Pediatric Nurse Assigned Adult Med-Surg Patients as a Float

[tcquilter0707]

I have been an RN for 31 years. All my experience has been L&D/postpartum for the first 8 years, then nursery, level 1 NICU, private fine arts school nurse, and Pediatrics. I have never worked in adult med-surg. After Hurricane Irma visited Florida, our hospital was very busy. My Pediatric unit was only needing two nurses due to low census, and instead of giving the third nurse and tech an LCD (low census day), they were gloating us to assist in other units. It was my turn to float and I was told to go to the OB overflow unit where I would be an "overpaid tech." However, when I got up there, instead of it being postpartum and newborns, it was actually adult med surg patients. The night Peds nurse was utilized as a tech with one nurse and 7 acutely patients. I was told I needed to take an assignment because the day nurse, who was a pool nurse, couldn't take 7 patients. The tech assigned to us was on OB tech. I initially was refusing to take an assignment because I felt this was way out of my specialty areas and I know how complex they can be with multiple Ned's and underlying conditions. The AOD said my manager said I had to work there. We had a new Peds nurse on our unit who had just moved to Peds from adult Oncology. I felt she should have been floated instead of me since she had the experience in that area of nursing, but they said since she worked over the hurricane and was tired, they weren't going to float her.

My question is, do I have the right to refuse an assignment that could possibly jeopardize the safety of the patients as well as my license? I did end up taking a two patient assignment and had to do a discharge. A nurse educator finally came in to do the discharge education since I had no idea how complex it needed to be based on audits the hospital does, the patient and as fiabeticcsnd on a lot of medications plus some new ones to go home on. My other patient was on 9 medications, was confused, and then I was assigned a renal patient on telemetry in CHF! Do nurses have to just take an assignment when they are completely out of their element?

[Ruby Vee, BSN]

In the wake of an enormous disaster such as Irma, you may well be assigned to float into areas in which you have little to no experience. I would encourage you to pitch in and help out as much as you can. Floating is extremely anxiety-producing for most of us, but a nurse who worked during the hurricane should not be forced to float instead of you, nor should the float pool nurse be over-loaded with patients because you don't want to float out of your comfort zone. An adult nurse forced to float to peds may know nothing at all about children including how to talk to them. A peds nurse with thirty one years of experience has been an adult for 31 years, no? You at least know the developmental stage you can expect to find in an adult. Yes, it's difficult with man co-morbidities and many medications. But take your time and look things up when you need to.

Irma put many of us out of our comfort zone.

[Here.I.Stand, BSN, RN]

I'm not sure how safety or your license was being jeopardized. You may not remember the ins and outs of each condition or medication, but they were presumably stable. You know adult BLS, you know how to keep VS in range -- or you at least that VS's are out of range and that the pt needs intervention, you know who to ask if you don't know something. As a neuro/ENT surgical floor nurse I'd float to BMT or GYN onc; even now sometimes floating to the MICU or stepdown unit, there are conditions I'm not familiar with. If a pt asks me something or a physician is discussing something I'm not familiar with, I will say "I'm an experienced nurse, but I don't typically work on this unit. Give me a moment and I'll find you an answer." (in the case of a pt.) Or in the case of the MD, I'll say "I'm a bit out of my element here...can you explain/am I on the right track/should I be concerned about ____" etc.

[LollaPaupRN]

Hmm, as a nurse who frequently works with both pediatric and adult patients, I am comfortable with floating between all of the different ages; at the same time, I do understand your concern. Adults and pediatric patients are quite different, although, I would think it would be easier to float to adult patients, than to pediatric patients. At the same time, med-surge is basic nursing, one of the first units we have clinicals on or study during school. They weren't asking you to take on extremely critical patients (although, if you are not as familiar with ECGs, the telemetry patient may not have been appropriate), in which case, it would be in everyone's benefit for you to refuse. Also, it doesn't sound like they were completely throwing you under the bus, as the nurse educator did help you with a discharge, a procedure you were unfamiliar with on the unit. You are free to refuse an assignment, although, in this case, I am not sure your assignment was completely unreasonable.

[gcupid]

they should have floated the other nurse because at least she knew about adult nursing and would feel comfortable. The hospital should have offered her more incentive to work in that area. I'm sorry that you had to go threw this. I would admonish that the others giving insight also take into consideration if it had been them or their loved ones. I would want someone who is both comfortable and competent with providing care to adults taking care of me If I were sick. Personally, I would have refused the assignment and said call me if yall need help in my specialty.

The truth is we are held to a high standard and if some freak accident would have occurred, I dont think your employer would side with your best interest if it would cost them money.

[Sour Lemon]

I work in an adult only hospital, but we sometimes get a stray pediatric patient. The last one I can remember was an emergency appendectomy ...about seven years old.

It sounds like you were treated fairly under the circumstances. Having two patients would allow you extra time to look up unfamiliar medications and so on. You also had help with your discharge.

I do agree that floating from pediatrics to adults is probably easier than the other way around. There are some pretty big kids in the children's ward. I'd probably still be stressed and fuss a little, but...

[Ruby Vee, BSN]

they should have floated the other nurse because at least she knew about adult nursing and would feel comfortable. The hospital should have offered her more incentive to work in that area. I'm sorry that you had to go threw this. I would admonish that the others giving insight also take into consideration if it had been them or their loved ones. I would want someone who is both comfortable and competent with providing care to adults taking care of me If I were sick. Personally, I would have refused the assignment and said call me if yall need help in my specialty.

The truth is we are held to a high standard and if some freak accident would have occurred, I dont think your employer would side with your best interest if it would cost them money.

The other nurse worked through Irma.

[Calalilynurse]

I would be scared to take adult patients too because I have only ever done peds and floated to baby related areas. I think they tried to be fair by just giving you two and at least the educator did the discharge so you didn't have two. I don't know if this applies but where I work new hires or transfers can't float for 6 months that may have been why. If I got pulled to our med surg I would probably have close to 6 because that's what the other nurses have and we don't have a float pool. I know them people I would have been on my own.