Floating

[luvmybabes]

I just returned to work after a FMLA of 4.5 months. I am on restricted hours, 6 hours per day for 2 weeks. I was to work Fri, Sat, and Sun. Fri and Sat were going to be refresher days. I needed to update on our Epic system and all the changes in education and equipment that happened while I was off. We are not to do education at home or when on FMLA.

So, I sit down on Fri and start printing off what I need to work on. 30 minutes into my refreshing, my supervisor says I have to float to LDRP. I am a NICU nurse. We don't do moms. I did go and helped with discharges, babies and other tasky items. I did so without arguing as I was gone and it was my turn to float.

So I get to work for day 2 of refreshing to the unit, didn't get day one to do this, and I was told I needed to be a sitter in 3 ICU. There was a combative patient with a ICP drain, central line, Fentynal drip urinary cath and so on. I am told to not let him pull out any of his equipment. Before I finish getting report, I am told this patient was made a one on one with his nurse.

So on to the next patient. This patient is laying sideways in the bed, moaning in the bed, hand all over his body. He has an ICP drain, rectal tube, cental line, urinary cath and NO fentynal drip. I am to write down hourly information and make sure he doesn't pull anything out. This patient is trying to sit up, swinging at me when I try to move his hands away from all this equipment. I call my charge nurse in the NICU and tell her this is not an appropriate assignment for a NICU nurse. SO they were going to move the NICU, unit secretary into that room and me into the room she was sitting. I went to change assignments again and again called the NICU Charge nurse and tell her this is not appropriate for our unit secretary either.

Now I am in charge of the little old Alzheimer patient that gets confused and needs to be observed. The house supervisor then comes into the room. The NICU unit secretary is to stay with the little old lady, a CNA from 3 med/surg is going to watch the patient trying to pull everything out and I am to CNA on 3 med/surg. Just a little background info. I have a 4 level spinal fusion and have permanent weight lifting restrictions of 35 pounds. I can't get patients up, walk them or roll them. So the 2 CNA's that are on 3 med/surg are upset and rolling their eyes at me.

I am a NICU nurse since 2002. I have had 1 year of adult hospital nursing in 1997. I feel it is unsafe to put a nurse with very little experience in adult care into this situation. How would these nurses feel if they had to float to the NICU. They would refuse. We needed help with a withdrawal baby, just someone to rock him for many hours as when you put him down, he would cry continually. Everyone of the adult world staff refused to do this. We never see them when we are busy. We would not treat them the way we are treated when we float.

How would you feel as a patient if you knew a NICU nurse was helping with your cares? I need input on how other hospitals handle this and if anyone knows of any research articles that will help me with this problem.

Thanks

[HouTx, BSN, MSN, EdD]

Sounds like you got stuck in a series of bad situations. All nurse supervisors KNOW the limitations of floating. Nurses who accept responsibility for an assignment that is beyond their capability/competency are demonstrating unprofessional behavior. Your only defense is being assertive - just like you did. I'm sure it will get better.

[Here.I.Stand, BSN, RN]

While on one hand I don't agree with the concept "a nurse is a nurse is a nurse..." and were they asking you to float to the adult ICU as the nurse, that's a really bad idea. Likewise a med-surg nurse shouldn't float to the ICU, I as an adult ICU nurse shouldn't float to the OR...I once refused a PICU float myself because I didn't even know what hemodynamic values were normal for a child (but alternately I agreed to go to med-surg, which wasn't typically in the ICU float group).

On the other hand though, we have CNAs sit with pts like you describe all the time. They're not expected to know how to manage a ventric, not expected to know what to do if the pt's ICP is high--just keep the pt from pulling it out. They are considered competent for this. So I don't think it's unreasonable that an RN should be able to do the same, to just keep the pt from pulling at their lines. Along the same lines, I don't think it's unreasonable that an adult RN could float to the NICU just to rock the withdrawing baby. She wasn't being asked to be the NICU nurse.

That said, why are you floating 2 days in a row?? That stinks. Also, if that pt on day 2 was showing signs of pain such as writhing around in bed and moaning, perhaps his assigned RN could have managed his pain better. That means adequate prn's if not a drip.

[Here.I.Stand, BSN, RN]

Although I just had another thought. If the pt did manage to pull his ventric, would you be held more responsible than a CNA would? That would be something to ask your liability ins. carrier about.