ER float nurses

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Specializes in Critical Care.

Our facility has decided to create a critical care float pool taking nurses from progressive care/stepdown and sending them to the er.

The way our er works is team nursing where 2 nurses are responsible for 12-14 pts at most. But the float nurses are getting an abbreviated orientation to the er and will be unable to take ICU pts, peds or traumas. I think this is unfair to the float nurses because they aren't adequately trained to take all pts and also to the er team member because they basically get half a nurse. Not only that I think it's unreasonable, undoubtedly the float nurses are bound to run in to icu, peds and traumas on a daily basis. To me, patient safety is also at risk.

I am one of these float pool nurses and am having a lot of stress about not being prepared for the er. We have mentioned that we would like to be fully er trained but so far it is falling on deaf ears.

Thoughts?

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Specializes in Emergency.

Little confused here. How can you be a critical care rn if you can't take icu pts?

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Specializes in Critical Care.

We take some titratable gtts (nitro, dilt, esmolol, a few others), non-invasive vents, bipap, hi flow 02, etc. We are on an in-between unit, pts that aren't so unstable that they need icu but can't be cared for on a med surg unit. I would say the biggest thing we are unfamiliar with is pressors and vent sedation.

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Specializes in ICU.

Interesting...I guess this is their answer to staffing problems? Could you task? 12-14 pts seems like a LOT for 2 nurses in ER. On a side note....what is a noninvasive vent??

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Specializes in Med/Surg,Cardiac.

How is it a critical care float pool if the nurses are progressive care nurses? I'm confused.

~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~

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Specializes in Critical Care.

That's exactly my point about using progressive care nurses and calling them critical care and using them in the ER, about it being unsafe and unfair.

By non-invasive ventilator I mean not intubated but vented through a tracheostomy.

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Specializes in Pediatric/Adolescent, Med-Surg.

As a float pool nurse (soon to be ER nurse), I float to my ER on a regular basis and am generally given a med-surg or step-down assignment. On occasion I have taken a peds pt, but I also have a peds background. They never give me the ICU pts. Just being able to help with my pts is a big help. Occasionally, all my pts will get beds and then I will run around helping other nurses by giving meds, lab draws, etc.

I think as long as you aren't working outside your scope AND you are given some sort of orientation to the ER it might work.

Forgot to add, 12-14 pts between 2 RN's is a lot. I never have more than 4-5, and I only go up to 5 if they are all med-surg no tele

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

I worked in a very busy suburban ED (Average daily census 300-360) and the vast majority of those were your run of the mill type ED patients and admit holds. I would have killed for a float nurse to take those off my hands so I could attend to the patients with actual emergencies. I highly doubt in any situation a float would be given critical patients at all even if they were trained for it. The ED nurses' patient load sounds atrocious and dangerous when you add criticals into the mix. Personally sounds to me like you just don't want to do this (AEB the "unfair" statement) and you're trying to justify your feelings which I totally understand and probably have done at some point in my career. I HATED floating when I worked in the PICU.

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Specializes in Med-Surg, Emergency, CEN.

Sometimes any hands are better than no hands, and if someone gets floated to help me out, I'm more than happy even if they can't take certain patients. Thank you for occasionally floating down! Otherwise, we'd being dying to keep people from dying!

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Specializes in Critical Care.
I worked in a very busy suburban ED (Average daily census 300-360) and the vast majority of those were your run of the mill type ED patients and admit holds. I would have killed for a float nurse to take those off my hands so I could attend to the patients with actual emergencies. I highly doubt in any situation a float would be given critical patients at all even if they were trained for it. The ED nurses' patient load sounds atrocious and dangerous when you add criticals into the mix. Personally sounds to me like you just don't want to do this (AEB the "unfair" statement) and you're trying to justify your feelings which I totally understand and probably have done at some point in my career. I HATED floating when I worked in the PICU.

It's not that I don't want to float to the ER, I had actually applied for a position there but then they implemented a hiring freeze. I would just feel better about it if we were fully trained for it. Also it's not like they are using the float nurses as extra staff, they would be using us on a team. They've already said that they are going to use float nurses before per diems and thus before more experienced ER nurses. My husband has been a nurse in our ER for 5 years and agrees the patient loads are pretty heavy, especially when you throw a critical pt that becomes 1:1 and essentially leaves the other team nurse with up to13 patients. I really do think it is unfair to everyone to throw an inexperienced nurse in the ER without a proper orientation (2 weeks vs 2 months). I'm sure we will catch on, but really...

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.
It's not that I don't want to float to the ER, I had actually applied for a position there but then they implemented a hiring freeze.

I stand corrected. However, what I'm telling you is that the ER staff isn't going to use you for critical patients whether you are trained or not so it doesn't matter. They will rearrange assignments so that the ER staff will take care of the critical/sick peds/trauma patients and you will have the regular patients. If that means an ER staff nurse is taking care of two criticals at one time then that is what they will do, guaranteed. And again, the vast majority of patients in the ER are not critical, sick peds or traumas. They are belly pains, boo-boos, headaches and LOL who"just don't look right" to their family memebers who haven't visited them at the home for a year. I think you are stressing yourself out about a situation that isn't likely to happen. Think about what happens on your floor. Do you give the sickest patient on your floor to a float? Doubtful. :x3:

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Specializes in ER.

My thoughts are that I just left an er with 12-14 patient teams for two nurses. NEVER AGAIN will I work like that. I wouldn't worry about the specifics of training in the er. You don't need to understand triage or urgent care and the purpose of a float is to decompress. Training you takes up valuable education money from the unit.

If you feel uncomfortable, just refuse a particular assignment. In team nursing, the beauty is you have some flexibility as the nurses to make the assignment work. Focus on the admits, the med/surgy types and the stable stuff you feel like you grasp. Don't do the other stuff.

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