Floating

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So I work float pool but an interesting topic came up yesterday while I was on a med- surg floor. Thought it might be a good topic to discuss.

So a nurse from a psych unit was also floated but he had not done med-surg in more than 15 yrs. No orientation to the unit or equipment.

Anyhow, that sparked a discussion at work and obviously there were 2 sides.

1) If you have RN/LPN then you are fair game and expected to float regardless.

2) They should give an orientation at least before expected to float to other units. Not a full orientation but some kind of training/re-training. Especially if float nurse has no experience with that floor or has not worked that area in several years.

Specializes in Utilization Management.

When I was a Rehab floor nurse, my co-worker was floated to...wait for it...the CATH LAB and expected to fully take over the duties of the off-going nurse.

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Specializes in Pediatric Critical Care.
When I was a Rehab floor nurse my co-worker was floated to...wait for it...the CATH LAB and expected to fully take over the duties of the off-going nurse.[/quote']

Insane!

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I'm actually a float pool nurse right now. However, if I'm put in a situation where I have no experience or don't have the knowledge necessary to care for a patient I let management know and they are responsible for either training me or changing my assignment. I feel like Psych is a highly specialized unit and shouldn't be interchangeable with Med-Surg etc. Once I got floated to Psych and had no experience there so I had NO IDEA about not having scissors, sharps, or a lanyard around my neck. Another nurse saw me with all of my gear and almost passed out.

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Just because you're an RN doesn't mean you can just be floated around, let alone a psych RN.

Does this mean, you being in the float pool and a licensed RN can work or be floated in a hemodialysis unit? Of course not!

It seems like nothing bad happened. But that's just plain wrong and was unfair for this psych RN and for the patients.

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Specializes in Case manager, float pool, and more.
I'm actually a float pool nurse right now. However, if I'm put in a situation where I have no experience or don't have the knowledge necessary to care for a patient I let management know and they are responsible for either training me or changing my assignment. I feel like Psych is a highly specialized unit and shouldn't be interchangeable with Med-Surg etc. Once I got floated to Psych and had no experience there so I had NO IDEA about not having scissors, sharps, or a lanyard around my neck. Another nurse saw me with all of my gear and almost passed out.

Exactly. My manager would have a fit if any of us were floated like that without at least some orientation or something. Nothing bad happened, but it sure got us all talking and expressing concerns.

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They used to float me to tele all the time despite my telling them I only recognize very basic rhythms. I'm not a cardiac nurse and have no experience in that field other than what is seen on a general med/surg floor.

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Specializes in Critical care, tele, Medical-Surgical.

From my state's hospital regulations. Hospitals have been cited for floating licensed nurses who were floated without having demonstrated competency and oriented to the unit.

... No hospital shall assign a licensed nurse to a nursing unit or clinical area unless that hospital determines that the licensed nurse has demonstrated current competence in providing care in that area, and has also received orientation to that hospital's clinical area sufficient to provide competent care to patients in that area.

The policies and procedures of the hospital shall contain the hospital's criteria for making this determination...

View Document - California Code of Regulations

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The hospital I work at currently does not have med surg nurses float to specialty areas or nurses from specialty areas float to med surg floors. We pretty much float like to like. psych nurses do not float to med surg floors and med surg nurses do not float to psych. At the the previous hospital I worked at (I was on geri psych) and nurses floated to all areas (i was lucky in that in 2 years I never floated but I worked nights) but the med surg nurses who floated to us were usually terrified at floating to an area they knew nothing about, meds they werent familar with, and patients with behaviors they had no clue about.

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I'm a psych nurse and even floating between age groups can be a challenge. I have experience with adults and geri psych, so when I float to peds psych I feel completely out of place. The developmental stages and behavioral issues are so different; I have a hard time knowing what to say to a kid in distress versus and adult. That and all the laws are so different regarding minors and adults in psych- for example length of time in restrains without needing another order is significantly shorter for kids. I guess what I'm trying to say is floating anywhere is hard.

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Travel nurses are the first to float on any unit which has been a con for me since starting. I don't mind it unless it's mid shift. Like coming on, getting an assignment at the beginning of your shift (5:1), then at 11 pm being floated to receive a new team. I worked at a hospital where it was legal and normal practice to float nurses every 4 hours. I've received report from someone who had 12 patients throughout her dayshift, that couldn't tell me one thing about her last 4 patients. She was totally discombobulated, disoriented and flustered!! Who wouldn't be, I feel this puts our license on the line! Fatal jeopardy! Talk about preventable sentinel events. Needless to say I didn't extend my contract at that facility! It never makes sense to me that a fresh nurse coming in gets the patients you've had for 4 hours and you then have to float an receive another team. Continuity of care is lost and patient satisfaction scores plummet. It's all about the numbers know a days........

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Specializes in Pediatric Critical Care.
Travel nurses are the first to float on any unit which has been a con for me since starting. I don't mind it unless it's mid shift. Like coming on, getting an assignment at the beginning of your shift (5:1), then at 11 pm being floated to receive a new team. I worked at a hospital where it was legal and normal practice to float nurses every 4 hours. I've received report from someone who had 12 patients throughout her dayshift, that couldn't tell me one thing about her last 4 patients. She was totally discombobulated, disoriented and flustered!! Who wouldn't be, I feel this puts our license on the line! Fatal jeopardy! Talk about preventable sentinel events. Needless to say I didn't extend my contract at that facility! It never makes sense to me that a fresh nurse coming in gets the patients you've had for 4 hours and you then have to float an receive another team. Continuity of care is lost and patient satisfaction scores plummet. It's all about the numbers know a days........

I've done the q4h float thing too. You never have time to really think about things in depth, and its always just "what meds and tasks are due in the next 4 hours?" Plus, when you switch units at the 4 hour mark, nobody seems to remember that you have to give report before leaving and you can't just teleport to the next location!

I always felt so bad for the patients that get the q4h nurse change. Talk about lack of continuity of care.

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Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

In school, we were required to attend a board of nursing disciplinary hearing. One nurse was there to try to obtain her license after the following incident occurred:

Nurse stated she was an ICU RN whose mgr asked her to float to ED. She stated she verbally told her mgr she was uncomfortable with this.

She recvd a pt who was, according to her, involved in an assault / mva / trauma of some sort. I believe that she said the pt was screaming and hysterical and happened to also mention feeling numb / tingly. The nurse did not implement appropriate interventions.

It seemed as if the pt suffered a sentinal / near sentinal event.

She lost her license for failure to provide prudent nsg care.

I was shocked, because I wouldn't have known what to do in that situation either. I now do, because the story stuck with me.

However, the story made me understand that there are potential risks to your license if you float to an unfamiliar unit.

I try to keep this in mind when I get weird assignments without training on the needs of that particular type of pt.

Also, because of our union, we have a form we can fill out called assignment despite objection that gives mgrs notice that you believe your assignment is unsafe for pt care.

From what I understand, once you receive report, you are responsible to care for the pts Needs, even if you later on state you felt you weren't sufficiently trainined.

In my opinion, sometimes, it's best to just say no to an unsafe assignment that you aren't trained on how to provide appropriate nursing care.

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