SRU Nurses Embrace New Challenges, Situations
Jack-of-all-trades and master of many—that’s how Clinical Director Lori Puthoff, BSN, MSN, RN, describes Specialty Resource Unit (SRU) nursing staff. She and Clinical Manager Katie Brady, MSN, RN, CPN, sat down with Inspire recently to explain the role their team plays in ensuring that inpatients at Cincinnati Children’s receive the best care.
SRU Nurses Embrace New Challenges, Situations
Jack-of-all-trades and master of many—that’s how Clinical Director Lori Puthoff, BSN, MSN, RN, describes Specialty Resource Unit (SRU) nursing staff. She and Clinical Manager Katie Brady, MSN, RN, CPN, sat down with Inspire recently to explain the role their team plays in ensuring that inpatients at Cincinnati Children’s receive the best care.
“We work in a constantly changing environment,” says Puthoff. “The census goes up and down. Patient acuity increases and decreases. And as it does, the medical center adjusts its staffing needs. The SRU serves as a float pool of highly skilled personnel to help fill the gaps when this happens.”
Some people think nurses are interchangeable, that you can just pull them from one unit and plug them into another. But it’s more complicated than that.
“Every specialty unit has a need for nurses who can provide a particular kind of care,” she explains.
When they experience a staffing shortage, they need someone with the right skill set to fill the void. Our nurses are highly trained in a variety of areas, such as chest tube management and respiratory care. We understand the importance of being flexible so we can provide the right nurse at the right place at the right time.”
New recruits to the SRU receive extensive training for 16 to 18 weeks, moving through multiple cycles of precepting and learning, coupled with on-the-job experience.
“We reinforce the foundations of nursing practice, then focus on specialty care and geography,” says Puthoff. “As an SRU nurse, you get assigned to many different units at Burnet and Liberty Campus, and they’re not all laid out the same. You have to know the basics, like where the Pyxis machine is and where the clean and dirty rooms are located.”
Trainees spend time working in areas like Hematology/Oncology and Bone Marrow Transplantation, then move to the Newborn Intensive Care Unit They finish up with time in the Cardiac Intensive Care Unit and the Pediatric Intensive Care Unit.
“After they complete work in the CICU and PICU, they have time to assimilate everything they’ve learned. This is where they come into their own as a practitioner,” says Puthoff. “It’s a very intentional schedule, which is why the Joint Commission recognized our orientation pathway as a best practice.”
Having such comprehensive training allows an SRU nurse to function in a uniquely versatile way.
Puthoff offers an example: “Nurses in the CICU are proficient at managing chest tubes, so the SRU nurse adds value with expertise on the respiratory system. In the Transitional Care Center, their staff are masters of the respiratory system but may not be as comfortable managing chest tubes. Our SRU nurses can be the resource for that skill.”
Ditching the Comfort Zone
For many unit-based nurses, the prospect of being floated to a different area is scary. The staff, the patients, and the physical space are unfamiliar, and it takes awhile to get acclimated. But for an SRU nurse, embracing this uncertainty is a way of life.
The unit is split into a Days team (daily assignments) and a Months team (6-week assignments).
Says Brady, “Some SRU nurses switch assignments every 4 hours. There’s no chance to get to know the patients, the doctors, or the other clinical staff at all. But it’s what they sign up for, day in and day out. This kind of flexibility is so necessary to meet the staffing needs of the hospital.”
An SRU nurse must be a fast learner, adaptable, and have a positive attitude. They also must be confident enough to initiate relationships, questions, and conversations in a spirit of inquiry.
“We like to use the term ‘grit’ when talking about the characteristics of our SRU nurses,” says Brady. “You have to push through when the going gets tough, and the past 2 years have been especially difficult, thanks to COVID.”
The scheduling process starts with the Managers of Patient Services (MPS), which is the central repository for inpatient staffing requests. MPS looks at all the needs of the house and prioritizes them for each shift. SRU nurses can choose among themselves which assignments they prefer—whether they want to return to an area they worked the day before or go elsewhere.
SRU nurses fill in for colleagues who are out sick or on leave. They relieve staff who need a break from caring for challenging patients. They also share best practices for situations a unit may not have as much experience with, such as assisting dying patients and their families.
The demand for SRU nurses is high, so not all requests can be filled as envisioned, but everyone does their best to accommodate the needs.
Future Challenges and Opportunities
Like every other division of the medical center, SRU nursing has endured the impact of the COVID pandemic, including staffing shortages and feeling disconnected from fellow SRU members. Some of the team were reassigned temporarily to other areas and decided to stay because they offered more stability and regular hours.
"We like to use the term ‘grit’ when talking about the characteristics of our SRU nurses. You have to push through when the going gets tough, and the past 2 years have been especially difficult, thanks to COVID.”
“Before COVID started, we were known as a very high-retention unit,” says Puthoff. “We are working on a competitive approach to attract the best talent.”
SRU nursing holds lots of opportunity for leadership and quality improvement. Members of their team were called on to open the COVID isolation unit at the beginning of the pandemic. Another nurse, Carly Heckman Stein, initiated a practice change for patients with G-tubes involving Farrell bags, which led to a significant cost savings for the hospital.
SRU nursing also provides other services, including:
- A trauma team of nurses, who work 12-hour shifts around the clock every day of the year. They are associated with nurses in the Trauma Bay but are inpatient-based. They carry a pager so that when they are not busy in the ED, they can round on inpatient units where their skills are needed.
- A radiology nurse who transports patients off the unit for testing, so the primary nurse can remain on the unit with the other patients
- Remote patient monitoring, which reduces hospital stays, improves patient flow and provides a better patient/family experience.
Says Brady, “It’s a rare person who is drawn to the kind of work that an SRU nurse does, and rarer still, the person who is good at it and enjoys it. I’ve been at it for 15 years now, and I’ve never felt burned out. There is always something new to take on without having to leave home.”