Does floating kill patients?

[TKHnurse]

Hi all, 
We have a Consultant Chief Nursing Officer at our hospital since July 2020 who made the statement in front of seasoned nurse leaders that “Floating Kills Patients.” She is against the nursing supervisors floating nurses across the hospital units during COVID-19. This is a long-term care hospital with eight patient care units. One dedicated COVID isolation  unit with a census of two patients with an average of three nurses all three shifts.  If the supervisors don’t float nurses, it leaves the units unbalanced where one unit has eight nurses and another unit only with three nurses but with higher acuity. Can anyone share insight on this topic, any evidence out there floating kills patients during this pandemic? 

[Sour Lemon]

12 minutes ago, TKHnurse said:

Hi all, 
We have a Consultant Chief Nursing Officer at our hospital since July 2020 who made the statement in front of seasoned nurse leaders that “Floating Kills Patients.” She is against the nursing supervisors floating nurses across the hospital units during COVID-19. This is a long-term care hospital with eight patient care units. One dedicated COVID isolation  unit with a census of two patients with an average of three nurses all three shifts.  If the supervisors don’t float nurses, it leaves the units unbalanced where one unit has eight nurses and another unit only with three nurses but with higher acuity. Can anyone share insight on this topic, any evidence out there floating kills patients during this pandemic? 

My hospital tries to keep "clean" nurses clean, but it's not always possible due to staffing logistics. Beyond that, we all "float" home to our families who have been floating around, themselves. The only absolute, from what I've observed, is that staff are not floated off covid units mid-shift.

[TKHnurse]

Very true, we all float to our families every day our nursing supervisors float clean to clean, and “dirty to dirty” theses (dirty units) are units in the hospital placed under quarantine any given day for 14 days after a staff member tests positive for COVID-19. However, the CNO still has a problem and wants NO FLOATING. Our COVID unit has dedicated nurses and CNAs that she has directed to only work on this unit. The census on this unit has gone down to one patient, and she kept three nurses. 

[DavidFR, BSN, MSN, RN]

I agree that nurses shouldn't be floated mid shift from dirty to clean, but other than that it's probably wildly impractical in most busy facilities to have entirely clean and dirty teams forever.

Also, while it sounds perfect in theory, in reality some nurses who have been constantly "clean" can be tempted to let their guard down thinking they're safe, when in reality, we're all at risk.

[TKHnurse]

No mid-shift floating is occurring, before this directive, nurses were floated from clean to clean units then go home.  CNO abolished the float pool and assigned agency nurses to specific units to “stop the floating.”  This is impractical dealing with staff call outs and staff testing positive for COVID.  

[MunoRN, RN]

I'd be curious to hear the Consultant's reasoning behind this since it would seem the result would be units that are sometimes understaffed, and there is actual evidence to support the idea that understaffing affects outcomes.

[TKHnurse]

The consultant CNO brought in mid this pandemic, and she has made it clear her focus for our hospital is addressing COVID. She has created an environment where 3-4 units are understaffed on any given day, and the other units are overstaffed since supervisors cannot float to balance the hospital. COVID cases are extremely low in this hospital, and it makes no sense not to float nurses, especially with nurses very good with their PPE and infection control practices. 

[LibraNurse27, BSN, RN]

In this case it seems more like NOT floating kills patients...

[TKHnurse]

Any evidence base floating kills patients? Any recommendations on articles to counter this CNO’s directive and no floating policy? 

[MunoRN, RN]

12 minutes ago, TKHnurse said:

Any evidence base floating kills patients? Any recommendations on articles to counter this CNO’s directive and no floating policy? 

You could reference Aiken's research on staffing levels and outcomes to support the need for appropriate staffing levels which are hard to achieve without some amount of staff redistribution to meet staffing needs (floating).