Floating from the NICU

[sfk26]

Hoping to get some feedback from other NICU nurses. I have 4 years NICU experience and that is the only area I have ever worked in. I recently began a travel assignment (not my first) and have been floating pretty regularly.

In the past 4 years, both in permanent staff positions and previous travel assignments, as a NICU nurse I was only expected to care for infants under 1 year of age. Recently, on one of my float shifts I was assigned teenage patients. I refused this assignment as I have no experience outside of the NICU and a 15 year old is a very different patient population than a NICU patient. I feel like often times nurses feel intimidated and accept assignments that they are not comfortable with. Do other NICU nurses feel that refusing a teenage patient load is unreasonable?

I always come back to the feeling that a floor peds nurse who routinely cares for 15 year olds would not be expected to care for a 23 weeker if floated to the NICU.

Thoughts? Suggestions?

[Julius Seizure]

As an old NICU nurse, I understand the OP's point. NICU nurses do not use the same equipment, do not use the same guidelines for assessment parameters, do not use the same documentation forms, do not function under the same policies for a lot of things, etc. Unless you have been oriented to the relevant equipment, policies, etc. of that unit -- a nurses (even a traveler) should not be expected to step in and take full care of a patient that is so different from the population she has been hired (and oriented) to care for. )

Fair point. I take care of peds cardiac patients. They once floated me to the trauma PICU and gave me a pair of patients that was about as far outside of my comfort zone as you can get in peds:

Patient A was a toddler with a shattered pelvis s/p surgery, with pin care and all that good stuff.

Patient B was a pre-school age neurosurgical case that was due out of the OR about 20 minutes after I got report.

Oh believe me, I was a VERY needy nurse that day. And agreed, I wasn't equipped to give the level of care that one of the regular PICU nurses probably could have given.

So, I guess I see both sides of the issue. I do recognize that I am a little biased, because as a pediatric nurse, I get floated to the NICU and so its just kind of become part of my nursing world. Generally, the perspective that I've seen from peers is that if "we" can float to NICU, then why wouldn't NICU be able to float to us? (My NICU orientation was, "This is the NICU, here are your babies. Feed them every three hours and don't touch them in between.")

It sucks, though, to be put in a situation that you don't feel like you've been equipped to manage. Valid point.

[Wuzzie]

Patient A was a toddler with a shattered pelvis s/p surgery, with pin care and all that good stuff.

Patient B was a pre-school age neurosurgical case that was due out of the OR about 20 minutes after I got report.

Oh hell to the no! THAT would be an assignment I would have refused. Well, I might have done it IF they buddied me with another nurse but I'm pretty sure they were thinking that since you took care of kiddie hearts (which scare the bejeezus out of a lot of nurses) that you could handle this patient. Nevertheless, these are the events that make floating so scary and where good communication is the key. That being said I've never floated to a unit where they weren't willing to work with me to make an assignment I felt comfortable with but that's because I communicated my willingness to be a flexible team player. Remember the floor nurses have just as much desire to have their patients receive good nursing care as any critical care unit nurse.

[llg, PhD, RN]

? (My NICU orientation was, "This is the NICU, here are your babies. Feed them every three hours and don't touch them in between.")

It sucks, though, to be put in a situation that you don't feel like you've been equipped to manage. Valid point.

Thanks. And I agree that you were not treated correctly when you were floated to the NICU.

No one should be floated to a unit where the population is significantly different and the equipment, documentation, protocols, etc. are significantly different and expected to jump right in. That's the whole point. No nurse should have to put up with that.

This is the type of management behavior that is abusive to the nursing staff, causes job dissatisfaction, low morale, high turnover, etc. We need to stop this type of thing.

[NICU Guy, BSN, RN]

Our guidelines state that we can only be assigned kids up to 18 mo when floated to the PICU.

[Whull1, BSN, DNP, RN, APRN, NP]

I think new nurses (1-2 years post school) should float to get a wide variety of patient types. When you're fresh out of school it is easier to float because you still understand and remember basic nursing school knowledge. Also it helps you verify that you're current specialty is what you want to do for the next 40 years. As a new nurse (close to three years of experience) I started out in NICU, cross trained to General Pediatrics and Newborn Nursery. I have worked full time in a Level III NICU, ED and now a Level IV NICU. By floating and cross training I was able to see what nursing had to offer (the areas I was most interested in) and took full advantage of it and now I have a specialty that I call home. Is it scary and uncomfortable? Yes! Absolutely! But so is NICU when you go to your first delivery where the baby is crashing.

[vintage_RN, BSN, RN]

I would probably be fine as I worked with adults for 4 years...but luckily in our NICU the only place we can be floated is the PICU and only with kids under say....2 years old or so. We also don't take floaters from any other area of the hospital except the PICU, and they are usually given a feeder-grower assignment.