NICU nurses floating to PICU

EmilyUSFRN, RN · Feb 13, 2008

i work in pedi, but we float to PICU, NICU, newborn nursery and the postpartum floor and have an assignment of just babies.

Part of orientation to our floor is to float and have a preceptor on each of those floors since things are really different. Maybe your manager or education coordinator could arrange that, if not for you, then the next group of new grads...

However, we float somewhere I'd say once a month. Luckily, our census has been nice and high so its not as often these last few months. PICU floats to us often, but rarely do we get NICU nurses, unless they're pool and then its just part of the job description.

TexasPediRN · Feb 13, 2008

we're having slightly the same issue at our hospital right now.

our picu is severly short staffed, and therefore the pedi special care unit is required to float back to picu.

--- however, you should have been oriented to the unit.

whats happening for us though, is my unit is required to float to picu, while nicu nurses and pedi nurses float to our unit. (double pulling).

speak with your educator about your concerns. explain that you were not oriented, and you didnt feel safe. since you cant turn back time, ask them to please make sure all nurses are oriented before floating.

its scary to float no matter where you are floating to. i hate floating to other floors with a 6:1 ratio when im used to half that. picu scares me b/c of the vents. when nicu floats to us, most are terrified ( i feel horrible about that, but its just part of the job). make sure you always have the charge nurses number and never be afraid to ask for help.

most of the time, they are happy if the patients are clean and alive. the charting is second compared to the patient.

i hope you dont float again soon, but if you do - you'll be better prepared next time :)

bubbly · Feb 13, 2008

Thank you for your post meghan. My educator is new (she actually oriented with me and the other NICU interns when she was hired for the NICU ed position to see what we were learning). So I guess we were kind of her gunea pigs and she didn't really have a good understanding of the way our NICU was operated. I had asked one of the interns about if we were going to get a PICU oriention since that is what I thought I was told during the NICU orientation. She and another girl had asked the NICU educator about the PICU orientation and her reply was that it was not needed now and we were unlikely to float. Well anyways, one of the new nurses that interned with me was floated there one night, but actually ended up coming back to the NICU because she was so upset and overwhelmed by being in the PICU. I had told my charge nurse that if I was floated I wanted an orientation. I had even told my manager that I felt unsafe floating to the PICU and wanted some type of orientation. Unfortunately no one listened to me. When my manager took me to the PICU when I floated, she was like well all the NICU nurses hate it here so I am not expecting you will like it either. It was nice that I did get lots of help from both the NICU and PICU charge nurses and another nurse pretty much took over the care of my second PICU patient. Since I have already had my float shift in PICU, I guess I no longer need the orientation now since I learned some of the things the hard way. I just feel like my managers knowingly put me in a bad position and didn't care.

RainDreamer, BSN, RN · Feb 13, 2008

Floating after being on your own for only 6 weeks?! Wow. I can't imagine how horrid that must have been for you! I remember just being on my own after 6 weeks in the NICU I was still terrified just going into my own unit and working.

Where I work, new grads can't be floated until they've been there a year.

They need to give you all a decent amount of orientation time if they expect you to float to PICU. It's just too different than NICU.

Penguin67 · Feb 13, 2008

I work a general peds floor, and am expected to float to NICU and PICU. While no one especially cares to be floated, PICU makes a very appropaiate assignment for me that I can handle. Usually 1-2 patients that would be on the peds floor if we had a room. I was never oriented to PICU, but feel fine floating there, because my assignment is appropriate for my skill set. I have taken PALS and could assist in an emergency. The charge nurse is usually close by and everyone helps me if I need anything.

When I float to NICU, it is a bit different. I took 4 patients, which sounds like a good number, but when you don't know where anything is and you don't know any policies and you are not familiar at all with sick little neonates, it can be a long shift. Because the neonates were all on low stimulation, you do cluster care, which meant do your feeds, assessment, diaper changes, bath, meds, all at once. You no sooner finish, then it is time to go down the line 4 hours later and do it again. No one offered to help me, and I had to find staff when I had a question. I don't feel competent in NICU and I've never taken NRP, so I would be useless in an emergency. I would feel better if I were given a task, like doing all the feeds for a group of patients, at least I feel competent doing that.

I did float once to a step-down nenoatal unit, and felt like my skills were used appropriately. There were 9 neonates and 3 RN's. They knew I was floating, so they assigned me specific tasks, like corificeat challenges, labwork, feedings, paperwork, etc... so that they could do the detailed work that I didn't have a clue about. It worked out great for all of us. I felt safe and also like I was able to help, and not hinder things.

I feel like the L/D and postpartum nurses (who all take NRP) should float to NICU and let the peds and PICU nurses float between themselves. A warm body is not all it takes to be an effective float nurse, and I don't know when management will figure that out. You need knowledge and experience, and some orientation. :twocents:

MA Nurse · Feb 14, 2008

Don't feel bad. I feel like you do after being a NICU nurse for almost 18 years. I don't like to float, either. Our hospital gives us 3 days of orientation to the PICU. We only have to take care of babies 1 yr or younger. The PICU is a different world than NICU. I think hospitals should have big enough float pools so nurses who don't want to float don't have to!

The neuro kids can be scary, esp. the ones with EVD's.

Don't worry about it, hopefully you won't float often.

SteveNNP, MSN, NP · Feb 14, 2008

I voluntarily crosstrained to PICU at my last job, just to get a feel for the "other side." We get pretty darn comfortable with our set of NICU drugs, procedures and such. I can resuscitate the heck out of a blue 23 weeker in the DR, but my head spins when it's a 6 or 16 year old. PICU comes with its own set of conditions, traumas, drugs, procedures, etc. It's not natural for you to feel comfortable in an overwhelming, strange environment. At least when PICU floats to us, we give them 3-4 babies to feed. Never anything more involved. There are really no such pts in PICU, since they all go out to the floor. I hope your educator listens to you and either holds off floating you until you get some experience as a nurse, or gives you a PICU orientation.

denicu · Feb 16, 2008

Hello. I graduated nursing school in May 2007 and I had only been off my NICU orienation for about 6 weeks and was recently floated to PICU. I am struggling enough to keep up with my time management and nursing skills in NICU that being sent to PICU was kind of a shock. Apparently any NICU nurse off orientation is up for floating and my hospital has had a low consensus right now. I was given no prior orientation to PICU and had never even visited the floor before. The charting was completely different along with everything else. The supply room is different, the meds are stored differently, and they even do nursing skills differently (they are not as sterile and don't use mask and cap for changing fluids, drawing labs, etc.) They had given me a full 2 patient assignment. The patients were both babies. One was a neuro kid which i had never taken care of that kind before. Both were on at least 6 drips a piece with meds every 2 hours, assignments more difficult then what I have had in NICU. I asked for help a few times from other nurses, but 1 was a NICU float too and the other 2 near me it was their first week at that PICU. I couldn't keep up and didn't feel safe at all. Even with the PICU charge nurse helping me, I still felt behind. When my charge nurse came to see how I was doing, I just broke down and told her I couldn't do it. Fortunately with her help and the help of some other nurses, I was able to get everything finished and charted. I just hadn't felt so overwhelmed and down on myself before since I started NICU. The good thing is that they said it will probably be at least 1 year before I float again. I just felt so awful that night that I am going to dread being floated again.
So anyways, do NICU nurses float at your hospitals? If so, do you at least get an orientation first?

I have 20 yrs exp in NICU but have been doing agency for the last 6 yrs. I try not to go to any hosp that has PICU but sometimes i dont have an option. While on a contract last yr i was floated to the PICU several times and once i got over the initial shock-all the drips and different tubes-i was ok. Most of the time it was a change of pace for me-In the Nicu, my assignments were usually feeder growers, while in the PICU i was taken care of sicker kids. I can tell you one thing-whoever i get report from cannot leave until i get a detailed report and explainations of procedures i am not familiar with. I had to be oriented first and the policy at this hosp is that anyone who floats must have an orientation first. I would take this up with your manager and hopefully she will talk to the PICU manager to ensure that floaters should get appropriate assignments.

neonatal_icu_rn · Feb 20, 2008

When hired, we're oriented at least a week to the areas we are expected to float to which are peds and well baby. We're rarely pulled to peds except late fall to early spring during peds' busiest time. The peds charge will try to give us infants, and we only assist with new admits. They're great about helping us out and trying to make us as confident with our work assignment as possible!

wjf00 · Feb 27, 2008

There seem to be 2 different subjects in this thread. One issue is being miserable for having to float. The more concerning topic is taking an assignment where the nurse may not be qualified to care for the patients.

On the matter of not being happy about floating, I am very sympathetic.. been there.. done that.

More concerning is being asked to take an assignment when the nurse may not have the minimum competencies. On this matter I would strongly advise any nurse to REFUSE THAT ASSIGNMENT. I have been in this situation as well. The powers that be may rant and rave and threaten, but more often than not they will back down and change the assignment. I have been threatened and even disciplined by one ex-employer. But I wore that discipline like a badge of honor. My responsibility is to my patients, not to compromise patients to meet a budget or save overtime costs.

NeoNurseTX, RN · Apr 2, 2009

I've heard of people in my NICU floating to PICU soon after orientation is over and w/o orientation to PICU..and they took patients they did not feel able to care for. If I get floated up there and get something other than babies (I feel VERY unknowledgable with peds...I'd rather do adults) that I don't understand...Safe Harbor for me. I may lose my job, but at least I can keep the license I worked so hard for!