"Floating" rears its ugly head again - page 3

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... Read More

  1. by   hoolahan
    Have to agree w fab4 and others...a nurse is not a nurse. I learned all that in nursing school, and I memorized what I needed to know for OB and never looked back. I hate it, I never read articles in it. I have no idea what the normal dose is for a pit drip or how to titrate it, and I wouldn't go to an OB unit if they threatened me w abadonment, I would walk out and give up my license instead! Likewise, I would not have expected an OB nurse to walk into my CT ICU and remember much about chest tubes, or the early signs of cardiac tamponade or how to shoot a cardiac output.

    Floating is fine, IF you have recieved an orientation, and in an environment which is in the same area. Good point that med-surg is a specialty. Nurses are supposed to be competent in the procedures that occur regularly in their unit, if you don't have experience in that unit, how can you say you are competent in that area?

    Fgr8Out, maybe it is a cop out for me, b/c I am not as brave as you. I am glad you feel so confident in your abilities. I had myself backed into a little specialty corner, and feel insecure going outside of that box. I even refuse to see post-op C-sections in home heath for wound care. They think I am being petty, but to me, when I do an assessment of a pt, it is a holistic and complete assessment. When you assess a new mother, 7 days PP, shouldn't you also be able to offer guidance w breast-feeding if it comes up? Observe the subtle signs of PP depression? Isn't it best for a nurse who feels competent in this kind of care to be that pt's nurse? If I were the new mother, that is what I would want.
  2. by   shay
    Originally posted by hoolahan
    Likewise, I would not have expected an OB nurse to walk into my CT ICU and remember much about chest tubes, or the early signs of cardiac tamponade or how to shoot a cardiac output.
    And God bless ya for that!!! Whew!!

    :chuckle heh heh....floaters...heh heh....
  3. by   fergus51
    We have the "what would a prudent nurse do?" as our BON standard for malpractice and negligence. A prudent nurse doesn't practice unsafely, so I try not to either. However you feel about floating and possibly risking your liscence is your business.

    I understand that it is frustrating and you are tired Adrienurse, we all are at times, but in the end it's up to you and your coworkers to decide if you are going to practice where you feel unsafe. I agree with you there may not be a good alternative to floating, but their is always a choice. At the very least, you can fill out an "assignment despite objection" form detailing why you feel unsafe, which documents that your supervisor knows you are not properly oriented to the floor. At least then, if something happens legally you aren't the only one who will be in that mess. It sounds like a very scary place you're in. Do they ever float nurses to your unit (It doesn't sound like it)? If you are always being floated to the same unit, couldn't they provide some of you with a real orientation or something?
    Last edit by fergus51 on Jul 19, '02
  4. by   Fgr8Out
    "...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??? "

    I stand by my comments... and to those of you who freely admit you're not "competent in general nursing care..." I'm sort of scared. I suppose that's why you are, too.


    I graduated with a working knowledge of ALL aspects of Nursing care... and while I again admit that I wouldn't fare as well outside my own Medical-Surgical specialty, I also have the confidence to know that I STILL can take vital signs, auscultate, assess respiratory status, safely administer the drugs I'm qualified to administer (critical care meds aside), do dressing changes, start IV's and a whole HOST of other Nursing care for ANY patient.


    Again, perhaps I'm fortunate to work in a facility that makes allowances for the nurses who, on occasion, are asked to work outside their specialty and are given consideration for what they do/don't know and provided with an assignement that is suited to that RN's particular skills. I certainly hope that those of you who are the recipients of Floats do all you can to make the experience a positive one for the Nurse who is unfamiliar on your Unit. (But then, of COURSE you do... you wouldn't be complaining so LOUDLY if you yourselves didn't make a newcomer feel at ease <g>)

    I truly do believe that, more often than not, Nurses make a bigger stink out of working an unfamiliar Unit than the actual assignment warrants.

    :: you may now return to your safe havens ::

    Peace
  5. by   adrienurse
    I did attend a session where they demonstrated on dummies and reviewed policies for such things as central lines and IVs and such. We were told that if we wanted to practice doing the procedures the supervisors would "find" a patient for us to practice on. Like I have time during my own shifts to do this, Who's gonna take care of my patients. As if the other nurses want me coming in and "playing" with their patients. This in the mind of management was sufficient orientation to be able to work on any unit in the facility.

    I'm starting to sound really whiny. I'm gonna stop.
  6. by   fergus51
    Originally posted by Fgr8Out
    [B

    I stand by my comments... and to those of you who freely admit you're not "competent in general nursing care..." I'm sort of scared. I suppose that's why you are, too.


    I graduated with a working knowledge of ALL aspects of Nursing care... and while I again admit that I wouldn't fare as well outside my own Medical-Surgical specialty, I also have the confidence to know that I STILL can take vital signs, auscultate, assess respiratory status, safely administer the drugs I'm qualified to administer (critical care meds aside), do dressing changes, start IV's and a whole HOST of other Nursing care for ANY patient.

    Peace [/B]
    Ummm, define "general nursing care". Would you want an OB nurse to be primarily responsible for you when you have an MI or CVA? Would you be willing to look after a woman in OB on a MGSO4 or pitocin drip or one attempting a VBAC alone? That's my general nursing care, it probably isn't yours. It sounds like you would do what I do, tasks. What's bad about that? It's safe and better patient care. I don't get why nurses would be so adamant about other nurses taking a full assignment when they float somewhere they aren't used to working or criticize them for not wanting to...
  7. by   Fgr8Out
    "Ummm, define "general nursing care". Would you want an OB nurse to be primarily responsible for you when you have an MI or CVA? Would you be willing to look after a woman in OB on a MGSO4 or pitocin drip or one attempting a VBAC alone? That's my general nursing care, it probably isn't yours. It sounds like you would do what I do, tasks. What's bad about that? It's safe and better patient care. I don't get why nurses would be so adamant about other nurses taking a full assignment when they float somewhere they aren't used to working or criticize them for not wanting to..."

    ~*~*~*

    I believe I described "general nursing care." The items you describe are indicated only in specialized settings, no? "Assessment" is not a task by any means... CNA's and LPN's don't assess, they "gather data". I don't believe that I was ever "adamant" about floating nurses with the intent of handing them a "full assignment" that they are certainly not prepared to handle. What I AM saying is, when a Unit is short... then having an RN on the scene is sometimes much more appreciated than having say, a CNA or other technical person. And that, were I in such a situation, I would certainly expect the Nurse who is experienced in those items that I am not, to handle those while I care for patient's who don't require such specialized care. I know I would (and DO) this very thing whenever I am blessed with a nurse during a short staffed day.

    Give and take... help and be helped....

    Peace
  8. by   fergus51
    Yes, the labor and delivery stuff is considered specialized, so you wouldn't want to take an assignment alone there right? My point is, if I have been working in a specialty for years, why would you expect me to feel safe taking an assignment alone on med-surg? I don't see how it can go both ways. The "I would never float to your floor, but you should be able to float to my floor because you were trained in general nursing" thing makes no sense to me.

    What is wrong with doing tasks instead of assessments and care plans? I consider it to be plenty helpful, especially considering that when I am shortstaffed there isn't a chance in hell of getting any of those nurses to come help me. Most realize that and are happy for the help I can safely provide.

    To me it sounded like you were saying people should stop whining and take the assignment even if they don't feel safe. I got that impression from you saying that nurses not feeling safe on a unit they haven't oriented to is scarey. That sounded like a criticism to me. Maybe I misinterpreted because I think accepting assignments on floors you haven't been oriented to is absolutely stupid and dangerous.
  9. by   Fgr8Out
    {{{{Fergus}}}}

    Yes, you've totally misinterpreted what I was saying. I don't expect anyone to be placed in a situation where they are required to perform duties they are unfamilar with. What I've been saying is that when I take an assignment elsewhere, I'm given patient's who meet the criteria for that unit (or maybe they don't, they could just be there because of bed availability), but who aren't in need of those treatments I would have no clue about administering. And if a patient of mine would require such treatments, the nurses from that Unit are there to see to those particular aspects, in actuality THEY are performing tasks that I cannot.

    For example, I float to Oncology (Med-Surg module). I don't know squat about Chemo, so the Charge does not make an assignment for me that includes those Oncology patients who require Chemo. I'm given patient's that actually are more Medical. Or on Telemetry, I have another RN actually take care of the monitor and strips portion (we have monitor techs who see to those). Should there be an order for drugs to push that I'm not qualified to push on my Unit, the Charge would see to it that staff from that particular Unit did.

    I would never say this is the perfect solution. The perfect solution would be to have each floor adequately staffed 100% of the time with Nurses who were thoroughly trained in that particular area. What I am saying is, from floor to floor (L&D not included), there are general basic care issues that all nurses are taught... the ABC's, and we shouldn't feel uncomfortable just because certain patient's in that population have needs we're unfamilar with. Just don't assign those "particular" patient's to the Nurse who floats to help out. Heck, in ICU, nurses from other Units are given those patient's they will be receiving later that day anyway... step downs and ICU transfers, etc.

    If where those of you shouting the loudest are being expected to perform tasks not generally associated with your area of expertise then you should, of course, report to the Supervisor about the inappropriateness of such assignment. But to simply complain about being called to help on another Unit because you're unfamiliar with certain aspects (aspects/treatments which you should NOT have to do), just doesn't make sense.

    And again... the next time YOUR floor requires someone to float to YOU from another Unit...remember your own insecurities about floating to theirs and treat that nurse as you would wish to be treated.

    Peace
  10. by   mattsmom81
    I know it is tough to say 'no' in our short staffed hospitals today, but sometimes we have to set boundaries for safety's sake.

    If I was floated to OB, I'd have to be very clear with the nurses there...I can task...start/check IV's for you, do vitals, basic cares...but I'm NOT qualified to do the hi tech stuff on OB. I might be able to help with uncomplicated patients early in their labor...but that's about it. (After 25 years things in OB have changed a lot, I'd wager, and I wouldn't know a whole heck of a lot of what they do...especially in a high risk unit).

    I was floated to a combined nursery/midlevel NICU once...and did some OJT with the staff who taught me to do tube feeds and vitals on premies...sometimes we can be helpful to them just 'tasking'. Again, I would not assume assignment of a patient load.

    I don't want to be a burden on the short staffed unit...so I speak very honestly with the staff first...usually they're grateful to have an extra set of willing hands vs not having ya at all! LOL!

    And I like getting medsurg- type nurses floats to ICU...there's usually a few patients ready to move out to stepdown they can take with me as a resource.....if not they task for us...and if they like our unit, and show an interest, I give 'em my recruiting pitch! LOL!

    We all have our limits and need to think hard how far we want to stretch ourselves in these situations...I think it's an individual decision.
  11. by   fergus51
    Thanks for the explanation figr8out. Like I said, I don't mind floating to PP, peds or the nursery because I have been oriented and practiced there recently. I get offended when I float to a med-surg floor and people think I should be able to work there like any other nurse. I worked med-surg for a whole three months after grad and things have changed since.

    And like I said, NO NURSE HAS EVER floated to our floor without being a current employee on our unit (which means they have had an orientation and training to the area). If we are short, we're short. Period. We don't get anyone to even help with vitals or IVs because a woman in labor is apparently a terrifying thing That's one reason I don't have a problem with being assertive when I float and not taking a team assignment. That and the fact that I can get called back to L&D anytime during the shift if a preggo walks in!
  12. by   stressedlpn
    Hello everyone, I could not help myself I work as the night shift Float nurse in a small rural hospital. My first statement is I never float I run!!!!!LOL On a serious note though I was hired to do Resp. care since RT are in short supply around here anyway, take last night for instance I come to wk at 7p as usual get report on the pts I am required to take on med-surg, b-4 report is over the ED is paging me to draw bld gases, OB wants me to cover while they are in a delivery, and ICU needs an ECG. this continued all night long. Just as it does every day. Now take into consideration that it was either sink or swim I never recieved any orientation to any of these units besides hands on I begged pleaded demanded training and all I got was your a fast learner and you will be okay. I cant even begin to describe the fear I felt when I first began this job. Lucky for me I wk with a very tight knit group who took me under there wings and taught me the things I needed to know also we are a small facility of only 94 beds, I agree that there needs to be more training and orientation I just found out that adm. hired a new grad to become my relief. At least when I started I did have some expierance with critical care. I don't know what the solution is to the "float" prob. is However to quote one MD I wk with, "I know you have to learn lets just hope that the pts understand why, due to cutbacks and all, that they are going to get an med-surg nurse to assist in their surgery" No pun intended to the Med surg nurses out there, I know how hard yall wk.
  13. by   RyanRN
    Firstly, I'd like to comment as to WHY so many competent, educated, experienced nurses are scared to death when they hear YOU HAVE TO FLOAT TODAY! There IS something to that!!! All the reasons listed for not wanting to float are valid and no one is listening! Very easy for administration to sit in their comfortable offices and dole out outrageous assigments without blinking an eye. Their focus is MONEY. No doubt about it.

    It would be easy, Fgr8out, if we all felt like you. We don't. We are being asked to do a job we are NOT qualified to do. I often wonder what our CEO would do if he was made to 'float' to say, Worldcom. to 'fill in' as the CEO that night!!! After all isn't a CEO a CEO? The 'basic's are just not enough to risk losing a life, harming a person or losing your license. I wouldn't want my podiatrist to do my cardiac catheter, who would? And docs know all the ABC's and basics too. The subtlies of being capable of recognizing a potential disaster takes experience. And a short orientation isn't going to cut it either. I don't want to be oriented to a med-surg floor today, after 15 years in ICU, and then be expected to function in 6 months when asked to float there, just because I completed a little check off list 6 months ago.

    I handle 2 usually 3 pts. in ICU and appreciate that I would never be able to handle and multi task 10 patients on a med surg unit. That's a gift. I don't have that gift or experience anymore. Asking to just help out or take a smaller pt. load because I feel inadequate just doesn't work when the 34 bed floor has 1 staff RN, 1 LPN and ME , the float! The regulars are alreadyfamiliar with more than half the patients on the floor. I know nobody and have to start from scatch. I don't like it, never will. Reverse is also true, if we are short in ICU and have 13 pts, 3 staff members and 1 med surg float how in the heck can we divide it so that she gets a more stable ratio. Someone is stuck having 3 or 4 CRITICAL patients because the stable ones have to be given away. THAT is scarry and patients suffer.

    All that said, I want to remind us of who is to blame in all of this, THE ADMINISTRATION. They don't hire enough nurses, send people home, keep cutting, cutting, cutting.

    I know all the popular complaints in the media for nursing - mandatory overtime, nurse/pt ratio, outdated salaries, etc. I think we ALL ought to start focusing on the very unsafe and frequent use of floating as administrative solution to save more
    money.

    It's my license and I'll whine if I want to.
    Last edit by RyanRN on Jul 20, '02

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