"Floating" rears its ugly head again

[Nurse Ratched]

Once again I found myself in the position of charging and being told one staff member (not specified) would have to float to another unit. This was not floating to a like unit - it was going from ours (psych with a med-surg component) to a cardiac floor.

One staff member has worked there on several occasions, having been oriented to float throughout the house. The other nurse and myself have never worked on the other floors. I said the logical thing would be to send that staff member. She was upset (understandably, I think - few people like to float) and called the house supervisor. Claims that the super told her we would need to "take turns" floating. I told her she could do what her comfort level allowed, but I would not be accepting an assignment on a unit I had no familiarity with and endanger pt's due to my utter lack of experience in that specialty. Period.

She wound up not having to go there (went home instead - said that on further inspection they decided that they in fact had the correct number of staff without her, and that she'd like the day off.) I should add that I later found out that the original situation arose because the house super had called off a person on the other unit (who wanted a day off) to float our much less experienced nurse (our census was low.)

Who here has refused an assignment, and with what reaction? Is this common *everywhere* to try and force you into roles you are not equipped to fill?

[fab4fan]

First of all, I want to say from the outset that I oppose floating of any sort. But management will not change their minds about it where I work, so it's an unfair part of the job.

However, if it has to be, then I don't see anything wrong with letting someone do only that which she if comfortable doing. To refuse to do anything is unfair to the dept. she floated to.

A few months ago, a nurse from PCU was floated to the ED. I was in charge; being sympathetic to her situation, I told her we'd just utilize her to start IV's or do EKG's, get vitals, help people to the BR, etc. She refused to do ANYTHING. Instead, she just tagged behind one of the travel nurses. After about an hour, I called the sup. and said, "Send her back...she won't even take vitals, and I don't want my dept. paying her to do nothing for 8h." Supervisor told me we were stuck with her, and I should try to orient her. I told the supervisor I couldn't do that, because we were dangerously shortstaffed, the ED was packed, and this gal was refusing to be shown anything.

Very frustrating situation; I was on her side...I would never have asked her to do something she felt uncomfortable doing, but geez, she works PCU...I know she starts IV's and does EKG's and VS. After her shift ended, I told the sup. not to send her back if she was going to refuse even taking a BP.

[fergus51]

Ratched, doing tasks usually takes A LOT off their hands, and frankly I don't care if it doesn't. The alternative is to have me practice negligently and risk harming those patients. Usually they are just so happy to have someone come to help that it isn't a big issue. You'd be surprised at how much time they can save by not doing baths, catheters, IVs, dressings, feedings, toileting, lab reqs, etc. On a ward with 4 RNs and 4 LPNs, if one RN doesn't show up the other three increase their load to take on the missing RNs patients for assessments and I do all their tasks and help the other RNs teams as well. I function more like an LPN than an RN and things are usually fine. I am not comfortable doing assessments and determining treatments for medical or surgical patients.

Like I said, one nm had a tantrum about it, but no one can force me to do anything unsafe.

I should say that I don't mind floating to floors I know how to work on like PP, well baby and the occasional peds shift. I just won't do sick people...

[Squeeta2]

I agree, floating can be dangerous. Where I work we are told that we work for the facility not the unit. if we don't float we are asked to leave our badges with the Nsg Supv. & go home. To me that is ridiculous..As they are then short yet another nurse. Many Nurses who float to my unit (vent) are overwhelmed. We usually tell them to concentrate on meds & that the regulars will deal with the vent alarms, Docs, Families etc. On the flipside they like to float us as we seem to have a higher tolerance for chaos, they tell us we should be thankful for a less stressful day! Working with pts, Docs, & family that are unfamiliar. Oh yeah thats my idea of a grand time!!

[hoolahan, ASN, RN]

Floating sucks, but it is a necessity at times. Everyone knows nurses get floated, so they should be cross-trained on orientation, or within a reasonable time.

Eg. A NICU nurse may be able to be cross-trained for L&D, Post-partum, and possibly peds or PICU. An ICU nurse can be cross-tarined for CCU, ER, PACU. Med-surg nurses should be given a telemetry course and pass competencies before being able to be pulled to a cardiac unit. NO ONE should be pulled to an area where there is no familiarity at all, like an OB nurse to ICU or vice versa. Or, and adult nurse to a peds unit and vice versa.

I don't think floating will go away any time soon. For that reason, it is NOT FAIR to keep pulling the same person over and over, that really sucks! They should keep a list, so everyone goes, after proper orientation, in a rotation. Including the charge nurse. Another RN can be placed into the charge position.

As far as floating to another floor so one of their nurses can have off, well, that should be on a seniority basis throughout the house. Either that or you would need to become a closed unit, meaning you never have to float, AND no one ever has to float to you to help either, you have to cover yourselves entirely. Which is the worse evil??

When I was doing agency, it was in my contract that I didn't have to float, except to other critical care units. So, if they wanted someone to go to the med-surg unit, one of their nurses had to go. Man they were always PO'd, and I understood that entirely, to which I replied, why would you work at a place that continues to put your needs second? If you want to be in my shoes, quit and go agency too. Everyone has a choice. I personally choose to not work in hospitals anymore b/c I was sick of being abused. I know someone has to work there, but after all those years, shouldn't you earn something for it?? One hospital I worked for had a policy, that after 10 years, you never had to float again. Now that was a great policy!!!

[Fgr8Out]

First of all... when I am Charge, I don't float... Period. My assignment for that shift is Charge where I am.

Now then...(quick check one last time for sharp objects in anyone's reach)... I DON'T mind Floating.

Where I work, we're generally floated within our "Module", meaning Med-Surg: Medical, Nephrology, Telemetry, General Surgical, Oncology, Orthopaedics. I would be completely lost in OB/Peds but, I've floated there also, and my assignment was ammended to those items I felt the most comfortable doing. After all... I was sent there to HELP. And, while there are certain techniques in certain of these areas that I'm not familiar with, I am competent in general nursing care... aren't we ALL???

Yes, I don't do Chemo... or CAPD/Hemodialysis... or Cardiac Monitors... or I need a brief instruction on Traction or certain other Orthopaedic devices. But I'm an RN trained originally in all aspects of Nursing. I'm pretty certain most of us were.

I really believe we allow ourselves to get worked up when it truly isn't necessary. Whenever I float to another Unit, I accept my assignment and do the job. I make sure I've talked with the Supervisor for that Unit, and let them know what areas I'm the least familiar with. Maybe I'm just lucky but, I've yet to be given a patient I'm not able to care for 100%. I mean, what's the point? Another nurse would have to intervene and that would increase their workload as well. Better to just make appropriate assignments right off the bat and reduce the tension.

Only when a nurse arrives to a Unit squawking and whining about how unfair it is that they have to float, have I witnessed unprofessional behavior on the part of the receiving Unit. I make sure I offer assistance where I can, in exchange for assistance in something I'm not familiar with. "Hey Nurse B, I'll do that dressing change/IV/bath for you if you'll ____(fill in the blank)." The whole idea is to work as a Team.

Yes, I've had experiences where I wasn't treated fairly... or given an assignment where I felt a little bit overwhelmed. But, I go with the flow... and I never hesitate to call up a Nursing Supervisor for a hand when I need one. And believe me, if I were in a situation where I felt totally uncomfortable... THEN I would be the first one in the Charge Nurse's face, demanding that I be assisted with whatever it is I felt I needed help with.

Yes, we all prefer to work in the setting we're most familiar and comfortable in... but think about it this way... when YOUR Unit is short staffed and you need help... don't you appreciate another Nurse floating from THEIR floor to yours?

The street runs in both directions, folks....

Peace:)

[BadBird, BSN, RN]

I let my agency know where I will work, all ICU's, ED period. One nursing supervisor told me I had to go to telemetry, I told her I will go home or work in ICU take your pick, I also called my agency in front of her and let them know about the situation, I told my agency that I was not abandoning any patients as I have not accepted a assignment yet and if the supervisor did not want me in ICU then I would leave, the agency backed me up and the supervisor shut up. End of story, do not let anyone push you around!!!!!!!!! By the way, I could have gone to another hospital 15 minutes away if they did not want me, that was the last time that ever happened.

[misti_z]

I am so glad we do not have to deal with these situations. We have hospital employeed "floaters" in the "float pool", who go to where they are needed. Sometimes when they get to a floor they maybe called somewhere else, I don't think they really mind--unless they get called to the 9th floor, from what I've heard its hell--they are just happy not to be called off.

[Nurse Ratched, RN]

You all have given me a lot to think about. Our facility has no policy for orienting nurses to other units - only states that, as another poster put it, you work for the facility, not the unit, and are essentially at the mercy of the house super as to where you go. I would be open to the possibility of orienting to other units, but only if ALL the nurses on mine do so, and we would all be rotated equally, including the regular charge nurse, since others are also qualified to charge in her absence. I don't see this happening.

I had very limited float experience at my last facility, and none of it good, which may have clouded my thinking on this issue. The main problem is that it's all or nothing. You can't say "I am qualified to go here but not here." It is that whole nurse is a nurse is a nurse mentality. Last facilty, however, we did have clusters of interrelated units within which you floated, so you weren't yanked to something totally outside your realm of expertise (not that they didn't occasionally try.)

We used to have a float pool, but it was dismantled in a recent reorganization, and all the float nurses went to units.

Thanks for the food for thought.

[fergus51]

Originally posted by Fgr8Out

. And, while there are certain techniques in certain of these areas that I'm not familiar with, I am competent in general nursing care... aren't we ALL???

But I'm an RN trained originally in all aspects of Nursing. I'm pretty certain most of us were.

Yes, we all prefer to work in the setting we're most familiar and comfortable in... but think about it this way... when YOUR Unit is short staffed and you need help... don't you appreciate another Nurse floating from THEIR floor to yours?

The street runs in both directions, folks....

Peace:)

First off, yes I was trained in all aspects of nursing, but that was years ago. Things have changed and I don't think it's a good idea to float me to a medical floor. One poster already brought up the fact that you would never expect this of a doc despite the fact that they were all trained in the basics of medicine.

And in my facility the street DOES NOT run in both directions. When was the last time a med-surg floated to L&D? In my facility it was....hmmm...let's see.....Oh, that's right, it was NEVER. They can't be floated to L&D because they don't have the training for it. If their job is so different from mine that they can't do my job, why should I be expected to be able to do theirs? The real problem is that nurses still don't recognize med-surg for what it is: A SPECIALTY IN IT'S OWN RIGHT.

I will help when asked to float, but I will not do anything I don't feel safe doing on a med-surg unit anymore than a med-surg nurse should be expected to on my unit.

[fab4fan]

Well, physicians rotate through all the different aspects of medicine, but no one would expect a dermatologist to provide competent care to a high-risk OB pt., would he?

I don't believe in the philosophy of "a nurse is a nurse." The fact is, we all specialize, whether it is in med/surg., ED, peds, etc. It is unreasonable to expect someone to be well-versed in all areas of pt. care. There are liability issues at stake here, and I for one do not believe my hospital would support me if I made a mistake while being floated to a different area, even if I felt comfortable with the assignment.

We are not pegs that can be plunked into empty slots...we are skilled medical professionals, with unique abilities and talents. I am thankful for people that want to do L & D...I want nothing to do with it. Heck, I hate even having to assist in the gyn room in the ED.

Doing what is comfortable for you in an unfamiliar unit is one thing; being equally skilled across all specialties is a bean counter's fantasy.

[nell]

Originally posted by Fgr8Out

I am competent in general nursing care... aren't we ALL???

NO! And I'm not willing to jepardize my livelihood and sanity by floating where I can't competently care for my patients.

But I'm an RN trained originally in all aspects of Nursing. I'm pretty certain most of us were.

Yeah, 25 years ago.

If any of you are in CA and are being floated to areas where you haven't been oriented to and completed competencies for, your facility is breaking the law.

[mattsmom81]

It is a written policy in my hospital that a nurse does not have to accept an assignment in a unit she has not been fully oriented to.

I think that is a good policy...and protects everyone. :)

Most NPA's probably have something in there about the prudent nurse not accepting an assignment outside her competency too.

We liked to crosstrain our sharp PRN nurses who were willing...if more $$ goes to those who float to multiple areas they will :).... it's nice when hospitals have well paid, happy, competent PRN floaters who are comfortable in several areas, and makes housewide staffing easier too. :)

My best friend is at the high end of our float salary because she works 5 units... so she makes good money and gets to pick and choose her days off around her family. :)