case study(med-surg nurse getting pulled to busy L&D unit)

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hi you guys,

I'm doing this case study and I just wanted some of you all opinions on the situation. Here's the scenario:

A nurse who's been working on oncology med surg unit since graduating from college a year ago. She's a good nurse and is complimented often by her supervisor. she is often pulled to other med surg units when census is low in her department. this particular night, she is pulled to a busy deliver room. she protest because she don't know alot about obstetrics or caring for obstetrics patients. The supervisor tells her that she's the most qualified person and to "Just go and do the best she can". Her supervisor is not at the hospital, and the charge nurse does not feel comfortable in advising her on the situation. she is now confused and torned between professional, personal, and organization obligations. What do you all think she should do?

I was going back and forth with ideas. but I feel that she should not take on this assignment if she does not feel comfortable. If she does not know what she is doing, then she will not be that helpful to the patients or the other staff on that unit. I also feel that she is putting her license on the line if she go in the deliver room and make a mistake of some sort. These are just some of the ideas I came up with. I would like to know what some of the experience nurses thinks because I know you all probably have been pulled to other units during your career.

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Specializes in OB, M/S, HH, Medical Imaging RN.

I think your thoughts are right on. Another thing is that it is always the med-surg nurse that is pulled? Other departments are not pulled to med surg because they don't have enough med/surg experience, well duh, I don't have L&D, CCU, or SDC experience either, but this doesn't seem to make a difference. Anyone concur?

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Well ...im new here but i just wanted to add that having just taken my NCLEX exam I had tons of questions regarding assignments given to floating nurses...so i guess you are expected to do it..just remember that you should be assigned the most stable and predictable patient...thats how i answered the questions anyway....

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Specializes in Med/Surg, Geriatrics.

You are dead on, you should definitely refuse the assignment.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

Well, I'm going to disagree with the others. Keep a positive attitude and go to the delivery room. She should report to the charge nurse there and discuss her concerns about what she doesn't know about delivery. If the charge nurse is any kind of a charge nurse, she will give this nurse who was floated duties to perform that do not specifically involve actual delivery of an infant. If you've ever been in a delivery or OB area you would know that there are plenty of things that this nurse could be assisting with that do not involve anything to do with actual delivery or assessment of labor, i.e. answering lights, assisting with personal care, starting and maintaining IV's, speaking with visitors, reassuring the patients, transporting patients, etc. If the charge nurse insists on having this nurse perform things that she just doesn't know, then the supervisor should be called immediately and told the situation and asked for help. The alternative to this whole situation is to risk being fired for insubordination by refusing to do what they were asked to do. The fact of the matter is that no matter what area you end up working in, some patient could come through your doors into your unit with a problem that you know absolutely nothing about treating. Then, what are you gonna do?

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thanks you guys, these are really good opinions. It is very helpful to me to see it from both sides. daytonite, I really enjoyed your response because it let me see it from the opposite perspective. Thanks again to all opinions.

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Tasks only. There is a reason L&D is the most litigious area of nursing. If she values her liscence and her patients' lives, then there is no way she should take an assignment. If the hospital would try to give her a patient assignment in that area when she has no training and not even NRP, then she should start looking for a better place to work because that's a hellhole.

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this is straight out of potter and perry....

"Floating is an acceptable legal practice used by hospitals to solve their understaffing problems. Legally, a nurse cannot refuse to float unless a union contract guarantees that nurses can work only in a specified area or the nurse can prove the lack of knowledge for the performance of assigned tasks. When encountering this situation, nurses should set priorities and identify potential areas of harm to the client."

Potter, P. & Perry, A. (2001) Fundamentals of Nursing 5th ed p435 St. Louis:Mosby

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Actually that scenario is pretty rare. More likely, med/surg nurse would get floated to postpartum, (where they could take the most stable load) and PP nurse would go to L&D. As a MS nurse, I'd feel ok with a PP patient load, as long as I had a good nurse on the floor to help me out if I got in a jam. But there is no way I'd go to L&D when the only experience I've got is nursing school from years ago (where basically I was told to stay out of the way and watch!)

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This is just a symptom of the external de-professionalization of nursing. Nurses are not deemed fit to decide whether they are competent enough in a "foreign" area to take an assignment - they are just expected to go and to be "jacks of all trades" or face losing their jobs. No mention is made that they also have licenses to lose. In front of the BON, the nurse would have no legal justification for taking an assignment he/she was not competent to handle. The BON will not care that the nurse was threatened with losing his/her job. They are there to protect the public. NO ONE is focused on protecting the nurse (unless a good union is in place).

"Do the best you can" does not cut it in nursing and TPTB know that. If every nurse was equally qualified to work on every unit, why does each area (including med/surg) offer an extended orientation to nurses with no experience in a given area? Is it not necessary? (OF COURSE IT IS). Why will units not accept an agency nurse that is not experienced in a given area to work a shift in that area? It is also "just for one shift" and that nurse could also "do the best he/she can". When you look at it like that, floating doesn't really make a whole lot of sense, does it?

It is simply cheaper to "borrow" a nurse from another unit (no matter if it puts the nurse's career and the patients' safety in jeopardy) than it is to pay for an experienced agency nurse or to pay overtime for a nurse from that unit. Perhaps a better solution would be to call in the assistant managers, the nurse manager, and on up the chain for that particular area BEFORE anyone (other than a dedicated float pool nurse) is floated. That might be more effective in getting chronic staffing problems addressed (ever notice that some areas ALWAYS need a float nurse?).

DutchgirlRN - it is not just med/surg nurses that get pulled. Specialty unit nurses get pulled all the time.

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I think your thoughts are right on. Another thing is that it is always the med-surg nurse that is pulled? Other departments are not pulled to med surg because they don't have enough med/surg experience, well duh, I don't have L&D, CCU, or SDC experience either, but this doesn't seem to make a difference. Anyone concur?

I've actually had the opposite experience. TPTB in a few hospitals don't consider med-surg a specialty, so anyone can go there. By contrast, med-surg nurses wouldn't be pulled to OB/NICU (because they didn't have NRP or FH monitoring cert.), Peds/PICU (because they didn't have PALS) or ER/ICU (because they didn't have ACLS)... They didn't expect med-surg nurses to be able to function in those areas, but for some reason thought that people like me should keep up our med-surg skills from nursing school. It's completely stupid because med-surg is as specialized as any other area.

I've actually left my PALS cert off my resume for this reason.

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I've actually had the opposite experience. TPTB in a few hospitals don't consider med-surg a specialty, so anyone can go there. By contrast, med-surg nurses wouldn't be pulled to OB/NICU (because they didn't have NRP or FH monitoring cert.), Peds/PICU (because they didn't have PALS) or ER/ICU (because they didn't have ACLS)... They didn't expect med-surg nurses to be able to function in those areas, but for some reason thought that people like me should keep up our med-surg skills from nursing school. It's completely stupid because med-surg is as specialized as any other area.

I've actually left my PALS cert off my resume for this reason.

That has been my experience as well, except I have been pulled to Peds and PICU without PALS and to med/surg and ER without ACLS (it's enough to make your hair stand on end when you realize that if you were a patient in a hospital, the nurse taking care of you may or may not have ever worked in that area before - much less have the necessary skills and certifications). The only place I haven't been pulled (knocking on wood) is LDRP. The med/surg nurses almost never have to float, except to other med/surg units, because med/surg is almost always busy.

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