Published Jan 28, 2001
is there anyone out there who can help me with policy on floating to areas im not qualified to work in. im a new grad have been on the med surg unit less tha 6 months my facility floated me to the telemetry unit with no orientation not even a tour to show where meds and supplies were kept. i tried to refuse the assignment and was led to believe this was not an option. i do not feel safe practicing in that enviroment i was also expected to the full pt. load of 5i did refuse this and was sent back to my unit and they sent another new grad up that wouldnt balk at the assignment. is there anything out there to protect us from these assignments that jeapordize pt safety and our license? HELP PLEASE. [email protected]
Vette: You did the right thing. I used to wonder what the nurses that accepted assignments without orientation knew that I didn't know, having gone to the same school. I quit asking myself that question when I became aware of the results. Stress, errors caused by stress, gossip about those errors. This also does nothing for your reputation with the docs about your judgement, which is important when advocating for your patients' needs. Stick to your guns. Listen to your instincts. Put your concerns and rationale in writing and give it to your management. Let us know what happens. Best wishes.
You bring up some good questions. I've mentioned this before: our ICU's use a float evaluation form you fill out when you float. It involves check boxes for things like did you recieve a tour of the unit? Did the charge ask you if you needed help- what assignment did you get etc. It has definitely improved our floating arrangements. Perhaps you can suggest that. In addition: you are right: unless you are trained to read those EKG's- tele is not a safe place to practice. Its a little scary but stick to your gut- don't do it if you feel its unsafe! Your patients thank you!!!
You did the right thing. It is not only your right, but also your responsibility to recognize the areas in which you are not qualified to care for patients. Every nurse has the right to NOT do something that they are uncomfortable with or that may place the patient in an atmosphere of less than optimal care. Good for you!
I must add though that this may not make you the most popular nurse with administration. But are we there for administration or the patients?
Good luck with the fall out from your strong stance and sticking to your ethics.
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Charles S. Smith, RN, MS
There are 3 places you should look for answers to your dilemma. First, look in your nursing policy manual for the float policy. This policy must address who can float to what areas. The policy should address what types of care you are to perform in an unfamiliar environment with skills inadequate to provide appropriate care. If your hospital is JCAHO accredited, look at the JCAHO requirements for safe and effective floating. These requirements are very specific and hospital/nursing policy must reflect these requirements in order to be accredited. If these requirements are not met, your hospital has violated its own policy and can be held liable for incidents that occur (respondeat superior). Also call your State Board of Nursing for guidelines. Since you are a new grad with no telemetry experience, I am sure they will give you the written guidelines.
Remember, though, when floated to an area where you are unfamiliar or are not prepared skill wise, you can bargain to do basic nursing care. Basic nursing care is within your scope of responsibilities and your capabilities. Hand over other duties to better prepared nurses.
As always, Chas has the greatest answers. If you have a union, this should also be addressed in the contract.
Our hosp nursing P&P states we can float to "like" areas, e.g., NICU to peds or post partum, med-surg to other "floor" areas like ortho or neuro, PICU, PIMU, peds floor to NICU (they work in the less acute, convalescing area, with a staff buddy, and are carefuly oriented), etc.
If, when floated, we recieve an assignment with which we do not feel safe, we do try to negotiate; if that doesn't work, there is an assignment despite objection form we can fill out that goe to management and to the union.
We can refuse an assignment, but if an assignment is accepted, you can't leave, that's considered abandonment. It would probably be better NOT to accept a dangerous assignment than to put a pt's life and your license in jeopardy.
BE SURE to write a letter stating your side of the story for placement in you personnel file.
I think you did the right thing. When I was a new grad, I looked at floating like some sort of adventure, or a learning experience. I would even consider how it would be to work there; if they were mean to the float... I asked a gazillion questions, they were probably glad to see me go!
Even now, when the census gets low in the NICU, I try to keep it in my mind that it could be my turn to float today, so that they don't surprise me. I keep a good attitude; I know I'm not a "plug and play" nurse, but I usually know nurses on those other floors because they float to us. That makes it easier, at least there are friendly faces.
When I was brandy new, less than 6 months on med/surg- ICU needed a float. I knew I wanted to do ICU, no one else on my unit would go, and the house sup insisted the float was just for a pair of hands- no assignment. Well, I went.
I get there and the doc starts giving me report on the new admit who crashed pre-hospital and was now unstable, proned, and in 4 pt leathers. I balked. Reminded them of why I was there and what my abilities were- "things changed" while I was in the elevator.
I refused the assignment and was yelled at by the RNs and the sup and was written up. This was a union hospital. It was horrible and I got no support from anyone but my lack of knowledge could have killed that woman.
Hopefully you will have better experiences and will find a buddy who will continue to mentor you long after your orientation. But never take an assignment you aren't qualified for and never assume that higher ups are aware or are bothered by your abilities. If you take something on that you shouldn't have, they will blame you, not support you. You did the right thing and don't let them tell you otherwise.
If I understand correctly, you can refuse to float to any specialty unit for which you have not received orientation. Haven't actully looked this up in the nurse practice act but haven't had administration write me up, either. I have also refused asignment when the nsg. supervisor was short staffed and gave us too many pts. Amazingly, after she claimed she couldn't get anyone to come in after calling around for 2 hours, she had an additional licensed person less than 10 minutes after we stood up for ourselves and our patients. It still wasn't full staffing but was doable. We have to advocate for ourselves as well as our patients.
hollykate, you mentioned that you use a floating checklist. I'd appreciate any specifics. If anyone else uses a floating checklist, please reply with the specifics. This week with no advance notice, our unit began forcing RNs to float to a less desirable unit which has difficulty retaining staff. Hopefully this checklist will provide management with information and ease the floating arrangements.
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