Getting pulled...

[Bluebolt]

So I'm an ICU nurse in CT right now in the ICU. While being here I've found that they are using me as the official "pull" nurse to the progressive care unit. This unit takes up to 4-5 pts a piece, they are mostly off telemetry, vitals every 4 to 8 hours, everybody voids, techs dont keep up with accurate I/O's, always on the call light for petty wishes, no advanced medical equipment, no interesting challenging disease processes, etc.

So my problem is this is my worst nightmare unit. I went straight from graduation to the ICU for the very reason that I knew from clinicals I wanted no part of this type patient population. I find no professional development in it and personally dread going to the floor. I enjoy and take pride in what I do and that is the ICU.

Don't misunderstand, I'm not too good to ever help a PCU out on a rare occasion. I will put myself in a pull rotation schedule with all the other nurses in the ICU to help PCU out but this hospital uses me every time. Nobody else wants to go so I get sent every time. This has become a problem and I'm more like a traveler hired for the PCU who can float to the ICU if needed. I even took assignment on two critical patients, did assessments, gave meds, talked with families and they told me 3 hours into my shift they were calling in an on call ICU nurse to take over my patients so they could pull me to PCU. This felt like an insult and a slap in my face. Instead of sending the nurse who was coming in with no patients they were going to make me give up my patients to her and send me to pick up 4 new patients. Ridiculous.

The way you approach and think about PCU patients and ICU patients are different, I'm uncomfortable having patients off monitors and walking around the rooms, no IV drips, nothing.

So my question is has anybody else ran into this issue as a traveler? I of course understand you will be expected to be versatile, but to be pulled all the time?! Has anyone had any luck in putting in your contract that you don't float or you at least only float when it's your turn?

What have you done?

[Bluebolt]

If I find it important in my next assignment to limit floating I'll guarantee it's written into my short term contract. Management will be aware of floating stipulations and if there is some type of conflict with a union then we'll work it out or they will be in violation of the contract. I appreciate your concern but I don't travel to make all the staff my best friends. They love me now, as they send me out to other units so they won't have to. I'm there as a professional and not to make friends, if they are petty and selfish enough to refuse to float at all and resent me for it then I'm not looking for friendship with that person. I'm there to take care of patients for a few months, that's it.

As for other units and fragile ego's... everyone has their place. Some nurses like telemetry, med/surg, pcu floors and stay there for their entire career. I personally (like most ICU nurses) don't enjoy those areas at all and never want to work in them. Although I'm glad someone does like it because those patients have to have a nurse too.

[Underthemoonicp6]

Everyone works where they do for a reason. I work ICU because I like unstable pts and managing multiple gtts. I feel like most ICU nurses would say the same. At my last full time job there were a couple people who would float to ICU from ER when needed. They didn't particularly enjoy the experience and preferred their ER environment. Again, to each their own. But I don't feel disrespected because a nurse who has made a decision that they like to work in an ER does not enjoy working in the unit that I choose to work in. I appreciated them coming, and we would often give them easier assignments so that they're night can hopefully go as smoothly as possible.

This leads to my next point regarding ICU nurses floating. I experienced this in my permanent job and as well as a traveler. Maybe others could say if they have experienced the same. When floating I would seem to always get a horrible assignment with the pts that the regular staff don't want. So now I'm in an unfamiliar environment where I don't know where everything is, and my pts are rude or confused and trying to climb out of bed constantly. This was the main reason why the ICU nurses back home hated floated. Sure it's not the acuity that we desire, but if our assignment was actually reasonable most of the time then we wouldn't mind it as much.

The last point I want to make is that ICU nurses need ICU hours for CCRN. Whether they're trying to obtain it for the first time or need to renew, we need to verify that we are indeed and ICU nurse. If you're signing on thinking that you'll be working ICU but end up being floated most of the time, you are losing hours for your CCRN. A traveler at my last assignment had to pick up a lot of OT to make up ICU hours that were lost due to being floated too much on her previous assignment.

A piece of advice to Bluebolt, if you take an assignment at a smaller community hospital where it's either ICU, stepdown/PCU, or med/surg, you are more likely to be floated to a population you don't have a passion for working with. If you work in a large hospital with multiple ICUs like MICU, SICU, CCU, CTICU, and BICU, then if you have to be pulled you'll most likely be pulled to another ICU and not to a lower acuity unit.

[BonnieSc]

Very true, and the acuity even in the ICU may be too low to be interesting. All of the acuities at my current placement seem to be stepped down from what I'm used to--to the point that the med-surg units are just dead at night.

As I said I've got no issue with finding something boring (personally, I think I would find the ICU boring, based on my limited experience with it... not what I got into nursing for--and some particular units, like ortho and acute rehab, are nightmares for me). But what we non-ICU nurses tend to take issue with is the suggestion that our jobs are somehow less challenging than ICU. Or, not that you said this, that ICU is where the smart nurses are. Anyway, I think we're on the same page with that. I get that you're not in travel nursing to make friends, but there are plenty of petty, immature nurses out there who will find ways to take it out on you at work if they perceive you as getting special treatment. God, I hate this environment sometimes.

[Underthemoonicp6]

I agree that we are on the same page. I would never want to disrespect someone working in another unit because I struggle when I go to those units. Working ICU, I've seen the ICU nurses who think they are God's gift to nursing. I believe that's toxic to a work environment and think it's unacceptable when they talk down to others because "I'm an ICU nurse so I know everything." That's BS if you ask me. As a profession nurses are often seeking more respect whether it be from MDs, patients, or families. If you can't respect your fellow nurses how are you seeking someone else to respect you more?

I do think the original poster has a point though. I don't know what unit you work but if you were on assignment and hardly ever got to work in your desired unit, you'd probably be seeking a resolution as well.

[BonnieSc]

I was hired on at this placement for PCU and I've been on PCU about 1/3 of the time... the rest has been various med-surg units. I'm not sure why they even hired someone for PCU. But since, as I mentioned, the acuity is low here anyway, I don't even feel like there's a big difference. Floating every shift gets to me more than I thought it would, though--not for the same reasons as the OP, but because I don't get to build relationships with patients/families or build teamwork with the staff.

[NedRN]

I can tell you why! Higher trained nurse available for higher acuity patients as needed. They may not have even had to pay a higher bill rate than for a medsurg nurse. Pretty simple decision for both the manager and the bean counter.

[wanderlust99]

I have never liked floating because I work my ass off whenever I am floated. And I mainly work in CA with ratios. That's one reason I'll never travel to the south, for fear of having more than 5 patients at a time. 4 patients is rough, especially a group of 4 busy patients. I honestly would be happy to be bored if I am floated. I have had my ass handed to me on the floors before. That is a tough job. Especially those cardiac tele units with all these admits/discharges, post ops constantly coming in, chest pain, etc.. it is tougher than working in the ICU. Much respect.

But yea, floating is one of the things that makes me not want to travel anymore and has made me incredibly picky about any position I take. If you work in CA ever, I can tell you which hospital floats and who doesn't.