General question for Critical Care nurses

Zee_RN, BSN, RN · Jan 4, 2002

My hospital as an 18-bed adult ICU and a 48-bed Telemetry unit. ICU Nurses only float to telemetry, not to Med-Surg or anywhere else. Telemetry nurses can be floated into ICU if there are appropriate patients for them to care for. Telemetry nurses were getting pulled into Med-Surg but I don't know if they're still doing it...it really raised a ruckus. And now Telemetry is so short staffed, they don't get pulled anywhere!

LilgirlRN, ADN, RN · Jan 4, 2002

My hospital has CVICU with 14 beds, ICU with 15 beds and a 35 bed step-down unit. CVICU and the 35 bed step down float back and forth depending on the patient census. CVICU floats to the ICU but they don't care for new craniotomies, Icu floats to CVICU but they don't care for fresh CABG's. We in the ED are rarely asked to help elsewhere and it's usually voluntary. I am frequently asked by the nursing supervisor to start IV's on the floors but that's about it. I myself have never been pulled from my unit. I would have NO idea what to on a floor, they utilize majorly different paperwork and use bedside computers that we don't have, nothing would be lacking in my care, I just wouldn't know how to document it.

askater · Jan 4, 2002

I'm actually from a cardiac step-down. Our "sister" unit is CICU. We get pulled there all the time.

They try to pull med/surg nurses to med/surg floors. Intensive care nurses to intensive care units.

I felt useless the times pulled to med/surg. I haven't worked med/surg for 5 years. And when I did it was at another hospital.

I feel more comfortable on CICU. Everytime I'm pulled I tell them I have no vent experience. Fortunately I've never had a vent patient while pulled. Our supervisor said if pulled and given a vent patient we'd have to take that patient. But I WON'T accept that. For the sack of the patient, unit nurses and myself.

defibvt · Jan 4, 2002

Although floating is very difficult, I have never had a problem with it. I started nursing as a med-surg float LPN and then held the same position as an RN.

Albeit difficult at times, I find it refreshing to get back to the basics of nursing. The regular floor nurses are more than helpful and even ask for my expertise in certain situation.

I can understand the frustration of critcal nurses being pulled to the regular floor but I feel that patient care is patient care. Some of the nurses on my unit have a elitist attitude toward floor nurses, I on the other hand am humbled with the complexity of nursing care that they do. Imagine taking care of 5-10 patients and their families and being able to actually keep it all straight. Ugh!! Give me a good ol' IABP and a bunch of drips anyday.

What I am trying to say is my hats off to them. And I will work with them anytime, anywhere, and any day.

RNed · Jan 4, 2002

23 bed CV-ICU. We float to PCU (tele-unit) on a rotational basis, PRN. This does not happen often, about once every two months per individual.

We float to no other areas of the hospital.

Jenny P · Jan 5, 2002

Our hospital has CCU, ICU, and CV-ICU plus 2 tele step down units and an interventional CV-care unit; so those of us in the critical care units float to those units only. It is very rare that a tele nurse floats to my unit (CV-ICU), but it does happen at times and we try to give them the stablest patients we have. We also have remote tele in our hospital, but I know nothing about that!

I have the utmost respect for any nurse who can juggle more than 2 or 3 patients-- I recently read somewhere that med-surg IS a SPECIALTY and should be considered as such instead of being thought of as the training grounds for specialty or "real" nursing (I'm not kidding; that's what the article said!).

Many years ago (>13!) I had to float to ortho and came out of report scared silly! I told the nurses that the only thing I knew about anything on that floor was the code cart! Those nurses were so kind to me that whenever it was time to turn or move my patients, they came in and did it for me! It was probably the safest thing for those poor patients, too! :eek:

mattcastens · Jan 5, 2002

I know what you mean, Jenny. I would say that med-surg is definitely a specialty -- which is even more reason to not float critical care nurses there. I have never had any problems floating, nurses have always been helpful to me, but that doesn't mean I like to do it.

Floating from critical care to med-surg takes a huge shift in practice. Assessments are different, there are more things to juggle and less time to manage them in, and I can't stand not having the time to read and know about every aspect of my patient's history and hospitalization. Fortunately, it doesn't come up a whole lot. Med-surg is a specialty I'm just not cut out for ... sort of like OB. :)

Jenny P · Jan 5, 2002

The thing that amazes me about med/surg nurses is that they know how their patients are doing WITHOUT MONITORS and machines!!! :eek: :eek: :eek:

You'll never catch a critical care nurse doing that!! :eek:

pebbles, BSN, RN · Jan 6, 2002

At our hospital, Critical Care nurses can be floated to any of the critical care areas. On the general wards, they may be floated to the Step-down units (and will have only 2-3 acute patients). They are allowed to refuse if someone tries to send them to just a general ward.

But there's such a shortage if ICU nurses here, and the ICU is almost always overflowing, so the issue almost never comes up.

-jt · Jan 6, 2002

By contract, all of our floors are divided by division specialty and nurses may only float within their specialty division - and only after being properly trained on that floor. We float by order of least seniority and then up the chain so its not always the least senior nurse floating.

Critical care floats only to critical care (ICU-CCU-Telemetry-ER) and when floating to ER, is floated only to the critical room in the ER and may not take that room without regular ER RNs also assigned to be in there, med-surg floats only to med-surg but if a med-surg RN from one floor is floated to the oncology med-surg floor, she cannot be assigned any pts receiving Chemo. Maternal/Child floats only to other areas of maternal/child.

Some areas are one-way floats and are also dependent on the nurses usual specialty ie: NICU RNs may float to peds ICU and care only for the infants. Peds ICU RNs may not float to NICU Intensive Level but may float to NICU Intermediate step-down. L&D RNs may float to Mother-Baby and care for both mother & baby but Mother-Baby RNs may not float to L&D. They may float into Well Baby Nursery. Long-term ventilator unit nurses may float to med-surg but med surg are not usually floated into the ventilator unit & if they are, they can only take pts who have already been weaned off their ventilator.

Psych is a closed unit and those nurses float only to the psych ER.

OR & Ambulatory Surgery are closed units and those nurses do not float. PACU is a closed unit and nobody floats in but PACU RNs may float to Ambulatory Surgery's Recovery Room. Sometimes when they have no cases in either RR, the nurse may volunteer to float to critical care if needed since they all are critical care RNs to begin with - but they cant be forced to do that.

Floating staff nurses is to be done only in an emergency & is not to be used as a "staffing tool" and may only be used as a last resort. We cant be scheduled to float.

Since all of this is guaranteed by contract, the hospital must uphold it & cant have float us wherever it feels like it or use floating as a regular means to staff a unit. Known holes in the schedule must first be filled by per diem, voluntary OT, and agency.

ratchit · Jan 8, 2002

I haven't worked the floors in years and feel like a fish out of water there. The nurses who can do that job well get a HUGE round of applause from me!

I don't think it's elitist to say that an ICU RN shouldn't float to med/surg. I don't know how to do the job. A med surg nurse shouldn't be floated to ICU either.

Best float policy I ever saw was closed unit- you weren't asked to float to a unit that wouldn't be able to return the favor. A close second was the hospital that would float ICU nurses to med/surg as a last resort but only allowed a 1:4 ratio. I don't know med/surg charting, med sheets, or time management. Give me fewer patients to be 100% responsible for and if I have extra time I'll be more than happy to spend it helping others out.