Float ICU RN to Med-Surg?

nurse2033, MSN, RN · Jul 26, 2011

I don't think their request was unreasonable but you know your abilities better than anyone. They would certainly throw you under the bus if something adverse happened. It sounds like you are a traveller. If they can't float you to meet their needs they have the right to find someone who will. Technically it is not out of your scope to work with lower acuity patients. Sorry but I think you should be more flexible. Being out of your comfort zone is not the same thing as unsafe.

mturner88 · Jul 26, 2011

So you're saying that its safe for the patient to go on a unit with no orientation because the patients are low acuity?

eriksoln, BSN, RN · Jul 26, 2011

Today I was told that i had to float to med-surg from icu. I refused the assignment due to safety reasons. Futhermore, the did not offer any orientation nor did the want to send me to a tele floor. Ive never been a med-surg nurse and feel that its out of my scope to work with 7-9 patients. Now the hospital cancelled my contract and i think this is beyond unfair. Thoughts?

Well. You said "cancelled my contract" which leads me to believe you are a travel nurse. Truth is, as a travel nurse, you have to go "above and beyond" on a daily basis. I could tell you some stories from my days in the business that would make your head spin. It comes with the territory.

Fact: Their attitude is "We want ICU nurses who can float anywhere, and you don't provide that, we'll fill the spot with someone who can." The way the supervisor at the time saw it was probably: "I'd rather keep my staff ICU nurses in the ICU, and let the travel nurse float and have a night of hell. Thats what they are here for anyway."

My hospital, when everyone was going through a period of low census, issued a statement to the Crit. Care nurses stating they would float "everywhere". If you were in the ICU, unlike before, you could now go to fill in at rehab./Med. Surge./Short stay etc ect.. In the past, that was considered a waste of "expertise". But, the admin.'s attitude was "It's how we are doing it. If you're not happy with it, feel free to find an establishment that suits your needs better."

More than a few CC nurses left, pretty much said "The first day this is in effect is my last day of working." They moved on, and the hospital suffered, but not as much as the nurses who moved on would have liked. Sure enough, when CC nurses were floated to less acute units................it didn't work. It didn't work AT ALL. I'll be honest with you, I worked one night when we had an ICU nurse on the unit and..........I would've just preferred to be short. I had to babysit and watch over that nurse all night. She just could not adjust to the different culture. She was used to getting calls back from doctors within 5 min., stat orders were actually treated like they were "stat" by other dept's (stat CT ordered etc), if she was behind and not caught up in the ICU people noticed and avoided giving her an admit.......not so on a M/S unit. These are all things she pointed out, not things I made up or observed myself. It simply did not work. Now, even though the facility retains it's right to float ICU nurses anywhere.......it doesn't happen.

Unfortunately, you are like one of the nurses who left before the policy was initiated. They didn't like it, said so, stood their ground and........well, both sides decided parting ways was the way to go. The ones who stayed and tolerated admin.'s learning curve while they took their time realizing what a mistake they made still have a job and don't have to worry about it so much anymore.

xtxrn, ASN, RN · Jul 26, 2011

Today I was told that i had to float to med-surg from icu. I refused the assignment due to safety reasons. Futhermore, the did not offer any orientation nor did the want to send me to a tele floor. Ive never been a med-surg nurse and feel that its out of my scope to work with 7-9 patients. Now the hospital cancelled my contract and i think this is beyond unfair. Thoughts?

You are an RN??? Then 7-9 patients are within your scope. You just aren't used to it. :)

I worked neuro med-surg and we had Neuro ICU nurses float to the floor (and sit ON the floor between their rooms :)), and I had to float to neuro ICU...how it works. They'd give me appropriate patients (either DNRs w/nothing more I could do TO them-lol, or those transferring to the floor in the morning)

Orientation on a med surg floor for floats- usually consists of report, and a quick rundown of where stuff is- otherwise, it's the same hospital, so the basics are the same (code phone number- if they don't have wall buttons, fire protocol, etc).

Refusing to float is a big no-no when it's between 'like' patients ( ie- OB nurses do not go to CV or trauma, just about nobody goes to OB - but could go to GYN-surg). Sorry .....

delabeaux, MSN · Jul 26, 2011

7-9 pts?????????

Simply unsafe.

It's better for you, find a hospital with safe nurse to patient ratios.

mturner88 · Jul 26, 2011

This is my second travel contract and I've never been told to float to med-surg. Had they offered me an orientation then maybe but my license is more important to me than a temporary contact. I can see how much of a disservice it can be to a med-surg nurse to have an ICU nurse running around like crazy.

eriksoln, BSN, RN · Jul 26, 2011

7-9 pts?????????
Simply unsafe.
It's better for you, find a hospital with safe nurse to patient ratios.

These actually are GOOD night shift M/S numbers. Many facilities will have you take 12. Not a few............many. My facility goes up to 8, with the option of stretching it to 10 in the case of emergencies (happens, eh, about 5 times a month). And we still are better than most facilities in the area.

xtxrn, ASN, RN · Jul 26, 2011

These actually are GOOD night shift M/S numbers. Many facilities will have you take 12. Not a few............many. My facility goes up to 8, with the option of stretching it to 10 in the case of emergencies (happens, eh, about 5 times a month). And we still are better than most facilities in the area.

When I graduated, on a 28 bed acute neuro med-surg floor, there were 2 RNs... period. And no computers-all hand charting, rare access to blood sugar machines, so had to do urine dips (or foley aspirations), not many IV pumps, so had to count drops and keep checking to see that the bag wasn't dry, no aides to help turn, lots of fresh CVAs, laminectomies, cranis the first night out of ICU, etc...and we got it done. Just how it was- sink or swim... we did a lot of swimming :)

xtxrn, ASN, RN · Jul 26, 2011

This is my second travel contract and I've never been told to float to med-surg. Had they offered me an orientation then maybe but my license is more important to me than a temporary contact. I can see how much of a disservice it can be to a med-surg nurse to have an ICU nurse running around like crazy.

Wanting to spare the med-surg nurses is nice, but not a good reason :) You have the knowledge, and the skills. :)

eriksoln, BSN, RN · Jul 26, 2011

This is my second travel contract and I've never been told to float to med-surg. Had they offered me an orientation then maybe but my license is more important to me than a temporary contact. I can see how much of a disservice it can be to a med-surg nurse to have an ICU nurse running around like crazy.

That, in effect, is the decision you have to make. If you feel it is unsafe.............you must make the call and stand your ground. Hospital supervisors and admin. are not going to watch out for your license for you, and if something happens, they have no problem throwing you under the bus for it ("Well, she should have known better than to take the assignment, where is the autonomy in her practice if she accepted the assignment?")

I must add though.........when you get pulled, you don't get oriented. How would you be? They don't know you are going to have to go there till that night, so the only option is to "orient every nurse on every unit just incase". Not going to happen. People barely get oriented to the units they call home much less..............

Its not any different for staff nurses. I get hired on a unit, get oriented to it and work there till my 90 days is up and I can float. When my probation is up and I can float..........when the day comes that I have to.........I go to w/e unit they need me on. I have not been oriented to it. I can only simply go there and make the best of it. Not being oriented to a specific unit is not grounds for refusing to work there.

On the other hand, if you assess dangers in your assignment outside of your scope of practice...........thats a different story. But you didn't even go, so you can't say that. Your only argument is that you are not used to that many patients.

You say: "I am not oriented to that unit and am not equipped to handle a patient load of 9."

They hear: "Thats too much work, I'm not going to do it."

At least, if you don't even go to see what your assignment is like, thats how they take it.

As a travel nurse, I refused to float only one time, and it was the exact opposite of your situation. They wanted me to go to a heavy cardiac unit, and I was strictly M/S at the time. I went, listened to report, and found out I was given many patients on cardiac med. drips, and one was new onset a-fib. I called the supervisor, told her I was not taking the assignment and I could be found on my M/S unit if the problem were fixed and she needed me.

I didn't get fired, not even written up. But that is because I could state what the dangers of the assignment were and why it was beyond my scope of practice.

What on the M/S unit was beyond your scope of practice?

mturner88 · Jul 26, 2011

You are an RN??? Then 7-9 patients are within your scope. You just aren't used to it. :)
I worked neuro med-surg and we had Neuro ICU nurses float to the floor (and sit ON the floor between their rooms :)), and I had to float to neuro ICU...how it works. They'd give me appropriate patients (either DNRs w/nothing more I could do TO them-lol, or those transferring to the floor in the morning)
Orientation on a med surg floor for floats- usually consists of report, and a quick rundown of where stuff is- otherwise, it's the same hospital, so the basics are the same (code phone number- if they don't have wall buttons, fire protocol, etc).
Refusing to float is a big no-no when it's between 'like' patients ( ie- OB nurses do not go to CV or trauma, just about nobody goes to OB - but could go to GYN-surg). Sorry .....

I went with the ANA code of ethics with the right to refuse an unsafe assignment. Out of my comfort zone or not, its not safe. The have their nurses on orientation and should do the same with any outside agency.