"A nurse is a nurse"

  1. Are you expected to float throughout the hospital, regardless of your training and background? I left a hospital last year that would float nurses, and expect them to do assessments and pass meds anywhere in the hospital. Since I am an OB nurse, and it has been 5 years since I have seen a med/surg patient, I was horrified when they sent me to ER and ICU. Those areas, as well as OB, require specific training, often months or years to become proficient in the the specialty. Managements attitude was one of "You're an RN, you should know this."

    I resigned when I was left as the only labor nurse in the hospital with 4 labor patients. Not even the supervisor was qualified to assist with deliveries or do neonatal resus. What a danger to the patients!!!

    Has anyone else encountered this floating policy? It seems insulting to the nurse, and dangerous to all, to expect a nurse to function outside of her training.
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  2. 22 Comments

  3. by   fergus51
    There are quite a few posts on this if you do a search. I am also an OB nurse and so when I float I will not accept a patient assignment but will do tasks only. Any hospital that wants OB nurses in ICU or vice versa is looking for a lawsuit.
  4. by   mario_ragucci
    This is a situation many have been exposed to in the arena of management communication. Once I had a job with an airline corporation and wanted to demonstrate my abilities, so I took computer classes and would "float" around the facility turning the management on to how pc's actually work. I didn't have the title of computer tech (my title was "office support") but performed computer tasks the management didn't have time to train for. Same story because eventually I became disgruntled when folks could talk more about golf and fancy cars had the real in.

    For the last year I have went to many classes to get into an RN program. Then will come 2 years to get my RN. Then another 2 years from that for a BSN. If I was asked to do RN tasks, before receiving my RN, that would be unsafe. Wouldn't the management be up the creek if you made a mistake becasue you were not trained in a skill? Maybe they know you won't. Here we go with the "they" "us and them"

    How could you be faulted if you don't perform a task you are not proficient in? This is interesting
  5. by   pebbles
    It doesn't scare me so much, because I work in a teaching hospital, there are lots of residents around, and the other nurses on the ward will help me out if needed. I always ask questions if I'm not sure of something, and I stand my ground about not going over my competency level in any area. In a less supportive environment, floating would scare the hell out of me.

    In my hospital, general duty nurses cannot be floated to ICU or ER though... No matter where you work, you should have basic asessment skills to cope with most types of patients. Also, your hospital administration should work to make sure that when you are floated, you don't get the more complicated patients on the ward, just the stabe, easier to handle patients. Leave the others to the nurses who have the expertise in the area.... When my ward is short staffed and we get a nurse floated from another ward, we always give that person a "stable" assignment - you might still be busy, but you shouldn't have to handle a crisis without help!
  6. by   jenadox
    In the hospital where I work, a nurse can get pulled anywhere, but there are limitations on what they can do in each area. OB/LD/NY nurses act as PCAs when they come to the floors or units. They get VS, blood sugars, pass ice. Some think that it is demeaning, but it is safe. They do give some prn meds if they feel comfortable doing so. Unit nurses that come to the floor can take patients, just not 9 or 10 at a time. When floor nurses get pulled to the unit(which rarley happens), we usually just give them specific tasks to do. That only happens when we have a really bad patient and need someone to catch up our meds and get VS while we get the crashing patient fixed. Our pull policy isn't perfect, but we try to keep it safe!
  7. by   nightingale
    quote:

    How could you be faulted if you don't perform a task you are not proficient in? This is interesting



    NEVER accept an assignment that you are not comfortable in... PERIOD....

    It is YOUR license.... certainly.... I would never want to live with a mishap that created harm because I was "under the guise" that someone would help me with what I am ULTIMATELY and LEGALLY responsible for....

    The more we continue to "help" management bandaide problem service needs of the facility... the more we perpetuate the real issue of providing unsafe conditions for the patients... the longer this will be allowed to continue.....

    Let the hospitals go on "diversion" to other facilities in the area to provide adequate nursing (of skill, safe ratios, and expertise) that is the only answer, as far as I can see, that is appropriate....

    When in doubt, check with the Nurse Practice Act in your state, you may obtain a free copy for the asking......
    .... this is what you are legally responsible for...

    Thank you for this post... It is an VERY important topic...

    B.
  8. by   RNforLongTime
    I worked in a hospital where the RN's were floated pretty much anywhere there was a need. I was floated to OB--the postpartum side a few times. Whenever we had an Ob RN floated to our med/surg floor, she would never take an assignment. We would have her do things like answer call lights, pass ice water, do vitals and get blood sugar chem strips. Basically she would function as a Nurses Aide, we were always thankful for another body. And whenever a Psych RN would get pulled to our floor, they would REFUSE to take an assignment, so once again, they functioned as an side. But if I was pulled to Psych, I was expected to take a full assignment. Same with OB, I was expected to take a full assignment. Hospitals seem to think that Med/Surg RN's can and should be able to function on any unit whithin the hospital and this is so not true.
  9. by   NicuGal
    Our nursing senate just passed a new float policy...you can only float between your services...ie Maternal Child, Med/surg, Trauma/critical care. And when we go, if we are given an assignment that isn't something we feel comfortable with we tell them we want babies only, being from NICU...anything under 1 year. I will take bigger kids if they aren't complicated.

    Before this, I had been floated to Telemetry, CCU (wouldn't that make you feel good to know I was you nurse LOL)...but those nurses were so appalled that they would send one of us that I was just a scut-puppy...I was absolutley no use to them, so why bother to send me in the first place? One other girl got sent to SICU and another to Burns. The supervisor that did this to us...and there was only one, would say...you girls know vents, a vent is a vent....okay whatever...they have a freaking garden hose down them when I am used to the inside of ballpoint pen!

    This is a tough on to abolish, especially in small hospitals.
  10. by   CATHYW
    When I worked ER and we were pulled to the floor (rarely!) we started IV's and hung IVPB's, that kind of thing, answered call bells, passed ice-once I even cleaned the refrigerator at the request of the Head Nurse!

    When I worked agency, I was working ICU at a small hospital. I told them I did not know vents, and told them I would always have to have a more knowledgeable ICU nurse with me. for the first 2 weeks, that is what I had. One night I went in, and they wanted me to be charge nurse of ICU with a floor nurse to help me. Excuse me! I refused to accept the assignment. The ICU head nurse told me to go home-then said wait, let me call the Super. In the meantime, I called my agency. The owner said, "well, can't you do it?" I told her no, and that she knew that I was not qualified to. She then asked me if I was refusing. I said yes. Bottom line-the hospital was desperate that night. They pulled me up to the Med-Surg-Peds floor. I did admissions and discharges, started IV's, answered call bells, did Ward Secretary duties for the admissions, went to Pharmacy (locked, no pharmacist on duty), pulled meds and mixed IV's for new patients. Thank goodness I'd had experience doing the med thing in the ER. When the shift ended, I let the door swing shut behind me, knowing I would never go back there to work, or as a patient, and that I would never do agency work again. It was a horrible experience. P.S. I forgot-if ICU or L&D needed meds from Pharmacy, guess who got them AND delivered them?
  11. by   hillbillyrn
    Cathy,
    I read your message regarding having to float and do agency
    work. Your agency should have backed you up, but unfortunely
    the shortage is so bad that I have found that no one seems to
    care as long as they have a "warm body". I have icu/ccu/tele/pacu experiance, so imagine my susprise when I was floated to an orthro/medsurg floor with 8-12 patients! I got lucky and a very understanding NA
    taught me the ropes quickly. I was frightened for my patients as
    well as myself. No amount of protesting mattered, I was stuck.
    The hospital was a small one and there was no one to replace me
    and I was informed that if I left that I was abandoning my pts.
    So I stayed and treaded water for 8 hours. This is not the only
    time this has happened and I fear it will not be the last. I no longer work at this facility, but they still practice this. If you're
    a RN you can be fair game. I try to learn as much as I can when
    I'm in a sticky situation and enlist help from anyone I can.
    Sorry you had to go thourgh that and I pray it doesn't happen
    again. Try to learn as much as possible and if you don't already
    subscribe, then get a subscribtion to a good nursing mag.
    By the way, I've been a RN for 11 years and live in
    the eastern US. I'll be starting my first travel assignment soon,
    so pray for me.

    Janet (hillbillyrn)
  12. by   Jenny P
    Hillbillyrn, READ YOUR NURSE PRACTICE ACT! If you did not accept the assignment, you would not be abandoning your patients.You would be placing your license in jeopardy if you work an area that you are not familiar with. I read lots of nursing journals, but would still refuse to float to OB, Peds, or ortho these days. Putting the patients' life in danger is what you are doing when floating to an area you are not oriented to.

    Mario, you are the one person responsible for your license; not the hospital, the doc, or even your supervisor. If you accept an assignment you are not oriented to and unable to carry out; that patients' life is in danger; and so is your license. If a supervisor threatens to take your license away if you do not work in an unsafe situation; remember: only the state board of nursing is able to take your license away. And that happens only because you have made an error, jeopardized a patients' safety, or some other major problem.
  13. by   NicuGal
    That is true...they can not write that you abandoned patients unless you walk out after accepting the assignment. Like after the shift started. Our hospital was doing that up until last year...a bunch of us refused to sign the papers and then legal got involved and they told the nurse managers that they can not put that one there....they are opening themselves up to trouble!

    I would never accept an assignment that I was uncomfortable with, and if the floors have a problem, then call the supervisor, and document, document!
  14. by   peter73
    my two cents on this subject,

    a specialty in nursing is like a specialty in medicine...
    after all if you don't use it you loose it. I know I would panic if I had to deal with ICU, burns, L&D etc. I had rotations in these in school but, that was a long time ago, and I have not needed to palpate a fundus or read/run monitors for years...I would be so unsafe I would be scared to take patients.

    I never understood why in this profession a nurse is a nurse and in medicine a MD is not an MD!?!

    Come to think of it I may enjoy seeing the faces of a psychiatrist floated to peds, or a gynocologist floated to a burn unit. Then be the one to say, Your a doctor you should know this. You had a rotaion in this 10 years ago, remember. It is just like what you do every day in (what ever specialty), . . . isn't it?

    Nurses, contrary to popular belief are not interchangable coggs in the health care machine. We all play a specific role, developing specialized skills to deliver the highest quality of care to the niche we serve. The skills that are not appropriate or not benificial to our patients are forgotten and replaced with highly adapted skills for our particular specialty.

    I look forward to the day nurses are given the same respect as other highly educated and specialized professionals.

    peter

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