Do you see a problem with this?

rn/writer, RN · Mar 22, 2006

Yes, it appears that you ran into some double standards. But, as you said, that's life. At least you managed what came your way and came out none the worse for wear.

EDs do seem to function in a parallel universe compared to the rest of the hospital. They're the bridge between the hospital floors and the streets and they incorporate elements of each into their system. Nurses usually have more autonomy than other units (except critical care), there is a more casual, flexible, sometimes even cavalier attitude toward general protocols (although rarely toward patient care itself or ED protocols). Reminds me of the differences between a MASH unit and a regular army unit.

As for a nurse not floating to ED because she can barely make it on the floor--I guess that's reality for you. No, it isn't technically fair, and if there are remedial actions this nurse could be expected to take, she should be asked to do so. But we both know that there are people who can function at a certain level and that's all the higher they're going, no matter what they might be threatened with. There are others who need a vigorous boot in the bootie to get themselves up to speed, but if this nurse didn't fall into that category, they're probably cutting her some slack because she IS useful in other situations. If she's facing limitations due to age/physical stressors, I'd encourage you to try to keep a good attitude and hope that what goes around comes around if you ever find yourself in that situation.

All in all, it sounds like you went in with a decent attitude despite your legitimate questions, and you fielded whatever got sent your way with grace and creativity. Well done.

sharann, BSN, RN · Mar 23, 2006

I DO see a problem with a nurse who doesn't even know how to get to the ED being floated to a unit in which they have not been oriented. If you have been oriented thats a different story. Even an experienced ED RN should be given some form of orientation before being floated or as a new hire. How can you function independently without the orientation? I don't get it. You didn't even know where supplies were for goshsakes!

I may be alone in this but I think you would have the right to refuse to go somewhere(unless its a major dire emergent situation like a flood or fire), ANYWHERE in the hospital without the proper training. Would they send you to ICU or LandD? Your hospital might. Just wait until someone gets injured or dies and you are giving a deposition in court. I'm sure management will say they are behind you 100%

neneRN, BSN, RN · Mar 23, 2006

Just trying to clarify, were you sent down to ER to take care of the pts already admitted/ waiting for beds or did you have to take care of ER pts?

I can imagine floating outside your home unit isn't something anyone looks forward to (I work ER and we never leave the unit). But, I gotta say, if you were floating down to take care of the admitted pts/floor orders, the ER nurses are probably overjoyed to see you! Our hospital has never sent a nurse down to do this, but I would love it if they did. Med/surg and ER are completely different types of nursing and its always a pain for us to try to juggle all those pages of floor orders along with doing our regular ER stuff.

If you were having to take care of ER pts though, that's completely different, and I would refuse unless I got orientation.

TazziRN, RN · Mar 23, 2006

As an ER nurse, BLESS YOU!!! My ER is small enough that it's rare that we have to hold an admit for that long, but when we do and the floor nurse comes to assume care, we bend over backwards to make sure he/she has everything needed to care for the admit so we're free to care for the rest of the ER.

sharann, BSN, RN · Mar 23, 2006

If the patients are going to the med surg floor and you are monitoring them I take back my answer. But if you are technically in the ER with ICU patients and such it is a different thing. I am all for teamwork and helping other departments. My answer is still the same for floating to any dept though. One must be oriented at least for one shift(without a caseload)

weetziebat · Mar 23, 2006

Yeah, I sure see a problem with it. When I worked ER we never floated anywhere else, but the floor nurses floated to ER. Often without any orientation. Aside from being so totally dangerous for them it was more trouble than it was worth for us, cause they didn't have a clue - no idea where anything was kept, no idea of the paperwork, or our policies - so we spent more time helping them figure things out than if we'd done it ourselves.

We nurses must be pretty dang good that patients aren't dying off like flies when we're being sent to units without orientation, no other nurses, and still expected to function like regular staff. If/when a patient does die, can just picture management denying they had any responsibility for it.

Do nurses have the right to refuse to float without orientation? I don't know but would like to find out. Hmmm.......Seems like a given, but what makes sense often has nothing to do with reality in our jobs.

gr8rnpjt, RN · Mar 23, 2006

I would take the compliment and be agreeable to floating any time needed because you are someone that can "handle it". Not sure why floating has always been considered a major problem. Anyway, they seem to have a lot of confidence in you so it is something I would consider a compliment.

Antikigirl, ASN, RN · Mar 23, 2006

The facility were I am currently working (I am agency) also floats nurses all over at a moments notice, but they are allowed to decline if they feel they have not gotten orientation or have never worked in that department before. You just have to explain your valid reason why not...and they do their best to accommodate.

Like me for instance, yes I have worked ED (obviously by my nic)...but our ED is chaotic and well...mismanaged, so I totally utterly choose NOT to work there (if I wanted to I would have applied or signed up for that float option). Maybe in a few months (I have only worked at this hospital three months and just getting things down)...but for now..no! I also do not do telemetry since I have not taken their course in it (awaiting approval...I work exclusively in their hospital, so they are debating if it would be worth their dime to teach me telemetry...I think it is!).

I guess the nurses in my facility and myself are rather lucky. If you have a valid reason not to work on a floor, they do their best to accommadate because they know if you are uncomforable then things may not get done properly.

I guess talking to the DON and asking (when you are off duty) if there is some way of avoiding working in areas you are uncomfortable with, or getting orientation to floors that will be a potential float area would be a good idea. I know I would certainly like some orientation first...especially ED! I don't think that is too much to ask, and if you go about it in a positive light...asking for orientation...they may just appreciate your proactiveness!

Good luck!

bethin · Mar 23, 2006

I see a problem. Last weekend at work a nurse was told to float to a floor where she had never been. Didn't even know how to get there. Didn't know patients (it's a LTC facility attached to our hospital). I think this can be dangerous. She refused to go. She went but another nurse that knows the floor went with her to orient her. She said that it was dangerous and that her license could be on the line.

If there was a code and someone asked you to get something out of the supply closet, could you do it fast enough?

If you float then EVERYONE should float. If management wants nurses to know the ED, then why don't they orient you one or two days before shoving you into an unknown environment?

DallasRN · Mar 23, 2006

Thanks for all the replies.

To clarify, I was sent to the ER to take care of patients that had been admitted and were awaiting bed availability on the med/surg floors. These patients were being held in a special "holding" area of the ER. Unfortunately, beds did not become available for all patients until the very end of the shift. I was NOT expected to care for regular ER patients.

I generally float among all the med/surg units and actually, rather enjoy floating. Keeps down the boredom factor. For about 15 years or so, I worked ICU/ER (in different hospitals), so even floating to those departments wouldn't bother me but I would expect at least a brief orientation prior to staffing those areas. Even tho' the "holding" patients were med/surg patients, I would have appreciated an orientation to the ER in terms of supplies, etc. I spent much unnecessary time searching for IV fluids, IV start supplies, blankets, and even the infernal fax machine to fax pharmacy orders!! LOL (They have a big fax/copy machine that I didn't know served 2 purposes. On the floor, ours is little.)

All that said, my main issues with the entire situation was the "policy" that requires "everyone" to float. It isn't enforced for everyone. As I was told, another nurse on the floor isn't subjected to floating as she can "barely handle the floor." So in other words, the "policy" is selectively enforced. That sort of stuff doesn't set well with me, although as rn/writer pointed out, it is a reality of life. But darn it! Don't tell me it's a "policy" that "ALL nurses have to float!" That is obviously not a true statement. I think I would have felt better if the supervisor had simply said to me, "Dallas, you are the only one on the shift that I would feel comfortable sending to ER holding. I would appreciate it if you would go, even though it isn't your turn to float." (Note: I had floated to another floor Sunday, was off Monday, and floated again on Tuesday.)

My second issue was simply the lunch break thing. First, it's a big no-no to eat/drink at the nursing desk. Infection control, risk of spillage, the appearance, etc. I understand that. What gave me a problem was simply being told it was OK to eat at the desk because "things are different down there." I honestly felt that someone - even the supervisor - should have come down to relieve me for a short lunch break. I didn't WANT to eat at the grungy desk for all the reasons we're not allowed to...infection control, having my mouth full of food when the phone rang or someone walked up, people breathing over my food. Plus...after 7 hours, I simply needed a break away from all the chaos, as we all do. It was even more important to me after working with the added stress of an unknown environment.

So all in all, my issue had little to do with actually being floated and more to do with the double standard in terms of policy and lunch. I'll rarely object to floating, although they had better not ever try to float me anywhere where there is even a slight hint of a baby being born!! Or patients under 5 feet tall. :eek:

grinnurse, RN · Mar 23, 2006

Yes, I see a problem with it. I have been done this way several times to our SNU unit and although it is not as intense as ED it is still different from my MS floor. I am looking forward to my magical 1 year as a new nurse ending so I can orient and float to other units. I don't like being sent over to the SNU unit b/c to this day, I have worked over approx 5 times out of 9 months or approximately every 2 months and I absolutely feel like a burden to the nurses over there, it takes me 3 times as long to pull meds (we have to pull them ourselves-not put in pt drawers), supplies, and this past time I was there I had had a patient for 1.5 hours and was expected to go into a "team" meeting and state what I thought the patient would need at D/C........huh? I was so embarassed and everyone was laughing (granted I know these people from previously working with them on Rehab in the tech position) even my new DON!! I don't enjoy feeling like an idiot!!

And I do have an EXTREME problem with people getting out of being floated. I think what's fair is fair and the "nurse can barely handle the floor" she needs some reorientation or something. Or here is a good one, if you don't like going to a particular area or have problems with another staff member in that department you don't have to go. Whaz up with that? Yeah, I guess I will say I have a problem with someone over on SNU and see if I don't get to go next time..............LOL