Closed Units

[rnkitka]

I was wondering if anyone out there currently manages a closed unit (no floating in or out of unit)? If so can I get pros and cons, and how it was proposed to upper management. Currently working in a Universal Bed Model Cardio-Thoracic Unit. We recover our open-heart patients and keep them untill they are discharged so our ratio's can range from 1:1 to 1:4 at times. We currently have a difficult time staffing due to our nurses being pulled to other units.

Any info would be helpfull...............Thanks

[Double-Helix, BSN, RN]

I find it very strange that your staff would float if the unit needed nurses. Our PICU nurses float, but only if we are overstaffed. We definitely don't float anyone if we are busy. We also receive nurses from other peds units when they are understaffed. Those floaters are life savers when our census is high.

Having a closed unit sounds good in theory, but I think it would create some problems. What do you do if you are understaffed and no off-duty staff can come in? You cant take any outside help. What if you are overstaffed? Nurses will have to go home and take time unpaid or use vacation time because no hospital will pay for staff who don't have an adequate assignment. If your unit is open, those nurses can float and still earn money.

I think your bigger problem is that nurses are being floated when you need them at their home unit. Who is in charge of staffing and assigning floaters? Perhaps you should speak to your manager about why staff are being floated when the unit needs them. Look into the policy regarding floating. Explain the problems you have been having and that staff should not float if they are needed on your unit. See what she has to say and why solutions you can come up with.

[honeykrown, MSN, NP]

I work on a closed unit (as in no floating). Its med/surg with peds. So far we are staffed full but then when we are short we cant pull from ICU even when they have no pt and two staff. Apart from that the unit gets by whenever we are short. The charge usually takes pt's although its not fun

[aCRNAhopeful]

I work on a closed unit CVICU that also has the universal bed system for open hearts. Staff are required to take one on-call day per week on 3/4 weeks in a month. We rarely get called in but that's how we keep the unit staffed in case of call ins or extra high acuity on the unit

[NicuGal, MSN, RN]

We were closed for a time, but went back to floating when we had trouble covering shifts. We were required to take on call, which stunk, but when we got hit hard we had a hard time getting people to come in or stay over to cover. Sometimes floats can save your butt. But, we use an acuity system that allows us to say, ok, we need 19 nurses because my census is this and I have these types of patients, then we can get floats, if available, or extra PRN staff to help cover. Closed is great if you know you can always staff yourself.

[tntrn, ASN, RN]

If you are a specialized unit, such as Labor and Deliver/PP, you can use floats. When med/surg people float to our unit, they are assigned the female surgical patients or the c/section moms. But they never are responsible for the babies.

When we have to float to Med-surg, we are totally fish outta water. It's unsafe; no other way to describe it.