Made to float, when I know I will sink.

highlandlass1592, BSN, RN · Jun 8, 2010

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?

I"m not going to lie but you are in a difficult spot. If the facility floats you and you take the assignment knowing you aren't qualified, then you run the risk of placing your license in jeopardy if everything goes south. You could offer the floor you're being floated to that you would help with things but not take an assignment but the facility could terminate at will. It takes a lot of courage to stand up to a facility and you have to be willing to be terminated. I know, I've been in that position before. Problem is, it's your future earning potential you're worried about...your license. And NO facility has the right to put you in a position to put that in jeopardy.

Solution? No easy one. You might start looking for agency employment to supplement your current income in case your permanent job does come to an end..you'd at least have something in the pipework to help you live on. Remember an important point: you are NOT responsible for a patient until you take report. Yes, your facility is going to try to intimidate you by throwing around insubordination...but legally, from a licensed standpoint they can't MAKE you take report. I've had nursing supervisors tell me (when I was charge) we were getting an admission...I refused to take the admit and to take report...which really flabbergasted the supervisor. I got told I couldn't refuse, to which I calmly replied "if you send that patient up, you better send a nurse with them. I'm not taking it and you can't make me." Amazingly, they usually found a nurse. Bottom line, I was willing to lose my job to protect my license. At that time, the job market was a lot better.

Supervisors count on someone always backing down...nurses who are afraid of losing their jobs will shut up and take it. I'm not putting them down, we all have to do what we have to do to get by...I realize that. But the most empowering night of my career was when an entire shift...every night shift nurse on the unit I was working at the time REFUSED to take report until they found us help. We wouldn't allow the charge to start report and we weren't coming out. The supervisor on call didn't know what to do but finally found us help. The point is, the only way I see out of this for you is if the nurses there band together and express a collective NO. And honestly, I don't see that happening in too many places. Too many people in dire straits these days.

I wish I could offer you more words of wisdom, a quick fix. I know the position you're in and it's a terrible one. If I can ever offer a shoulder, please feel free to contact me off-board. Good luck to you.

wooh, BSN, RN · Jun 8, 2010

Find some literature on the dangers of floating, send it to your Risk Management department.

It also helps to demonstrate that you're willing to float when it's safe to do so (a similar unit.) When you go to a similar unit, don't by whiny about it. (And I understand it sucks, I used to be on a unit that was always first to close with low census, so I was floating all the time without getting the pay benefits of being in float pool. I whined all the time!) If you show that you're a team player as long as it's SAFE, then it doesn't look like you're just trying to pull the safety card to get out of doing something you just don't like doing, and you'll be taken more seriously.

Good luck. We used to be able to seriously consider walking when our workplaces were unsafe. With the economy right now, I know it's a lot harder to do so. Our choice has gone from "unsafe or different job" to "unsafe or no paycheck."

cb_rn · Jun 8, 2010

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.

Perhaps you're right but I couldn't, in good conscience, not attempt to do something. I don't know what the answer is but doing/attempting nothing, changes nothing.

Maybe someone on the other end of the phone would have an idea about what might work.

Zookeeper3 · Jun 8, 2010

Dang, many of us have obviously been there, me too. While you fight the battle with management and the higher upps that think.. a nurse is a nurse.

I'm going to give you some suggestions, but don't think these lie in place of fighting the non float battle, I support you. I've also been through this, I'm 15 years in, trust me they've tried to screw with me too.

If you are in a right to fire state, you can still demand "orientation".. The pediatric manager and their nurses need to provide didactic and hands on training on the differences of the pediatric population. Demand inservices now and fast (sure you don't want them but until it's fixed you NEED THEM) A resource nurse needs to be designated to each staff member that "floats in" to ask questions, verifies all med calculations and runs through each scenrio. The hospital will pay for time spent upon education to research all the pediatric policies and proceedures and you're required to have an orientation check list that is supervised and done by the experienced resource nurse.

I could go on, but once you state, you are perfectly willing to float when these issues are previously address and didactic as well as mentors are put in place..... and you say that with the nicest smile.. things will improve.

BUT never ever agree to be the med nurse... ever.... way too many varriables in a situation that will take you down.

cb_rn · Jun 8, 2010

I'd be interested in knowing other's opinions on this: Public whistleblowing.

What would happen if someone took the issue to the newspaper? How would the community feel about being cared for about nurses that don't have adequate training to float from specialty to specialty? Does the need for good PR have the power to either change the policy or force the hospital to roll out adequate training for the nurses for any floor they may have to float to?

Would the damage to the hospital's reputation (and to nursing's reputation) be too great to justify?

Would the almost sure outcry and subsequent changes in the policy justify any damage because the patients are kept safe?

I don't know how I feel about it, I came from a community where the hospital switched to for-profit and the outcry from the community about the decrease in quality care is still getting blasted in the papers regularly six years later.

There were/are issues in quality of care at the hospital but I feel like it also gives the many excellent nurses and physicians that work there a bad name by association.

wooh, BSN, RN · Jun 8, 2010

I'd be interested in knowing other's opinions on this: Public whistleblowing.
What would happen if someone took the issue to the newspaper? How would the community feel about being cared for about nurses that don't have adequate training to float from specialty to specialty?

Don't you watch tv? A nurse IS a nurse. If tv nurses can have patients in the ER and the floor and the ICU, all the while scrubbing for surgery, oh yeah, and giving chemo too, with at least one patient being an angst-ridden teenage girl, and one patient being a demented old woman, then we should be able to do so too!

The public won't get it anymore than the hospital bean counters.

UM Review RN, ASN, RN · Jun 8, 2010

Just remember, if the patient goes south, you get the blame--and you have to live with your share of the responsibility forever after. Legally, morally, and ethically.

I don't know about you, but no job, no amount of money, is worth that.

imintrouble, BSN, RN · Jun 8, 2010

Thanks everyone. I posted early this AM about 0200 thinking I probably wouldn't get many responses. I love this site. So much support.

You all have excellent ideas. It helps just knowing most of you have been in my shoes....and survived.

The next time I'm told to float where a mistake could cost me my license, I will calmly survey the situation. I will ask/demand/discuss an assignment that is closest to my ability level. As we all know though, when you have RN behind your name in a hospital you are super woman.

PostOpPrincess, BSN, RN · Jun 8, 2010

Dang, many of us have obviously been there, me too. While you fight the battle with management and the higher upps that think.. a nurse is a nurse.
I'm going to give you some suggestions, but don't think these lie in place of fighting the non float battle, I support you. I've also been through this, I'm 15 years in, trust me they've tried to screw with me too.
If you are in a right to fire state, you can still demand "orientation".. The pediatric manager and their nurses need to provide didactic and hands on training on the differences of the pediatric population. Demand inservices now and fast (sure you don't want them but until it's fixed you NEED THEM) A resource nurse needs to be designated to each staff member that "floats in" to ask questions, verifies all med calculations and runs through each scenrio. The hospital will pay for time spent upon education to research all the pediatric policies and proceedures and you're required to have an orientation check list that is supervised and done by the experienced resource nurse.
I could go on, but once you state, you are perfectly willing to float when these issues are previously address and didactic as well as mentors are put in place..... and you say that with the nicest smile.. things will improve.
BUT never ever agree to be the med nurse... ever.... way too many varriables in a situation that will take you down.

Excellent reply:yeah:

rn4life2009 · Jun 8, 2010

I was in an area where my unit closed and I was frequently floated. I had one night where I took a patient I really shouldnt have(postpartum on post op) and it did go south. Needless to say I was able to handle everything but it scared me so bad that I will never take a patient who I am not comfortable with. I mean you can kinda reason it was a post op situation. I would only float to area within my experience. I have floated to a pedi/adult mix unit but I flat out told them I would not take pedi patients!! Period. I was reading somewhere the other day about RNs being the popular scapegoat when they get sued. Not me!!!

RNTwin · Jun 8, 2010

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?

all hospitals do this...I used to work at a hospital(in the Texas Medical Center) that would float floor nurses to CVICU , poor patients!!! and poor nurse for taking it, one time a "floor assignment" as our managers would called it ended up on a ballon pump, swan, intubated and on several drips. management thought it was okay. so what happened? i ended up taking it, with a fresh cab and a fresh MVR!!! management sucks!!! my suggestion is leave that hell whole, before you loose your license b/c of a mistake. remember hospitals will turn your ass into the board in heart beat or fire you, without thinking about it twice. trust me...olders nurses use to tell me all the time that i worked in a unsafe environment, that i should leave but me the hard-headed/stubborn one, would say "no,they won't do that to me"... O YES THEY DO, hospitals don't care about you, b/c they can replace you as fast as you leave....

ukstudent · Jun 9, 2010

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.

The BON might not be able to do anything but JCAHO can. I used to work for a hospital that floated people around (not to the extent of the OP's hospital). Enough that someone made an enounomous call to them and they showed up for a surprise visit. Went straight to HR an demanded to see the RN's folders documeneting the compentancy in different areas. How people floated and to what areas really changed after JCAHO's visit. :yeah: