Floating or closed unit?

[Wyo Nurse]

HI! I am also new to this site and hoped someone out there could help my facility with a few concrens. I currently work on a Family Care Unit (FCU) in Wyoming. Our unit consists of L&D, postpartum, nursery levels I and II, and pediatrics. I worked for two years at a larger facility with a closed unit and it worked quite well, but there were 3 times the number of employees there. At our hospital, we are currently required to float to other units, such as surgical, med/surg, ICU, behavioral health, and extended care. It seems that our unit is required to float more often than the other units as 1) our manager accurately staffs our unit, 2) the FCU has its own set of rules that prevents us from taking advantage of the system, and 3) our unit has the most turnover in terms of patients. There is a thing called "the book" at our facility as well. Any person in the hospital can put their name in "the book" and they are the first person to be put on call, no matter what unit they are from. It is a first come, first serve basis, exsept with our unit, which has a rule about putting one's name in "the book." This causes issues because that person will be put on call and one of the FCU nurses will float to their unit. There have been times when FCU nurses have staffed another unit, with only one nurse there from that unit. Stress levels are high, numerous people have thought of leaving our facility, and in general, it has been a bear! We recently had a staff meeting about closing our unit. Everybody so far has been in agreement to close the unit. We will, hopefully, be having a 12 week trial period with a closed unit, but we need some feedback from others so that we can put this information before administration. Some of the quidelines have been 1) all staff have to be for a closed unit, 2) if it is closed, that means no one will be floating to our unit and no one floats out of our unit, ever, 3) we will have to put in extra call shifts per month (we already put in 8 extra call hours for c-sections every 2 weeks) 4) our unit will be responsible for picking up all open shifts and all sick calls, and 5) we were asked if we wanted to be salaried at our current hours (72 hours FT every 2 weeks) or if we still want to be hourly, givien we may now have extra low census days due to the closed unit. Do you have any suggestions or comments? THANKS!!!!!

[wayunderpaid]

A couple of questions for you,

1- when you float, are you required to take a pt assignment (let's say for a specialty floor like ICU), this would be quite unsafe, especially if you are not trained or have certain competencies completed such as ACLS, etc.

2- What is the vacancy rate in your unit? If you are close to being fully staffed in your unit, then I'd say take the closed unit policy over floating. Our facility does not float nurses to other floor, though I am a flex nurse, meaning that I rotate between badly staffed units. I work mostly in the 4 ICU's but once in a while I get an assignment to another floor (sorry but I never have to do peds or maternity, and glad for it. I am not made for it)

wayunderpaid

[mom2michael, MSN, RN, NP]

We have a min. staffing guideline regardless of how many patients we have, we staff even if we are at zero. We are also a closed unit and we don't float outside our unit. We do however still receive floats to PP if the need arises but we also staff an on call person 24/7 and our manager is great at incentives to get us to work, so rarely do we need a float from the outside.

We keep track of our call off dates, when it's time to call a person off they go by the dates. If you REALLY do not want to be called off - you can tell them no and most of the time someone else will take your call off.

When we are called off we are on call for the next 12 hours (which we get paid $3/hr to be one call) so it's not a free day in the sense you can just take off and do whatever, you are expected to be back into work within a reasonable time if called in. Call offs are the first to be called into work (since you already supposed to be there anyway) and you are paid for a min. of 4 hours if you are called in and you get call back pay (which is time and half) so.....

The only thing that stinks is we seem to run in spurts where we called off frequently and then suddenly they can't find enough help and they are begging for you to come in. But I will gladly take the call offs' vs. being floated to a floor I've never worked on a day in my life. Yikes.

BTW, my facility actually has an interagency pool of RN's they use for floats and they are required to work and be proficient in all areas to get the premium pay so I'm not sure any department really "floats" that much anymore which is kind of nice.

[Riseupandnurse]

What a heavenly option; go for it!!* I hate floating above all else because it's just not safe or effective to think a nurse can go to a floor two or three times a year and know what to do.* I have seen med-surg new grads floated to the ICU, and LPNs floated there from a med-surg, rehab nurses caring for patients going for open hearts, cardiac nurses sent to the NICU, etc.* And yes, they may take an assignment. Gives me the shivers and makes me ill every time I report for work.* UGGGH.* Take what you can but definitely go for the closed unit.* Develop a working team that can take care of each other and enjoy nursing!

[Wyo Nurse]

To respond to some of the responses: Yes we are required to take a patient load most of the time, some well out of our comfort zone, such as tele or chemo patients. If we do take a patient on tele, one of the regular nurses from that unit watches the tele and charts on it, but most of us feel that that is like asking a surgical nurse to come take a labor patient while we watch the strip. You still do not know what is truly going on with your patient. We can be floated as a CNA or an RN. Although they can pay a CNA double time, with a shift differential, cheaper than they can float an RN, they still do it. It is a smaller hopsital and in a college town to boot, so the turnover is high due to students coming and going. Our floor is pretty well staffed, but some of the other managers seem to have problems staffing their own units accordingly. We also do not have a charge nurse, but utilize a hospital wide nursing supervisor. I also work night shift, which seems to have a whole different set of rules than day shift. When we do get a float to our unit, they ONLY take a normal PP mom or one of the surgicals, NO infants, labors, or peds. What do other hospitals do for nurse to patient ratios in peds, L&D, and nursery? what are some of your policies? Does anyone have a good website or a link to other inforamtion about national standards on this topic?

[cassioo, RN]

We closed our unit several years ago and it works out pretty well most of the time. When we weren't closed we would get pulled and if we need help any help that got sent couldn't do much more then V/S so we closed.

We have a call off roatation also if you don't want the manditory call of you can say no and they go down the list and if everyone says no if you're at the top you get it and it's your choice to be use your PDO or to just take low census. You aren't on call but you can tell them to call them if they want you. We also have a request off so if there is a low census we look at that list first before going to the manditory list. There are other guidelines like certain amount of manditory call off per pay period, staffing for meetings (don't call people off if others have to go to a meeting). If you do get manditory and don't want it you can call the house supervisor and ask if they need help on another unit and can work there if you want to. The charge nurse of the previous shift decides on call off.

[babysrhs]

Hi, I work at a small commmunity hospital that does about 650-700 births a year. We have approx. 20 RN's on our dept with about half of those RN's being full time. We are all crossed trained to do LR/DR, Nursery, Level II Nursery and PP. We closed our unit about 8 years ago and it works great.

In becoming a closed unit we agreed to cover the dept for all staffing needs (vacations, calloffs, hi pt census). We take approximately 25-30 hrs on call every 2 weeks without pay, and if we get called in we get time and a half. Usually people sign up before there shift or after for their call hrs. We usually sign up for 4 hr slot minimum, but you can take as much time as you want. In return we also have to size down if our census is low. It is usually not a problem because several staff members don't mind taking on call if the census is low and we also take turns being on call if nobody really to be called off. It has worked pretty well. Of course, there are always a few staff members who don't sign up for enough call and they get reminded if they are not doing their share. It works well, because you know you have backup if you get busy. We just look at our on call calander and call in our contigency staffing. The contignecy staff person has to be on the dept 40 min after getting called in. Before we had our closed unit, we'd rely on the supervisor to call extra staff. The Hospital supervisor was always too busy and made little attempt to get extra staff to assist you. You really come to appreciate your co-workers and depend on them to make the unit run smoothly. Our department is very fortunate to have a great patient care manager. She is always willing to help out when we get busy and will work extra to meet the needs of our department. I really hope you get your closed unit, It's better for your patients and it's better for staff moral. I

[BirthCenterRN]

I hate floating.