Fear of Floating | Life of a Nurse

[JeanstarMSN]

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.

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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

[VivaLasViejas, ASN, RN]

I’m weird, I guess, but I loved being a float nurse. I got to do so many things and learned many skills that I never would have on my home med/surg unit. I worked mother-baby and critical care fairly often, so I developed a fair amount of competency in those fields and was allowed to take patients on my own. It was what got me through my last couple of years as a hospital nurse. 

[thecareerchanger, BSN]

I dreaded floating when I was in the hospital but honestly my assignments were usually better than my home unit and I left on time more often then not. Most staff were appreciative as well. I am now trying to go back to the hospital, hopefully as a float (currently in home care). 

[ajdizzle43, LPN, LVN]

On 9/21/2021 at 3:09 AM, CalicoKitty said:

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. ?

I agree. For me, I enjoyed the instability of floating. Nothing like documenting "per RN supervisor" and gone to the next random floor my next shift. It's lovely. Underpaid, but lovely. Ironically, choosing to float or not float is one of the limited choices that Nurses and CNA can pull weight and say yes or no and have a semi-choice of their working situation.