Labor Nurses to Med-Surg

[crissyc03]

Hi, I previously posted the thread about our labor nurses floating to med-surg and possible infection issues....thanks by the way to all who replied. Here is the other issue and I wanted some more advice.

Not only are we concerned as labor nurses about the whole infection control issue (which by the way we are expected to float to med-surg when needed and then float back at moments notice for labor patients) but most of us have been labor nurses for most of our nursing careers and are being forced to float to med-surg without any orientation/training. I remember the day I went was a disaster, I wasn't familiar with many of the drugs I was giving (no time to look them up either because all the meds were already late), I wasn't familiar with any of the policies/procedures, I couldn't not answer questions for patients and their famililes because I didn't know. It was a sinking and scary feeling to not have a clue whats going on. I feel like this is unsafe practice. It seems that if you are an alive warm body then thats good enough for med-surg...who cares if you're actually competent.

We have tried and tried to fight this....our unit director does not care. We've even tried to go up the chain of command and we just don't get very far. Many of us are in the process of calling the ethics hotline about this issue and feel we have no where else to turn.

We are being forced to go to med-surg and are threatend with our jobs if we try to refuse to go.

Does anyone else know who else we can turn to about this? And if I were terminated because of refusing to go to med-surg would there be any legal action I could take?

[Jolie, BSN]

Contact your State BON and see if there are any requirements for orientation prior to accepting an independent patient assignment on a unit to which you are not regularly assigned.

A number of years ago, we were experiencing a similar situation, with NICU nurses being pulled to peds (Can you say, "infection control?") I was a the NICU manager, and I got a call at home from a newly-hired staff nurse (She hadn't even completed NICU orientation,) stating that she was being told to go to peds and be in charge. I fought with the supervisor, and won. The Director of Maternal Child Health had to come in and work the shift. I had little sympathy for her. It was her job to accept 24 hour accountability for the unit, since she had fired the previous NM, and couldn't find anyone else willing to take the job.

I then began to research BON requirements for orientation of new staff. Found out it was against BON policy for a nurse to be floated without having completed his/her orientation and also for nurses to take charge on any unit to which they had not received a specific orientation. The Director knew that. She just didn't want to ruin her weekend.

Another facility (in another state)wanted to float Maternal-Child nurses to med-surg, but the BON required evidence of formal orientation prior to a nurse taking an independent patient assignment. Of course, they didn't want to pay the money to actually orient the staff, just wanted to float them. The compromise was to send RNs to buddy up with staff nurses, rather than give them individual assignments. That way there was at least a resource person immediately available, and we didn't have our names on the assignment sheets. If a need arose on our home unit, we could drop our patients and run. Although that still didn't address the infection control issue!

[jenny456]

I would IMEDIATELY contact the board of nursing for your state AND The Joint Commision on Accreditation of Healthcare Organizations (JCAHO). Hospitals are terrified of JCAHO. My hospital almost lost its accreditation because of a tragic patient death that was highly publicized in the media. The pressure was so great on my facility to change " its evil ways" that it resulted in many firings of problem management, nurse patient ratios were lowered, and the hourly wage dramatically went up. Many new policies were put into place to protect nurses and patients. Do you have a union?

[jenny456]

ooops--typo--"immediately"--sorry!

[crissyc03]

No union.

[tntrn, ASN, RN]

Even with a union, unless there's a no floating agreement in the contract, you may still be required to go. Our Birth Center/NICU nurses are required to go, and as far as orientation goes, they've had us do a large number of "competencies", which are little handouts, and questions about the handouts that they will use as proof of orientation. Give me a break!

When I float, I tell them I will be happy to help out, but that I won't be taking any assignment that includes medications/treatments/diagnoses I am unfamiliar with. They don't like it one little bit, but I stick to that. I also throw in that I'm unwilling to do anything that will jeopardize patient safety OR my license.

What our place usually does is assign only 4 MS patients to the floaters, while the regular staff will have 8 or 9. Can you say madhouse! I might also add that when my DH needed prostate surgery in December, I did not for one microsecond consider my hospital as the place to go. And because of the horrible staffing ratios and also knowing that nurses like me (31 years in L & D) might be assigned to care for him.