Float ICU RN to Med-Surg?

crb613, BSN, RN · Jul 26, 2011

Sorry you had bad day. I am not a travler so I known nothing about how your agreement works. My only thought is that as an ICU nurse you should not have a problem with MS pts. You would certainly have to adjust to having more pts, but I don't see how that would be unsafe.....unless the pt load was ridiculous. You know your limitations, and it is your license.

Mrs. SnowStormRN, RN · Jul 26, 2011

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.

Not trying to be mean, but you asked for thoughts - did you mean validation? I have no experience in travel nursing, but I have been floated to a different floor before. When I had questions I asked, I practiced within my scope and if I did not feel comfortable with a task I let someone know. I know agency nurses cannot get oriented to every facility/floor, I imagine travel nursing is similar/ the same thing. I worked MedSurg evening shift and we sometimes had 6-8 patients, the acuity is less than that of an ICU patient. We also did not have techs on this floor, so it was a lot of work. The acuity level wouldn't be considered difficult for an ICU nurse, IMO. But you did what you thought was right, you cannot change that now. What is done is done. I wish you much luck in the future.

eriksoln, BSN, RN · Jul 26, 2011

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.

It wasn't an unsafe assignment though.........it just wansn't comfortable for you. There is an ocean of difference between "unsafe" and "comfort". Your complaints fell into the "I am not comfortable" zone, not the unsafe zone. What were they asking you to do that you were not qualified to do? A cardiac gtt. that you are not qualified for? Any equipment that required certification that you had to use? What?

Your complaint was that it was too many patients. To juggle more patients requires time management and hustle, things you should have already mastered as a travel RN. You can not in one sentence say you are qualified to be an ICU nurse and in the same sentence pronounce you can not do M/S nursing. Thats the way RL nursing is.

It's the "ivory tower" thought process at work. Not saying its right, but it exists and you will have to have encounters with it as a CC nurse. It is assumed that, since you can handle "X" acuity level patients in the ICU, you can also handle the lower acuity patients on a M/S unit. That is how the decision makers think.

This is not accurate, as my OP pointed out, but it's how the people signing the checks see it hence, right or wrong, you'll be dealing with it your entire career. Giving "that's too many patients" as a reason to refuse an assignment will get you fired every time. And no state BON is going to accept that or back you up. That's one of the fallouts of CC nursing.

littleneoRN · Jul 26, 2011

In my hospital, travellers ( who are rarely used anyway) are the first to be floated if an appropriate assignment is available. Any of those m/s patients could have been stuck in ICU waiting for a bed? Would you have refused them as part of an assignment there? If not, then it purely has to do with number of patients and your preferences, which doesn't make it out of your scope. I only get orientation if I float to a unit with a different population entirely...eg if I floated to adults. I didn't get any orientation before floating to our equivalent of a m/s floor. Sorry thatyou didn't appreciate this, but I'd expect that if you continue travelling, you'll find other places. with. similar expectations. Good luck to you.

roser13, ASN, RN · Jul 26, 2011

Seems that I"m in the minority here, but I think an ICU nurse who is accustomed to total care for 1-2 critical patients could seriously be jeopardizing her license by trying to take on a 7-9 patient load on med/surg. With no orientation, yet.

The thought process always seems to be that if you can handle Critical Care, you can handle anything (or so some ICU nurses have told me :)). But time management skills for 9 patients? The ability to balance the priorities of 7-9 "lesser acuity" patients (when lesser acuity still may mean hanging blood, assessing new post-ops, certain types of telemetry issues, near-constant pain management, timed lab draws, etc., etc., to say nothing of dealing with the families) is nothing to to be cavalier about.

I'm with you, OP. I think you did the right thing.

delabeaux, MSN · 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.

I'll stick with the local magnet hospital. Never... ever... EVER.. more than 4 patients per nurse during the day. 5 at night. I do clinicals at a facility that has 5-6 starting during the day. And what do I see??? Rapid assessment, med pass repeat X 5-6, and guess what? Its time to start over. Do that 3 times in a shift and you're done. It kind of invalidates 3 years of nursing school if you're medication monkeys and can't really provide any actual nursing care...

wooh, BSN, RN · Jul 27, 2011

And people say med/surg is not a specialty...

It's a different world. You can't know EVERYTHING but all of your patients. You can't control everything. You can't assess everything and reassess everything.

M/S is all about focusing on their principal problem while keeping all the other stuff under enough control to not make the principal problem worse. It's all about prioritizing and doing the best you can with too much to be done. And I've seen lots of ICU nurses that can't do that. Give them time to work up to it, and they'd do great. Just like if you give a M/S nurse time to orient to an ICU, they'll do great there.

Saying an ICU nurse should be able to handle a M/S load just goes right along with managements that think a nurse is a nurse is a nurse.

eriksoln, BSN, RN · Jul 27, 2011

And people say med/surg is not a specialty...
It's a different world. You can't know EVERYTHING but all of your patients. You can't control everything. You can't assess everything and reassess everything.
M/S is all about focusing on their principal problem while keeping all the other stuff under enough control to not make the principal problem worse. It's all about prioritizing and doing the best you can with too much to be done. And I've seen lots of ICU nurses that can't do that. Give them time to work up to it, and they'd do great. Just like if you give a M/S nurse time to orient to an ICU, they'll do great there.
Saying an ICU nurse should be able to handle a M/S load just goes right along with managements that think a nurse is a nurse is a nurse.

I remember one of my clinical instructors talking about how the old idea of nurses who could go anywhere and do everything is slipping away. More acute patients, more technical equipment, deeper/more complex rules and policies, more complex treatment plans............all make every nursing field it's own specialty.

Problem is, despite the increasing challenges that face nursing, decision makers are more interested in reducing staffing than they are in meeting said challenges. Unless a certain quality parameter is mandated of them, they won't meet it.

Nursing has become specialized enough that yes, if you expect your staff to float here and there, you should have training in place that makes said floating safe for the patients. If you expect M/S nurses to go to tele floors, give them the low level tele. classes so they are not completely clueless. Want your ICU nurses not to be scared out of their wits of less acute unit ratios........maybe don't have pt. ratios that stretch even your most experienced M/S nurses to the brink.

But, this costs money. And, it's easier/less hassle to just let the staffing be unsafe and point the finger at the nurses when the system fails. Why bother with all that.........I mean, we are here for billing insurances, not for good health..................

I feel for the OP. I can't say for sure what I would have done in her shoes because I'm on the other end of the spectrum. I can say certain things are out of my scope of practice if they take me from M/S to ICU. If I were in her shoes, I probably would have gone, done the best I could, and if anyone complained followed with a simple explanation that "I've never done M/S nursing, I'm not going to be able to perform the role like a well oriented/experienced nurse. I'm willing to help and do my best, but my work isn't going to be top notch. This isn't my specialty."

My guess is, they would have given her a lot of dirty looks and clicked their teeth at her, but not fired her.

nerdtonurse?, BSN, RN · Jul 27, 2011

I wonder if the OP went from nursing school straight into ICU? I'm lucky, in that I started on a telemetry floor and ran nights with 8, sometimes 12 telemetry patients, so I know how to run a crowd. It stinks, it's not safe, but I know how to make it work. When the nurses that were hired straight out of nursing school to ICU get tossed upstairs with a boat load of patients, sometimes there's problems.

When I float, I tell them what I'm not good with -- orthos, babies, children. If they've got someone who's been with us but is now better, that's a good fit, as is someone who's cardiac or neuro intensive. If they decide to give the the crap assignment -- all the golytely preps, all the dementia screaming/clawing out of bed/waiting on a psych admit folks -- then I call the docs and get the meds the patients should have gotten on first shift so they and their poor roommates can rest. And I make sure I remember who did that little assignment selection for me so that when we need help, I can return the favor. I'm not talking about nights when everyone's bad, I'm talking nights when they're all chatting at the nurse's station and I don't even get to eat.

I check their code carts first. They don't use them very often, and honey, it shows...

I draw the line at being told I'm charge -- not having worked on that floor, I don't know the M/S specifics. When that was brought up once, I was like, "Are you crazy?"

eriksoln, BSN, RN · Jul 27, 2011

I wonder if the OP went from nursing school straight into ICU? I'm lucky, in that I started on a telemetry floor and ran nights with 8, sometimes 12 telemetry patients, so I know how to run a crowd. It stinks, it's not safe, but I know how to make it work. When the nurses that were hired straight out of nursing school to ICU get tossed upstairs with a boat load of patients, sometimes there's problems.
When I float, I tell them what I'm not good with -- orthos, babies, children. If they've got someone who's been with us but is now better, that's a good fit, as is someone who's cardiac or neuro intensive. If they decide to give the the crap assignment -- all the golytely preps, all the dementia screaming/clawing out of bed/waiting on a psych admit folks -- then I call the docs and get the meds the patients should have gotten on first shift so they and their poor roommates can rest. And I make sure I remember who did that little assignment selection for me so that when we need help, I can return the favor. I'm not talking about nights when everyone's bad, I'm talking nights when they're all chatting at the nurse's station and I don't even get to eat.
I check their code carts first. They don't use them very often, and honey, it shows...
I draw the line at being told I'm charge -- not having worked on that floor, I don't know the M/S specifics. When that was brought up once, I was like, "Are you crazy?"

Funny. A friend of mine went from school to ICU, sited patient ratio and "more respect from management" for it. He lasted about 7 months and is out of nursing now. Last I hear, he became a counselor at a youth group home.

The thing about crash carts on M/S units..................hilarious, but sad too.

RN1555 · Jul 27, 2011

Sorry, I think it was fair of the hospital to cancel your contract, and I don't think it was unsafe and really don't think it's out of scope of practice. Yes, I agree that it's a different skill set on med-surge-- it's called time management, organization, and prioritizing. And I'm 100% certain that those skills were taught in nursing school, tested on the NCLEX, and understood by the BON that you had acquired those skills when they gave you your license. This was a standard nursing assignment and you are a nurse. You should have been able to handle it. I know it sounds harsh, but that is my honest opinion.

Flo., BSN, RN · Jul 27, 2011

As an ICU nurse I think you should be able to handle any pt a M/S floor throws at you. After all in the unit don't you see everything? I get that the ratios are not what you are used to but these pts are not as sick. I think you could have tried. The thing with floating is ask lots of questions and admit what you don't know.