Floated to ICU with no experience

[missnursingstudent19]

I’ve been a medsurg nurse for about a year. Today I was randomly floated to the ICU even though I’ve never worked on an ICU at all. I absolutely did not feel comfortable with this. Is this common to be floated to an area you have no experience in?

[Sour Lemon]

On 9/11/2020 at 7:54 AM, Been there,done that said:

 If you have been med-surg for a year, I am sure you have had to assist with intubation.

I've been in med/surg for ten years and only had one case of a patient needing to be intubated. Policy was to call "code blue" even though the patient was up and talking.

A huge team of people came, and they did everything. My role was to provide information about the patient to the ER doc and the receiving ICU nurse, but that's about it. As soon as the tube was in, they wheeled him away.

[Been there,done that, ASN, RN]

8 minutes ago, Sour Lemon said:

I've been in med/surg for ten years and only had one case of a patient needing to be intubated. Policy was to call "code blue" even though the patient was up and talking.

A huge team of people came, and they did everything. My role was to provide information about the patient to the ER doc and the receiving ICU nurse, but that's about it. As soon as the tube was in, they wheeled him away.

Seems we all have had different experiences with intubation. Back in my day, 1906 or so, I assisted with many intubations. There was no rapid response team and it would be me, RT and the physician.  We don't have enough info from OP yet to determine just HOW unsafe that assignment was.

[Lipoma, BSN, RN]

I have 23 months of ER experience and would not feel comfortable being floated to ICU without proper training. That said I do hold onto ICU level patients for extended periods BUT I have no experience with art lines or the other highly invasive procedures...

[Tweety, BSN, RN]

8 hours ago, Been there,done that said:

Seems we all have had different experiences with intubation. Back in my day, 1906 or so, I assisted with many intubations. There was no rapid response team and it would be me, RT and the physician.  We don't have enough info from OP yet to determine just HOW unsafe that assignment was.

These days in 2020 in most hospitals (other than perhaps teeny tiny ones in rural areas) it's the Respiratory Therapist that does the intubation and nurses barely assist other than gopher what they need.

[Tweety, BSN, RN]

Once, over 20 years ago I floated to ICU and was given two stable patients that were just overnight holds for observation and to be moved to the floor the next day.  The staff there was very helpful and supportive.  

However, since that time it's become policy that Med Surg nurses not float to ICU and ICU nurses don't have to float out.  In very small hospitals this might not be an option but it makes sense to me.

At the end of the day when a bad outcome happens, lawyers, BON's and even upper management are not going to question whether the assignment was unsafe that was given to you.  They are going to question you and ask "why did you accept an unsafe assignment".  

We fear for our jobs and for rocking the boat and feel like we don't have a choice.  None of us wants to be "that nurse".    But setting the precedent that because of their short staffing that a med surg nurse is suddenly qualified to float to take care of critical care patients doesn't sit well with me and I personally would refuse.

[CampyCamp, RN]

6 hours ago, Tweety said:

These days in 2020 in most hospitals (other than perhaps teeny tiny ones in rural areas) it's the Respiratory Therapist that does the intubation and nurses barely assist other than gopher what they need.

In 4 hospitals I've worked in, most intubations have been done by the residents or intensivist or anesthesia if they're unable. Respiratory does them if they need the numbers but in teaching hospitals, residents often need them more. 

The nurses draw up (confirming their calculations against the resident's) and push all the meds and have the necessary supplies ready to pass to the head. 

[renatanada]

The hospital only cares about staffing a nurse body in the ICU. You are responsible for your license and scope. Never ever (ever) assume that anyone is looking out for you or going to help you. If it feels wrong, it is. But you will absolutely be seen as "the nurse with the bad attitude." Get used to it. Welcome to nursing! 

[RNNPICU, BSN, RN]

So much would depend on the patient you were assigned in the ICU.

Sometimes there are patients who are cleared for transfer to the floor but there are no beds available. Since the patient no longer meets ICU criteria this could be an appropriate assignment since the patient should be on the floor.  

As for the patient needing intubated.  A patient could need to be intubated on the floor  because of deteriorating status.. This can happen anywhere. 

Please tell us more about the patient when you received them. 

Also, how many ICU beds does your hospital have? Is it a few, is it a Level 1 trauma center, community hospital? There are many other factors that could have gone into your float.  

[turtlesRcool]

1 hour ago, RNNPICU said:

As for the patient needing intubated.  A patient could need to be intubated on the floor  because of deteriorating status.. This can happen anywhere. 

Of course a med-surg patient could deteriorate to the point of needing intubation. But when that happens, the patient is transferred to a critical care bed, not left on a med-surg floor for the original med-surg RN to care for.

OP didn't say that she had a patient who deteriorated and was intubated; OP said the assignment was to care for an intubated patient.  This is really different.  I'm okay being a gopher, pushing meds, and generally helping in a code situation on a med-surg floor where a patient is intubated, but I am wholly unqualified to manage a ventilator.  

[michaelb, BSN, RN]

for me its a disposition think, look at it as an oppurunity...

You do have a license to protect and that should help guide any decisions.

I often ask myself "how would the prosecuting attorney ask me this question?"  Make sure that you make it clear that you don't have the experience or appropriate orientation( in an email) and make it clear when you get to the unit and give-er. be safe, do your best, ask intelegent questions.

[PhillyQueenRN]

It's absolutely wrong in every way, you need to speak up for yourself. 

[SmilingBluEyes]

Unless you work in a "closed" unit, you may be floated from time to time. When that happened to me, I would do things like vital signs, hanging antibiotics, and other familiar meds. I did bathing/AM/PM cares. And I/O charting. That was it. I was never assigned a load of patients by myself.

Because I worked in OB, I could be called back to the unit if the labor bus pulled up and we got busy.

Consider it an opportunity to learn but be clear you are not ready to take on patients all by yourself. But be willing and open to learning and help any way you can; they will appreciate you more.

Good luck.