Float ICU RN to Med-Surg?

wooh, 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.

The problem isn't handing "any" patient that the floor throws at you, it's handling ALL the patients that the floor throws at you. And as great as ICU nurses are at ICU nursing, most of the ones I've seen float to the floor and give it a try end up failing miserably at prioritizing the needs of 5+ patients. They get too caught up in little details that there is simply not time to address when you have a bunch of other patients. You do a full ICU type assessment on floor patient #1, #2 and #3, you could have floor patient #5 lying dead in the bed before you even get to #4.

AntFlip7395 · Jul 27, 2011

Unfortunately, as a traveller you are going to have to float to areas that may be outside your "comfort region". While that may not seem fair, that is the price to be paid for having flexibility and most likely, considerably more money than a regular staff nurse.

However, I disagree that an ICU nurse should be able to handle anything that is thrown their way. Exchanging ratio for acuity is not an "even Steven" undertaking. It is highly dependent upon each circumstance. Before going to the ICU, I worked med-surg cardiac tele and at night the average was 7:1. IF you were organized and efficient, and nothing major happened, you would survive. That was with doing bare minimum assessments on people and aides to help out. ICU is a completely different culture. Assessments are more frequent and more complex. I worked on the tele unit for seven years and I know that going back to that environment would be difficult because I am no longer accustomed to it. No matter how sick the patient or how hard I have to work, ICU is for me because I can focus on giving excellent care to all my patients (ratio 2:1) versus having to rush around just to get tasks done on 7 patients and feel guilty because some got more attention than others. Besides, how many times in med-surg have we all basically ignored the majority of our patients while one got all the attention because they were either too sick to be on that unit and the physician wouldn't transfer them to ICU or because the patient/family were a PR problem?

Nccity2002, MSN, RN · Jul 27, 2011

Sorry about your experience... but the reality is that, as a critical care traveler; the expectations are for you to be flexibe and capable to float to any lower acuity floor. I was a traveler for five years, and it is very common for the traveler to be the 1st to float. As an agency nurse, you are expected to hit the floor running and as an ICU nurse, you are expected to be able to handle lower acuity patients. As a traveler, make sure to read the fine print regarding the floating requirements of an assignment....and if the hospital really needs you and is willing, stipulate your unwilliness to fload to the floor before accepting a traveling contract ( warning: good luck finding an assignment with that kind of stipulation).

Nurse1966 · Jul 27, 2011

The problem isn't handing "any" patient that the floor throws at you, it's handling ALL the patients that the floor throws at you. And as great as ICU nurses are at ICU nursing, most of the ones I've seen float to the floor and give it a try end up failing miserably at prioritizing the needs of 5+ patients. They get too caught up in little details that there is simply not time to address when you have a bunch of other patients. You do a full ICU type assessment on floor patient #1, #2 and #3, you could have floor patient #5 lying dead in the bed before you even get to #4.

This is so true. I started on M/S, went to Tele and am in ICU right now, but my M/S years were a long time ago! Yes, I can go to a M/S floor and work, but it ain't gonna be pretty! M/S nurses are a "specialty" just like any other...I don't know the first thing about setting up Buck's Traction, starting a bladder irrigation, or good Lord, fundus checks! I'd figure it out, but just because I can manage a patient with vasopressors, insulin drips and a vent doesn't mean I can hit the M/S floor running and not trip over my own two feet. And I'm tele-dependent...yes, I'm addicted to seeing that my patient's have a rhythm! Unless they're in PEA, I can sit and chart and look up and see the beat...when I have unmonitored patients, I'm constantly checking on them, like an anxious new momma! God Bless the M/S nurses because they work hard and with more patients!

Should the OP have floated? I don't know...but the idea that a nurse is a nurse and we're all interchangeable, is ridiculous!

nyrn5125 · Jul 27, 2011

in my hospital critical care nurses can only float to stepdown but never med surg. they cannot take more than 4 stepdown patients.

stepdown nurses can float to any dept as long as it is telmetry(ratio1:8)/stepdown(3-4 pt) whether they are in icu/er/pacu we have to go and will never refuse. This means that we go from 3-4 patients to being floated monthly to have 8 pt's, very frustrating, but we can't refuse. The cc rn that float to us to take stepdown pt get overwhelmed and are the neediest ones. they are used to a certain way of care and they have everything in front of them including md/pa at their service. So is it safe to float them to have 8 pt's when they have trouble with 3. no. to me it would mean that the rn on the floor would have to constantly be helping and they have 8 pt too.

Dazglue, ADN, BSN, MSN, RN · Jul 27, 2011

Sorry you had such a bad day. But I wish all I was responsible for was 7-9 pt's!!!! Lol.

CharmedJ7 · Jul 27, 2011

My first thought when I saw this was that I would love it if in ICU nurse floated down to my unit. But I guess we are more step-down than med-surg, and we get a lot of borderline-ICU patients as it is, and we take into account where a nurse is floated from when making the assignment for them. My hospital doesn't really have official "stepdown" units, it's all just med-surg but surgical floors tend to be 4:1 and medical floors 5-6:1 from what I can tell. I feel like an ICU could handle 4-5 somewhat less acute patients, but NO ONE should ever have 7+, I don't care how walky-talky they are, the idea that nothing goes wrong at right and everyone just sleeps is ludicrous.

There is so much specific technology and devices these days that it is flat-out unsafe to put a nurse too far out of her 'comfort zone.' Docs complain all the time about nurses not knowing what to do with CBI, PEGs, J-tubes, chest tubes, mediports, vents, etc etc etc but honestly the only way to know these things is to have familiarity and experience with them.

Anyway. Floating is a funny thing. I got floated to a medical unit once and found the conditions on the floor to be super unsafe and unimpressive and rapid responsed one of the patients they gave me @ midnight (who had clearly been going bad since the early afternoon) within 2 hours. In that case I was sort of glad they floated me to a "less acute" unit because I was able to recognize the person was really sick and get them out of there. I think there is a place for an ICU nurse float on med-surg, sure some of the BS stuff might slip through the cracks, but they offer a set of expertise and recognition that I think could be really helpful. And realistically, even with 5+ patients, if you have 1 that's super acute the others kind of meld together and less acute tasks might get delayed or pawned off because you do sometimes need to focus in. Just my two cents.

Esme12, ASN, BSN, RN · Jul 27, 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.

My experience with travelers/agency is that it is written into your contract whether or not you can be floated out of the critical care area. Some contracts do not have that stipulation and therefore as the temporary personel te expectation is that you will float. It is unreasonable for you to expect NOT to float when, like you said, it's a temporary contract and the staff who are committed to the institution do not like to float either.....the employee's preference should be respected first.

As a critical care nurse it is understood that the safety of the patients is not in question because you are an expert in assessment, intervention, and care. That the patients are in no immediate danger. Is it out of one's comfort zone? Absolutely, but unsafe? No. So my feelings are that it might not be pretty, and it may not be ideal, it's better than not having a nurse at all...... :smokin: As a supervisor I would have probably would have floated to the tele unit then floated a tele unit nurse to med-surg........if it's a union facility then my decisions would be governed by their contract first and your last....

Is it fair to expect some type of orientation...yes. There are joint commision requirements that need to be fullflled and you have every right to refuse your assignment.....by contacting your agency. But the facility has the right to end your contract at any time. By ending the contract early there are usually penalities that are to e paid to the booking agency which is why hospitals usually don't end contracts unless they have a really good reason........especially in this day and age when wastful spending is really frowned upon.

http://journals.lww.com/nursingmanagement/Fulltext/2010/06000/Pitfalls_to_HR_standards_compliance_for_agency_and.5.aspx

http://www.jointcommission.org/assets/1/18/2011_HCS_Guide.pdf

Personally, I can see how much of a disservice it was to the patients and the other med-surg nurses having to adjust to having one less license on the floor caring for those patients and spreading those 7-9 patients amongst the nurses that were left that definately left them all running like crazy if not more that a little unsafe.

In the furture I would negotiate my contract more carefully to excplude floating but be prepared not to be booked to a few facilities.......

MunoRN, RN · Jul 28, 2011

Where I work the ICU Nurses don't float to Med-Surg; most of us would drown on med-surg and they'll be the first to admit to that. But at each of the places where I've worked ICU travelers are expected to float to med-surg and without any orientation beyond "here's the store room, here's the med room", that's why travelers make the big bucks.

elthia · Jul 28, 2011

Wow...7-9...I work Tele/cardiololgy/cardiovascular/thoracic surgery and our usual ratio is 5-6 on a bad night 6-7 and that's only if we are short 2 nurses. We always have aides.

turnforthenurse, MSN, NP · Aug 7, 2011

The 2-3 patient load in the ICU is equivalent to the 7-8 patient load in med-surg. ICU patients have a lot more going on with them and are more complex and require more monitoring, which is why you only get 2-3 of them max. Sometimes even 1:1 if they are really unstable.

As a traveler, you will float to areas that you are not familiar with. You probably won't get an "orientation" to the unit - you will just have to ask your coworkers where things are.

I work in progressive care and myself (as well as my fellow PCU workers) are occasionally floated to the ICU. We are also occasionally floated to the ER, but only to help out (mostly with IVs and other things; the ER at my hospital uses a different documentation system than the other floors so unless we have been oriented on that type of documentation, we won't take patients). We'll get floated to med-surg once in a blue moon.

linearthinker, DNP, RN · Aug 14, 2011

Well, I think you were wrong to refuse and we would have canceled your contract too. We expect travelers to be "team players." Yeah, I think it would have been a crappy shift, no doubt and I get why you didn't want to. However, it isn't inherently unsafe and certainly isn't outside your scope of RN practice.

Better luck at the next assignment.