PP nurse being sent to med-surg floors to take pt assignment?

[livealoha]

I am a fairly new RN (2.5 years in) and was hired out of nursing school on a postpartum floor that has no nursery so I have new mamas and newborns as my patients. I love my job! However, when our census dips, as it has recently, we have been sent to other units to task.

Recently, we have been told we now have to take patient assignments on med-surg units. I have had to do this once since this has begun and was anxious the entire shift.

I am not comfortable doing this as I feel inadequately trained to handle a med-surg patient and their vast array of medications and diagnoses. Yes, I know I was exposed and taught many med-surg topics in nursing school, but my focus has only been moms and babies for the past 2.5 years...not med-surg issues.

When I asked my director if I had the option of refusing the assignment and being put on call or just calling in she told me I would have to accept the assignment and my only option would be to call safe harbor. (This conversation took place after the fact, in anticipation for the next occurrence.)

Am I wrong in not wanting to accept these assignments or am I making a much bigger deal out of things? I do not want to risk my license or, more importantly, put any patients in danger. I feel a great responsibility to provide the very best care possible to my patients and don't ever want to put their well-being in jeopardy.

[MomBabyUnitRN]

I absolutely don't think it's wrong to tell them you can't take patients. How would a med/surg nurse like to come up to L/D and take a patient?

I used to float to med/surg all the time early in my nursing career from a PP/L/D floor. I worked med/surg for years and was comfortable there. Just because we've all gone to nursing school, those in administration believe we can be floated around and take patients wherever we are.

Not true; the old days of med/surg are no longer. It became more specialized and when I'd float there, I was finding I was more of a hindrance than a help. So I'd go and basically work as an aide or a tech.

I'd refuse to go unless going as a tech. I can take people to the bathroom, do VS, bathe and bring them dinner -- I can even help out in a code... but managing art lines is a different matter altogether. Yes, our med/surg floor took care of art lines.

Give me a good old laboring mom... I'm comfortable there.

[brillohead, ADN, RN]

As a floor nurse (more medical than surgical on my unit), when we have OB nurses float to our unit, they function as an aide/tech -- they do vitals, glucose checks, toileting / brief changes, Q2H turns, fetching drinks or turkey sandwiches, etc.

[brillohead, ADN, RN]

Oh, and we do the same on the rare occasion when we float to the mother-baby unit. Aide/tech duties only.

[jennylee321]

Floating to other areas is very common where I work, it's basically their main way to staff the hospital. I have only ever worked NICU so yes I panic when I'm floated. They seem to think it's fine to float us to peads to take a full patient load. I however don't know anything about kids, never had an inpatient paediatric placement and don't even have any of my own. It's always under the illusion that you will get babies when you go but last time I had 4 kids no babies. It really isn't safe. We should be floated there to take specifically young babies or be a CNA/helping hands role. We also occasionally get adult nurses floated to us that have never worked with babies, not a lot of help.

[MCURN]

The concept of a "nurse is a nurse is a nurse" that gets tossed around management is ridiculous. In areas that are highly specialized it is dangerous to move nurses into other units and is unsafe to all patients. I have been a postpartum nurse for 5 years and would not have a hot clue to what to do with an acutely ill adult pt. Give me a mom that is PPHing any day but just not a colostomy lol. Just as when a medicine nurse gets pulled they have no idea about baby care and education we provide. It is completely reasonable to refuse a pt load that you feel is out of your scope and is unsafe. .

[jdub6]

As someone who used to float from PICU to ED to NICU to pedi med-surg-tele-cardiac, my suggestions:iask for (abbreviated) orientation to med-surg (perhaps when you have low census and not floated they can send you to orient rather than send you home on call). A couple shadow shifts to learn where to find stuff, how to document

Instead of all the nurses in your unit taking turns being floated everywhere maybe train a few nurses for each med-surg floor and when possible float those who have been oriented when that floor needs help. if a particulatar floor needs floats a lot then orient more people there. there will be shifts where no one is oriented to the floor that needs help, but you wouldn't be worse off than now.

If the floors you float to have certain types of patients they see often-like they always have a few CHF exacerbations-see if floats from your unit can be oriented with those patients. Then they know to assign ob floats to the CHFers, or post-op hips, or whatever-any patients whose care follows a common protocol. Then you can focus on learning what needs to be done/monitored/documented for a few conditions. If possible have available for your staff the written protocols (including MD decision flow trees and nursing p&p) for those conditions.

Ask your manager to meet with the med-surg manager (or at least a charge meeting with a charge) to establish which types of patients your floats should get (see above), find out what complaints their staff have about floats (they don't do the OR sheet right/at all, they setup the tube feed wrong, or whatnot). Your mgr/designee should be told the biggest issues you've had floating (don't know how to use the Hoyer, not comfortable with cardiac meds, post-op protocols).

If you are floated relatively often to a [few] floor then your mgr or designee should create a tip/FAQ sheet using the problems brought up by staff from both units. A nurse from your unit should go to that floor and create a map/info sheet (where stuff is, unit routines etc.