ICU nurses- floating to floor

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Specializes in ICU/PACU.

Ok. So I started in an ICU right out of school and have worked in an ICU for 5 years. I have never worked on a floor or step down unit before so you can imagine I was pretty freaked out when I had to float to a floor today. I had 4 patients, but WOW was I running my ass off. I was under the impression I would be floated - but to other ICUs ( which I am perfectly flexible and okay with!! ) When I interviewed I was told I would be assigned to 1 ICU and all the other travelers I've talked to have said you will float. I was ok with that, but never did I think I'd be floated to a floor. Am I being a complete princess here? I am trying to be flexible but today I felt unsafe - for my license and for my patients. I'm thinking back to today and I know I missed things. My patients were all stable when I left, but still I did not provide adequate care in my opinion. I'm just really worried here. I just started this travel assignment. Any words of advice fellow ICU nurses? I don't know what to do. I was prepared for refusing patient care assignments on particular ICUs ( balloon pumps or other devices I'm not trained on) but I don't think they'll accept me refusing to take care of floor patients. I've been traveling for 2 years, so maybe I am just completely spoiled from my previous assignments? I don't know. I know if it's not in your contract you can't really control it?? But even when I spoke to the manager during my interview, I made clear to her I am not a cardiac nurse and I don't want to be floated to a cardiac ICU - and she said no we wouldn't do that, that is illegal. So because of that I'm just surprised that they would float me to a floor. I don't know, what do you guys think??? It's just so unsafe IMO and I"m scared to death.

One day I can handle, maybe a few more days I can handle, but if this is a daily or maybe even a weekly thing I don't think I can do this and will find a way to get my contract canceled?!?

I love the area I'm living in so much and I really love the particular ICU I'm suppose to be assigned to, but I don't think it's safe for me to float to a floor!

Ok.. end rant. Thanks for reading.

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Specializes in ICU/PACU.

Ok. So I was searching through the posts and now I realize I should have been more specific in my interview...and put in will only float to other ICUs in my contract!!

Man. Lesson learned. It just hasn't happened to me in 2 years of traveling. And it's a different situation than say a floor nurse floating to an ICU - I mean of course that is wrong. But technically I am adequately skilled/trained to care for these patients - just not 4 at a time, but it's just a shock when you are so used to taking care of 1-2 patients ( usually 1 most of the time actually in my case! ) to 4 patients. And they were so busy. I have an all new respect for floor nurses. I'm just trying to figure out how to organize myself so I can do a better job next time. I know I'll do better next time, unless they find something wrong I did today and fire me?! I don't know. Still freaking out here. Scary day. Everything was so different, the charting, the routines, didn't know where anything was and I was just a mess the whole day.

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OK, don't freak out! I worked on the floor prior to working ICU, and yes, the priorities are very different. If you are unable to get around having to float to the floor, I'll give you a few pointers:

Unlike ICU, you don't need to know every single detail of the patients hospital story. Dates of extubation, dates of MRSA diagnosis, etc, are irrelevant when now your patient's priority is to get ambulating, eating, and going home. Pertinent dates, such as surgery dates are still important, though!

Your goal is discharge, either to home or a SNF, or wherever. So, your big interventions are getting PT/OT to work with your patient, getting their IV meds changed to PO, d/cing catheters, making poopies, and things like this.

Giving meds usually takes some time in the AM, so if you organize your day by getting report, reading charts--first day and the last 2 days of progress notes, diet and activity orders, grabbing one of their meds, and heading into that patients room for the assessment as well as morning meds. And grab the meds for the next patient, and go in an assess. And so on.

If your patient is there for pneumonia (and no real health history), you can save time by using a focused assessment, instead of a full head-to-toe. Listen to lungs, take a temp, promote turn cough deep breathe, and have your CNA's check vitals, give meals to your patients, etc. Sounds like your cutting corners, which in a way you are, but if your patient doesn't have a neuro deficit, you don't need to do a full neuro exam!

Anyway, hope this helps. :D

Try to relax!! They can't make you resign!

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Specializes in ICU/PACU.

Thanks for the advice Becky, I really appreciate it! Things have been going great, no floating to the floor since. But I know it'll probably happen again and hopefully I'll be better prepared to handle it. Thanks again.

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Hi I worked the floors for 4 years before jumping to the ICU. Just keep in mind the pts are not as sick as the ICU ones. Trust your gut though if you have a feeling that the patient doesn't look right. Deligate to your CAs when you can.

Unlike ICU too the response time to a call light can be 5-10 minutes. (Especially if you have 3 call lights going off at once). Hope this helps.

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Specializes in ER, Tele, Cardiac Cath Lab.

I work in a step down unit and our ratios are 6 to7. If you only had 4 that was great !!! please tell me where that hospital is !!!! The best advise i can give is to stay out of south florida. Especially palm beach county. They expect travelers to float almost every day. The travelers are there to make the staff happy.

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Specializes in ICU/PACU.

In California, I believe the ratio is 1:4 on the floors & tele units. I've worked @ 3 hospitals here and that's how it is..but I'm not an expert on the floor or tele units.

I haven't floated again. But I did speak with my recruiter who was upset that this happened. She told me facilities are not suppose to do this, when they book an ICU nurse..it's for the ICU, not the floor. So next time call her or my clinical liason if they try to do this again.

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I'm at a hospital in LA and was under the impression when I signed that floating to tele was possible, but that it would be rare. This hospital can't staff it's tele units so it purposely overstaffs it's ICU float pool to cover. Or that's the rumor. The first month I spent more time on tele than in an ICU. Needless to say I turned down the extention.

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