Floating from the NICU

  1. Hoping to get some feedback from other NICU nurses. I have 4 years NICU experience and that is the only area I have ever worked in. I recently began a travel assignment (not my first) and have been floating pretty regularly.
    In the past 4 years, both in permanent staff positions and previous travel assignments, as a NICU nurse I was only expected to care for infants under 1 year of age. Recently, on one of my float shifts I was assigned teenage patients. I refused this assignment as I have no experience outside of the NICU and a 15 year old is a very different patient population than a NICU patient. I feel like often times nurses feel intimidated and accept assignments that they are not comfortable with. Do other NICU nurses feel that refusing a teenage patient load is unreasonable?
    I always come back to the feeling that a floor peds nurse who routinely cares for 15 year olds would not be expected to care for a 23 weeker if floated to the NICU.
    Thoughts? Suggestions?
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  2. 17 Comments

  3. by   atriRN
    I think I would have refused as well. It comes down to scope of practice and like you mentioned it would be absurd to think that a pediatric nurse floating would take a 23weeker assignment. It's not a matter of skill or intelligence because I'm sure you could muddle through the care if you had to, but that wouldn't be the best or the safest for the patient.
  4. by   Wuzzie
    Quote from sfk26
    I always come back to the feeling that a floor peds nurse who routinely cares for 15 year olds would not be expected to care for a 23 weeker if floated to the NICU.
    Thoughts? Suggestions?
    No, but they would be expected to care for the stable feeder grower they were assigned to. Seriously, you're a nurse. Surely you can monitor vitals, do assessments and look up any medications you are unfamiliar with. You've only been out of school for four years! You can't possibly have forgotten how to care for patients over the age of one. I floated as a NICU nurse. I didn't like it one bit but I did it. I find that if you approach the charge nurse on the unit and let them know you are out of your comfort zone they almost always give you very stable patients and go out of their way to be more than supportive. I have never been overwhelmed. Refusing the assigment was over the top and will give you a reputation of being difficult. Negotiating would have been a far more mature and professional way to handle the situation. Your argument that it is unsafe is weak.
  5. by   NicuGal
    We only take kids 2 years and under. We have float guidelines for all units that show what each floor can take or not take when floated.

    Check to see if you have a float policy. Up until about 8 years ago we whole house floated....and we were sent to adult ICUs. Most of the time we ended up functioning as an aide.

    You have the right to say something at
    The beginning of your shift. If you aren't comfortable say something. Better yet, see if there is a way to set up float guidelines if there aren't any in place. The old adage " a nurse is a nurse" really doesn't work.
  6. by   Wuzzie
    Quote from atriRN
    I think I would have refused as well. It comes down to scope of practice and like you mentioned it would be absurd to think that a pediatric nurse floating would take a 23weeker assignment. It's not a matter of skill or intelligence because I'm sure you could muddle through the care if you had to, but that wouldn't be the best or the safest for the patient.
    Oh for heaven's sake. No float nurse EVER would be assigned a 23 weeker! You know very well they get the stable feeder growers. As to your "scope of practice" argument. Our scope is determined by our BONs and is not determined by our specialty. There is NO scope issue here. Look, I get it. Floating is unpleasant. Nobody wants to do it. I certainly didn't want to take care of teenagers (ick) but it's a part of nursing. That's what's in play here. You don't want to do it so you're coming up with rationales, really weak ones at that, to support your agenda without making you look bad. I'm sure I've done that more than a few times myself. We are generalist trained. The vast majority of your training was with adullts. It is the FOUNDATION of your nursing skills. Why not turn floating into a positive? Make some new nurse friends. Learn about a new medication. Be a team player knowing you're there because they need the help. Or throw a hissy fit and earn the reputation of being a princess (don't forget I was a NICU nurse once I know what they say about us). You decide the kind of nurse and person you want to be.
  7. by   Wuzzie
    Quote from NicuGal
    Check to see if you have a float policy. Up until about 8 years ago we whole house floated....and we were sent to adult ICUs. Most of the time we ended up functioning as an aide.
    You have the right to say something at
    The beginning of your shift. If you aren't comfortable say something. Better yet, see if there is a way to set up float guidelines if there aren't any in place. The old adage " a nurse is a nurse" really doesn't work
    I bet even functioning as an aid was a huge help though! I agree with saying you are uncomfortable. But I also think we should remain flexible. If my float assigment had me concerned I would speak with the charge and we would adjust accordingly. Maybe it meant I took an extra patient because I got all the easy ones. Or I got the youngest patients. But I never flat out refused an assigment on the basis of age! Although I probably would have drawn the line at adult ICU. Yikes!
  8. by   DeeAngel
    You are expected to know your own personal scope of practice. If you do not feel comfortable with an assignment due to that then you refuse the assignment. Hospitals and agencies will always try to force nurses to work outside their experience and comfort zone, they just don't care.
  9. by   Julius Seizure
    I would understand if they floated you to an ICU and gave you a teenager. But it sounds like they floated you to a med-surg type floor and gave you a teenager, right? That sounds like the equivalent of giving someone a grower-feeder when they float to NICU. Wuzzie has a good point.

    No, I don't think that "a nurse is a nurse is a nurse" BUT I do believe that you have the basic skills to manage a stable floor patient for 12 hours when you have resources available to you. If I were a NICU nurse, I might ask to either have patients under age 2 (or something) or be given a very stable assignment. But I do believe that you are very likely able to safely care for this patient - even if it sucks.

    Also, you are a traveler. You must have great adaptability skills! I bet you could assess a 15 year old and use your resources if you were unclear about something.

    What exactly is it that makes you uncomfortable? (This is a real question that I am honestly curious about.) When I take care of NICU babies, the main thing that makes me uncomfortable is that sometimes their O2 sats go all over the place and nobody seems to worry too much. When I take care of adult patients, the main thing that makes me uncomfortable is that I don't really know how assertive I should be in making them ambulated/eat/drink/etc. And that I don't like taking care of people bigger than me! So what is it for you?
  10. by   llg
    As an old NICU nurse, I understand the OP's point. NICU nurses do not use the same equipment, do not use the same guidelines for assessment parameters, do not use the same documentation forms, do not function under the same policies for a lot of things, etc. Unless you have been oriented to the relevant equipment, policies, etc. of that unit -- a nurses (even a traveler) should not be expected to step in and take full care of a patient that is so different from the population she has been hired (and oriented) to care for. )Even traveler's get a little orientation to get acclimated to their unit.)

    Every hospital I have ever worked in (and there have been several) had special guidelines for floating for nurses who came from units that are vastly different from the ones they are familiar with. The NICU nurses floated as "helpers," and not assigned to do total care for patients. They are shown certain tasks at the beginning of the shift and then asked to do them to help out the other nurses who are assigned to the patients -- to be the 2nd pair of hands when needed -- etc.

    You can't assume that the NICU nurse knows how to use the blood pressure machine, thermometer, IV pump, etc. because the NICU may use different brands and have different policies/procedures in how they are used. You can't assume that the NICU nurse will recognize the side effects of medication she has never given in her career -- or the danger signs of a complication that she has never seen before. etc. And as for floating to peds -- not all nursing students get an inpatient peds clinical. A traveler may never have worked with an inpatient peds patient before. You can't safely assume that they got that experience in school.
  11. by   Wuzzie
    Quote from llg
    As an old NICU nurse, I understand the OP's point. NICU nurses do not use the same equipment, do not use the same guidelines for assessment parameters, do not use the same documentation forms, do not function under the same policies for a lot of things, etc. Unless you have been oriented to the relevant equipment, policies, etc. of that unit -- a nurses (even a traveler) should not be expected to step in and take full care of a patient that is so different from the population she has been hired (and oriented) to care for. )Even traveler's get a little orientation to get acclimated to their unit.)

    Every hospital I have ever worked in (and there have been several) had special guidelines for floating for nurses who came from units that are vastly different from the ones they are familiar with. The NICU nurses floated as "helpers," and not assigned to do total care for patients. They are shown certain tasks at the beginning of the shift and then asked to do them to help out the other nurses who are assigned to the patients -- to be the 2nd pair of hands when needed -- etc.

    You can't assume that the NICU nurse knows how to use the blood pressure machine, thermometer, IV pump, etc. because the NICU may use different brands and have different policies/procedures in how they are used. You can't assume that the NICU nurse will recognize the side effects of medication she has never given in her career -- or the danger signs of a complication that she has never seen before. etc. And as for floating to peds -- not all nursing students get an inpatient peds clinical. A traveler may never have worked with an inpatient peds patient before. You can't safely assume that they got that experience in school.
    I get what you're saying but I AM an experienced NICU nurse who has floated and survived. It's not rocket science. You don't know a med look it up or let the charge nurse know. Be a "helper", that extra set of hands they need. Really, how hard it is to figure out a BP machine? Or a thermometer? By your requirements no nurse from any unit should ever float to begin with. That just isn't going to happen. I think guidelines are a great idea and should be used for all nurses from any unit who is floated. But I don't think that refusing an assignment based on age of the patient alone is professional. And I think we all should remember how we feel when we are floated the next time somebody is floated to our unit. Nobody likes it. Everybody is scared when they are out of their comfort zone. The bottom line is we are all here to get the job done and sometimes that means doing things that stretch us a bit.
  12. by   llg
    Quote from Wuzzie
    I get what you're saying but I AM an experienced NICU nurse who has floated and survived. It's not rocket science. You don't know a med look it up or let the charge nurse know. Be a "helper", that extra set of hands they need. Really, how hard it is to figure out a BP machine? Or a thermometer? By your requirements no nurse from any unit should ever float to begin with. That just isn't going to happen. I think guidelines are a great idea and should be used for all nurses from any unit who is floated. But I don't think that refusing an assignment based on age of the patient alone is professional. And I think we all should remember how we feel when we are floated the next time somebody is floated to our unit. Nobody likes it. Everybody is scared when they are out of their comfort zone. The bottom line is we are all here to get the job done and sometimes that means doing things that stretch us a bit.
    I agree that going as a "helper" is the preferred model ... and that the OP should have been willing to do that. But that doesn't sound like what was happening in her scenario. It sounded like she was being asked to actually take responsibility for the patient.

    And in this day and age, we can't assume that every nurse had inpatient peds experience in her curriculum and/or had any specific experiences as all programs are a bit different. Hospitals need to come to terms with that and develop the "helper model" of floater or something like that before they asked nurses to float -- especially if she did not go through that hospital's orientation program (like a traveler would not have done).
  13. by   MGMR
    Age does not determine acuity here, and I think that if you were given the teenager, that was their most stable, appropriate patient. It may make you uncomfortable, but you're always going to be uncomfortable floating. That isn't your unit, not your specialty, you don't know where the supplies are, you don't know the medical team or the nurses. In my opinion, their job isn't to make you comfortable, it's to keep their patients safe - and that was probably their safest assignment to give you.

    The example of giving pediatric nurse a 23-weeker is misleading because here, gestational age CAN determine acuity. And something like the management of a 23-weeker in the NICU would never even be mentioned in nursing school whereas the general principles of a teenager are covered.

    If you are uncomfortable, always ask the nurse you get report from the vital sign ranges that they want and what the big things are to watch out for. I like to ask something along the lines of, "What could make this patient sick today/tonight, and how will I know?" You should also know who the charge RN is, because he or she is there to help with any questions or concerns you may have. You're NOT expected to be an expert, but you're expected to keep that patient safe. And as an ICU, regardless of patient population, you should be able to pick up on big changes in patient status.
  14. by   Julius Seizure
    Quote from llg
    As an old NICU nurse, I understand the OP's point. NICU nurses do not use the same equipment, do not use the same guidelines for assessment parameters, do not use the same documentation forms, do not function under the same policies for a lot of things, etc. Unless you have been oriented to the relevant equipment, policies, etc. of that unit -- a nurses (even a traveler) should not be expected to step in and take full care of a patient that is so different from the population she has been hired (and oriented) to care for. )

    Fair point. I take care of peds cardiac patients. They once floated me to the trauma PICU and gave me a pair of patients that was about as far outside of my comfort zone as you can get in peds:
    Patient A was a toddler with a shattered pelvis s/p surgery, with pin care and all that good stuff.
    Patient B was a pre-school age neurosurgical case that was due out of the OR about 20 minutes after I got report.

    Oh believe me, I was a VERY needy nurse that day. And agreed, I wasn't equipped to give the level of care that one of the regular PICU nurses probably could have given.

    So, I guess I see both sides of the issue. I do recognize that I am a little biased, because as a pediatric nurse, I get floated to the NICU and so its just kind of become part of my nursing world. Generally, the perspective that I've seen from peers is that if "we" can float to NICU, then why wouldn't NICU be able to float to us? (My NICU orientation was, "This is the NICU, here are your babies. Feed them every three hours and don't touch them in between.")

    It sucks, though, to be put in a situation that you don't feel like you've been equipped to manage. Valid point.
    Last edit by Julius Seizure on Jan 31

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