Help!!!!!!!!!!!!!!!!!!!!

TazziRN, RN · Jul 23, 2007

Make sure that every time you are floated over there that you make it very clear that you are are not qualified to do anything but basic nursing on that unit, and that you consider it a dangerous assignment that you are accepting under protest. This will help if something negative happens because of your lack of experience in rehab. It wouldn't absolve you, but you'd be in a lot less trouble. Try contacting your BON to see what they say about it, it might be in writing somewhere.

And last......if it's been happening to you regularly and you're that afraid for your license, I would look for another facility to work for.

BBFRN, BSN, PhD · Jul 23, 2007

Contact your BON and state nurses association on the way out.

lyceeboo · Jul 23, 2007

Contact your BON and state nurses association on the way out.

"safe harbor" or "working under protest" ... in my experience i've never seen these work...too easy to blame the nurse IMHO

pls think abt moving on to another employer

llg, PhD, RN · Jul 23, 2007

If changing jobs is not an attractive option for you and you want to try to make it work in the position you are currently in ...

Emphasize your willingness to help out (and float) in any communications you have with your supervisor and/her any other administrators in your facility. Emphasize that while you are willing to help out, you need to have some orientation so that you can practice safely.

From a political standpoint, there is a big difference between saying that you "don't want to float" and saying that "you are willing to float, but need some orientation and/or some guidelines to do it safely."

At my hospital, each unit has a set of guidelines for people who are pulled to their units. Those guidelines include the types of patients they may be assigned to care for, the types of skills they will be expected to perform, information on how to locate and use resources they need to help them. After each shift of floating, the floated nurse fills out a form that asks how the experience went. This gives the nurse the chance to say whether or not the experience fell within the established guidelines and whether or not the staff on the receiving unit provided her with the support she needed to do the job safely. If problems start to develop, they can be dealt with through inservices and/or 1 on 1 education for all involved.

For example: When staff is pulled from a general care unit to an ICU, they are not expected to take a full assignment. They are used as "assistants" to the regular staff. When the neonatal ICU staff is pulled to a general pediatric floor, they are similarly considered "assistants" and not expected to take a full assignment. They may, however, be given more responsibility if the patient is under 1 years old.

BBFRN, BSN, PhD · Jul 23, 2007

"safe harbor" or "working under protest" ... in my experience i've never seen these work...too easy to blame the nurse IMHO
pls think abt moving on to another employer

I wasn't talking about safe harbor. I was talking about letting them know that this facility is engaging in this practice, in addition to leaving.

lyceeboo · Jul 23, 2007

I wasn't talking about safe harbor. I was talking about letting them know that this facility is engaging in this practice, in addition to leaving.

Yes I knew what you meant. I was just trying to put in my 2 cents with a quick post...by combining something TazziRN said with your suggestion. (Should have been more specific...but I'm at home babysitting and trying to spend a little time on allnurses.)

My concern for the OP is that I've spent 3 yrs in acute Rehab and 6 months in Psych. They are not interchangeable. BTW in the acute rehab hospital I saw 2 GOOD nurses named in law suits & 1 reported to BON.

All 3 cases involve long stories, pts who fell, etc... .. but suffice it to say short & inappropriate staffing played a large part in the problems.

I agree when this type of floating goes on it is often safer to get a new job.

MA Nurse · Jul 23, 2007

Anyone out there experience problems with supervisors forcing you to work on medical floors without meeting their unit competencies? This practice is being done where I'm at. A supervisor is using Psych. nurses to help staff a medical floor (Rehab)....If you have any suggestions as to how to help....it would be appreciated. I feel like my license is in jeopardy everytime I'm forced to float over to Rehab, and the complaint is falling on deaf ears.....I really question the legality of this practice....

Do you have a union? You need to go to them and find out your float policy. We are required to have 3 days of orientation before we float. I work in NICU and we only float to pedi, picu or post partum.

maryx · Jul 25, 2007

If changing jobs is not an attractive option for you and you want to try to make it work in the position you are currently in ...
Emphasize your willingness to help out (and float) in any communications you have with your supervisor and/her any other administrators in your facility. Emphasize that while you are willing to help out, you need to have some orientation so that you can practice safely.
From a political standpoint, there is a big difference between saying that you "don't want to float" and saying that "you are willing to float, but need some orientation and/or some guidelines to do it safely."
At my hospital, each unit has a set of guidelines for people who are pulled to their units. Those guidelines include the types of patients they may be assigned to care for, the types of skills they will be expected to perform, information on how to locate and use resources they need to help them. After each shift of floating, the floated nurse fills out a form that asks how the experience went. This gives the nurse the chance to say whether or not the experience fell within the established guidelines and whether or not the staff on the receiving unit provided her with the support she needed to do the job safely. If problems start to develop, they can be dealt with through inservices and/or 1 on 1 education for all involved.
For example: When staff is pulled from a general care unit to an ICU, they are not expected to take a full assignment. They are used as "assistants" to the regular staff. When the neonatal ICU staff is pulled to a general pediatric floor, they are similarly considered "assistants" and not expected to take a full assignment. They may, however, be given more responsibility if the patient is under 1 years old.

I agree, but the bottom line is all about money. The supervisor that is forcing the Psych. staff to float to Rehab is the Nurse Manager for both units. The Psych. staff was never asked to float to the Rehab unit until this supervisor became Nurse Mgr. of both units.....also, I chose Psych. as my field of nursing because that's what I want to do. I'm not interested in practicing any other field of nursing, and don't feel as though I should be forced to...just to accommodate patient nurse ratios on a unit that's short staffed. He, my Nurse Mgr. refuses to adequately staff both units so he can run both with minimal payroll....... meanwhile it puts us at risk, not to mention the patients...perhaps I should add that information when introducing myself to the patients and their family when floated to that unit....that I'm a Psych. nurse that's been floated to that unit for that shift to help out...maybe if the protest of this practice coming from informed patients and their family might make thr mgrs. pay attention.

maryx · Jul 25, 2007

Yes I knew what you meant. I was just trying to put in my 2 cents with a quick post...by combining something TazziRN said with your suggestion. (Should have been more specific...but I'm at home babysitting and trying to spend a little time on allnurses.)
My concern for the OP is that I've spent 3 yrs in acute Rehab and 6 months in Psych. They are not interchangeable. BTW in the acute rehab hospital I saw 2 GOOD nurses named in law suits & 1 reported to BON.
All 3 cases involve long stories, pts who fell, etc... .. but suffice it to say short & inappropriate staffing played a large part in the problems.
I agree when this type of floating goes on it is often safer to get a new job.

That's my point! Psych. and Rehab. are not interchangeable

Daytonite, BSN, RN · Jul 25, 2007

maryx. . .I was a nursing supervisor and I want you to know that we did exactly what you are saying is happening to you. The Rehab unit is the easiest of the medical units when it comes to knowing generalized nursing. The patients on the Rehab unit should be medically stable and there for. . .rehab. . .physical and occupational therapy. The way I and the other supervisors I worked with were instructed to explain this to nursing staff who might object to floating there was that almost all of the nursing procedures you are going to need to do (take vital signs, give medications, perhaps change a dressing, reposition patients, assist them in toileting and other ADLs) are basic nursing care that you should have learned in nursing school. I would also offer you the choice of going to another unit instead, but it's likely you wouldn't like it anywhere else since it would probably be a medical or surgical unit that would have more acutely ill patients. What I told the staff nurses who would call me to question our, or my, decision to float them to Rehab was

you can take a blood pressure
you can answer a call light
you know how to give an oral medication, and if you don't know the medication you are giving, there are drug handbooks on the unit that you can look them up in
if you have an IV go bad, ask another nurse on the unit to help you with it, or call me
I'm telling the staff that you are coming from xxx unit and that they are to give you the easiest patients they have
I will be checking up on you throughout the shift to see how you are getting along. If you are having any problems at all--page me

When the Rehab unit was informed they were getting a float they would also be told that the float nurse was going to be upset about the floating, probably scared if coming from a unit such as Psych and to give her a very easy assignment and lots of support. Some nurses would just put you in the position of a nursing assistant. I sometimes did this when I was in charge on the stepdown unit and someone who was scared to death was floated to us. During my first round I would check with the staff nurses on that unit and personally ask them what assignment they gave you. However, if the float nurse shows up on the Rehab unit with a lot of attitude and anger to match so that it distances them from the regular staff, how does that help you get through the shift?

Your license is going to be in jeopardy if you fail to do something that is basic nursing and the patient ends up with a permanent injury. What's even worse, is if you don't have enough wherewithal to pick up the phone and call me, the supervisor, if you think you are in a situation with a patient where you feel you are drowning and you need someone to discuss and collaborate with. That's part of the charge nurse and supervisor's job. No one, not one staff nurse, should ever feel that they are totally alone on the job without backup, especially in a large acute hospital facility. However, on my first round I would have spoken with you and gotten a mini-report from you on the patients you were assigned to, so I would have a good idea if there were a potential problem since I do have a lot of med/surg experience.

Before I became a supervisor I was a med/surg and stepdown staff nurse for many years. I had to do my share of floating. Guess where we stepdown nurses got floated to? ICU and CCU. Don't you think we were scared? We NEVER EVER got floated to Rehab. We would have given our right arms to get floated there, pun intended. Nurses who got floated to Rehab were the med/surg nurses, pediatric nurses, OB nurses, new grads when it was finally their time to float, and, I'm sorry to say, the dumber nurses that we knew would be dangerous to float to any other units (just some insider info). Trying to get a med/surg nurse to float to stepdown was like pulling a tooth without novacain. Floating, unfortunately, is a fact of hospital work. I've also learned that nursing isn't the only industry that floats its workers. I've learned that the large bank and pharmacy chains also float their tellers and pharmacists between sites on a day to day basis. Flight attendants also are subject to floating.

maryx · Jul 25, 2007

Understood, but the expectation when floated to this unit is for us to perform as medical nurses, and carry a patient load where the patients are split up. There is no consideration for us by giving us the "easiest patients", in fact the rehab unit is not allowed any transferring equipment like hoyer lifts or even trapeze bars or it disqualifies these patients as "rehab" since they're suppose to be able to "participate" in their recovery. So if there is (and was) a 300 lb. CVA patient, with one sided paralysis guess who gets assigned these patients? I haven't seen an "easy patient" yet on this unit. I'd like to know what you think an easy patient is.

Of course it doesn't take a brainiac to toilet someone, dress them, take vital signs, and answer a call light, etc. I'm not worried about parting someones hair crooked and getting myself in trouble. I'm concerned about significant assessments and observations that could be missed because of the lack of perceptiveness to recognize these events which are impaired by lack of practice, not intelligence....

But on this occassion there is nothing gereralized about the assessments we are asked to do. The patients we have are CVA, MRSA, VRE, dialysis, and post surgical with ORIFs etc.

It's a fact.......

You lose the skills you don't use when working one field of nursing. That being the case, how can you assess a patient, and document on them if you don't know "what to look for?" To have an oversight of this information would be considered neglect. If that's not considered dangerous then why not float Psych nurses to ICU then?

This same hospital had to call the "Ready Response Team" When a patient's blood pressure fell to a panic level. The Psych. tech. assigned to this one to one patient didn't even know that this patient was in any distress while she was shaving his face. Her perception was that he was breathing, and as long as he was breathing, he was okay!

My father was injured once by a nurse who lacked the competencies to take care of him. She perforated his intestine. When it went to personal injury court, guess who won? Not the nurse, and not the agency. He was awarded an astronomical amount, as this was before the cap was placed on these type cases.

God forbid any harm comes to any patient on this rehab unit, but I can guarantee you that if the patient and there family were given the informed choice of care for themselves or their loved one they would much rather have a medical nurse tending to their medical patient than have a Psych. nurse with rusty med. skills.