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

maryx · Jul 25, 2007

addendum to previous message for "Daytonite"

Your insider info. about the dumber nurses being floated to Rehab is really insulting and rude. I think you owe all Rehab nurses an apology.

classicdame, MSN, EdD · Jul 25, 2007

As long as the float nurse is doing what every other RN is educated/trained/licensed to do, then there should not be a problem. But the RN who floats cannot assess or teach to specific conditions for which they have not had training.

BBFRN, BSN, PhD · Jul 25, 2007

Why do higher-ups not realize that nurses are specialized today? I work in critical care, and would be totally lost if I were pulled to psych or rehab. I'm guessing they don't pull the rehab nurses to psych, do they?

We do occasionally have stepdown nurses pulled to our ICU, but that's only if we have a team of stepdown patients that we can't get moved out d/t no beds for them.

lyceeboo · Jul 25, 2007

IMO....The wording is harsh and the poster quoted below may not know that changes in funding have led to a situation where acute rehab pts can be quite medically complex.

BUT..NO OFFENSE taken to the insider info provided. It would be a pleasure to float with a supervisor in charge that put that much energy into providing a safe environment. Most Supervisors are too overworked themselves & pushing to "make the numbers" in a business sense to make rounds & talk to the RN's they floated.

When I did med/surg we were floated to tele stepdown....It was great when one good Charge RN was on...basically if you did your best she would do everything she could to protect the med/surg floater. LOVED floating to tele-stepdown when this charge was working. Great pt ratios & someone who really knew what the floater is up against.

I still think the only answer is to quit. Telling the pts about staffing probs is against most hospital's policies...and it could cause the pt undue stress. And I realize you were probably just venting OP.

I say the smart folk are the ones who walk away from these impossible situations. My family and my sanity are more valuable than any job.

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 27, 2007

...Actually no, the Rehab nurses are never floated to Psych. and have verbally expressed their absolute repulsion for Psych. stating that they would not like dealing with those type of patients or the families. In addition, the Rehab. nurses would have to have SAMA training which would train them on techniques to process with the Psych. patients...first using verbal skills, then at last resort physical, so as not to harm themselves, or a patient that requires a "follow down"....who is an imminent threat to himself or others...but not only that....they would also have to have the right attitude, emotional stability themselves..etc,...etc...to deal with those type of patients....It's not easy...many people can't do it....they don't have the stomach for it, much less the appropriate temperament....perhaps I did not mention....that as an LVN...which I am...I am not even required to do patient assessments on my unit...but yet they want me to do assessments on Rehab....My comment on informing the patient of being a Psych. float is not intended to stress the patient any more than them READING MY I.D. BADGE which clearly states the same information is.......If I appear to fumble around, and seem lost, it actually helps the patient to know that I don't work that unit....instead of them stressing about my competency...For the higher ups to acknowledge that nurses are specialized would disallow them to continue to "pimp out" nurses to other floors with the same disregard they are allowed to now. They wouldn't dare do that. They will continue to place themselves in a position to assume all the profit, while we hapless souls go off as sheep to the slaughter and assume all the risk....

Daytonite, BSN, RN · Jul 27, 2007

addendum to previous message for "Daytonite"
Your insider info. about the dumber nurses being floated to Rehab is really insulting and rude. I think you owe all Rehab nurses an apology.

I was giving you some insider info. What do you think happens when a Rehab nurse is asked to float to a med/surg floor? It takes about 6 months for a new supervisor to learn all the nuances of floating staff within the hospital. It is not an easy task to learn. I still say that if there were things you were being asked to do that you didn't know how to do, you should have informed someone as well as the supervisor.

You orginally asked for help and suggestions. I gave you a glimpse into the world of the supervisor and how the decision was made to float nurses and all I see you doing is arguing back. I'm trying to help you work on this problem. Makes me think you were deceptive in asking for help or suggestions and just want to vent and complain. All that does is feed your anger and turn the problem into an even bigger one for you. You have to be willing to listen and change, but obviously that isn't a part of your game plan. I worked with a supervisor who would have thought nothing of sending you to a regular medical/surgical unit or the stepdown unit the next time your turn to float came up as a punishment for all this venting of yours. She was very sly, too. She would have goaded you into an argument and done her best to get you to clock out and walk off the job which would have been an automatic termination--problem solved and you would never be a bother to her again.

lyceeboo · Jul 27, 2007

Bingo to quote below. OP put the wrong spin on my clearly worded comment. That will not help your situation. I know what you're up against OP & my intentions were pure..I was trying to help, inform and support you as best I could.

And this isn't a contest of who the smartest nurses are. Different strokes for different folks.

btw in acute rehab nurses usually have to go through classes on how to work with combative and brain injured pts. Ours was called Mandt Certification but it was similar to the classes I took to work Psych.

I was giving you some insider info. What do you think happens when a Rehab nurse is asked to float to a med/surg floor? It takes about 6 months for a new supervisor to learn all the nuances of floating staff within the hospital. It is not an easy task to learn. I still say that if there were things you were being asked to do that you didn't know how to do, you should have informed someone as well as the supervisor.
You orginally asked for help and suggestions. I gave you a glimpse into the world of the supervisor and how the decision was made to float nurses and all I see you doing is arguing back. I'm trying to help you work on this problem. Makes me think you were deceptive in asking for help or suggestions and just want to vent and complain. All that does is feed your anger and turn the problem into an even bigger one for you. You have to be willing to listen and change, but obviously that isn't a part of your game plan. I worked with a supervisor who would have thought nothing of sending you to a regular medical/surgical unit or the stepdown unit the next time your turn to float came up as a punishment for all this venting of yours. She was very sly, too. She would have goaded you into an argument and done her best to get you to clock out and walk off the job which would have been an automatic termination--problem solved and you would never be a bother to her again.

maryx · Jul 28, 2007

Daytonite.....The supervisor's informed...he's the one floating us....and the suggestions I was looking for was not from the supervisor's perspective in order to empathize with him or her...so I don't know how you thought you could be of any help.

It's unfortunate that you perceive others voicing their opinion as arguing, or as being deceptive just because it doesn't agree with your thinking. It sounds as though my opinion has fed your anger, as is evident by your allegations, and insults.

You would benefit from your own advice to be willing to listen, and change....but your game plan is just to get in a pissing contest, and try to attention seek with how clever you believe you are.

In regard to the supervisor you mentioned who likes to "punish nursing staff" by spitefully floating them, and then attempts to provoke them in to getting angry and quitting....I would never feed in to that type of childish behavior. I've delt with many bipolar, labile, borderline patients for quite some years...also those like yourself who are grandiose and intrusive as well.

You're welcome to reply to this message, and say whatever you need to in order to feel better about yourself, it's of no effect to me. I worked my field long enough to know you that you can't reason with the irrational, and those with a perception that is not reality based.

See you on Geri Psych.!!!!

Now prove me right, and respond back!!!!!!!!!

nell · Jul 29, 2007

Daytonite,

You are a California supervisor: please look up Title 22. I have to go to work now so don't have time to get a link, but in CA, a nurse must have documented competency for any unit s/he works on.

And "A nurse is a nurse is a nurse" attitude as indicated by your "basic nursing care that you should have learned in nursing school" comment just doesn't fly anymore. Someone who has been doing a specialty such as Psych excusively for even 5 or 10 years is most likely NOT going to be competent to care for the kinds of patients on Rehab units these days.

I'm pretty apalled at your entire post.

nell

Daytonite, BSN, RN · Jul 29, 2007

daytonite,
you are a california supervisor: please look up title 22. i have to go to work now so don't have time to get a link, but in ca, a nurse must have documented competency for any unit s/he works on.
and "a nurse is a nurse is a nurse" attitude as indicated by your "basic nursing care that you should have learned in nursing school" comment just doesn't fly anymore. someone who has been doing a specialty such as psych excusively for even 5 or 10 years is most likely not going to be competent to care for the kinds of patients on rehab units these days.
i'm pretty apalled at your entire post.
nell

nell. . .as it turns out, i was a nursing supervisor in two other states--not california. i happen to be living in california at the moment and not working as a nursing supervisor. if i were, i assure you that i would be aware of the parameters i would need to follow under the california law as well as what my employer policy dictated. as a supervisor (in 2 states other than california), i had a manager above me who directed my specific practices with regard to floating and staffing. this is responsibility that was taken with great seriousness by the nursing administration in the places where i worked and not something that was done on a whim or to try to trick staff nurses. it happens that i was a staff nurse in each place before i became a supervisor, so i did my share of floating as well. i am not a mean person and i always took the emotional and professional concerns of the staff nurses to heart when i had to make floating decisions. i followed up, kept track of the floaters and looked after them during my tour of duty because i was often just as concerned as they were. can you say that about all your supervisors? if you have never been a supervisor or manager you cannot understand the position. as i said previously, i was giving staff nurses a glimpse from the supervisor's view. guess you aren't interested in hearing all the sides of the story in making your assessment.

maryx · Aug 26, 2007

This message is intended only to inform anyone else asking the same question originally posted in this thread...and not to provoke Daytonite...Just wanted to post some information, and help......

After some research I became aware of the following information relative to the Texas State Board of Nurse Examiners....The full document including the Nurse Practicing Act Rules and Position Statements can be viewed in full at the Texas BNE's website.....

ALL LICENSED NURSES PRACTICING IN TEXAS ARE REQUIRED TO "KNOW AND COMPLY" WITH THE NURSING PRACTICE ACT (NPA) AND BOARD RULES. RULE 217.11(1)(T) REQUIRES THE NURSE TO "MAINTAIN A SAFE ENVIRONMENT FOR CLIENTS AND OTHERS." THIS STANDARD ESTABLISHES THE NURSE'S DUTY TO THE PATIENT/CLIENT, WHICH SUPERSEDES ANY PHYSICIAN ORDER OR ANY FACILITY POLICY. THIS "DUTY" TO THE PATIENT REQUIRES THE NURSE TO USE GOOD PROFESSIONAL JUDGMENT WHEN CHOOSING TO ASSIST OR ENGAGE IN A GIVEN PROCEDURE. [sEE POSITON STATEMENT 15.14 DUTY OF A NURSE IN ANY PRACTICE SETTING].

LUNDSFORD V. BOARD OF NURSE EXAMINERS, 648 S.W. 2D 391 (TEX. APP.--AUSTIN, 1983)

A NURSE HAS A DUTY TO THE PATIENT WHICH CANNOT BE SUPERSEDED BY HOSPITAL POLICY OR PHYSICIAN'S ORDER.....

NPA SUBSECTION 217.11(1)(B)

THE NURSE'S "DUTY" REQUIRES THE NURSE TO INTERVENE APPROPRIATELY TO PROTECT AND PROMOTE THE HEALTH AND WELL BEING OF THE CLIENT OR OTHERS FOR WHOM THE NURSE IS RESPONSIBLE......

NPA SUBSECTION 217.11(1)(T)

....REQUIRE THAT EACH NURSE PRACTICE WITHIN THE LEVEL OF HIS/HER EDUCATIONAL PREPARATION, EXPERIENCE, KNOWLEDGE, AND PHYSICAL AND EMOTIONAL ABILITY.

There's much more information on this including the fact that by refusing an assignment.......... it is absolutely forbidden for a facility or person to retaliate by placing a nurse on suspension for refusing, or terminating them as well......Read the complete document at the home website for Tex BNE......

You do not have to be bullied into these assignments with threats, etc......

reesern63, RN · Aug 26, 2007

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.

I would not introduce myself as "the Psych nurse that's been floated to help out..." You would be setting yourself up for a world of hurt doing that.

If you really do not want to be cross-trained (and there is nothing wrong with that), then really, your options are limited. Psych. is one of those specialties that does limit your mobility, so if it is your true "calling," bear in mind that it may make reduce your choices for employment.