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to accept wasting when there are constant complaints about the cost of healthcare."
"You need multiple job titles to meet Medicare rules," says Henry Rey Jr., RN, USAF, quality assurance inspector and nurse manager/surgical director at Schulze Surgery Center in Savannah, Ga. "Medicare needs to restructure the standards to allow small organizations to meet requirements. The current standards place a financial strain on small centers that don't have the same staffing resources as a hospital."
And, of course, there are those who seem mainly concerned with scrutinizing your facility's earnings and holding your feet to the fire if they don't like what they see.
"The partners," says Beverly Kirchner, BSN, RN, CNOR, CASC, president at Genesee Associates in Highland Village, Texas. "They're always looking for improved bottom lines so they have more money in distribution, but they do not always work with me to decrease costs and obtain the bottom line they want."
"Unrealistic expectations of owners regarding cost containment," says Cynthia Gress, CRNA, MSN, CCRN, administrator at Saint Charles Surgical Pavillion in Jasper, Ind. "The successful efforts we've made to decrease spending and costs, while maintaining excellent patient care and satisfaction are unappreciated."
Ultimately, if it isn't one thing in particular that's graying or thinning your hair, it's everything.
"There is no room for error," says Ms. Hites. "Managing staff. Keeping up with all the changing regulations. It's very stressful when you know many people's jobs rely on you."
"I never feel caught up or completely finished," says Rebecca F. Spehr, RN, administrator of the Peachtree Orthopaedic Surgery Center at Piedmont in Atlanta, Ga. "Meeting constant deadlines, jug-
