Made to float, when I know I will sink.

[imintrouble, BSN, RN]

My hospital has begun a practice that I feel is dangerous to pts. and nurses. In order to save money, nurses are being floated to different areas of the the hospital. We are being plugged into holes with no regard for our level of expertise. As a med/surg nurse, I completely understand being sent to a different floor, or nurses' station. I don't like it, but that practice is a fact of life. What has started to happen is, med/surg nurses are being sent to pediatrics. I have never been a pediatric nurse. I am not familiar with meds, normal VS,......It's scary. What's even worse, med/surg nurses are being scheduled in ER, ICU, et telemetry units. Without ACLS certification. If the nurse voices resistance, INSUBORDINATION is tossed around. Without management saying it, we recognize our jobs are threatened if we do not meekly do as we are told.

What recourse do we have without a union?

[medicrn13]

I hate floating. That being said, it's an occurence that happens all too often and will most likely occur depending on your facility' staffing levels.

THAT being said...I do believe that it's dangerous to float nurses to areas where they have no clinical experience. It would be akin to tossing a fresh GN out on the floor on their first day with a full patient load.

My hospital floats nurses...but we do not float Med/Surg nurses to the ER/ICU or other specialty areas such as L&D or surgery. We will float aides though.

I would suggest filing a complaint with your state board of nursing, or maybe the Dept. of Health...see where taht takes you. Good luck.

[Reno1978, BSN, RN]

We float, but our hospital has pretty strict rules about where a nurse may float. For example, I work in the ICU and I can only be floated to the Cardiac Unit (these patients are typically MI, vascular surgeries, post-op open hearts off their drips and walking, or post-cath lab patients, which are all types of pts we took in the ICU before this unit was created). I couldn't be floated to the surgical floor unless I was oriented to the floor, and our contract states that floating out of my cluster results in a $7/hr pay increase, so if I elected to go to surgical, I'd get a pay increase.

What your hospital is doing doesn't sound safe. I'd be looking for a new job.

[imanedrn]

What your hospital is doing doesn't sound safe. I'd be looking for a new job.

It's easy to say leave, a lot harder to do when money is on the line. That said, is your license worth it? If you're not ACLS or PALS certified, and you can't provide SAFE PATIENT CARE, what good are you doing yourself and your patients?

I've heard of this happening randomly before but never in such a large lot, as you've mentioned. I honestly don't know what immediate recourse you have, but your state BON sounds like a good start. They are there to protect pts. If your hospital is directly threatening the safety of its pts, it seems the BON can give you some advice.

Good luck.

[lkwashington]

My facility has something called the healthy work environment. You only float to floors that you can manage patient care. Med surg stick with med surg. Tele may go to ICU but dont take vents. Tele and ICU may go to ER. ER dont usually get pulled but they put in a new policy before ER send someone home they need to all the nursing office to find out if they are needed on another unit. Yes I would think you would need certain certifications to work on certain units. I say be careful and maybe be in the process to find another job. I know this is easier said then done. I am concern about the hard work you put in to get your license. Just a thought.

[SandraCVRN]

Do you have something called Safe Harbor in your state? I'm not sure if it's a national thing or not. But here in TX you can decline an assigment by declaring

Safe Harbor...it turns into a big f'ing deal, BUT you have proof of your concerns. Also it keep them from retaliation.

Do you have a float policy? Dig it our and read it.

Our place tried to do this with OR staff going to floors, LOL, you can imagine how well that went over. Now we have "lateral" areas we can float to, but right now we are so slow it's more about being sent home then floating to a different unit.

Good luck.

[PostOpPrincess, BSN, RN]

1. Look up float policy.

2. Standards of Care across the nation (in major hospitals)--most require that you are COMPETENT in the areas to which you are floated. i.e you are TRAINED and have PROOF of it. If you don't, that you are considered NOT competent to take on care and should be utilized as a CNA, or take kids without meds and anyone of adult size.

3. Please contact HR and see what recourse you have without making it a "big deal."

4. Document your concerns to your leadership team--specifically your NM, and Educator--in writing and then move up as your concerns are dismissed, have PROOF of the standards of care. The onus will be on leadership to catch you all up to speed. You also have your BON. Get with them.

You don't need a union for this, just use your common sense, and whatever you do, stay professional at all times.

P.S. You can always make a whistleblower call to JCAHO (or whatever they are called) and they can send their local agents to "review" the situation. That should be your last step.

[BluegrassRN]

I work at a small hospital, and we frequently float to all areas of the hospital. I work on the medical floor, and in the last year have floated to step down, surgical (as in, the "surg" part of med-surg), peds, mother/baby, nursery, ED, and acute rehab.

While no one likes to float in general, I am personally comfortable floating to any area. On my floor, we charge nurses make every attempt to give the incoming float the most appropriate assignment, and other floors do the same thing. When I float to ICU/stepdown, I get the least complex patients. When I float to ER, I typically don't get assigned patients, and instead I just support the nurses in whatever way possible--doing EKGs (it's easy to learn to do them), drawing labs, starting IVs, helping with procedures, etc.

When I've floated to peds, the nurses always ask me which patients I want. Since I have kids, and have floated a lot to peds, I'm pretty comfortable with everything except the acutely ill kids under the age of 2. Typically they give the float nurses the older teens and pre-teens.

When a nurse floats to our floor, I try to give them patients they might see on their own floor. If they are from a floor that doesn't get a lot of admits, I will give them a fuller load initially, so they don't have to take an admission during their shift.

Like I said, most of us don't like to float. But really, I don't mind it anymore. It keeps my skills up. It's also nice to work with other people, to cultivate relationships with other floors. It helps hospital morale and cooperation between units.

I think newer nurses really fear floating. We have a policy that you can't float until you've been off orientation for 3 months. I kind of wish it were longer, say 6 or 8 months. On slow nights, rather than send someone home, if there is a new nurse who has not floated yet, he or she will get floated to a unit to orient. Meaning they don't take patients or take a lighter load. I found that helpful as a new nurse.

Floating happens. And I'm glad it does, I am always so thankful when we are understaffed for whatever reason and someone floats to us. I do believe there are ways to make floating a safe, positive experience. If the hospital is big enough, floating to similar units is one (we unfortunately don't have that option, in our small hospital). A unit orientation, receiving the least complex patients, receiving patients similar to what you would get on your home unit, etc all help a float nurse to be safe and comfortable in their environment.

[lkwashington]

The facility I work is about a 140 bed hospital. I would think floating would be positive but some nurses dont like change. This may become a problem.

[cb_rn]

Maybe I'm just inflamed at the moment from thinking about a nurse with no training in pediatrics being sent to take care of my ill child but I wouldn't wait around to see what link on your hospital's chain of command is going to take you seriously if they're tossing around words like insubordination.

I believe I'd hop right to an anonymous report to the BON and Joint Commission and see if they think it endangers patients.

I don't normally advocate hopping off the chain of command but a possible blatant safety violation is reason to get moving.

This isn't about floating, its about taking care of a population that requires a skillset you haven't been adequately trained in. If you were to tell me this hospital is providing an orientation and skills check off for all the different areas before they send a nurse, sure, send them, I think that's a-ok. But to send a nurse to a totally different environment, especially peds or ICU is just asking for trouble.

Without the required skill-set, safety is dependent on a charge nurse making out an appropriate assignment and the luck of nothing bad happened. Not really the kind of care I want to give or receive.

Joint Commission and BON are set up to protect patients and the hospital shouldn't be distressed to have a sudden visit from either if they are providing patients with a consistent quality of care that is safe.

Safety shouldn't be a core value only when someone is due a visit from JCAHO.

[highlandlass1592, BSN, RN]

Maybe I'm just inflamed at the moment from thinking about a nurse with no training in pediatrics being sent to take care of my ill child but I wouldn't wait around to see what link on your hospital's chain of command is going to take you seriously if they're tossing around words like insubordination.

I believe I'd hop right to an anonymous report to the BON and Joint Commission and see if they think it endangers patients.

I don't normally advocate hopping off the chain of command but a possible blatant safety violation is reason to get moving.

This isn't about floating, its about taking care of a population that requires a skillset you haven't been adequately trained in. If you were to tell me this hospital is providing an orientation and skills check off for all the different areas before they send a nurse, sure, send them, I think that's a-ok. But to send a nurse to a totally different environment, especially peds or ICU is just asking for trouble.

Without the required skill-set, safety is dependent on a charge nurse making out an appropriate assignment and the luck of nothing bad happened. Not really the kind of care I want to give or receive.

Joint Commission and BON are set up to protect patients and the hospital shouldn't be distressed to have a sudden visit from either if they are providing patients with a consistent quality of care that is safe.

Safety shouldn't be a core value only when someone is due a visit from JCAHO.

I hate to share this with you but the BON is essentially powerless when a facility tries to pull something like this. While in theory they protect patients, they can't protect patients from facilities. Calling JCAHO and CMS probably won't do much good either.

[xoemmylouox, ASN, RN]

I think that this is a serious, but not suprising new policy. I think we are going to continue to see horrible things like this due to "cutbacks". I think floating can be very helpful when done correctly, but this is NOT the way to go about it... Sad sad state of affairs. I would start with the BON and your chain of command.. Good luck!