Forced to float and already short

[DYLANB]

The hospital I work for has for several years now used a system where they will float two nurses, one from a critical care area (ICU/CVICU) and one from a medical/tele unit, to the ER when they are holding pts. (pts with admission orders but no room in the hospital to accomodate them). If it is your units turn on the schedule to float and the ER is holding pts reagrdless of what staffing looks like for that day on your unit you will be forced to float a nurse. Now to make things worse, they have recently started to float a nurse from units not scheduled to float to ER to the unit who is floating a nurse to ER leaving you short a nurse even though its not your day to float. This whole thing drives me crazy. I am a charge nurse in the ICU and I end up having to float nurses away from my unit while already short to begin with. I asked my director if we could have a meeting to solve this problem and his response was "I don't see what the problem is we've been doing it like this for years". I explained what I felt the issues were and he was very short with me stating he had to leave and we could talk later. Any thoughts on this situation or similiar situations in your hospitals?

[jadelpn, LPN, EMT-B]

Ugh, tread softly else you will be the one who will have to float or take the extra patients.

Is your staff unhappy with floating? If so, you could go at it by that angle.

Perhaps the ER or med/tele should have a float pool or per diems or part timers.....or sounds like full timers who are specific to the holding area of the ER.

All to save money. Sigh.

The only thing you can do is to state that your ICU is a 1 nurse to 2 max patients. That when the nurses have to have 3 patients, it is a patient safety risk. Dig up your state's stance on ICU ratios, even your professional organization's stance as well.

But again, be forewarned that you could end up being a charge/manager who has to take patients, or even float. Which may not be a good thing--it makes me nuts that directors (a nurse?) are so short about these things...when it will be a cold day in heck when he puts on a pair of scrubs and helps.

Good luck and let us know how it turns out!

[SubSippi]

What would happen if you told them no? If mistakes are made in your unit due to unsafe staffing, I doubt you'll be given a break.

At my hospital a group of nurses refused to float to another unit and redivide their patients. Before that, nobody had ever refused to float, but the acuity was insanely high, and I think they felt like they were being taken advantage of and had enough. The director ended up having to come work a night shift on the floor because they couldn't find anyone else. Everyone involved got written up, yelled at, and suspended. But they also managed to magically find a way to hire a couple nurses to this floor that was chronically understaffed, and was the reason for the constant floating.

[icuRNmaggie, BSN, RN]

What would happen if you told them no? If mistakes are made in your unit due to unsafe staffing, I doubt you'll be given a break.

At my hospital a group of nurses refused to float to another unit and redivide their patients. Before that, nobody had ever refused to float, but the acuity was insanely high, and I think they felt like they were being taken advantage of and had enough. The director ended up having to come work a night shift on the floor because they couldn't find anyone else. Everyone involved got written up, yelled at, and suspended. But they also managed to magically find a way to hire a couple nurses to this floor that was chronically understaffed, and was the reason for the constant floating.

This is a great example of how a group of nurses who stand together can effect big changes.

[Esme12, ASN, BSN, RN]

Choose your battles carefully. ER over crowding is a big deal. Solutions cost money I would do your research abut patient satisfaction and CDU units. Clinical decision/hold units and the improvement of patient satisfaction scores. Show them the money and they might spend the money.

Approach it as a cost development patient satisfaction improvement with a positive outcome and a solution for that process. A positive spin that might increase revenue and satisfaction scores as well as expedite the ED admit process to therefore decrease wait times....instead of a complaint session where nurse are considered to be whining. Your boss has no real control over the decision to float...which I am sure accounts for his curt response.

clinical decision units and patient satisfaction

[icuRNmaggie, BSN, RN]

I think the original poster was describing an ER overflow unit not an observation unit.

If hospitals would offer cash incentives to work the overflow unit during times of over the peak capacity, it would be fully staffed. For example, double time plus $20 per hour. They have no trouble getting people to say ok to that. Some hospitals still do this, mainly in the New England states. It is not my fault that nursing administration didn't advocate for the patients and trying making a few phone calls. They think we're stupid.

It is perfectly okay to say no, unless it's a hurricane or a blizzard, I can't do it. They need me here. I would rather do that than leave my coworkers in unsafe situation.

[firstinfamily, RN]

It all comes down to revenue, it is ashame but true. If your ICU does patient satisfaction surveys you can use that as a tool to show the pts needs are not being met. Is there family member issues that are not being addressed, have them participate as well. The negative PR will have a greater impact than the group of nurses being proactive. Unfortunately, this is usually true. Once the director sees how the lack of staff can have an impact on the patient stay(staffing ratios) he might be willing to bring the problem to the higher levels of management. Sounds like they need to staff the CDU with regular staff. What are other facilities doing in your area??