The problem with floating ER Nurses

gardengal1, ASN, RN · Oct 26, 2011

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.

LadysSolo · Oct 27, 2011

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).

LadysSolo · Oct 27, 2011

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.

frenchfroggyAPRN, MSN, LPN, RN, APRN · Oct 27, 2011

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. :w00t: 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 :twocents:

msn10 · Oct 27, 2011

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.

sunflrz321 · Oct 28, 2011

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.

newtinmpls, BSN, RN · Oct 28, 2011

"Sometimes we are used as sitters for psych 1:1 patients"

I work in Psych, and that is ridiculous. We use Mental Health Workers (basically CNA's) as 1:1s. Using an RN is paying way too much.

"My position is the ER can change from calm to tornado in one hour and we need to be ready for just that."

Is there a way to only float in 4 hour blocks? granted, that could still suck, but this way they can "keep" the RN all day, 4 hours would at least be a limit.

"We have a useless union."

Yup. We have MNA. Now get this, this is the union of most of Minnesota. So if all the MNA hospitals negotiatied at the SAME TIME and didn't agree UNLESS all the other hospitals agree - think of the power. It would be like teamsters (or like they used to be).

ah well...

On another note, seeing as how I work in inpatient psych, I am so not up on medical stuff, it would be a terrible idea to float me.

Dian

TheSquire, DNP, APRN, NP · Oct 28, 2011

OP: since it appears that your ED has been floating out for a while, you could do a retrospective study comparing similar time periods before and after the floating rule change, looking at adverse events, incident reports, outcomes, and the like. Your working hypothesis would be that floating nurses from the ED increases poor outcomes, and thus increases costs to the hospital.

Also, are you filling out incident reports every time your department gets slammed and the other floors refuse to release your patients? Just 'cos they're inpatient doesn't mean they're the only ones who get to cry "patient safety" when ratios become ridiculous.

Dixielee, BSN, RN · Oct 29, 2011

I can't help you out, but I have not worked on a general hospital floor in more than 20 years and that was when I worked in ICU. I would have no idea what the routine is on the floor. It would be like floating an OR nurse to the floor. Just because your title has RN behind it does not mean you can be a jack of all trades. I have given birth to 2 children and am an RN but that does not qualify me to safely work in L&D! You might as well float me to maintenance as unproductive as I would be!

TheSquire, DNP, APRN, NP · Oct 30, 2011

OP: since it appears that your ED has been floating out for a while, you could do a retrospective study comparing similar time periods before and after the floating rule change, looking at adverse events, incident reports, outcomes, and the like. Your working hypothesis would be that floating nurses from the ED increases poor outcomes, and thus increases costs to the hospital.
Also, are you filling out incident reports every time your department gets slammed and the other floors refuse to release your patients? Just 'cos they're inpatient doesn't mean they're the only ones who get to cry "patient safety" when ratios become ridiculous.

...and by "refuse to release your patients", I meant "refuse to release your nurses". My bad.

~Mi Vida Loca~RN, ASN, RN · Nov 10, 2011

Because of stuff like this they started creating Critical Care Float nurses at one hospital I was at. They would float to ED, ICU, CVCU and PACU

HikingNinja, BSN, MSN, DNP, RN, APRN, NP · Nov 29, 2011

I work at a variety of facilities in my large metro area and have experienced the following:

Most have some float guidelines in the union contract. For example one contract says RNs can be floated, for tasking only, as need to like units (ortho to med surg, ER to ICU) and must be called back when ratios in the donating unit mandate the return (ratios also in the union contract). So I've been sent to other units to help out, start IVs, give some meds, help with procedures etc. No biggie, get sent back to my ED when needed. Never chart anything cause the floor uses a different system, floor nurses do it for me and even thank me for helping out. It's cool. Builds rapport and we tend to be less witchy with each other when giving report later on too cause we have worked together.

I have worked for a hospital system with their own float pool (several facilities in same town) and kinda acted like agency. They would call and send me to one of the facilities on the days I said I was available and I would go wherever they needed me (getting paid critical care pay and a float pool differential no matter where I went, SWEET!)

Some of the facilities have "push backs". Where in some day staff are called and asked to come in later due to census (its volunteer, we have plenty who want to sleep in or not work a 12 hr shift). They all also have varied shifts, 3p - 3am, 1p - 1a etc to account for the difference in typical pt census.

As for your situation, even though your union appears weak, it is still a good idea to fill out an ADO (assignment despite objection),submit it to your union and keep a copy of it. Eventually you will need it when your state BON comes after you because some poor pt died because you were so poorly staffed. And I agree with a previous poster, this is a staffing and patient safety issue. I would encourage you to review your union contract concerning staffing issue, and float policy if there is any and remind management that this will come back to bite them when someone sues because they didn't get appropriate and timely care resulting from not following the staffing guidelines set out in a legal document they signed.

So sorry you and your comrades are going through this. These hospitals chains can be such money grubbing _____ (fill in the blank). I've had my best experiences working for nonprofit hospital systems.

D.