Jump to content

Is there a line floating?

Posted

Specializes in ER.

So a place that I know about likes to float their ICU nurses. Apparently they are now floating them to specialty units such as OB, psych, and ER along with the standard stepdown and med-surg. Is there a line when it comes to floating? If the nurse is not specifically crosstrained in the charting style and does not have previous OB or psych experience, should they be forced to go to the specialty units to take on patients? One nurse was told that four post c-section patients were the same as med-surg patients (I do not think that they got the babies since four patients + babies seem like a lot, but I may be wrong and I do not know how many days post-op they were). The nurse supposedly was yelled at for trying to report it as unsafe since she never received crosstraining as an OB nurse nor did she have previous experience.

I would flip out if I was sent to work in OB or psych. Those two are specialty units.

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 10 years experience.

I would decline to float to a place I felt unsafe. Safe Harbor or just refusing to take report. It is my right to refuse. It is their right to deny me employment based on my refusal.

cayenne06, MSN, CNM

Specializes in Reproductive & Public Health. Has 10 years experience.

Yikes. When we have to send our OB patients to ICU (VERY rare, thank science), we still go down to do OB-specific assessments.

Obviously ICU nurses are more than able to take care of ANY patient- they are smart, quick thinking and good at making split second decisions. But you cannot care for a patient that you are not trained to care for. OB and psych are two very specific specialties and floating to those units seems very unsafe.

I'm an LDRP nurse and when they float us to other units, we *only* do things like sitting and providing ADL type care. I have never worked in any other speciality than OB (not even as a new nurse) and I would be very uncomfortable caring for even a straightforward med/surg patient.

As an aside, in retrospect I wish I would have followed the old adage to get my feet wet in med/surg. Oh well.

If there is a line they have crossed, IMHO.

I personally would not accept patients who required specialty nursing care that was outside of my experience and ability to safely provide.

Karou

Specializes in Med-Surg. Has 1 years experience.

There is a line. As a medical-surgical nurse, I would refuse to float ICU, ED, L&D or NICU/nursery. Unless in those units they could find patients acceptable for me to care for, which means those patients probably don't belong in those areas anyway. If I were to float to cardiac or a telemetry floor, I still can't take patients with certain cardiac drips.

Unless you are competent with those kinds of patients, you shouldn't be floating there. ICU nurses are probably better equipped to float to a larger variety of areas, but that doesn't mean they are the best person to float to those units. I mean unless they have L&D or neonatal experience, then that wouldn't be somewhere I would expect them to go. They also may not feel comfortable taking six med surg patients. It's a different flow even though the patients are not as acute.

I'd be looking into your facility policy on floating. We also can't float any new nurses ( less than 6 months experience).

In my opinion, hospitals should have a "cluster" of similar and/or appropriate units that are fair game for floating. ICUs, tele, med-surg, etc. It's really the best approach for safe patient care.

The hospital I work for doesn't float ICU nurses to the floors or vice versa, but has very few restrictions otherwise.

Caffeine_IV

Specializes in LTC, med/surg, hospice. Has 7 years experience.

There should be a line. The policies at my current facility would be that you only float to sister units. The ICU nurses can float between the various ICUS (surgical, neuro, and cardiac). L&D nurses could do mom/baby. And if they float you outside of your sister unit, they should handpick the patients to be something suitable to your ability.

At my first job, ICU nurses could come to the floor (med/surg, tele) but only take 4 patients max. We (medical nurses) were floated everywhere except ER. In the ICU I would get a stable patient that would likely be moved to the floor the following day.

The nurse supposedly was yelled at for trying to report it as unsafe since she never received crosstraining as an OB nurse nor did she have previous experience.
This site talks a lot about people not doing things within their scope of practice and are usually wrong about what that means, but this is actually a scope of practice issue if she has not had mental health or OB training then that particular branch of nursing isn't in her scope of practice. In NZ it actually says on your registration card that you have a restriction to work in that area if you haven't had that training. For example, there are lots of nurses that did the old style hospital training that didn't have a mental health aspect and these nurses have a mental health restriction on their license.

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 10 years experience.

I work on stepdown and occasionally ICU nurses get floated to us. They hate it. They want to provide ICU level care...on 4-5 patients. It is one beat down of a day for those ladies. We get floated to ICU and given 3 patients. Pretty unsafe in both cases.

This site talks a lot about people not doing things within their scope of practice and are usually wrong about what that means, but this is actually a scope of practice issue if she has not had mental health or OB training then that particular branch of nursing isn't in her scope of practice. In NZ it actually says on your registration card that you have a restriction to work in that area if you haven't had that training. For example, there are lots of nurses that did the old style hospital training that didn't have a mental health aspect and these nurses have a mental health restriction on their license.

But the US trains and licenses all nurses as generalists, and we all had basic, entry level education in psych, peds, OB, etc.

This is one of the reasons I'm glad I'm no longer floor nursing. That said, I never had the experience of such an abundance of ICU nurses that they were regularly floated anywhere. On occasion, and that was an unusual occasion, we might see an ICU nurse on our med-surg unit. Those were difficult shifts for everyone involved, as the ICU float was not accustomed to having 5 patients on days and 6-7 patients on an evening shift (welcome to the Norm on our med-surges) and therefore struggled mightily with keeping up on medications, treatments, charting, etc. Typically they were quite far behind by the time they were due to report to the night shift. Which, naturally, made for a hellish night for that last shift nurse, who was receiving not just those patients but probably one or two more, and perhaps an admission. Bad for all, but on rare occasions it's what happened because of staffing issues.

All the med-surg units (several, with various specialty emphases) floated among themselves. They were, in a sense, cross-training nurses to work in all the med-surges; unit-specific things like vents and stroke scales were handled as they came up, and it worked out.

Now, if you took a med-surg nurse and sent him/her to OB, that nurse was expected to be 'helping hands': NOT an assignment. After all, it was NOT something they were competent in, newborn care and postpartum care of obviously detailed specialty areas that unless you WORK in them, simply having passed the NCLEX umpteen years before will not sufficiently prepare you for such an assignment. I would not want someone who had only a nursing school education HOW many years ago as the basis for an unassisted float and assignment out of their comfort zone, such as OB or peds. And PSYCH? Seriously, no. Never.

ED and ICU had requirements; in order to be "cleared" for such a float, an RN had to have been there long enough, taken on such assignments, been floated enough times, to demonstrate an ability to handle those areas with minimal oversight. Frankly, there were never really enough ICU staff to babysit new nurses so they could only take someone in who could take one, perhaps two patients off their hands for a shift. I did this pretty regularly BUT also never got an admission, as those were much more involved than my own med-surg admissions, and it was more appropriate to give the patients and not the paperwork :)

calivianya, BSN, RN

Specializes in ICU.

My facility will float anyone anywhere. I have been fortunate as an ICU nurse to only float to the other ICU, stepdown, and an oncology med/surg floor, but some of my coworkers have been floated to L&D, postpartum, the ED, and other units with no previous experience in those areas.

I even thought floating me to the oncology unit was pretty stupid. I am not chemo certified and several of my patients were receiving chemo. It was a lot of work for the oncology nurses to handle my patients' medications, too, on top of having a full patient load themselves. Some of those nurses were hanging meds on 12/13 patients, since they had seven or so of their own in addition to having to hang everyone else's chemo. Very poor planning...

Now, if you took a med-surg nurse and sent him/her to OB, that nurse was expected to be 'helping hands': NOT an assignment. After all, it was NOT something they were competent in, newborn care and postpartum care of obviously detailed specialty areas that unless you WORK in them, simply having passed the NCLEX umpteen years before will not sufficiently prepare you for such an assignment. I would not want someone who had only a nursing school education HOW many years ago as the basis for an unassisted float and assignment out of their comfort zone, such as OB or peds. And PSYCH? Seriously, no. Never.

(If this is in response to my post above, I was not suggesting that every nurse is equally competent to practice in every area by virtue of having completed nursing school at some previous time in their lives; I was just responding to malestunurse, who was talking about legal "scope of practice" issues from the perspective of someone in a country where people do specialize in school and licensure, and pointing out that that, specifically, is not the case in the US.)

FurBabyMom, MSN, RN

Has 8 years experience.

Ah. How I don't miss the floor. :)

I worked neuro stepdown with med/surg and tele patients thrown in (they had this bright idea to do neurosciences care and have everyone not ICU status on the same unit). It was quite a continuum of patients, but I was only floated twice in a year. Both times to a med/surg unit with the same amount (or maybe 1 more) patient and MUCH lower acuity. Both of my float days were pretty awesome because the nurses on the other units were a much better team than the ones I worked with routinely. Also, having way easier patients helped.

It also helped we were generally short staffed...and people got floated to us. Well, I mean, kind of. Floating an inpatient rehab nurse to neuro med/surg and stepdown? Maybe not the best option. They got all of our easy patients on those days (our charge nurses were merciful - to the floaters and unit staff).

(If this is in response to my post above, I was not suggesting that every nurse is equally competent to practice in every area by virtue of having completed nursing school at some previous time in their lives; I was just responding to malestunurse, who was talking about legal "scope of practice" issues from the perspective of someone in a country where people do specialize in school and licensure, and pointing out that that, specifically, is not the case in the US.)

Thank you for clarifying....I did get the impression you believed that since all US nurses had the same basic general education, they should all be competent to go wherever. DID strike me as odd, based on other posts of yours I've read! :)

Maybe one day hospitals will realize employees are not interchangeable from one specialty to another simply because they share the common license of "RN" :cautious:

FLAlleycat

Specializes in L&D, Women's Health. Has 30 years experience.

The hospital in which I worked labor and delivery for ten years started having a slump in pts. So, administration, in its infinite wisdom, converted some of our postpartum rooms into orthopedic rooms. At first, they said med-surg nurses would care for these pts. That lasted a couple of months. Then they "trained" the postpartum nurses (1-2 days) and med-surg nurses went back to their floor. I reported to work one night and told to go to the ortho pts. I had no orientation. I didn't know how to set up those machines or to assist pts out of bed safely. I got out of it that night because of the lack of orientation but was told I WILL DO ortho pts. Got a new job the next day. To me, the hospital was really stupid to take such a risk, not to mention mixing OB pts with med-surg pts. Then when ratings on our floor started to plummet, admin got on our asses. We used to lead the hospital in pt satisfaction. Gee, could it be because we "acted" like we didn't know how to use the machines? Dumb hospital administration! But, at least they never did float any nurses to L&D.

~PedsRN~, BSN, RN

Specializes in Acute Care Pediatrics. Has 4 years experience.

My hospital made the PICU and NICU closed units. I don't have to float there and they don't have to float to my floor. Bad news is when they are short, there's no help. As a result they work funky call schedules, etc.