2006 AM Poster Winner

1
The Specialty Resource Unit An Innovative
Pediatric Resource Management Structure William
T. Lecher, RN, MS, MBA, Senior Clinical Director,
Specialty Resource Unit, Mary Shinkle, RN, BSN,
Clinical Manager, Specialty Resource Unit
The Innovative Design
Innovative Clinical Development

• Results Outcomes
• Increased base of flexible staff
• Strong recruitment of team members
• Retention of team members has been good
• More than 100 nurses working in our teams
• May limit of new hires during peak 2007 hiring
  season as a result of high employment interest
• We have been building the SRU Teams to more
  effectively provide flexible staffing resource
• The high vacancy rates in 2003 2004 were
  primarily the result of increased RN FTEs
• We are now positioned to optimize the flexible
  resources to meet patient care needs.
• This will occur after our 2007 new hires
  complete their orientation and residency pathways

Cincinnati Childrens Hospital Medical Center
New Graduate Residency and Internship The SRU has
hired new grad RNs for a very long time.
Approximately 9 of 10 new hires to SRU have been
new graduates about 90 of them successfully
complete the orientation pathways, timelines and
associated milestones. This has been
counter-intuitive to how most float pools have
functioned. A structured and sequential
orientation and development process facilitates
the development of pediatric nursing skills and
the ability to successfully work across a variety
of clinical areas The orientation and residency
process incorporated didactic and preceptor
orientation followed with periods of independent
clinical practice. This is followed with
sequential orientation and independent work
across clinical areas throughout the first
year The SRU financial incentives are applied to
base pay after successful completion of clinical
orientation and worked time, not from the date of
hire. Or in other words the incentive is earned
over time.

• Introduction
• A new and dynamic resource management structure
  was implemented in a large pediatric academic
  medical center to strategically align nursing
  resources with immediate, short-term and
  intermediate inpatient staffing needs. Nursing
  staff are hired into one of three teams
• Days Team Addresses the immediate day-to-day,
  shift-to-shift changing staffing requirements.
• Weeks Team Addresses identified short-term unit
  staffing needs every 2-3 weeks.
• Months Team Addresses identified intermediate
  unit staffing needs months in advance (6 weeks
  in advance for LOAs, vacancies)
• The conceptual framework for compensation in the
  column to the right defines clinical
  competence/expertise and flexibility matrix for
  financial incentives to the position an
  individual holds within a SRU team.

14 Unique Clinical Areas A Resource Management
Model SRU General Care (11 units)
A3N 22 bed Surgical Short Stay A4C 24 bed
Rehab Transitional Care Unit A5S 24 bed
Hematology/Oncology A5N 14 bed Bone Marrow
Transplant A6C 16 bed Cardiac Step-Down
A6N 24 bed Adolescent Medical-Surgical A6S 24
bed Medical-Surgical (infant-11 years) A7 34
bed Neurosurgery Neurology B5E 19 bed GI
Colorectal Surgical Unit B5W 25 bed
Transplant ENT Surgical Unit ED Emergency
Level 1 Trauma Center SRU Critical Care (3
units) B4 59 bed NICU (level III) B6W 25
bed PICU B6E 15 bed CICU

• The Challenge
• The challenge was to redesign a robust nursing
  resource management structure to be more
  responsive in meeting the inpatient nursing
  staffing needs.
• The new structure would need to meet the
  projected growth of the inpatient organization.
• Development of New Innovative Staffing Teams
• The project and implementation was based on the
  needs identified by our internal customers
  (general, specialty and critical care inpatient
  areas).
• Each area was represented when defining the needs
  and the model.
• Staff nurse representation was instrumental to
  define clinical competence and job satisfaction
  to attract and retain staff to build the
  proposed teams.
• Individual orientation pathways were developed
  for competence of new and experienced nurses in
  providing general care, critical care or both
  general care and critical care pediatrics.
• Special emphasis was placed on new graduate
  recruitment as the means to build and develop
  our teams.
• This has been a successful approach for growth
  and has provided for competent, proficient and
  expert competency for our staff.

• More about Specialty Resource Unit
• While the Days Team is similar to the definition
  of a daily float pool the differences are
  notable
• New grads have been welcome and successful in
  this team for a very long time
• Over 90 of the RNs are full or part time, not
  PRN
• RN loyalty commitment is high among this team
  to the department hospital
• The Months Team as a staffing team also serves a
  recruitment retention function
• Approximately 10 RNs/year permanently fill
  vacant positions on assigned units
• RNs move to the Days Weeks Teams as clinical
  foundation comfort increases
• SRU Trauma Resuscitation SRU Radiology
  Transport
• 12-14 RNs work 0.3 FTE as Level I Trauma Team
  24/7
• 4 RNs work 0.3 FTE providing care for off unit
  procedures Mon. to Fri.

Experienced RN Orientation Pathways An
experienced RN is defined as having at least one
year nursing experience to differentiate them
from new graduates. As a result there is wide
variation in the experience and skills from one
experienced nurse to another. There is also a
lot of difference between an experienced RN with
pediatric versus adult nursing experience.
Therefore, the orientation pathways below are
individualized based on the experience of the
nurse with general care (Gen.) and/or critical
care (CC)
Future of the Project If continued growth of
these teams continues to be an objective, the
incentives or pay may need to be reassessed.
While the financial incentives have provided for
high retention in the Days Weeks Teams, the
number of experienced or tenured pediatric nurses
recruited has not been as strong. Lessons
Learned An innovative and dynamic structure
providing flexible resources can
flourish. Presentations and publication will
improve explaining and understanding our
non-traditional float pool