FLOATING POLICIES

In our hospital Critical Care RN's float to only critical care service and NOT to NICU/PICU, unless they are from burns where kids are regularly seen. The kicker is that 2 cardiac floors are part of critical care, and you can have as many as 6-8 pts there. Half the time you are trying to find your patients to assess them, because up in these units the pts have the amazing ability to walk! Other than that, Our floating policy seems pretty good and generally no one minds going to another ICU... but those two cardiac floors..... It surely isn't a lower level of care, there is a lot more instruction going on and the turnover for those ruling out MI's is huge. I agree that the "lower level of care" is a little bit ridiculous. Good Luck

Personally I don't like floating period. And I've been floated the other way, to ICU! That's pretty scarey, with about 5 min. orientation, they tell you, you'll only get the kind of patient your used to or they'll cover you on the stuff you don't know. I have to admit they did, but it is still scarey. I know some people like floating but I believe they've just gotten used to it. I believe it negatively impacts continuity of patient care, undermines the efficiency and morale of the unit dependent on floats, wastes prescious nursing time (we've had to delay report 20-30 min. waiting to hear who's coming)and generally creates a choatic environment.

My big beef is last month our manager sat us down and informed us that we would have to take turns floating with the PRN nurses! In other words if we, the permanent staff on the floor, had a PRN nurse scheduled to work our floor with us, and they needed a nurse somewhere else in the house more desperately, the PRN would stay on our unit and we would float if it was our "turn". We (permanent staff)sign a log with the date and place we float to and take turns based on that. But always, always if there was a PRN nurse in the mix she was the one who had to go, until this announcement. Now the PRN nurse would be allowed to sign our log when she floated just as if she was permanent staff. ( Many of our PRN's were permanent staff before they chose to go PRN ) This is a reflection on how dependent we are on PRN staff!

Anyway we the permanent staff strenuously objected and for now the policy change is on hold. But I see this as a harbinger of things to come as the nursing shortage becomes increasingly dire. And sadly more nurses will be alienated enough to say goodbye to nursing. We've entered a vicious cycle. ( short staffing = overworked, discouraged, fed up nurse that quits nursing = shorter staffing = greater discouragement, etcetera, etcetera, etcetera. This cycle will only be broken by some courageous advocacy for the bedside nurse, on the parts of managers, supers, and DON's telling it like it is, and administrations that listen. I won't be betting the farm on that.

I worked at a major hospital in NE, full-time until last month, on call now... I worked on an inpatient geri psych unit- many medically ill agitated dementia patients, with a fair share of people suffering from depression/substance abuse and other mental illnesses such as bipolar disease or schizophrenia. Our staffing ratio was changed so that we each had more patients and we then proceeded to feel like the new float pool (until our census stabilized to more than full most days), we were told we were to float wherever they told us to go, including ICU! Now, we have good med surg skills as so many of our patients are medically ill, which exacerbates their psych problems, but ICU is ridiculous- and we were treated very rudely although we tried to be as helpful as possible. Other units refused to float to us even though we treated them VERY nicely as we understood the dislike of floating and that coming to our unit with the number of agitated patients was obviously scary. Unbelievable what all nurses are expected to do by admin, down right dangerous!!!

I have to say that in the hospital that I work we have a fairly decent policy on floating. I work in a cardiac center on the floor or otherwise known as "tele". Our policy is to only float within the cardiac center, if needed. This means that RN's are floated to tele, step-down CCU or CCU. No where else do we have to float unless we want to. In addition, the floatee, isn't assigned her own patients. They work with a team member in a nurse technician kind of role. It is nice for the nurse not to be thrown to the wolves and for the floor to have an extra body.

Hello All,

As a travel nurse, I have become used to going to a busy and shortstaffed hospital and becoming a "part of the team" on the unit I am contracted to. I make friends and become one of the crowd, taking call and even rearranging my schedule to help out when needed, as I don't want my new friends to have to work short. But my latest assignment . . . . Oh My Goodness what a HORROR!!! I recieved 4 hours of orientation (during which I had a patient load) and have been floated all over the hospital. I guess their opinion is - a nurse is a nurse - but I see this as very unprofessional behavior. I was told I would be 'first to float' when I asked (and I accepted the assignment anyhow? YIKES) but if I had not asked I would have been totally unprepared for the situation I have found myself in.

Oh well, the assignment is almost over, I think I have worked 3 times on the area I had agreed to accept an assignment in. I pray before I go in to work each night, and as of yet have not had a patient I felt I was unqualified to care for, even though I have been assigned to several ICU's. When will the hospitals learn that floating is not a permanant staffing solution???

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Kalee G - Currently on

assignment in

Philadelphia with

Medst

The California Board of Registered Nursing has published an advisory of floating that includes, "A Registered Nurse has an obligation not to accept an assignment to give care he or she is not competent to provide. Any RN who accepts such an assignment, and the supervisory RN who makes the assignment, may both be subject to discipline by the Board for incompetence/gross negligence in the event of injury to a patient".

Keep records and try to make a deal for being assigned a resource RN to provide what you are not trained or experienced for.

As with short staffing WHY DOES MANAGEMENT GET AWAY WITH THIS?

We have a moral responsibility to the patients and a license to protect as well!

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Nurses who are reading this discussion please ready carefully the response from the nurse from California! WE have much to learn--get a copy policy and utilize this as your standard. NEVER accept an assignment that you feel in your heart is "unsafe"! When they started floating nurses in our unit (this was a few years ago when I was doing NICU-and they wanted to float us to PICU), we called the nursing supervisor, told her that we vehemently objected to the "floating" and all of us signed the sheet which stated if she "floated" any of us, she would be held accountable as we had informed her that we felt "unsafe" outside the area of the NICU. We were NEVER floated because we all stuck together! It wasn't one nurse objecting--it was the WHOLE unit! In unity there is strength! Hang ON!!

In reply to the floating issue. I just took a new job in a local hospital. I found out that the staff nurses are expected to float to any area in the hospital including all of the specialty units. I feel this is a VERY unsafe policy. Does anyone know where JACHO stands on this issue? In one case a Psych nurse was asked to float to Med/Surg. She stated that she was uncomfortable with this, and was told if she did'nt float it would be grounds for termination. Needless to say, she walked out and never came back. Hospitals wonder why they have a retention problem? I would like to suggest a new float policy that would include only floating to 2-3 units. If anyone has a policy like this that has worked, please contact me! [email protected] Thanks to anyone who can respond!

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Shawn Zimmer RN

Staff Educator

Originally posted by Patricia Smith:

Nurses who are reading this discussion please ready carefully the response from the nurse from California! WE have much to learn--get a copy policy and utilize this as your standard. NEVER accept an assignment that you feel in your heart is "unsafe"! When they started floating nurses in our unit (this was a few years ago when I was doing NICU-and they wanted to float us to PICU), we called the nursing supervisor, told her that we vehemently objected to the "floating" and all of us signed the sheet which stated if she "floated" any of us, she would be held accountable as we had informed her that we felt "unsafe" outside the area of the NICU. We were NEVER floated because we all stuck together! It wasn't one nurse objecting--it was the WHOLE unit! In unity there is strength! Hang ON!!

GOOD FOR YOU!

This works because the one forcing you to float does not want the RESPONSIBILITY for this. Also do not do what you are not trained to do. I won't refuse to float to oncology but will NOT give chemo. It is too dangerous, the MD and/or pharmacy may have made an error, many meds are not in the PDR yet, and I am not trained for this.

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My hospital recently changed the "floating" policy as well (do I sense a pattern here? ). Anyway, under the new policy 1)PRN nurses are not automatically the first to go; whose ever turn it is to go, goes and 2)Nurses in the "critical care division (ICU's and the 3 tele floors) CAN be floated to med/surg. The ICU nurses are "freaking" about this policy change. I can't say I'm happy about the idea of being floated to m/s either but supposedly they are going to put a cap on how many patients we can take (5 max). I certainly am not going to accept an assignment that I don't feel qualified to handle, ie giving chemo. Many nurses at my hospital have been there a long time and up till now, had a lot of loyalty--many RN's started as nurses' aides. However, the way management is treating the staff, all they are going to do is drive a lot of nurses out the front door to agencies or other areas of nursing ie home health. So it will be interesting to see how things evolve.

Laurie, RN

Originally posted by zimmermears:

In reply to the floating issue. I just took a new job in a local hospital. I found out that the staff nurses are expected to float to any area in the hospital including all of the specialty units. I feel this is a VERY unsafe policy. Does anyone know where JACHO stands on this issue? In one case a Psych nurse was asked to float to Med/Surg. She stated that she was uncomfortable with this, and was told if she did'nt float it would be grounds for termination. Needless to say, she walked out and never came back. Hospitals wonder why they have a retention problem? I would like to suggest a new float policy that would include only floating to 2-3 units. If anyone has a policy like this that has worked, please contact me! [email protected] Thanks to anyone who can respond!

Some of the bigger centers I have worked in have gone to cluster areas of floating where you should be able to function and the patient population and load resemble your home unit. (i.e. monitored units, med-surg areas etc.....) This business of floating outside your region is ridiculous, dangerous and stressful. Indeed, stressful enough to drive nurses from their hospitals and from the field altogether.

A previous poster asked about what JCAHO's position on this issue is. So I decided to try and find out. A search on the word "floating" did not yield anything on the JCAHO website. However, I was reading some items under the "standards" section and noticed that they do have a mechanism for complaints. Of course "The Joint Commission encourages anyone who has concerns or complaints about the quality of care to bring those concerns or complaints first to the attention of the health care organization's leaders". Obviously the people at JCAHO really have no clue what is truly happening in our hospitals! Imagine if they got FLOODED with complaints about every hospital and "patient safety" issues! Yikes! I'm sure my facility would not take it too well if someone were to file a few complaints with JCAHO over the fact that they are planning to change our ratios (giving each nurse MORE patients) and allowing us to float anywhere in the hospital! How beneficial are these actions to patient safety?

One more thought: Does anybody think filing a complaint with JCAHO will really be effective, even if I were to include evidence (in the form of prior studies)that show less patients/nurse = better outcomes? I'm more than happy to do it, I just don't want my efforts to go for nothing.

Laurie

[This message has been edited by LLDPaRN (edited October 18, 2000).]