Refusing and safety

OBNURSEHEATHER · Nov 7, 2002

I don't ever think I would refuse to float somewhere. What I may refuse is to take an actual assignment. Slight difference.

We float to Peds and NICU. I don't know nearly enough about those areas to function, even at a minimal level. I mean, even the paperwork and routines are different. But I walk into the report room and say "Hi, my name is Heather and I'm your float nurse today. I'd be happy to assist you with vitals, transfers, baths, feedings, call lights, etc, but I do not feel comfortable taking an assignment."

I've never had anyone balk at that, and I've never had to refuse anything. Everyone wins.

Heather

emily_mom · Nov 7, 2002

I agree with Heather. Sometimes a body that helps everyone equally is better than someone who takes an assignment and is confused all night.

They should be grateful that they got a float and that you're willing to do the dirty work...

Genista, BSN, RN · Nov 7, 2002

Check your nurse practice act. If you accept an unsafe assignment, and patients are harmed, you could lose your license (let alone your mind and heart!) I was warned in nursing school that if it boils down to it, better to lose a job than lose a life. If it's REALLY unsafe, then (at least in my state) you are obligated to not accept that assignment. True, it could cost you your job. It is NOT abandonment if you arrive, see the assignment as unsafe, never get report, and immediately notify your supervisor that you are not accepting the assignment. In the eyes of the board of nursing, anyway, legally, that is the way it is viewed. Your hospital may see if differently.

There are laws about floating to a unit you are not oriented to, as well. For example, I would never accept an assignment in ER or ICU, or L&D or Peds. I will float to other medical/surgical/tele type floors, as I am comfortable there. But try checking w/ your board of nursing & see what your nursing practice act says about it.

This is regarding "patient abandonment" from the BRN of California:

http://www.rn.ca.gov/policies/pdf/npr-b-01.pdf

and on floating:

http://www.rn.ca.gov/policies/pdf/npr-b-21.pdf

sjoe · Nov 7, 2002

It is only patient abandonment if you accept an assignment, and THEN leave without due notice and report. You can't abandon something you've not accepted in the first place.

km rn · Nov 7, 2002

I've only refused to float to a specific unit once. Instead of forcing me to go to that unit - I was pulled to another.

I was working SICU and they wanted to pull me to the Bone Marrow Transplant Unit where I would have a full patient assignment. I found out from one of the hospital's pool nurses that pool nurses couldn't float there until they had orientation to that unit so I refused based on that. At that same hospital I was floated to Neuro floors, ER, Rehab Unit, Cardiac Step down, Urology, etc... One of my friends got floated to Labor and Delivery.

Unfortunately, where ever you went you were expected to take a full patient assignment and sometimes got the worst assignment because you were the ICU nurse and should be used to very sick people. We also never had anyone float to our unit but critical care float pool nurses and on a couple of occasions a Medical ICU nurse got pulled. We always gave those nurses the easiest patients and kept checking to see if things were okay.

So...I would refuse to float to certain areas espicially if the expectation is you take a full patient load OR if you know float pool nurses in that hospital receive additional trainging before floating to that unit.

Good luck! It usually can't be considered patient abdonment unless you have accepted the assignment.

Tweety, BSN, RN · Nov 7, 2002

In Florida you can refuse an unsafe assignment. This includes floating to an area you are not qualified for.

I love to float. People make such a fuss sometimes about floating, even the techs. Our hospital floats med-surg, neuro, rehab, and PCU to each other. It's up to the receiving floor to make an appropriate assignment. I wouldn't give complex neuro patients to a PCU float, and I would try to make an assignment he or she is comfortable with.

Sometimes, people kick, scream, make a fuss, call the supervisor, hold their units hostage just because they don't want to float. I always say, "if you are licensed to do a head to toe assessment, you're qualified" (if they are coming from said areas) and I'm here for you. But I'd rather not recieve someone with a chip on his/her should because they didn't want to float.

Am I ranting? Or babbling?

Sourdough · Nov 7, 2002

Here in Canada you can refuse to float to areas where there are specialized skills required that you don't have....like being sent to a cardiac unit with telemetry, and you don't know how to read monitors...you can go to the unit, and let the charge nurse know that you have no telemetry experience, and she can give the responsibility of reading your patients monitors, or just give an assignment where you help the rest of the staff with all other kinds of paient care...it's so rare to get the extra help, anything you can done will be appreciated!!!

nell · Nov 7, 2002

In CA you cannot legally be floated to a unit that you have not been oriented to and do not have current competencies on file for.

ratchit · Nov 8, 2002

Floating stinks for most of us and within limits, we all have to do it because we should all be on the receiving end of it sometimes.

Safety is a huge issue with floating. If I am unsure if I should balk or not, I try to imagine justifying my actions in court. If a lawyer asked me why I thought I was qualified to take an assignment and I don't have a good answer, I don't do it. I'll go anywhere as a pair of hands- iv starts, foleys, whatever- but will not take responsibility for any patient care unless I feel confident to do so.

The only problem with this at my hospital is that ICU nurses are expected to float to all but 2 areas- L+D and one M/S floor. Cath lab, PACU, tele, and ER are all considered safe areas for us. But not ONE of these areas floats to us no matter how bad things are. If the ICU is short, we're out of luck, but they will strip the ICU to send us somewhere else.

We're in the middle of a revolt, demanding this be changed. If not one nurse EVER floats TO us, we shouldn't be required to float out, either. This isn't a safety issue, but it's a professional respect issue. If I'm in the float pool, I want the differential for that.

Safety is what it boils down to. I'd say it is not only OK but necessary to refuse to care for patients that you can't safely care for. Being able to do a head to toe assessment in one specialty does NOT tell me how to care for patients outside my knowledge base. A m/s nurse can assess an ICU patient, but won't know how to manage her findings. I have no idea how to juggle 6 patients or handle BMT patients.

A nurse is NOT a nurse. We don't ask dermatologists to be cardiologists. If I can't do the job right, I'll go as a helper. If they insist on giving me patients that will suffer for my ignorance, I will go home and save my license if I can't save the patient from the hospital's stupidity.

bagladyrn, RN · Nov 8, 2002

I have refused to float to another unit to take a patient assignment in the past, but try to offer alternatives when I do so. For instance: "I won't take a patient assignment as I don't feel qualified to assess such pts., but I will be glad to task and help with all the pts." or "I'll go to X area so that you can float someone with more experience to Y area" or "I'll float to MS if you will give me the Gyn pts. (I'm OB)" If negotiation fails then I will refuse if I feel it risks my license or pt. safety.

Tweety, BSN, RN · Nov 8, 2002

Ratchet, it is crazy to float critical care nurses out of ICU areas. Our hospital has three ICUs (surgical/trauma, neuro/trauma, and cardiac/medical) and they float within each other. (Again for instance a cardiac ICU nurse floats to neuro, they will not take the patients with ventriculostmies, ICP devices, etc. There almost always is a couple of patients this nurse floating can handle). Just as I can't do critical care nursing, having an ICU float to a floor and take six to eight patients is equally crazy.

We also have the "we float to them, and they don't float to us" problem, with our womyn's surgical unit. They are supposedly decentralized, and staff themselves. When they have extra staff they can take a vacation day, when they are short we float to them...grrrr....