Float Nurse Problem: Need Advice

[jaleath]

Greetings all. I am in search for a solution to a problem in my workplace.

I work in a 50 bed ER with about 90K+ visits yearly. Our ratio like anyone else is 4:1 (unless you are assigned to the trauma rooms, etc.) Our managment has allowed for extra staffing to "float" and assist to help those with regular room assignments. This help can range from helping with a critical patient, procedures, medication adminstration, discharge/admit, allowing for lunch breaks, you name it. However, we have hit a vicious cycle.

It starts with only but a few people who are possibly burned out and tired. They sit while the float nurses work. So they get burned out, and stop helping like they should. Then when it's their turn to take room assignment, they have upset others by not helping, and then in return do not receive help. Then we may have an influx of GN's or nurses new to our department arrive and they may or may not receive help. And so the cycle continues until cliche's form and favoritism begins.

Our managment recongizes the problem and has asked in our help to come up with a solution. Our current solution is to assign "team leaders" with specific qualifications and background. Each team leader is assigned to 3 nurses who are in turn over their set of 4 rooms. This has helped a great deal, but the problem continues as there is still lack of accountability.

We tried a feedback tool, where each nurse comments and rates their team leader for the shift and turns it in. We received quite a few but what to do with the feedback tools has become a problem. The staff has seen nothing done about their feedback and has lost faith in the system as nothing seems to have changed.

Does anyone have any experience in this, and if so, were you able to find a solution to the problem? How do you encourage people to step up to the plate, do their job, and be responsible? There is fear that if we cannot correct it, then upper managment may step in and either make rules for our department or do away with the float positions all together.

[Coffee Nurse, BSN, RN]

Seems to me it's not a "float nurse problem" that you have, but a problem with those few staff nurses who are burned out and not pulling their own weight. The team leader idea isn't a bad idea, but what's the point of soliciting feedback about them? I have a feeling that they're not the slackers who are causing the trouble in the first place. I would think the team leaders would be more useful in identifying the nurses who are slacking and focusing some more personal attention on them to a) help them out and encourage them to do their own work, and b) assess just how burned out they really are.

[netglow, ASN, RN]

"It starts with only but a few people who are possibly burned out and tired. They sit while the float nurses work."

Sounds like nobody is sure who does what and when. Did you intend to have the float take on a patient totally or just when the regular RN breaks. Did you want them to work side by side as a team? Did you want the float to assume the role of nurse's assistant?

I think as a float, you would want to know exactly what it is that is expected of you. All are RNs, so although the original ER nurses (of course) are far more experienced with ER, and even if the float knows that he/she is there to "help", the times they are given a patient on their own, they run things when the original RN ducks totally out. What are they to think? I would think, am I running this? am I not running this?

Wonder if you were very careful on the match-up of RN and RN float "team", see who works respectfully together and just use those floats, and define roles more clearly.

BTW, I only say this stuff IMHO, I have management experience, although (respectfully) not in nursing.

[krkrn98]

Where I work we were also having this problem, but we have implemented the use of Paramedics into the team. The nurses were getting burned out quickly because of the high patient turnover and we really needed help. The Paramedics are able to assist with many items including IV's, triage, meds, etc., but the overall care still stays with the RN. We work as a team and it has helped, RN turnover has greatly deminished and it gives the Paramedics the experience to keep up their licenses.

[cookienay]

Who cares if they are burned out? They are being paid to come in and perform a job like everyone else. Sounds like mgmt needs to step up to the plate. I work in a similiar sized ED as the OP and for the most part, things run pretty smoothly. When someone is not pulling their weight, the good charge nurses will find things for them to do. Our Team Leader function is focused on flow- new patients, discharges, and admits.

Management watches like a hawk and if they see a pt has been waiting a long time for something (medication, testing, discharge, etc...) they will call the charge nurse or that nurse to inquire why. Is this fun for the charge nurse or manager? No, but it keeps things moving and keeps folks accountable. If it is happening frequently with the same nurse, then things are addressed.

I am a firm believer in getting rid of the bad performers. To the OP- have a frank discussion with your manager, if you can. I understand not every manager is a reasonable person. This is not something that can be fixed at your level. This is definitely a management issue. Good luck!