Being pulled to different units

UM Review RN, ASN, RN · Feb 11, 2005

I'd have to refuse to work a unit that I am not qualified to work. Someone said it elsewhere on the board about a similar problem, and I agree: Better to lose your job than your license.

However, I would offer to make myself available for training and orientation to certain units--for instance, I wouldn't mind working ICU or ER if I was properly precepted and trained for it, but you'd never ever get me to work a psych unit or an L&D unit, or heaven forbid, a pede unit.

Where I work, we cannot be forced to work on a unit to which we have not been trained or do procedures (such as titrating certain cardiac drips) which we are not allowed not do on our telemetry unit, or give certain drugs (our unit cannot give Labetolol IV, for instance), so I'm really surprised that your Risk Management Team would not want to play it safe and back you up.

contingent · Feb 11, 2005

When I spoke with our nursing administrator he told us that we can listen to lung sounds and bowel sounds on anybody. He said everything that we weren't qualified to do would have to be taken care of by a nurse from that floor. My concern was that if I accept this assignment even though another nurse is watching the monitor for me what happens if something happens to this patient? There's a lot of things I'm, as a med/surg nurse, not qualified to do on that floor. Then if we go to court am I ultimately responsible for that patient? If I would loose my job over refusing to go to a different unit I think I would have to talk to a lawyer about that!! I would like a lawyer to tell me that if I refuse to go to a different unit due to being not qualified I can not be fired. Am I being to unrealistic???? I want to know who is suppose to be standing up for the nurses?? There are so many policies in place to protect the patient, but what about the nurses?? Thanks Angie for your response.

I'd have to refuse to work a unit that I am not qualified to work. Someone said it elsewhere on the board about a similar problem, and I agree: Better to lose your job than your license.
However, I would offer to make myself available for training and orientation to certain units--for instance, I wouldn't mind working ICU or ER if I was properly precepted and trained for it, but you'd never ever get me to work a psych unit or an L&D unit, or heaven forbid, a pede unit.
Where I work, we cannot be forced to work on a unit to which we have not been trained or do procedures (such as titrating certain cardiac drips) which we are not allowed not do on our telemetry unit, or give certain drugs (our unit cannot give Labetolol IV, for instance), so I'm really surprised that your Risk Management Team would not want to play it safe and back you up.

RN4NICU, LPN, LVN · Mar 6, 2005

When I spoke with our nursing administrator he told us that we can listen to lung sounds and bowel sounds on anybody. He said everything that we weren't qualified to do would have to be taken care of by a nurse from that floor

That is such a load of crap, I can smell it from here! (and I would bet that this nursing administrator knows it too). When you accept a patient assignment, you are accepting responsibility for the TOTAL care of that patient. What you delegate is up to you, but it is all your responsibility. If the patient has an emergent need and suffers an adverse outcome because the "qualified" nurse wasn't available, who's butt do you think is in the hot seat?

The "qualified" nurse? Nope - not his/her patient...not his/her duty.

The nursing administrator? Possibly, but not likely. He can always double-back and say you should have known better than to accept an assignment you were not qualified to handle (you can bet that is what the State Board of Nursing will say).

Yours? You'd better believe it.

No lawyer in a non-union state is going to tell you that you cannot be fired for refusing to float. Without a union contract, you can be fired for any reason or no reason. Which is worse, though: loss of job or loss of license?

Jedi · Mar 8, 2005

:yeahthat: OK - let's get back to basics here. If we're going to talk about losing a license, then it's best to think like a lawyer!

First thing is this - Request a written copy of the hospital policy on floating nurses to other units. Also, ask if there are policies for the specific units that you would be floated to.

I have heard that nurses that go to different units can act as "nurses". If they are not trained in a specialty, then yes - it would seem logical that you would be assigned a nurse to report to in the case that something came up that you did not know how to handle or if there was something that you were not trained to do, then that nurse would handle the procedure, assessment and determine how to handle the situation. But I wouldn't assume anything. I would want to see the policy for that unit in writing, otherwise, you don't know how to operate on the floor.

Another note - If this happens, I think it would be best to NOT FREAK OUT ABOUT IT. I think it would be best to go back to the basics of nursing. You do your assessment, you pass the meds you are trained to pass (obviously, you can't give chemo if you are not chemo-certified) >>>>>

BUT MOST IMPORTANTLY > > you are a patient advocate. If something goes wrong, you do something. If you don't know what to do, you go to a senior nurse or the nurse you are directed to go to for help (charge nurse). If her solution remedies the problem, you are fine. If it doesn't, let her know you are uncomfortable and want to notify an MD to cover eveyone (most importantly, your patient). If you can't get a doctor, get the AOC (Administrator on call).

Above all, I would remember that your title is Nurse, Registered Nurse. It's not Super-nurse. It's not "Nurse - Alone Nurse", nor "Nurse that acts in a vacuum nurse". Healthcare is a collaborative practice. You are out there to monitor your patient. The decision was made to float you to an unfamiliar unit, therefore it is only logical to expect that you would need to lean on your ability to collaborate with other staff RN's, doctors, administators, when you are put in this situation. Whatever it takes maintain the health and welfare of the patient.

Now, there is nothing wrong with giving feedback to people about how your assignment went. If you are telling people you are uncomfortable and they are giving you feedback that your performance was OK, then it's probably just your own jitters that you need to keep under control. If they think your performance was rotten on that unit, then make a written request for training in that specialty. You might want to request the training if they thought you did fine or not.

Sometimes you have to be assertive and exercise your rights as not just a nurse, but as a basic employee in a hospital setting If you put something in writing that requests training and the hospital floats you without the training, then it makes the hospital look more liable than you, basically revealing that they make a practice out of making innappropriate float choices. Put them back in the legal hot seat. Believe me, they will understand when paper comes to them to deal with, but it's a position they put themselves in and the ball is in their court. They may not like it, but you can just tell them that you feel you need more training to properly care for patients on this unfamiliar unit. No more, no less, don't get bated into an arguement that could cost you your job if you want to keep it. Sometimes, if you say the same thing over in different ways, they might stop asking you the questions. You can always say, "I'm looking to expand my abilities as a nurse and I see this float situation as a perfect opportunity. I think it will only help me to be a better nurse on my current unit and a more experienced team member on any unit that I work on for this hospital. It's the best way I can serve my patients".

If this prompts the hospital to re-evaluate their own floating policies, so be it and I'm sure patients will be safer in the end. If the situation gets to uncomfortable, I'd ask to transfer to a different unit. If you want training on that unit, ask to transfer to that one, because then you'll get the proper training.

Always good to peruse the job ads and it never hurst to network and go on interviews, whether you intend on leaving or not.

Hope this helps some. Word of caution - Be careful about boat-rocking too much if you can't afford to be out of work. But if you were to lose your job unexpectedly, I think another hospital would respect your choice. You just have to tell the story properly to make sure you look responsible and wise in your choices made.

mycotton · Jun 19, 2005

Would this hospital put a transferring nurse on any floor without a proper orientation? NO! Therefore, you should not be expected to take the role of a nurse who had a full orientation. If you are being placed in the position of working in an area where you are not comfortable or not 100% qualified, you must first tell the supervisor that is telling you that you must go there. You may have a chain of command, and utilize this system of communication. If they continue to insist, you must chart the fact that this supervisor was notified that you do not feel properly oriented or qualified to work in this specialty area. Let her know you are doing so. This usually stops it cold! Now, they are responsible for their unsafe assignment. Call your State Nursing Board, and double check, they will concur with this. Ask where you need to chart this. If you do not follow this Standard, you are then held liable for the care of this patient. Your administrator knows this, and is betting that you do not. If anything goes wrong, I'll almost assure you that she says that you failed to inform her that you were not comfortable in this situation. Your word against hers. Call the Nursing Board before putting yourself in this situation again. Good Luck.

ZASHAGALKA, RN · Jun 19, 2005

The BNE (Board of Nurse Examiners) for the State of Texas has a 'Safe Harbor' policy that states that, if any nurse is put into a position where s(he) feels they cannot provide safe care to a patient, they can declare 'safe harbor' and it legally puts the ball in the hospital's court. By law, declaring a 'safe harbor' situation cannot lead to reprimands (although what's legal and what's done are two different things).

Safe Harbor has 2 components.

1. It legally transfer responsibility for unsafe care from the nurse to the hospital. If the nurse has declared the assignment to be unsafe, then the hospital assumes the risks of not changing the assignment.

2. Safe Harbor is a peer-review act. Most states have a peer-review process to discipline nursing at a local level so that the state board isn't inundated with thousands of minor infractions each year. By declaring 'safe harbor' you are initiating the peer-review process against the hospital. At any point the issue is resolved (assignment is changed, etc), the issue drops. If it continues, the incident is reviewed by your local peer review committee (a primarily nursing committee).

I don't know if your state has such a deal, but it's worth checking into.

word of caution: I've actually seen this used 1 time and as a result, the DON came in to work a busy med/surg night shift in order to make the 'safe harbor' go away. But, the nurse who initiated it 'went away' less than a month later. Now, I think that particular nurse only declared 'safe harbor' because she was planning on leaving anyway, but there is risk involved, whether the state says so or not.

On the other hand, if you get termed within a few weeks of declaring 'safe harbor', then you'd have a nifty legal case, right to work state or not.

~faith,

Timothy.

justmanda · Aug 1, 2005

That is such a load of crap, I can smell it from here! (and I would bet that this nursing administrator knows it too). When you accept a patient assignment, you are accepting responsibility for the TOTAL care of that patient. What you delegate is up to you, but it is all your responsibility. If the patient has an emergent need and suffers an adverse outcome because the "qualified" nurse wasn't available, who's butt do you think is in the hot seat?
The "qualified" nurse? Nope - not his/her patient...not his/her duty.
The nursing administrator? Possibly, but not likely. He can always double-back and say you should have known better than to accept an assignment you were not qualified to handle (you can bet that is what the State Board of Nursing will say).
Yours? You'd better believe it.
No lawyer in a non-union state is going to tell you that you cannot be fired for refusing to float. Without a union contract, you can be fired for any reason or no reason. Which is worse, though: loss of job or loss of license?

I agree..this is total crap. I had to take a six week critical care course just to be qualified to work in the step-down units. SIX WEEKS. And the ICU/CCU departments require a nurse to be on orientation for three months if she has no experience there. For them to expect you to take responsibility of drips/telemetry readings/critical care patients when you have received no orientation is ridiculous. What's more, to be required to float there every now and then when you can't even consistently orient to the equipment makes me think they themselves have absolutely no medical background. Just ask them next time, when they want to float you to a critical care floor..."Would you let me take care of YOUR mother knowing that I don't know what the heck I am doing?" Gimme a break....just let my hospital try to float me to pediatrics (where I have NOOOOO experience and don't want any). I will be out of there so fast, their paper-shuffling heads will spin.

Mulan · Aug 1, 2005

Being floated everywhere and anywhere, including units, when one is not qualified, sure sounds like an HCA hospital I know.

legalnurse22 · Aug 2, 2005

I'm going to answer this as a Nursing Supervisor because most of the legal

aspects that I would say have been covered. I do everything possible not to

pull someone to an area that they're not qualified to be in. That puts the hospital, nurse, and patient in jeporday. There is a difference between "not

qualified" and "uncomfortable". I will not put a nurse at risk. I've made some

other nurses unhappy by re-shifting if I have someone else more qualified. I've

been extremely blessed with several nurses that are crossed-trained and don't

mind floating. If it is an emergency and I must have someone on that floor and the unqualified nurse is the only option, I look to see if there are any off-

service pt.s on the unit (ex: med-surg that's there because other unit was

full) or stable pt.s that will be disc. the next day. Might change assignments

of the other nurses if the nurse being pulled is OK with that. Most of my night nurses know that when I do that I don't have any other option and most of the time they're OK with that because they know I will "go to bat" for them. I've had to tell MD's that we can't take a patient. I've also called in another Supervisor to cover for me and I have worked the unit. Hope this helps. This makes my staff more willing to help other units.

legalnurse22

RN34TX · Aug 2, 2005

One of the reasons I left my last position was because of floating.

I worked ICU and the hospitals seem to think that if you can do ICU, then you can do anything. Not true.

I was pulled to specialty units and my nursing supervisor gave me the same speech about being "uncomfortable" vs. unqualified.

Specialty units need specialty training beyond the basic RN program, period.

Regardless of how short the hospital may be.