Floating to diffrent units in your hospital

stphnrnm · Dec 5, 2005

I am a nurse manager, in my hospital we have a "pool" of nurses, Registered and enrolled (LPN) nurses, allocated to float during each shift. They report to Nursing Administration Office at the beginning of their shift when it would have already been decided which area would need assistance and they are allocated there for that shift.There are times when specialty areas need assistance,(only general trained nurses are in the pool). This is where the shuffling comes in, if there is a critical care nurse or obstetric nurse elsewhere that can be utilized, then they are exchanged with the "pool" nurse.This works out very well as there is just an exchange of hands. However the ill feelings come in when the pool nurse is used and there is still a shortage, then you have to pull from the quietest area that can afford it, then there is the question of who gets moved today?

All in all, when you sign on with my hospital there is a written clause which tells you that you may be required to work your scheduled shift anywhere in the institution where needed, this is invoked as a last resort as it is considered an infraction if you refuse to float when requested. We try to reduce overtime wherever possible, but we do not allow patient care to be compromised :nono:

stphnrnm

kadokin, ASN, RN · Dec 8, 2005

My response to this as a supervisor was to point out that basic nursing is still basic nursing. A blood pressure on the OB unit is pretty much the same as taking a blood pressure on the medical unit. The same goes for answering lights, giving bed pans, taking people to the bathroom, giving medications and taking care of their IV's. The very specific stuff like checking someone's fundus in PP or wedge pressures on a patient in ICU are something that should be done by the regular staff of those units. They should have the wherewithall to know that, and if not, then the float needs to page the supervisor and tell him/her that the staff is expecting you to do something you have no knowledge of how to do. Do you tell the supervisor you feel you have been given patients the regular staff don't want? Did you tell the supervisor you felt dumped on? I would defend you and get after the regular staff. I let staff who do that know that I wasn't going to put up with it, that they were getting a float to help them out, they were anxious about it and they were to make the float feel comfortable, otherwise I guess they didn't need the extra pair of hands that badly. They didn't have to know about the rules I had to follow with regard to the acuity. On the other side of that coin is the burden a float is to the unit they are going to and they make it clear they do not want to pitch in and help to the best of their ability. That has nothing to do with abandonment and everything to do with insolence, attitude, insubordination, and basic old childish pouting. When you come back from a two week vacation you are faced with a whole assignment of new patients you've never seen before. You never know what you are going to encounter when you walk into a patient's room. What do you do? Basic nursing until you learn about their other more specific needs. Floating is not a whole lot different when looked at that way, special needs of a particular unit aside. Most everything done with a patient begins with basic nursing care and we all learned how to do those basic things.
By the way, board of nursing aside, walking off the job is viewed in other professions as job abandonment and grounds for immediate dismissal in most places. Why should it be different with nurses? I find it hard to understand people's refusal to compromise, especially when their job in on the line.

But, why float an RN to a unit to take v.s. and give baths? Come on, is this REALLY cost-effective? BTW, our hospital experimented w/having non-nursing personnel as house supervisors for a time. The director of respiratory care felt any nurse could float anywhere at any time, because "a nurse is a nurse is a nurse". What a fool. Would he feel the same way about this if a psych nurse was assigned to care for his loved one on ICU? You folks need to stop and think about the VERY specialized knowledge that staff members accrue when they work for a time in a particular speciality. Yes, even unit clerks and CNAs know how to enter orders and report to their superiors in very specific ways that are critical to pt. safety in their speciality. Think about it!:uhoh21:

Littlewonder · Dec 8, 2005

I just have one little comment to make. As a fairly new traveler (on to second assignment!) I do not float!!! It is already difficult enough to learn the routines, locations of supplies, and physician preferences in the department you signed up for, let alone try to figure all that out in a different unit! I would be compromising patient safety if I floated, because of the extra time it would take me to do everything - it would detract from patient time. And if the unit was already short staffed the other nurses just generally don't have the time to help as much. I currently to LDRP/nursery with prior experience in ICU and Med/Surg but I would not be safe in an ICU or Med/Surg because I am already slower in these areas and being unfamiliar with the work environment would just make it worse. Has nothing to do with not knowing HOW to care for the patient! Just with not having the specific knowledge base unique to that unit. I can deal with that in LDRP - at least I get one shift of orientation!!!

I get by with not floating because I always have it put in my contract. So, I don't go to those hospitals who always float travellers first! :cool:

lee1 · Dec 10, 2005

Do any of your hospitals staff in 4 hour shifts??? We have many types staffing in our hospital. Some nurses work 12 hours for example 7am-7pm. Some work traditional 8 hours. Some work 11am-11pm for the special needs of their unit, say OHS where cases come out later in the AM.

The 4 hour pull is always difficult but we also float within our competent areas. ICUs---ICUs or medica/surgical clusters. Med telemtry to med telemtry. Oncology to oncology, etc.

Do any of you use a questionaire that can be filled out at the end of the float and handed back to the Director of their own floor, etc. Several questions are asked and is a good tool for evaluating problems and seeking answers if used.

We also have a float committee that meets and is made up of the night supervisors, staff nurses, managers.

However, despite all of this, the 4 hour pull continues to elicit the most discomfort and we still do not have a good solution. BTW, we are a high acuty hospital and do have float pool only nurses that work Mon-Fri but when not enough we have to resort to those staff nurses where units are overstaffed to pull from. A log book is kept on each unit so that nurses float in turn. Agency float first. Travelers generally float in turn.

I think part of our problem is the cluster-----4 bedded areas that are between ICU and step down telemtry. Charting there is the same as the med/surg floor, not the ICU. ICU nurses that are pulled there don't always seem to get the same amount of attention/support as other med/surg nurses. Maybe that is just a med/surg mentality that there is an ICU nurse on the floor she shoud not need any help, BUT, certainly she still needs breaks/meals, help with turning, admissions, off floor testing, etc.

Now that brings up another problem. Our Head nurses take patients, charge nurses take patients. There is no one person unless the Director is there that is without patients.

loriab21 · Dec 23, 2005

Where I work, in OB/L&D/Nursery, we are getting floated to other units, of which we have not had any orientation and expected to take a patient load. If my home unit gets busy, like last night, they actually said that they would send our patients to another hospital because now we were understaffed. This makes absolutely no sense to any of us. But when we are busting at the seams, we do not get any help. They told us to "suck it up and deal with it". We did. we sent patients 75-350 miles from our hosptial to a place were they were better staffed. We have voiced our concerns, but it seems like no one listens. Any ideas?

kadokin, ASN, RN · Dec 24, 2005

Where I work, in OB/L&D/Nursery, we are getting floated to other units, of which we have not had any orientation and expected to take a patient load. If my home unit gets busy, like last night, they actually said that they would send our patients to another hospital because now we were understaffed. This makes absolutely no sense to any of us. But when we are busting at the seams, we do not get any help. They told us to "suck it up and deal with it". We did. we sent patients 75-350 miles from our hosptial to a place were they were better staffed. We have voiced our concerns, but it seems like no one listens. Any ideas?

Yeah, give the person who dreamed this up a breathalyzer sometime. :nurse:

Harleygirl · Dec 24, 2005

I work at a rural hospital and you can have up to 3 "modalities", meaning you train to be able to float to different departments, psych, med surg, OB, ICU, outpatient clinics, etc. They offer a pretty nice hourly compensation to be a "float" nurse, no matter if you work in your home department or where you float to. Gives you a pretty decent wage if you are a modality nurse that works nights!!

Zee_RN, BSN, RN · Dec 24, 2005

As an ICU nurse, I can be floated to any of our telemetry floors or the Cardiovascular ICU. I hate it. I'd rather take the decrease in pay, not that I can afford it; I just hate floating that much. When you're accustomed to taking care of 2 high-acuity patients with a 30-minute face-to-face report and then being given 5 or 6 tele patients (with different charting requirements) and rapid-fire taped report, it's very discomfiting. You can't find supplies. Everyone else is running around like chickens and you get rolled eyes when you can't find a 10-cc syringe. The Pyxis is two hallways away. I admire Tele nurses for the amount of work they do; I don't want that their job!

CVU pulls are the closest to "home." The unit is structured just like our ICU, with 10 beds instead of our 20. Their charting is different, but I can deal with it with only one or two patients to figure it out on.

They're talking about relieving the 15-year seniority nurses from floating and I think that's great -- unless it means I get pulled more! I know it sounds like I'm talking out of both sides of my mouth but ... well, that's how it. 15 years' seniority certainly deserves the relief. But I don't want to pick up that slack; I will certainly find a new job if I have to float more. Just my personal pet peeve. I know it sounds double-sided but ... I just can't stand it! (And, of course, I think it's my turn tonight; going in 11-7.)

MandyInMS · Dec 24, 2005

Had problems with floating a while back..a supervisor was determined that everyone was to float to ER.. my hats off to ER nurses, but I am NOT one of them..lol...there was no training or orientation prior to being floated there...some of the other nurses who gave in to her pressure described it as "sink or swim", being thrown to the wolves and being expected to perform as an experienced ER nurse...I cont. to refuse to go stating the obvious fact of no training,ect...it's a WHOLE diff way of nursing in the er...now mind you I have floated to numerous other areas that I felt comfortable/competent(sp?) with, so I'm NOT totally inflexable...and after seeing several other coworkers leave work in tears after being forced to float I knew "sticking to my guns" was the right thing to do. Sorry but I will NEVER be put in a position where my liscense or patient care is compromised....the end :)

RN34TX · Dec 24, 2005

And my hats off to Burn nurses.

I have nothing but the utmost respect for them, but I am NOT one of them.

My hospital considers the burn unit (BICU) a part of the "critical care" family, so we are required to float there at times.

The staff is wonderful and accomodating as much as possible to those of us floating from other ICU's. Most of the time they give me MICU or SICU overflow patients but sometimes the entire unit is all real burn patients so I have to take them.

This is where I think that the whole "a nurse is a nurse" management mentality is completely out of hand.

Again, the staff never throws me to the wolves and is always there to help with "burn specific" issues, but........

If any of you had a family member or yourself suffer severe burns, would you want or expect anything less than an experienced burn nurse taking care of you or your family?

IMHO, burn nursing is a whole world of a specialty in and of itself, and I just don't see substituting SICU/MICU/CVICU or whatever ICU nurses as being an acceptable solution.

Any other nurses have to float to the burn unit, and if so, how do you feel about it?

Zee_RN, BSN, RN · Dec 24, 2005

(And I did float last night, lol...to the CVU so it wasn't too bad. And now I'm at the bottom of the list to float again, thank goodness.)

sjrn85 · Dec 24, 2005

ITA w/ fergus; we would never expect this of physicians. It's totally inappropriate to expect that a nurse can float to any unit and function.

And I have to wonder at nurses who feel they can float anywhere, anytime. No one can be that knowledgeable in every area. "Jack of all trades, master of none," so to speak.