Floating non-ICU RN's to ICU!!?

[Keri29]

Hello fellow nurses! I'm having a hard time understanding why it's okay for my hospital to float med/surge, med/tele, and PCU nurses to ICU to care for ICU patients!? I work for a float pool so all I do is float, to 4 different hospitals. I get called and told that I'm going to a certain ICU but I will be caring for overflow PCU pts (I'm a PCU RN). I get to ICU and they try to give me all ICU pts. I refuse because #1 I'm not a qualified ICU nurse, I don't know their protocols, charting requirements, etc, #2 if my loved one were in the ICU and I found out a nurse not qualified in ICU was caring for him/her I would be LIVID!!!, #3 the safety of the patient!!, and #4 I'm protecting my license! If God forbid something happened to the pt I was caring for and I had to go to court, no one would be backing me up saying "oh well we made her take ICU pts", I would be the one in trouble! I've refused every time and every time it causes a big issue! I personally think the hospital is just trying to get away with paying a PCU nurse instead of an agency ICU nurse...just trying to save the $$$.  has anyone else dealt with this?! Do any others think this is wrong? I'm curious for your opinions! Thanks!!! 

[APRN., DNP, RN, APRN, NP]

The only instance I can see where it would be acceptable to float an RN to another floor is if the RN were going to be taking patients that the RN has demonstrated competency to care for.

In a court of law, the RN will always be held accountable to what a prudent nurse would do.

If you have not demonstrated competency in taking care of a certain level-of-care patient, you will be seen as making an error in judgement if you agree to take the assignment anyway.

[classicdame, MSN, EdD]

you may or may not be "protecting your license", depending on the NPA for your state. If you are a competent nurse there is a lot you can do for an ICU patient. Your first duty is to the patient, and if they have no other nurses, how will your refusal affect the patients? In Texas you could claim safe harbor and have your situation discussed in a peer review committee meeting, which the BON will review, but of course that is after the fact. Your license may not be threatened unless there is a bad outcome. Remember, new grads are hired to a lot of ICU departments. Yes, they get training, but they are working.

I recommend you read your NPA to be sure you are interpreting this situation correctly in regards to keeping your license. If you are a member of ANA or one of the state chapters then you have a practice expert to discuss this issue. The best thing to do now is get good information before making any decisions.

[brownbook]

I only know what I know....I don't know what I don't know...may apply here.

For five years...(about 15 years ago) I worked ICU. Afterwards for 5 years I was house supervisor and continued to monitor and help out in ICU.

I got my introduction to ICU as (I admit, but I did it), a scared med/surg float. Then when I worked there as staff ICU RN we often used floats. No patients were harmed on my shift. The floats did fine. The ICU staff helped me when I was a float; as (I) we paid it forward and helped other floats.

No you don't give the float a fresh vent with cardiac hemodynamic drips, Swan lines, art lines, etc.

I would never be concerned if I or a loved one was under the care, in any unit of the hospital, by a float.

[firstinfamily, RN]

I would float to ICU PRN but it was because I had previous ICU exprience at another facility. I never saw PRN nurses being floated to ICU. Supervisors may pull a PCU nurse to float to ICU and then the floater would replace the one who got floated to ICU. I would not recommend anyone who has not been properly trained to be floated to ICU. It is not good for the facility, the patient or the staff. Perhaps there is some research on this topic that you may be able to find to present to management.

[lidleanjel]

At the facility I work at, we will rarely float non-icu nurse to icu but have done it a few times because the patients were overflow because hospital was full. I am not in a huge hospital though. Only other time is when we are so busy we need extra hands to help with cares such as baths, emptying drains and patient behaviors are more than our unit can handle. We also will use to run our labs.

No matter what you do have the right to refuse assignments and you should talk to manager about orientation for icu if you will be floating to icu

[himilayaneyes]

I am an ICU nurse. When we receive float nurses, they receive the tele patients. Every once in a blue moon, they may receive a patient on some type of drip because we just don't have the manpower...but in that case, an ICU nurse will be responsible for the drip. You have every right to refuse the assignment...it's just not safe.

[Mountain Nurse]

It's not unheard of where I am. None of the ICU nurses like it, but, we weren't consulted....

[delphine22]

Like many, we will float PCU nurses to ICU, but they only take the PCU pts. They recently downgraded a bunch of our PCU floors to med/tele, so we often have up to 4 PCU "boarders" on the unit that are waiting for placement. As a former PCU nurse I have taken care of up to 3 of these pts at a time when I floated to ICU. One time I do remember I had a pt on a drip I wasn't familiar with -- Ativan or something, not a pressor -- and another ICU nurse managed it.

We have never floated a med-surg non-tele nurse to ICU. If it was like that, we'd float that nurse to a PCU floor and send another PCU nurse up. I would not want a nurse that didn't at least have ACLS on the unit.

A unit nurse who floats "down" NEVER takes more than 4 pts, no matter what the standard ratio is on that floor. And if he/she is the only extra nurse available for the unit, the nurse will generally just resource (what some are calling "extra hands") because it's very likely they will have to give up their team and be floated back to the unit at any time.

[whofan, ADN, BSN, RN]

I went from working med-surg to working ICU. My hospital has floated non-ICU nurses to ICU but only as "task" nurses since we do not have CNAs at night. It was there to help turn, bathe, give meds other than titratable drugs, and other nursing duties that was in their normal job description. The ICU nurses always titrated drugs, did trach care, and suctioned, and never left the non-ICU alone. This did mean that we either did not have a free charge or that someone(s) had to take 3 patients but with the teamwork it was not overwhelming. I may have a different view because I also work at an LTACH in their ICU with vented/trach patients and we take 3-4 there because the patients are more stable. I also have been known to pick up on the floor because I do not want to lose the ability to take 7 patients because who knows what I will want to do in 5 years. I like variety

[june2009]

When I worked PCU, every once in a while one of us would get pulled to the ICU or ccu. You could only be pulled if you had previous ICU experience or if the assignment was going to be pcu pts. Couldn't imagine being pulled to the Unit to care for someone with a swan or drip I wasn't familiar with.

[RainMom]

As crazy as our census & staffing has been, yep, we get floated to ICU. Typically we just aide/float but on occasion a nonICU nurse will be assigned 1-2 of the most stable pts (sometimes the pts have transfer orders & are just waiting for an available bed on the floor).

[NurseSpeedy, ADN, LPN, RN]

It really depends on the situation. I worked float pool for years at a hospital. My main floor was med/surg but I went to the area of greatest need. Now, it was only a 300 bed facility and I felt their ICU was like step down anywhere else. I spent a lot of time in the Unit. I would receive the least critical patients and if I didn't know how to do something (still within my scope) then I would ask and would not do it alone until I had done it with someone trained. The ICU nurses were very helpful and I didn't feel like I was put in an unsafe situation. However, if I was expected to work completely independently I would have felt differently.