Recruiting and retaining talented employees has become a long-term operational priority for ambulatory surgery centers.
The labor market has changed considerably since the height of the “Great Resignation,” but the underlying staffing challenge has not disappeared. ASCs still compete with hospitals, health systems, physician groups, and other healthcare organizations for nurses, surgical technologists, administrators, billers, schedulers, and other experienced professionals.
That competition is unlikely to disappear soon.
The U.S. Bureau of Labor Statistics projects approximately 189,100 registered nurse openings each year, on average, from 2024 through 2034, including openings created when nurses change occupations or leave the workforce. Meanwhile, the Health Resources and Services Administration’s latest workforce projections anticipate a nationwide shortfall of approximately 108,960 registered nurses by 2038, with larger percentage shortages projected in nonmetropolitan areas.
For an ASC, employee turnover is more than an HR problem.
Losing an experienced team member can disrupt schedules, increase overtime, place additional pressure on remaining employees, require managers to spend time recruiting and training replacements, and potentially limit the number of cases the center can perform.
Retention therefore needs to be treated as part of the ASC’s operating strategy.
Here are six practical ways ASC leaders can strengthen employee retention in 2026.
1. Offer Competitive Compensation and a Strong Total Rewards Package
Competitive compensation remains one of the foundations of employee retention.
ASC leaders should periodically evaluate whether salaries and benefits remain competitive with other healthcare employers in their local market. That comparison should include hospitals and health systems as well as other ASCs and outpatient organizations competing for the same employees.
A national salary figure by itself is rarely enough.
Compensation can vary significantly according to location, specialty, experience, position, facility size, and local competition.
ASCA’s 2025 Salary & Benefits Survey, for example, was designed specifically to help surgery centers compare compensation using factors such as region, number of employees, specialty, and patient encounters.
That type of ASC-specific benchmarking can give administrators a more useful reference point than broad healthcare salary statistics.
However, retention strategy should not stop at hourly wages or annual salary.
Employees may evaluate the complete value of working at your center, including:
- Health insurance
- Retirement contributions
- Paid time off
- Holiday policies
- Shift differentials
- Bonuses
- Continuing education support
- Certification reimbursement
- Parking and commuting costs
- Family benefits
- Schedule predictability
- Call requirements
- Opportunities for overtime
An ASC might not always be able to outbid a large hospital system on base compensation. But it may be able to offer something many clinical employees value highly: a more predictable outpatient schedule, fewer nights or weekends, a strong team culture, and greater familiarity with physicians and colleagues.
Those advantages should be considered part of the ASC’s employee value proposition.
Review Compensation Before Employees Ask
Do not wait for a resignation notice to discover that your pay scale has fallen behind the market.
Create a regular review process.
ASC leaders might evaluate compensation annually and conduct more frequent reviews for positions that have become particularly difficult to recruit.
Look for warning signs such as:
- Increased offer rejections
- Employees leaving for similar roles nearby
- Positions taking longer to fill
- Increased reliance on temporary labor
- Repeated compensation concerns during reviews
- Experienced employees being paid close to newly hired employees
Retention becomes much harder when longstanding employees learn that the only way to receive a substantial market adjustment is to leave.
2. Make Scheduling and Workload Part of Your Retention Strategy
Flexibility remains important, but in an ASC, “flexible work” needs a different definition than it does in an office environment.
A circulating nurse cannot work from home during a procedure. A surgical technologist cannot choose to complete the day’s cases asynchronously.
But ASCs can still provide meaningful flexibility.
Consider opportunities such as:
- Predictable schedules
- Advance notice of schedule changes
- Flexible start times where feasible
- Voluntary shift swaps
- Part-time or PRN opportunities
- Compressed schedules
- Reasonable PTO policies
- Cross-training that increases scheduling options
- Advance planning around known case-volume changes
Predictability can be as important as flexibility.
An employee may be comfortable with a demanding schedule when they know what to expect. Constant last-minute changes, unexpected late cases, understaffed rooms, or recurring requests to cover other employees can be much more difficult to sustain.
Workload matters as well.
CDC research has identified factors such as long hours and challenging working conditions as contributors to healthcare worker stress and burnout. Research reviewed by AHRQ also points to adequate staffing, teamwork, and strong leadership as important components of healthcare workforce well-being.
For ASC leaders, the lesson is important:
Burnout cannot be solved entirely with wellness programs if the underlying problem is an unsustainable workload.
A free lunch or employee appreciation event can be valuable, but it will not compensate for a team that is routinely understaffed.
Align Staffing With Case Volume
ASCs have another important advantage: scheduled procedural volume provides administrators with information they can use to plan staffing.
Review historical and projected case volumes by:
- Day of week
- Physician
- Specialty
- Procedure
- Operating room
- Block
- Case duration
Then compare those patterns with staffing coverage.
The objective is to avoid both extremes.
Chronic understaffing contributes to stress and overtime. Chronic overstaffing raises labor costs and may create frustration when employees frequently have hours cut.
Better operational data can help administrators make staffing decisions based on anticipated workload rather than intuition alone.
3. Strengthen Recognition, Communication, and Frontline Leadership
Competitive compensation is important, but salary alone will not create a workplace where employees want to remain for the long term. Their day-to-day experience also plays a major role, and much of that experience is shaped by their manager.
Employees notice whether leaders:
- Communicate respectfully
- Listen to concerns
- Respond consistently
- Recognize good work
- Address poor behavior
- Apply policies fairly
- Provide useful feedback
- Support employees during difficult cases
- Explain why operational decisions are being made
Recognition should be part of this environment, but it does not have to involve expensive rewards or elaborate employee programs. Specific, timely acknowledgment can often be more meaningful because it shows employees that leadership is paying attention to their individual contributions.
For example, thanking an employee for identifying a documentation issue, managing a difficult schedule change, or helping a new team member through a challenging case gives recognition a clear connection to the work they performed. That type of feedback is typically more meaningful than generic praise offered only during an annual review.
Create a Reliable Feedback Loop
Communication should also move in both directions. ASC leaders need consistent opportunities to understand what employees value, what frustrates them, and which aspects of the work environment may be contributing to dissatisfaction.
Consider using:
- Regular one-on-one conversations
- Brief team huddles
- Employee engagement surveys
- Stay interviews
- Anonymous feedback channels
- Structured post-orientation check-ins
- Exit interviews
Stay interviews can be particularly useful because they give managers an opportunity to identify concerns before an employee has decided to leave. These conversations can explore what employees enjoy about the center, what creates frustration, what might cause them to consider another opportunity, and what changes could improve their experience.
Not every request will be realistic or appropriate to implement, but a reliable feedback process gives ASC leaders a better chance of identifying recurring problems before they contribute to turnover.
4. Give Employees a Reason to Build Their Career at Your ASC
Employees are more likely to explore opportunities elsewhere when they feel they have reached the limit of what they can learn or achieve in their current role. For that reason, professional development should be an important part of an ASC’s employee retention strategy.
Not every surgery center has enough management layers to offer frequent promotions, but career growth does not always require a new title. Employees can continue developing their skills, expanding their responsibilities, and building experience in ways that benefit both their careers and the organization.
Opportunities for development may include:
- Cross-training
- Specialty training
- Certification
- Preceptor responsibilities
- Quality improvement projects
- Committee leadership
- Supply chain responsibilities
- Infection prevention education
- Revenue cycle training
- Scheduling responsibilities
- Compliance projects
- Supervisory development
- Mentorship opportunities
The right development path will depend on the employee and the needs of the center. A high-performing nurse may eventually move into a charge nurse or clinical director position. At the same time, a surgical technologist may become a specialty lead or take responsibility for preference-card optimization. A business office employee may develop additional expertise in revenue cycle analysis, payer contracting support, authorization management, or supervisory responsibilities.
The goal is to give employees a clear sense that they can continue learning and progressing without having to leave the organization to do so.
Cross-Training Can Benefit Both Employees and the ASC
Cross-training is especially valuable because it supports employee development while also making the ASC more resilient. When critical knowledge is concentrated in one person, the center becomes vulnerable if that employee is absent, changes roles, or leaves the organization.
For example, if only one employee understands a particular billing process, scheduling workflow, reporting function, or clinical responsibility, an unexpected absence can quickly create operational disruption. Cross-training helps distribute that knowledge across the team while giving employees the opportunity to learn new skills and take on additional responsibilities.
This approach can strengthen retention while also improving coverage, succession planning, and operational continuity.
Discuss Development Before Employees Become Dissatisfied
Career development should be part of regular conversations with employees rather than something discussed only when someone is already considering leaving.
Managers can ask questions such as:
- What would you like to learn next?
- Is there another function of the ASC that interests you?
- Are there certifications you want to pursue?
- Would you like to mentor new employees?
- Are you interested in leadership?
- Which responsibilities would you like to take on over the next year?
These conversations can help leaders identify realistic development opportunities that align with both employee interests and organizational needs. Even when an immediate promotion is not available, giving employees a visible path for continued development can increase their confidence that remaining with the ASC will support their long-term career goals.
5. Build a Continuous Recruiting and Onboarding Pipeline
The original approach to this strategy was simple: always be recruiting. That principle is still useful, but workforce planning in 2026 should extend well beyond posting jobs whenever someone resigns.
A stronger approach combines recruiting, onboarding, employee development, succession planning, and retention. Demand for experienced healthcare professionals remains significant, which means ASCs should be building their talent pipeline before a vacancy becomes urgent.
Potential strategies include:
- Maintaining relationships with nursing programs
- Building relationships with surgical technology programs
- Developing clinical rotation opportunities where appropriate
- Establishing employee referral programs
- Maintaining relationships with former high-performing employees
- Developing PRN talent pools
- Networking through state and regional ASC organizations
- Maintaining updated job descriptions
- Building succession plans for critical roles
Job postings should also communicate why an experienced healthcare professional would want to work at your ASC rather than simply listing responsibilities and required qualifications.
For recruiting surgeons, LinkedIn and surgery-related publications might make the most sense; for nurses and other staffing jobs, Indeed, ZipRecruiter, Craigslist, and the ASC Job Board have all proven effective for recruitment.
Depending on the center, differentiators may include predictable schedules, specialty experience, close working relationships with physicians, cross-training opportunities, organizational culture, professional development, competitive benefits, or limited weekend and holiday requirements. These factors can help candidates understand the full value of the work environment before they apply.
Do Not Neglect Onboarding
Recruiting the right employee is only the beginning. The first several weeks of employment can significantly influence how quickly someone becomes comfortable in the role and how they perceive the organization.
A structured onboarding process should clearly introduce employees to the center’s expectations, workflows, technology, policies, and culture.
A documented onboarding program may include:
- Clinical or operational orientation
- Technology training
- Policies and procedures
- Emergency protocols
- Compliance requirements
- Key contacts
- Role expectations
- Performance expectations
- Training milestones
- Questions and feedback
Assigning an experienced preceptor or mentor can also give new employees a reliable resource when questions arise. This can make the transition into the organization easier and help new team members become productive and confident more quickly.
Managers should also schedule regular check-ins during the employee’s first 30, 60, and 90 days. These conversations provide an opportunity to identify training gaps, clarify expectations, address concerns, and understand how the employee is adapting to the role.
If a new employee is struggling, it is far better to identify the issue early than to discover it during an exit interview several months later.
6. Reduce Administrative Burden With Better Technology and Strategic Outsourcing
The number of employees on staff does not cause all retention problems, but rather the amount of unnecessary work employees are expected to manage every day.
Highly trained clinical and administrative employees can become frustrated when too much of their time is consumed by repetitive manual processes, duplicate data entry, inefficient communication, and disconnected systems.
Consider how often employees are required to:
- Re-enter patient information
- Send or receive faxes
- Chase missing paperwork
- Manually notify multiple people about schedule changes
- Search for information across disconnected systems
- Perform repetitive billing tasks
- Reconcile information between spreadsheets
- Enter the same clinical information in multiple places
- Make repeated phone calls because systems do not communicate
Individually, these tasks may seem small. Repeated throughout the day and across an entire organization, however, they can consume a significant amount of employee time and contribute to unnecessary frustration.
Technology should help employees spend more time on responsibilities that require their expertise and less time acting as the connection between systems that do not communicate effectively.
For example, HST Pathways’ ASC platform connects functions including scheduling, charting, billing, inventory, patient estimates, patient communications, analytics, and reporting. HST’s Scheduling & Care Communication technology is designed to automate parts of the case scheduling process and reduce manual communication surrounding schedule changes.
Within the clinical workflow, HST eChart can import information from connected pre-assessment workflows rather than requiring clinicians to re-enter it manually. It also supports simultaneous charting, allowing multiple clinicians to work within a patient’s record.
HST Practice Management can also support administrators as they coordinate staffing with case volume while automating portions of billing and other business-office workflows.
Reducing unnecessary administrative work can improve the employee experience while helping the ASC make better use of the workforce it already has. The goal is not simply to increase productivity, but to remove avoidable friction from employees’ daily responsibilities.
Know When Outsourcing Makes Sense
Technology can eliminate some administrative burden, but it will not solve every staffing challenge. For certain nonclinical functions, outsourcing may provide additional capacity and access to specialized expertise.
Revenue cycle management is one example. Recruiting and retaining employees with experience in coding, claims, denials, payer follow-up, patient collections, and reimbursement can be difficult, particularly for smaller standalone ASCs.
If persistent vacancies or turnover in the business office begin affecting collections or operational performance, an ASC may consider outsourcing some or all of its revenue cycle responsibilities to a qualified ASC-focused partner.
Potential advantages include:
- Access to specialized expertise
- Greater staffing scalability
- Reduced vulnerability to individual employee absences
- Broader revenue cycle resources
- Less internal recruiting and training
- More time for ASC leadership to focus on clinical and operational priorities
Outsourcing should not mean giving up visibility or control. Before entering a partnership, the ASC should establish clear expectations around reporting, performance, communication, escalation, accountability, data access, and compliance.
The purpose of outsourcing is not to treat employees as replaceable. It is to determine which responsibilities are best handled internally and which can be supported more efficiently by technology or an experienced external partner.
Measure Employee Turnover Before Trying to Fix It
Retention strategies are more effective when ASC leaders understand exactly where turnover is occurring and which groups are most affected.
A basic employee turnover rate can be calculated as:
Employee Turnover Rate = Employees Who Left During the Period ÷ Average Number of Employees During the Period × 100
However, one organization-wide percentage rarely tells the complete story. A center may have an acceptable overall turnover rate while experiencing significant losses within one department or among employees with a particular level of experience.
Where possible, segment turnover by:
- Clinical versus nonclinical staff
- Job title
- Department
- Voluntary versus involuntary departure
- Length of employment
- Full-time versus part-time status
- Manager
- Specialty
- Reason for leaving
For example, one ASC may discover that most turnover is concentrated among experienced operating room nurses, while another may find that new employees frequently leave within their first six months. Those situations require very different retention strategies.
Understanding where turnover occurs allows leadership to focus resources on the areas where intervention is most likely to make a difference.
Track Leading Indicators, Too
Turnover itself is a lagging indicator. By the time it appears in a report, the employee has already left.
For that reason, administrators should also monitor signals that may point to emerging staffing problems before they result in resignations.
Potential indicators include:
- Unscheduled absences
- Overtime
- PTO utilization
- Open shifts
- Schedule changes
- Employee engagement
- Training completion
- Time-to-fill open positions
- Offer acceptance rates
- First-year turnover
- Employee referrals
- Exit interview themes
Looking at these indicators over time can help managers identify changes in workload, engagement, recruiting effectiveness, or employee satisfaction before staffing reaches a critical point.
Technology Can Support a Better ASC Work Environment
Employee retention will always depend heavily on leadership, culture, compensation, workload, professional development, and the relationships employees have with their colleagues and managers. Technology cannot replace any of those factors, but it can help remove unnecessary friction from the work employees perform every day.
HST Pathways designs its ASC platform around the case lifecycle, bringing together tools for scheduling, clinical documentation, billing, inventory, estimates, communications, analytics, and reporting.
For an ASC experiencing staffing pressure, the objective should be to make better use of employees’ time. That may involve automating repetitive scheduling activities, reducing duplicate clinical documentation, improving access to scheduling information, streamlining financial workflows, or using operational data to better align staffing coverage with case volume.
These improvements can help reduce administrative burden and allow employees to spend more of their time on responsibilities that require their knowledge, judgment, and experience. In turn, more efficient workflows can benefit staff, administrators, physicians, patients, and the overall performance of the center.
Retention Should Be an Ongoing ASC Strategy
Some employee turnover will always be unavoidable. Employees may relocate, retire, return to school, change specialties, pursue different career paths, or leave the workforce for personal reasons. The objective should not be to eliminate turnover, but to reduce preventable turnover and retain talented employees who continue to provide value to the organization.
For ASC leaders, that requires a combination of competitive compensation, manageable workloads, predictable scheduling, effective leadership, meaningful recognition, professional development, thoughtful recruiting, and efficient operational processes. These factors work together to shape the employee experience and influence whether people see a long-term future with the organization.
ASCs should also continue evaluating the systems and processes employees interact with every day. Repetitive administrative work, disconnected technology, and inefficient workflows can create frustration that compounds other staffing pressures. Removing unnecessary work can improve both operational efficiency and the quality of employees’ day-to-day experience.
The most effective retention strategy is therefore not a single program or initiative. It is a consistent effort to create an environment where employees feel supported, respected, fairly compensated, and able to grow professionally. For ASCs competing for experienced healthcare professionals, building that kind of workplace can become an important long-term advantage.
Are you ready to reduce manual work and create more efficient workflows for your ASC team? HST Pathways provides ASC-specific technology for scheduling, clinical documentation, financial operations, patient communications, analytics, and more, helping surgery centers build more connected operations around the people who keep them running. Contact us to learn how HST Pathways can support your ASC’s operational and staffing goals.