The problem with floating ER Nurses - page 3

by crabalot 10,721 Views | 35 Comments

As ER Nurses, are you required to float to wherever in your hospital? I have never been asked to float because of the dynamic nature of the ER until I started working where I am now. (Sorry, not telling where!) Anyway, I have... Read More


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    Quote from crabalot
    One day on the other rotation they floated all but three Nurses which left one Nurse for Triage (no Tech), one for patient care (we have 26 beds), and the Charge Nurse manned the phones and Telemetry.
    I have no words for this.

    Totally unacceptable ... and I'm sorry you're going through this.
    TheSquire likes this.
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    One day on the other rotation they floated all but three Nurses which left one Nurse for Triage (no Tech), one for patient care (we have 26 beds), and the Charge Nurse manned the phones and Telemetry.
    Well that is just crazy. That is not a floating issue, it is a staffing issue. Instead of trying to find floating protocols/research, it sounds as if you could just focus on safe ER staffing levels. ENA should have a lot of info on that.

    Some articles that might help - You will need CINAHL to access, I cannot post them online because they are copy written through my university - I am not doing APA format, just copy and pasting them for you.

    Impact of nurse staffing level on emergency department market share. (2007).
    Hwang J; Chang H; Health Care Management Review, 2007 Jul-Sep; 32 (3): 245-52 (journal article - research, tables/charts) ISSN: 0361-6274 PMID: 17666995
    Subjects: Emergency Nursing; Emergency Service; Patient Safety; Personnel Staffing and Scheduling

    Using queueing theory to increase the effectiveness of emergency department provider staffing. Green LV; Soares J; Giglio JF; Green RA; Academic Emergency Medicine, 2006 Jan; 13 (1): 61-8 (journal article - research, tables/charts) ISSN: 1069-6563 PMID: 16365329

    The relationships between emergency department staffing and clinical outcomes of the acute myocardial infarction patient.Detail Only Available
    (includes abstract); Oster CAH; University of Colorado Health Sciences Center, 2002; Ph.D. (244 p) (doctoral dissertation - research) ISBN: 978-0-493-59716-4 (This one is old but it is a really good dissertation)

    a comparison of in-hospital mortality risk conferred by high hospital occupancy, differences in nurse staffing levels, weekend admission, and seasonal influenza.Detail Only Available
    (includes abstract); Schilling PL; Campbell DA Jr; Englesbe MJ; Davis MM; Medical Care, 2010 Mar; 48 (3): 224-32 (journal article - research) ISSN: 0025-7079 PMID: 20168260


    Nurses' perception of nursing workforce and its impact on the managerial outcomes in emergency departments. Hu Y; Chen J; Chiu H; Shen H; Chang W; Journal of Clinical Nursing, 2010 Jun; 19 (11-12): 1645-53 (journal article - research, tables/charts) ISSN: 0962-1067 PMID: 20384667

    This is a start. Give these titles to your hospital librarian if you have one, otherwise, I am sure there is some nursing student floating around who can get them for you, maybe even your old alma matter.

    Let me know if you need more.
    Altra likes this.
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    I have to question, one nurse for patient care (we have 26 beds),how many of those beds were in use at the time? And what's the protocol for getting staff back to the ED if those beds start to fill?
    Because THAT is where you're going to have fight your battle. Management is jumping on the model of staffing based on current patient levels at the moment, re-evaluating hourly, every couple hours, whatever. They don't care what MIGHT happen. Which we as actual practicing patient care nurses KNOW is what really mucks up the crap staffing for us. They care what IS happening at the moment, and feel no need to pay for people to be on site "just in case."
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    Where I work, I never see the ER nurses get floated. They have a different charting system down there and therefore do not have access to the same charting system we utilize on the floors...hence why they don't float. On the flipside, nurses from my unit frequently get floated to the ER if my unit is overstaffed, but of course we do not have 100% access to their charting. We are able to chart through a different way, but that doesn't work the same when ER nurses get floated. I hope that makes sense.
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    We do NOT float, EVER. And, it is the rare occasion that you are allowed to go home ON CALL and must be within at 15 minute response time to get back there when **** hits the fan. I do not have sources for you to check. We follow safe staffing for ER's from the ENA recommendations. When we do occasionally have downtime, it is time to spruce up the unit - things that never get done - hosing down beds and letting them air dry, getting under the crevices of the mattresses which no one ever does; straightening out the supply room, etc. On occasion, we have other staff float to us when we are in crisis and need more bodies than we are staffed (which happens frequently) but they only task and do not chart. You might also check California rules for staffing since they now have mandatory staffing ratios - maybe you can find one for their ER's.
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    When I worked in the hospital (22 years Heme/Onc) I had to float to med/surg, tele, psych, OB, and ER. In ER they had me put IVs in everyone and draw blood (excellent venipuncture skills after that long in Heme/Onc). The ones I hated worst were psych and OB (bored).
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    But I DO have to say that ER nurses rarely floated except to ICU/CCU/step-down. And I don't think the staffing they left you with was acceptable! That was risky at best, dangerous at worst.
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    I work in a 25 bed acute care hospital. We do it all, ER and floor, so we dont have to worry about floating. We help each other out. If ER gets busy the RN/LPN on the floor helps (sometimes it takes all hands on deck, all 4 of our shift plus all of the supervisors, when they are there) and if the floor RN gets busy the ER RN helps. Of course, we are a small town hospital, our shifts are very close (at least the crew I work with is). We believe in TEAMWORK, if someone needs help, we do it because you may need help next
    msn10 likes this.
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    I work in a 25 bed acute care hospital.
    I love working with rural nurses!!!! They are the professional generalists. Small town hospitals see so much trauma without all the resources of bigger hospitals. I am in awe of a rural nurse's information base. They have to know sooooo much.
    frenchfroggyRN likes this.
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    I have not heard of ER nurses actually floating in either of the hospitals where I have worked. In both of the hospitals where I have worked, the ER nurses have been known to help out the IV therapy team and serve as their back-up when they have the time. IV therapy often has a back-log of IV's to draw and labs to start and central lines to place first thing in the morning, so it helps to have the extra hands for the first couple hours of IV therapy service, without requiring them to hire an extra IV therapist- and by doing IV's, you are usually free to go at a moment's notice.
    I worked in a small but intense PICU with a drastically fluctuating census.We would often start the PM shift nearly empty, and by the end of the night, every bed would be full with a very critical child. In order to address this, the small community hospital did put a few measures in place.
    1) PICU (and NICU, because they never knew when a critical baby would be born) had the "right to call back" their nurses from a float. This meant that if PICU got an admission or critical patient, they had the right to call their extra floated nurse back from the assignment, and the nurse had to be back to the home unit within 30 minutes MAX. In order to accomplish this, there were strict limits placed on the acuity and quantity of patients that we could be assigned when we floated, and the nurse that would be the backup and take our patients if we suddenly had to return to our unit had to listen to report with the floating nurse, to make the handoff quick and seamless. However these strict requirements made the other units not want to use the floats with right to call back, so then the PICU and NICU nurses would be placed on call, and they would have to come in within 30-45 min if an admit happened.
    2) The ER developed some alternative shifts that addressed the census fluctuations hour by hour. They kept a few nurses on the standard shifts of 8's (7-3, 3-11, & 11-7) or 12's (7a-7p & 7p-7a), and then they added several 11a-11:30p shifts, to address the peak census times in the ER.


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