Fear of Floating | Life of a Nurse

If the thought of floating to another unit sends you into a cold sweat, take a deep breath and try to re-frame your perspective. Imagine going into work and looking for your assignment. Then the charge nurse tells you that it is your turn to float. She says she is “sorry”, but you know she’s not. As you walk to the requesting unit, your anxiety is going up. You get to the unit and get report. Feeling overwhelmed in this unfamiliar place, you start your shift.

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Fear of Floating | Life of a Nurse

The Joint Commission's position states that the requesting unit that a nurse is to float to must be a similar unit1. That way the nurse can acclimate easier and function in a competent manner. This prioritizes patient safety.

The requesting unit is probably short-staffed which can mean a heavy assignment awaits you. The staff here may not be willing to help you out as much as the people that know you on your home unit. You feel like an outsider especially if the nurses are impersonal because you're not a regular member of their group. Some tips for dealing with these unsettling feelings:

1- Be Professional

You know you are confident in your nursing skills. Be proactive, introduce yourself, and be respectful of the team. Make sure you know who the charge nurse is and use her as a resource.

2- Ask for Help

If there is any task that you are unfamiliar with or are feeling overwhelmed, communicate this to the charge nurse. Maybe the assignment can be changed or the charge nurse can be a resource person and help you with an unfamiliar task. Remember patient safety should always be your priority.

3- Get to Work

Try to be open-minded if you have to learn a new task or a different way to do a skill. Offer to help out with other patients, be flexible. Try to make a good impression by having positive interpersonal and professional skills.

4- Be Reflective

Think about how your shift went and your feelings about the experience. Don't be too hard on yourself. Sometimes floating to another unit means you have to deal with a negative, stressful atmosphere. Maybe you didn't get the support you needed? Maybe you didn't feel accepted in the group. You're unhappy you had to eat alone. If the atmosphere was chaotic or hostile, try not to be too critical of yourself. You know you're a good nurse that cares about her patients. The more experience you get floating, the less intimidating it will be because you will learn to adjust to the group dynamics of the new unit. When you get better at your people skills you've won half the battle.

Emerging Themes

A phenomenological study revealed that six themes surfaced when nurses were interviewed about their feelings about floating2. The six themes were:

  1. Chaotic workflow process
  2. Unfair patient care assignments
  3. Unfamiliar work environment
  4. Psychological components, sociological factors
  5. Physiological needs

Chaotic Workflow Process

Nurses reported a lack of communication between the charge nurse and the floater. There is no orientation to the unit. Some requesting units act like just because it's the same hospital you know where everything is. That's not always the case, different units store their supplies differently and I know from my own experience I have spent countless wasted time just looking for something. If I was unable to find it, I have to wait until someone is not busy to help me. That causes a delay in patients' care which frustrates me to no end!

Unfair Patient Care Assignment

Nurses who participated in this study reported getting the worst patients on the unit that nobody wants to have on their assignment. Either you get the first admission right at the busiest part of your day or you get patients that are very needy, or you get lots of discharges then you have to get lots of admissions since you're the one with the least number of patients at any point. Also, nurses reported patient rooms were on opposite ends of the unit instead of concentrated in one area.

Unfamiliar Work Environment

When working on an unfamiliar unit, your confidence can take a hit. Not knowing certain protocols for post-op patients, for example, can be stressful. Not knowing that these patients need frequent vitals, frequent assessments, and what you need to document for the post-op period is something that needs to be communicated but sometimes is not. Lack of help and lack of teamwork can make a floater feel very lost and displaced. Not only that, but you start to feel like a bad nurse. These feelings make for a very long shift.

Psychological Components

Just finding out that you are floating at the beginning of the shift is very unsettling. It feels like you know you are going to have a bad day. If you could stay on your home unit, you could have a bad day but at least you are with your home team. Going to another unit makes a bad day so much worse. To know you have to float ahead of time could help with the anxiety that takes over when you find out.

Sociological Factors

Staff nurses can be unfriendly and unwelcoming to floating nurses. Some don't even acknowledge your existence. When you have to ask for help, it feels like you are being a burden just to have someone help you find a pillow for a patient. Unit managers need to step up to the plate and encourage a positive team atmosphere.

FACT: Float nurses should be acknowledged and appreciated.

Physiological Needs

Planning meal breaks can be difficult when floating to another unit. The charge nurse should make sure everyone gets a break but it can get busy and hectic. Sometimes meal breaks are delayed or missed. A 30-minute meal break is required by law but actually getting it can be a challenge. The staff nurses on the requesting unit are all going to cover each other for their breaks.

FACT: Floaters need to speak up for themselves but be respectful.

A literature review of this issue was conducted. The theme that emerged was simply that nurses hated to float. What followed was the development of the Float Ally Model 3. This came about because some requesting units did not provide orientation or resources to help the nurses acclimate to the unit and the patient population. With the implementation of this model, float nurses and aides are assigned a staff person to be their "ally" throughout the shift, orienting them and checking with them intermittently. The float staff is also given a packet to let them know if they need to attend rounding with the doctors and how to find supplies. When the shift is over, the float nurse is given a "caregiver celebration", a written thank you for helping the unit in their time of need. The results for the six-week pilot program for this model was an increase of satisfaction rate of 28-41% before the model up to 80-90% after the model. Clearly, it doesn't take much to help a coworker feel appreciated. A little kindness towards each other can go a long way to make the floating experience more positive.

It is suggested to be a mentor4, especially if the floater is a fairly new nurse and maybe is floating for the first time. Help that nurse to grow in their skills and cultivate their critical thinking. Be a leader, share your knowledge, help them to learn from your mistakes.

References

1Addressing floating and patient safety

2Exploring Nurses' Feelings on Floating: A Phenomenological Study

3Nurses Create a Model to Enhance the Float Experience: Allies Support Unit-to-unit Float Nurses

4The Mentoring Relationship: Advantages for Both

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JeanstarMSN

About JeanstarMSN

JeanstarMSN has 21 years experience in Med/Surg nursing. I teach nursing part-time.

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Specializes in Med-Surg, Geriatrics, Wound Care.

I think I worked on a hard unit. It got to the point I really enjoyed floating. I'd get a different patient population (my unit was pretty specific), see things I wasn't used to and overall helped me become a better nurse. I mostly disliked floating if it would be for only part of a shift (like 8 hours) then I would have to come back and do documentation on another group of patients in 4 hours, and lunch breaks were usually lost. And, yeah, sometimes I would get the "worst" of the patients, but my unit was pretty heavy, so it was usually not terrible. But, probably why I was excited to join the float pool later. ?

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

Maybe I need to eat a Snickers, or get some more sleep, but there was a couple things that just hit me wrong about this post.

First, I don't know whether the OP even wrote the introduction but "Then the charge nurse tells you that it is your turn to float. She says she is “sorry”, but you know she’s not" hit me as part of what's wrong with nursing these days. I'm charge 90% of the shifts that I work. If I have to tell a co-worker they are being floated, or mandated, I'm completely sincere in saying "I'm sorry", but what else can I do? I've volunteered to be both floated and mandated for other nurses numerous time, but that can't always be done. Why assume poor intent, or lack of sincerity, in actions and words of coworkers.

As far as the article itself, I appreciate that the attitude is intended to make a positive experience out of what may be uncomfortable for some. However, what about trying to influence the culture of the nurses on the unit getting a float nurse? When nurses see a float is going to be assigned a difficult patient or the first admission, do they ever think "I'm grateful someone is coming to help, I'll step up and take that patient or that admission?" Not generally, the nurses in my hospital think "great, a night off for me since there's a float. They can have the difficult patient, or they can have the admission." It's that culture of because it's happened to me, it should happen to them. It's so prevalent in hospitals these days, mostly because I think that everyone is feeling over-worked, understaffed, underappreciated, nurses are not looking out for their coworkers as they should. 

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

Thanks for the article!  It certainly accurately describes the reasons I always felt resistant to floating.  I think certain personalities adapt far better to floating than others, just as certain people thrive in highly intense vs slower-paced specialties, etc.  I totally agree with JBMom on this:

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However, what about trying to influence the culture of the nurses on the unit getting a float nurse? 

I'd experienced particular units where the staff was not merely "impersonal", but openly hostile.  There was one nurse manager who literally glared at the float nurses sent to help her.

Why should it be remotely acceptable to nursing leadership in that facility that the worst patients are dumped on the least experienced nurse in that specialty?  Especially if you factor in an unfamiliar increase in acuity.

I respect the fact that you did a literature review and described some ideas for improvement based on the behavior of the nurses on the short-staffed unit, including the "Float Ally Model".

My opinion below refers to that, and not your very thorough article, Jeanstar.

Maybe other nurses disagree, but if there is enough staff to allow for this....

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float nurses and aides are assigned a staff person to be their “ally” throughout the shift, orienting them and checking with them intermittently

....It is not a typical short-staffed unit who's charge nurses aren't sure until the last minute how many nurses they will have, who they will be and when they'll be there.  Common decency would suggest you don't need a slew of studies to tell you not to be mean to the new person who likely had no choice but to work on your unit.

This is certainly a nice idea....

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When the shift is over, the float nurse is given a “caregiver celebration”, a written thank you for helping the unit in their time of need. 

Most of us would be happy with a sincere thank you.  I know I would be.  I would imagine the last thing a bunch of frazzled, tired people want to do at the end of a shift is host a celebration.  I wouldn't wish that on the nastiest nurse manager.

I believe unit culture arises from intuitively decent human behavior, and must start "local". If you don't have that, "models" are in reality meaningless.

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Specializes in MedSurg.

Thank you!

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Specializes in Cardiology.

All I see is an article saying what hospitals should do and we all know they do the opposite. I will say though that when I did float I had no problem opening my mouth if I felt I was getting the raw end of the deal. 

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Specializes in SCRN.
On 9/20/2021 at 12:30 PM, JeanstarMSN said:

The staff here may not be willing to help you out as much as the people that know you on your home unit.

The core reason of floating anxiety.

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Specializes in Med/Surg, LTACH, LTC, Home Health.

The way I adapted to floating was to take the ‘if you can’t beat ‘em, join ‘em..’ approach. I became a float nurse. I got so sick of being pulled every single time someone called out. This was unfair and I was so angry that I left that unit to become a float nurse. That way, I would not have to pretend to enjoy working with co-workers who would throw me to the wolves whenever the opportunity presented itself. So, I ran with the pack for the next 14 years...making my own schedule and smiling on my way to the bank.?

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Specializes in MedSurg.

Wow! 14 years! Good for you! Thanks so much for your comment!

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Specializes in PeriOp, ICU, PICU, NICU.

I too joined the float pool.  I floated between adults and kiddos in all 3 campuses.  I made it the best I could and learned so much that it molded me in the nurse I am today.  I am the one who usually volunteers to float these days.  I am very assertive and verbal so I have never had any issues.  I do my work and don't try to fit in.  I ask questions and keep it moving.  After doing that for years, nothing intimidates me.  

Thank you for the article.

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Specializes in MedSurg.

? go girl!!

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Specializes in Community Health, Med/Surg, ICU Stepdown.

I wonder what causes people to treat float staff poorly. I don't see the incentive. Shouldn't we be happy to have more staff? I don't get it. Then no one will want to work on your unit and you'll be short staffed.  When I worked step-down we floated to med/surg, and they were always thankful and helpful. 

I hated when Med/Surg was full and they made Postpartum half Med/Surg overflow. The postpartum nurses treated us like trash. They made it CLEAR they did not want us and our dirty Med/Surg pts on their unit (even though no contact precautions pts allowed). They refused to co-sign insulin. They wouldn't let us push a bed by their nurses station, forcing us to go a different route about 3 times as long. I wonder if they were really worried about contamination or just liked to torture us!

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