Float staff having a hard time

[nursiee]

There is a very specialized unit in which some of the nurse friends I work with also float to, let's call it "Unit X." This unit has the reputation of being unwelcoming towards float nurses, especially the newer float nurses. Many of these nurses dread going to that unit. Here is a common scenario I often hear happening on this unit: New Nurse makes a mistake during an orientation shift. Unit X Nurse sees this mistake, and instead of going to New Nurse to tell him/her about it and provide a good teaching moment, he/she will correct the mistake themselves and go talk behind New Nurse's back to the other Unit X nurses. It is not even a med error where a patient has been directly affected. It's more things like a med not being constituted the right way (but has not been administered to the patient yet) or an IV line not being primed properly.

Other, perhaps more trivial things have also occurred on the unit: the Unit X nurses chat amongst each other without including the floats. They all decide to order food and don't include the floats (not the most polite thing to do, but definitely not the end of the world, IMO). Or, when a new float nurse is running around the unit, very busy with their patient load, the other nurses will just sit there and whisper about them instead of offering to help. Nurses from other units have suggested to them that they should get in touch with the manager of the float pool and let he/she know what is going on. However, a lot of them do not want to tell the manager; one nurse in particular said she didn't want to because she doesn't like confrontation. I then told her that there are other nurses who seem to be unhappy on that unit, so if they joined forces and all went to tell the manager, she wouldn't have to do it alone. The float nurses seem very eager to learn, but don't feel they are being supported in their learning on this unit.

I'm just curious to know the right way for this situation to be handled. Would it be better for the newer float nurses to politely confront the nurses on Unit X when the negative behavior occurs? If so, how should they go about doing it? Would going straight to the float pool manager also be a good idea? I currently don't float to that particular unit, but I guess it would also be helpful for me to know how to handle it in case I end up working there in the future.

[Sour Lemon]

Why are you so involved in this? And why are nurses who can't prime IV tubing or reconstitute medications correctly floating to start out with?

[Been there,done that, ASN, RN]

"The float nurses seem very eager to learn". Float nursing is not the time to learn. Float nurses are expected to hit the floor running. (been there, done that)

This is a management problem. They should NOT be using nurses in the float pool that make errors in medication preparation and priming IV tubing. Perhaps the float team does not receive adequate orientation to different areas.

Sounds like unit X is tired of being sent float nurses that can't pull their weight.

[beekee]

Don't believe everything you hear. Your experience on Unit X may be entirely different.

[RNperdiem, RN]

I have heard that the rule about taking a problem to a manager involves defining a specific problem and offering up a doable solution or two.

What in particular do you want your manager to do?

[Nurse SMS, MSN, RN]

My first question is "Why are nurses so inexperienced that they cannot prep a medication or an IV line properly being floated to other units?". Frankly, I do not blame Unit X nurses for being frustrated. When staff is so short that a float nurse is needed, that means they aren't in a position to be hosting "teaching moments". Is this the float nurse's fault? Of course not. But to expect there not to be backlash is unrealistic. New nurses should not be floated until they are minimally competent to practice independently. Failing to prime an IV correctly or mix a medication correctly falls in the vein of "minimally competent". The unit X nurses would do well to advocate for there only being experienced nurses floated. Otherwise it just makes more work and greater likelihood of patient harm along with a toxic work environment (which in this case is, frankly, the least of these concerns).

[nalie2, ADN, BSN, MSN, RN, NP]

I agree that float nursing is not the time to be learning how to prepare a medication or prime IV tubing Frankly, I learned IV tubing in first semester and it seems like a common task that nurses should know how to do. Float nursing isn't the time to be learning tasks like that. I'm currently on orientation/preceptorship and I float with my preceptor if she's required to float and she is the one that teaches me. The nurses on "unit x" are probably fed up with being sent nurses that need to be oriented. If you aren't being sent to that unit I would leave the situation alone. You don't want to make waves on a unit you don't even float to.

[nursiee]

Thanks for all your replies!

I'm getting the sense that the way things work in the hospital I work at is different from everyone else's. I apologize for not being clear. To clarify, these newer float nurses were doing orientation/buddy shifts. For those three weeks or so of orientation shifts, they are paired with a preceptor during each shift and share the same patient load. The preceptor is required to orientate that nurse, and obviously by the end of these buddy shifts, the preceptee should demonstrate some competence.

This unit has a very specialized patient population, and they do things a lot differently than the general units do. There are many medications given on that unit that aren't given on other units. They handle IV infusions differently. When a patient has a fever, an antipyretic is not routinely given right away like it is on other units; the source of infection needs to be determined before going forward. They only administer one type of narcotic on that unit. They also only administer one type of anti-emetic. Hence, there is a bit of a learning curve. What these nurses are used to doing on other units (e.g., the way in which an IV infusion is set up, preparing a medication), doesn't fly on this particular unit.

At our hospital, float staff are included in the baseline staffing numbers, they're not only needed when the unit is short-staffed.

[Nurse SMS, MSN, RN]

I think you are going to have to be more specific still after that post. Are these nurses included in staffing numbers? If so, then there is a HUGE problem.

I do not understand how mixing IV medications would be that different. I super don't understand how there can be a more specific way to prime IV tubing. Different meds and specific workflows should make this easier, not harder, in that there are fewer variables to factor in when considering pharmaceutical intervention.

I am just all around confused now. Are these float nurses or are these new grad nurses orienting for exposure on a floor in which they have no experience as part of their residency or what?

[nursiee]

To be more specific, the unit I'm referring to is a pediatric oncology unit. Some of the float nurses have a few years of experience on other pediatric units, but are new to this unit. Some are new grads who previously worked in adults who've since switched to pediatrics and have had orientation shifts on this unit.

[psu_213, BSN, RN]

Are these float pool nurses or nurses who are being floated from their home units D/T staffing? Everywhere I have worked, there have been complaints from float nurses--both float pool nurses and nurses floated from their home units--that they are given bad assignments, that they are not helped, that other nurses ignore them, that tech help nurses from that unit more than the floats, etc. I'm not saying any of that is right, but it appears to happen a lot.

2 things from previous comments that struck me:

1. If nurses are being floated to a unit on which they are not qualified to work, then this is the fault of the management. It does not excuse poor behavior by nurses on that unit, but the problem stems from management floating nursing who aren't ready to be floated. Also, if administration is hiring nurses for the float pool who cannot "fly" on their own, this, too, is an issue that management needs to address.

2. It is extremely frustrating to have to "teach" basics to a nurse who is billed as being experienced. Mine was a unit that was not as specialized as ped onc, but some nurses struggled on our unit (Step Down). One day I was oriented a float RN who had more years of experience that I. Halfway through the day, I realized that I had to start at the very beginning of med administration with her--luckily I realized this before anything bad happened. There were also issues once she was on her own (on her own against the recommendations of several nurses, including myself). I'm not there to see the exact behaviors of the nurses on Unit X, and they may very well be inappropriate; however, I can certainly understand why they may not be getting a warm and fuzzy from the nurses on the unit.

[nursiee]

Are these float pool nurses or nurses who are being floated from their home units D/T staffing? Everywhere I have worked, there have been complaints from float nurses--both float pool nurses and nurses floated from their home units--that they are given bad assignments, that they are not helped, that other nurses ignore them, that tech help nurses from that unit more than the floats, etc. I'm not saying any of that is right, but it appears to happen a lot.

They're float pool nurses. I do hear the same complaints as well; it seems to be a common trend in a lot of places.