Floats

We use floats and sometimes there are problems, but for the most part, we give them the easiest kids we can find. The PICUs will take intubated kids ans sicker kids. We don't give them admits, dc's, things like that. We try to rotate the kids between regular and float staff...we have had things missed,etc when floats have them for too many shifts in a row (we don't find this with our PICUs though, they are the best ones we get).

Do you guys have float guidelines in place? We have to give them kids that are similar to the population they care for, even if it means we have to take a crappy assignment. For example...nurses from our PICU and comp care peds can take stable OETS, trachs, chronics (although we tend to not give the chronics to them if we can help it....they do better with people they know), the regular peds and nursery people can only take feeders or non-critical NPO's. We give them the option of giving their meds...some aren't comfortable with some of our meds. We also always have a resource person assigned to them.

Just like when we float to them...I'm sure things get missed or whatnot...it isn't an easy situation all around. When parents get uneasy, we do explain to them that the nurse can care for the baby, but they just aren't familiar with our routines. Sometimes, there isn't much you can do. Hang in there!

We're pretty similar to BittyBabyGrower.

We make sure that one of our nurses picks up assignments from agency and float nurses, so we can make sure things are going as they should. We start NICU agency nurses off with feeder-growers, and as they get more comfortable on our unit and we get to know them, we'll start giving them "normal" sicker assignments if they want. We give OB/NBN nurses feeder-growers or term babies on room air who just need hydration or antibiotics. things like that. Peds and PICU nurses will get either those same kinds of easy kids, sometimes stable preemies or chronics, never vents if we can help it. (Though if a very sick or chronic baby has a primary nurse on that shift, she'll always get that baby for continuity.)

No matter how good a float or agency nurse is, we never give them admissions because there is so much policy and procedure involved, not to mention paperwork.

Unfortunately we are too busy right now to guarantee them easier assignments. The "easy" assignments we have right now would be considered too unstable for them if we weren't so short. We also have a few kids who are only getting floats most of the time (long story, but PICU gets first dibs on them and things are being missed). I was the "resource person" for all of them the other night, but like I said I was the only experienced staff person in the room so I was the "resource person" for EVERYONE. Couple that with my own assignment and I don't have time to give them meds or even supervise them that closely. I caught a half dozen things they either missed or did against our procedures, but I can't even imagine what else I missed. It's not that they are bad nurses, it's that some of our policies are the opposite of theirs and they aren't used to our equipment (the isolettes or the med pumps).

fergus...you need to document all this because, unfortunately, if you are accepting the responsibility of being resource person to all these people it is going to be your butt on the chopping block. We don't give anyone dibs on any kid...they get who they get. Sometimes the same kids go to the PICUs because they are the type of kids that need to be up there and they are fine with them.

Man, I hope you slow up soon....we had a summer like that it was horrible...we had 60 some kids in a 50 bed (and a tight 50 at that) unit. It was horrid and none of us were liking each other by the end of the summer.

Unfortunately we are about 15 babies over census and we have trouble staffing when we are at our normal limit (we use a lot of registry and travellers to meet ratios).

My 2 cents...

I know you probably won't agree with me, but I think I'd take my short staffing problem over your short staffing problem any day! We don't have floaters-ours is a women's hospital, no peds. Regular nursery is not cross trained to work in our unit; they cross to post-partum. We do have a list of PRN NICU nurses that we can call, but they are not obligated to work. So...we all take bigger assignments when we get short staffed. It is what we are used to and, really, I would rather be responsible for my own 4 ICU babies than to have to be resource to someone unfamiliar with our procedures, protocals, and medications. Don't get me wrong, I love to teach and help out, but there are big risks when untrained nurses work on any unit.

Interesting comments!! I am a float nurse! I have worked in every unit of our hospital, and yes there are things that I don't know...but more times than not, I have seen and done more than most staff. I end up teaching much more than I learn anymore. While certain units become familiar with only their pt. population, I have taken care of lots of things. I don't need to take care of your ECMO pt, but I can do ossilators, burns/traumas, ortho, medical emergencies, surgical emergenices and neos.

Please be pt and give folks a break, just as you would want if you had to float somewhere...everyone has something to share and learn!

Interesting comments!! I am a float nurse! I have worked in every unit of our hospital, and yes there are things that I don't know...but more times than not, I have seen and done more than most staff. I end up teaching much more than I learn anymore. While certain units become familiar with only their pt. population, I have taken care of lots of things. I don't need to take care of your ECMO pt, but I can do ossilators, burns/traumas, ortho, medical emergencies, surgical emergenices and neos.

Please be pt and give folks a break, just as you would want if you had to float somewhere...everyone has something to share and learn!

I'm not downing the floats. The problem is they DON'T have the experience you obviously have. Many of them are new grads to their own unit, then they get thrown into ours (these aren't experienced nurses in a float pool). It isn't fair to them. They are all nice people and I try to help them all I can, because I really do like them and appreciate the help WHEN THEY HAVE APPROPRIATE ASSIGNMENTS. I just don't think it's particularly safe right now as evidenced by the incidents we have already had! They don't know the patients, they don't know the equipment, they don't know the norms. They don't even know what they don't know. You couldn't pay me enough to accept an assignment on a floor that I don't have the knowledge to safely take.

It is great that you enjoy working in so many areas and have the experience to do well in each. I have nothing against someone working in the NICU that knows what they are doing and more importantly, asks when they are not sure. It just is not something we deal with at my hospital because we are in a women's hospital as part of an adult medical center. We don't have floaters. Outside our unit their is no one here who is prepared to do what we do.

I would rather be responsible for my own 4 ICU babies than to have to be resource to someone unfamiliar with our procedures, protocals, and medications.

I honestly agree with you.

Fergus I don't know about California nursing law, but in Texas I had a Safe Harbor provision through the BON...where I documented my concern, shared it with management on paper. I utilized it several times when I was dangerously understaffed due to numbers of nurses or experience factor in the critical care setting.

You definitely need to get your manager on board with your concerns. Good luck.