet and work with all the nurses, surgeons, anesthesia providers, and all the other members of our team. Once their orientation is complete, they are confident that they can work in any perioperative area, and so are we. The learning process doesn't end there, though-to keep skills sharp, we rotate assignments frequently and evaluate our nurses' competencies annually.

To promote information sharing among the staff, we hold in-service meetings every month. At each one, a nurse who is particularly knowledgeable about a particular task or piece of equipment-such as how to use a patient warming device, or how to operate an electrocautery unit-prepares a presentation on it for the rest of the staff. These meetings give the staff a chance to learn about and practice their skills with high-risk equipment that they may not be called upon to use very often.

Mentoring and in-service meetings give us time to do more than just sharpen our skills. They help keep us working and thinking as a team, which is vital in any healthcare facility, but even more important in a center where we don't have a lot of support personnel. Our staff cohesiveness is apparent to our surgeons and especially to our patients. One patient even commented on this on a recent patient survey. She said, "From the person who opened the door to the last nurse with the wheelchair, I had the best treatment. Everyone on duty worked so well together and kept me informed and comfortable. If we all had more experiences like this one, we wouldn't feel quite so anxious about [surgery] visits."

Let's all take the opportunity to mentor our colleagues, share our knowledge, and build strong, cohesive teams. By doing so, we'll create a positive environment for ourselves and our patients.

Ms. Saufl is the Manager of Port Orange Day Surgery, Halifax Medical Center in Daytona Beach. She is the President of the American Society of Perianesthesia Nurses.