ED Float Assignment

Just curious - does your facility consider RNs and Paramedics as interchangeable? In TX, their scope of practice is limited to first response only. In a hospital setting, they are considered Unlicensed Assistive Personnel.

We sometimes use a float in our er. We don't use medics in this role, just rn's. It's kinda like playing middle linebacker. You need to be very flexible and able to adapt to changing pts on the fly.

Our floats cover breaks, pitch in where needed and generally try to assist whoever's cup runneth over. I like floating, it's fast and you're almost always really helping out a colleague. Our manager has a strong sense of when to schedule a floater (or 2). Not everyone gets the assignment. It seems to go to the more adaptable rns, ya know, the "change is good" types.

We often have one float assigned to the entire department. There are no specific competencies required other than it's always an RN so they can assist with meds if necessary. Pretty much the same people get assigned to float. Generally it's the stronger nurses who are good at prioritizing, don't mind juggling 3-4 crises at one time and are good technicians (ie:IV starts). Not a job for a newbie or velcro-butts (you know...butts velcroed to their chairs). I know when I float by the time my shift ends I'm practically stumbling from exhaustion.

Our floats are always RNs (we don't staff medics). It depends on how busy we are as to how many floats we get - but not in a good way, if we are busier we need more nurses to take an assignment and if we are slower we don't have patient's for every bed and therefore we have extra floats. No specific competency or expectation, just that you help where help is needed. It seems that there are certain RNs that are typically assigned to float and some that are never float for a reason (i think we have a few velcro-butts in my ED too). I'm a new RN with almost a year of experience and I'm assigned float frequently and I think it helps me learn a lot - I see more patients, give more meds, start more IVs, see the interesting cases, etc.

Our ER isn't a level 1 trauma, but our float nurse usually works 11am to 7 or 11pm, depending on staffing numbers. This float usually covers for other nurses while they are on break. They also start IVs on patients in the trauma/ER rooms, go with a trauma patient to CT, assist with PRBC transfusions, assist with admit orders if needed (labs, scans, "now" meds, ect.). They do things for newly d/c ed pts, home instructions, f'us, d/c iv lines, ect.

Hope this makes a little sense.

Anne, RNC