Floating to other units, or not floating and how do you staff.

Daytonite, BSN, RN · Sep 15, 2005

Most of the units in my hospital float to other units, the unit I work on hasn't been, but now admin. wants us to stand alone, with no help from house floats, so we are supposed to come up with a plan on how to staff our unit, do we designate nurses to be on call or what. My question is what does your floor do? thanks

When I was a nurse manager it was one of my primary daily functions to make sure my unit was adequately staffed. Most of us head nurses made the staffing office our first and last visit of the day. We used prn and the part time staff to keep overtime down. We cut deals with the staff, such as "if you come in and work 3-11 tomorrow, I'll give you Saturday off." Then, I had a few more days to find someone to fill in on Saturday. It seemed like we were always robbing Peter to pay Paul, so to speak. Also, as a manager I got to know which staff nurses on units other than my own didn't mind floating and I would approach them about helping me to fill holes in my schedule. This was an exhausting part of being a head nurse and was a skill that took the longest to learn (I'm talking 6 months here). However, a smart manager knows that "romancing" and keeping a prn or float nurse happy will result in a better chance of getting them to come in and work on their unit.

So, from the staff nurses side of this. . .if you see "holes" in the work schedule bargain to work one of the "holes" to get a day off that you want. It could be one way to get out of working a weekend day. Make sure you have some sort of way to keep track of what you are doing by paperwork so you don't get caught as a no-call-no-show for a day you negotiated off this way. Most places have or should have some sort of paperwork that goes to the staffing or nursing office regarding changes in the schedule.

The best advice I could give you would be to negotiate and bargain with your co-workers to see what kind of coverage you can come up with among yourselves. It sounds like that is what your administration is trying to get you to do anyway. If you are going to be allowed to go into overtime (which I strongly doubt) get as much OT as you want. Utilize your part time nurses to help out. When I was working on my BSN I was very happy to work every Friday, Saturday and Sunday and my counterpart nurse worked every Monday, Tuesday, Wednesday and Thursday which thrilled her to death because she had every weekend off.

The fact of the matter is that the nursing supervisors are going to have to come up with some staffing solutions too. When they come in to work their shifts they usually have to look at each unit's acuity, how many nurses are scheduled to work and where. They have to figure out how to maneuver staff around according to the acuity of each unit. It's a mind boggling job. They are usually the ones who make the decisions about floating, not necessarily the nurse managers. There again, if you're thinking about earning some overtime, give the nursing supervisor a call a couple of hours before the start of a shift and offer your services. If they need you and are willing to approve the overtime, you will be working. You can negotiate which unit you will work on. If they sting you and you end up floating, you object and never help out like that again. But, if they're smart they will stick to any deal you made with them.

A problem I see with what the administration in your hospital is mandating is that it assumes that all nursing positions are filled, there are no vacancies, no one is on any extended leaves of absence and no one is calling in sick. That can't possibly be the situation, at least not in my experience. Not knowing anything more than what you posted it sounds like nursing administrators are frazzled about the complaints about floating and the staffing situation in general and have kind of passed the buck to their nursing managers who have passed the buck to their staff nurses. But as I said, that's just my observation. In the end, the fact is that the final responsiblity for staffing a nursing unit is the nurse manager's, not the staff nurse's. Staffing is one of the most difficult and intensive duties of nursing management and it can be a real pain in the you-know-what. Most of you, as staff nurses, are probably not aware of this managment duty.

jmgrn65, RN · Sep 15, 2005

thank you for input, what admin. is trying to say that if we don't want to be a unit that floats out and no floats in, not even house floats. Then we have to come up with a plan on what to do if call in's etc. do we have nurses be on call?

Some of your ideas is very good is talking to staff from other units that would/might be interested in floating or working the unit. thanks

USA987, MSN, RN, NP · Sep 16, 2005

We are a "closed" unit. Full time is 72 hrs. every two weeks. We are required to take 8 hrs. of call time every two weeks. We also have a holes list as the previous poster mentioned. These holes are usually filled by part-time or per diem employees. Full-time nurses can also sign up for the holes, but we are the first ones put on low census as it would put us into overtime.

Most of the time this works well. But, when it's really crazy it sucks that we have no one else to rely on but ourselves.

imenid37 · Sep 16, 2005

I am SICK of floating to the med-surg unit (one esp.) where the nurses are foul. Yes I do ob and you don't. It is a personal preference. I am glad to act like a nursing assistant and run errands, clean, feed, turn pts., fill water pitchers, do fingersticks, and some secretarial stuff. I will do assessment on pt's. who are GYN's less than 70 years old. I won't give meds to your 12 elderly pt's (meds and pt's not familiar to me). I am not doing an assessment on 10 confused, contracted people w/ CHF and on dialysis for you. I know you need help, but you need REAL med-surg nurses to help you. I would not expect you to interpret a fetal monitor strip or do a cervical check on a pt. if you came to my unit. Managers need to be brave and tell admin. if they want help, then they need to offer some $. If this particular med-surg floor paid bonus time on the weekend, they'd have more help like other places in the hospital. They'd also do better to tell their staff not to try so hard to bully or intimidate "helpers" from other floors. I wil not do what is not safe for me or the pt's. Pulling a nurse from another unit and expecting them to take off running is crazy. Penny-pinching administrators need to respect pt's and nurses alike and stop putting them in bad positions for the sake of the almighty $! It is asking for trouble and that big buzzword...medical errors.

Daytonite, BSN, RN · Sep 16, 2005

imenid37 is right. When I was supervisor we often had no choice except to float nurses. Hopefully, the nurses receiving the floats had sense enough to assign the floats to do things that were what I referred to as basic nursing care: V.S.s, I&Os, answering call lights, turning and repositioning, helping with toileting, etc. I checked up on the floats as soon as my report from the offgoing supervisor was finished and a couple of times over the shift. If they were assigned to do inappropriate tasks, then as the supervisor I would step in and re-direct the unit nurses to re-do their patient care assignments. A med-surg nurse going into a critical care area is really only going to function like a nursing assistant for most things and I would expect the ICU nurses to take on the responsibilites of taking care of the central lines, rhythm strips, cardiac outputs, etc. I think that is only fair and it's safest. I expected the same of med-surg nurses who recieved an ICU nurse as a float (yes! it sometimes happened). The ICU nurses would be scared out of their wits just like the med-surg nurses who floated into their ICU territory. If the med-surg nurses gave the ICU nurses a regular large assignment I would step in and re-direct the med-surg nurses to re-do their assignments. It was often more strategic to put an ICU nurse on an assignment like doing all the IV's or passing all the meds (we're talking about a medical unit here), or just work as a nursing assistant. To me, this is just using common sense. Sometimes that common sense has gotten lost in the stress and chaos of getting all the tasks done on a shift. When I became a supervisor I felt that this is one contribution that I could make in that position to help smooth things along during my working shift. I never forgot some of the harrowing experiences I had when I was floated as a staff nurse and I was glad to have the opportunity to make some kind of impact on a float nurse's experience. This is the kind of positive influence someone in a supervision or management position can exert. Not that I'm blowing my own horn, guys, but any nurse can make a big impact on her and her co-workers situation by using her leadership skills responsibly and with common sense.

Something else that used to bother me was staff nurses who complained about the float nurse help they got. Instead of putting on their thinking caps and coming up with a reasonable solution to splitting up their work load fairly and equitably, they would just complain. This kind of negative, wheel-spinning thinking just irks me to no end. It's OK to think out of the box sometimes. Nursing is a creative endeavor and when you put a group of us together, we should be able to come up with some very ingenious solutions to our problems.

Mommy2Katiebaby · Sep 17, 2005

Then there are we agency nurses... we cost money, but we're worth it when patient safety will be compromised by having folks work either shortstaffed or on zero recovery time.