no orientation as a traveler in Florida

[msbellanme]

Took a travel assignment in Florida in the ICU. RN for 10 years, experience in ER, CVICU and Cath Lab.

To start, when I began I was scheduled one day of orientation which was to be Thursday. I show up at 0700 but HR doesn't open until 0730 so I do not go to the floor until 0800. Upon arriving to the floor, I do not have access to the computer, no pin, my badge does not open doors, glucometer or pyxis machine for meds. They assign me to a RN, we try all day with run arounds to get my access. That afternoon, I finally spoke with IT myself and got access to the computer. Even though I have their system experience, theirs is different is some ways from what I used a year ago. So I was left with 4 hours of orientation time with only having access to the computer. The following day, I was assigned two patients once again with no access to anything but the computer and the charge nurse had to temporarily give me access to the pyxis. I had to infuse blood and without a pin, other nurses had to chart it for me. I was not shown or instructed on unit requirements for charting, transferring a patient, etc. by anyone, I had to ask questions as they arose. Finally that afternoon, they got me access to everything I needed.

On my fourth shift off "orientation", I show up to work to be told I am going to the IMU. I asked what was it and that I wasn't comfortable working a floor. They stated it was ICU step down. When I stated I had never worked a step down they stated I had to float. I asked where the unit was and was told "its at the end of the hall". I had to find the unit, which even though it is considered to be ran by the ICU it is in the other tower of the hospital. I received no orientation to the unit, policies/procedures or requirements. Nor did I receive a tour, code to door to med room/nutrition room etc. It was me and one other RN, in charge of 8 patients "too sick to be telemetry patient". No tech, no aid etc. We had 4 patients each, the other nurse being busy did not have much time to help me. The nursing charting area is in a break room area, you cannot see the monitors to the patients which are in the hallway. The monitor for the floor watches the monitors for IMU. The floor that is beside the unit, stated that we were ICUs responsibility and were of little to no help. We both had heavy patients, and two of mine were confused and the other nurse had a procedure that required her not to leave her patient for 30 minutes. The director and manager came through the unit twice, I expressed my concerns and felt I was put in an unsafe environment with no reply. I had to discharge two patients. I have never discharged a patient except from the ER. The nurse working with me didn't have time to help, so she called the charge nurse from the ICU. She came, however, she stated the D/C process in the IMU was different from the ICU and had to ask for help from another nurse. The next patient was to go to the nursing home, once again I called the charge nurse in the ICU. She came and stated she did not know how to transfer a patient to the nursing home and had the charge nurse from the floor help me. While I was working on the discharge, I was given a patient to admit and settle in. Once again, just two RNs to do it all.

The charge nurses at this facility do not have patients. At the very least they could show me the unit, familiarize me with policies, procedures and expectations. It is not appropriate to place a nurse on a unit without even a walk through. In addition, I did not receive a break today but if I had the other nurse stated she would be responsible alone for all 8 patients and vice versa if she went. When I asked why the charges didn't check on us, relive for breaks or come by she stated "we don't if you need anything unless you call". Confused how they don't know they are responsible for us and that there are only 2 RNs for 8 patients...

I feel I should've received an informative and comprehensive orientation to the facility, but especially would expect it if I am expected to float to a unit I have never worked on in my career.

I would not be surprised if my contract got voided, I won't be too upset as my license and patient safety is more important to me than this contract, but at the same time don't want a bad reputation as a RN.

Anyone else had something like this to happen??? What did your company do if anything???

Think I will be heading back to Texas ASAP!!

[NedRN]

Forget about your agency, they know nothing about your clinical situation. You have to handle this through the chain of command just like any other staff nurse. Go talk to the manager and explain the situation. It is concerning to go to an area outside your expertise with no orientation. Step downs are not easy. You must float? How about to the OR, or to dialysis, or to psych? If you feel like you are unsafe, you must refuse the assignment.

[msbellanme]

I attempted the chain of command with no response just laughs and oh well...I offered to float to the ER, Cath lab, PACU and OR...I will not accept any such assignment again, I do foresee either leaving early or my contract being cancelled as the staff states this is the norm for the travelers here...

[msbellanme]

As an update...next scheduled date they tried to float me there again. I asked if they did not have a float schedule etc. They stated "as a traveler you will go first every time" I refused the assignment and went home. As the chain of command did no good. I'm hoping it'll be considered breech on their part as they need a step down nurse not an icu nurse and this was never discussed with me or I would have never took the assignment.

[wanderlust99]

What ended up happening? I hope they just canceled you and you are done with it.

Hopefully new travelers will read this. Most of us just stick it out. As an Icu nurse you can find jobs that don't float or at least float you in rotation with staff but typically you are first to float. I feel your pain I really do as I had no tele experience only Icu before I started traveling.

You have to be careful with what job you take or they will really screw you over. I had a similar hospital Eisenhower in CA do this. They hired me as an Icu nurse but I ended up in tele most of the assignment. It was hell. And I do believe they did this on purpose knowing full well their Icu was staffed but I could cover both..more cost efficient.

[imanedrn]

What do you ultimately do in situations like this? I start my very first travel assignment tomorrow. I have read horror stories of stuff like this and, of course, have my quiet concerns.

[caroladybelle, BSN, RN]

Welcome to why no one likes working in FL.

To Flexiseal: I worked with several facilities that deliberately overbooked travelers into preferred good ratio units, and proceeded to float them all over creation, to the less desired units. It is especially prevalent in for profit facilities.

[LadyTiger44]

As a new traveler I would suggest contacting your agency. I would not put my license in jeopardy for any job or assignment. If the chain of command isn't working, the agency should be able to do something. Give them an ultimatum, and try to get out of there!