Floating to your unit

km5v6r, EdD, RN · Dec 30, 2006

Right now my PICU is so full with such high acuity I practically kiss the feet of any float who comes in. We will even have ADULT med/surg floats. I know they are scared spit less. We are having a hard time finding kids the floats can take. Just before Christmas 10 out of 12 of the kids were intubated with several 1:1's. Yesterday we had a float from general peds who had to take a pt with an Aline, CVP and dialysis. Honestly that was one of the most stable pts on the unit. I tried to help as much as possible but I was either dealing with a complicated family with a fragile child or a vent with freq suctioning. Personally I don't expect everything to be done or perfect when the float is there. How can they be? You are one person in an unfamilar environment working with unfamilar people and procedures. I am just so happy there is another set of hands and eyes. I admire anyone who chooses a position in a float pool. You learn many different units, rarely have the same assignment twice, and deal with a broad range of people. NICU huh? No thank you. To be honest if I were floated to general peds I would be posting the same things and having the same questions. I haven't had to try and coordinate the care and meds of more then 2 pts in years. It gives me the heebie jeebies just thinking about it. Any staff nurse who looks down on or becomes upset with qestions from a float doesn't deserve the extra help.

perfectbluebuildings, BSN, RN · Dec 30, 2006

Well I really appreciate you and nurses like you!! (To clarify, I am not in a float pool but am usually a general peds floor nurse.) Thanks for your perspective. I hope things get better on your all's unit soon!

Pediatric Critical Care Columnist · Dec 31, 2006

In our unit we float out, but only NICU (and very rarely at that ) floats in. When they do, we have to find them a suitable patient, meaning one that weighs less than 5 kg. With the number of nurses we already have with weight restrictions it's often very difficult to accommodate the NICU float. There's a sentiment that the float nurse should not be given an assignment in PICU, but that is inappropriate. The nurse without an assignment is the one who helps everybody else out with their assignments, runs to codes, takes the trauma admission or takes charge. So it's unrealistic to expect to float to PICU and be "extra". The patients we would assign to a ward float would be the kind of kid who would be going-to-the-ward-in-the-morning kind of kid.

perfectbluebuildings, BSN, RN · Dec 31, 2006

I want to float to your unit. Althought that sounds hard on PICU regulars.

The only thing we WOULDN'T get floating to PICU would be a kid on a vent.

AliRae · Dec 31, 2006

As a PICU person, I can be floated anywhere- peds, hem-onc (which scares me to death every time), peds ER and NICU. We get floats from pretty much any of those floors, and the occasional adult float. When we get a NICU person in, we give them the smallest kiddo. That's not too hard these days, because of a new policy that cardiac newborns come to us instead of NICU. We've got lots of minis around! When an adult person comes in, we'll try and give them the biggest kid. Or, if we have all small people, we try to find a kid with a more "adult" problem. We try and spare them the RSV and such. Whoever's in the pod next to the float (provided her kids aren't too crazy) seems to be the unofficial go-to person for that float. If we have to give a kid with an a-line or central line to a float, one of us will manage that for them- draw labs, calibrate etc. We get a lot of flak from other floors who don't like to float to us, but I think it's just hard to float no matter what. I get scared to death when I have more than 2 kids, and the idea of not knowing what's about to roll through the door turns me to mush. To each her own, I suppose.

AlabamaBelle · Jan 1, 2007

When we get floats from the general Peds floor, we do try to give them the most stable (room air, maybe a stable trach). We are just so grateful for the help and generally, we just don't have the time to sit and rag on the floaters -- we understand that they are doing the best they can.

By the same token, when the PICU nurses float to the floor, the floor personnel, in my opinion, generally tries to be good about the PICU RN's assignment. I did give them all a good laugh one night -- I was teamed with another RN in a pod with 10 kids - I asked, in all innocence, where were the other 2 RNs with us in this pod???? What do you mean I have 5 kids. Turned out great, though, they were superb to me. The general Peds floor has always been great to help us out in the PICU, so it would be in very poor taste to appear at all ungrateful.

The RNs who work in our hospital's NICU rarely, if ever, float. They tend to suck up all available RNs.

Just know that you gave it your best as it appears from your post and that's all you can do.

Cindy, RN

perfectbluebuildings, BSN, RN · Feb 7, 2007

So... I want to follow up because I floated again to the PICU on Saturday night, and although (once again) I had a decompensating pt who actually ended up intubated by the end of the shift- it was a WORLD of difference!! There were different nurses and a different charge nurse that night who were right by my side when I needed anything, wonderful RTs, and treated me like a competent intelligent nurse as well. So I wanted to come back and tell you about it, relevant or not as it may seem to you, and thank you all for the work you do- I got to work with many good PICU nurses that night and realized the others were probably not representative!!

(Although now I do have a reputation for "breaking" kids up there jokingly of course)

OK- that was a lot of rambling and still not getting my point across, but I know I was so negative the last time and wanted you to know the difference.

AliRae · Feb 7, 2007

Yay! Glad you had a better time this time around. We had the same thing happen to a float nurse yesterday, only we managed to keep the kid from getting tubed.

Now stop breaking PICU kids! :chuckle

AlabamaBelle · Feb 7, 2007

RayRae-

So glad this float was better for you. We, too, kiss the feet of the floor nurses who have been floated to our unit recently. We are a 12 bed PICU that has been running a 14-16 patient census since Christmas. We are finally down to 11 patients. We have been getting many floor nurses and always try to give a good assignment or they are the helpers - and helpers are the most invaluable people going!!!

We love having help. I think in our unit, we all take turns "breaking" the kids. But then again, we have had some that are so broke, you know you can't break broke.

On Friday we lost 2 children. One was a withdrawal of support and one baby with Pertussis coded multiple times before the parents said no more. Had floor nurses there and they were fabulous!!!!

:smilecoffeecup: Cindy, RN

Pediatric Critical Care Columnist · Feb 7, 2007

RayRae, those kids were probably broken long before you got them, and nobody picked up on it. It happens all the time. I work with some people who look at them as "just bronchiolitis" or "just aspiration" and get cavalier about assessing and watching and expecting. So don't go getting a complex about your experiences... it's not YOU!

perfectbluebuildings, BSN, RN · Feb 8, 2007

thanks a lot all of you!!