Questions on having closed Peds/PICU and stop floating

[loisrn1]

I am a 20 year Pediatric Nurse on a 25+ bed unit with a 4 -6 bedded PICU in a community hospital. I am attempting to do an evidenced based practice research paper for school and work determining the feasibility of closing our unit and putting an end to floating. We currently float to the Mother/baby unit and NICU on a somewhat regular basis with it being more often from about March to Sept. With the units getting more specialized with so many competencies and medications we are concerned about the safety issues involved. We alos know the more we float, the more nursing satisfaction decreases. I am looking for ideas on how to accomplish closing the unit, just floating to PICU as needed. Anyhting anyone can tell me or any suggestions would be much appreciated!!

[tigkaskit, BSN]

hmmm. I don't have any research to offer you, just personal experience. As a former PICU nurse who just transferred to mother/baby (and other OBGYN units), I can tell you that the knowledge base is COMPLETELY different. Granted, the pts in mother/baby are generally healthy, but you still need to assess appropriately (both mom and baby) and my PICU knowledge doesn't always cross over too much into the adult arena. Give me an intubated child with dropping O2sats or high ETCO2 and I could tell you exactly how to "troubleshoot" so to speak...give me a mom with PP hemorrhage and I get a little nervous.

And a Peds nurse floating to an ICU is just unsafe in general. Now I do come from a large teaching hospital with a Level 4 NICU and a 20-something bed PICU, and no one floats to other units.

I'm sorry I'm not really helping you. I'm angry for you that you're required to float and could potentially put these patients at risk.

[classicdame, MSN, EdD]

if you are in the USA you know we graduate nurses with GENERIC degrees, meaning that any licensed nurse ought to be able to do basic nursing care regardless of experience. OUGHT being the operative word of course. It is hard to argue the point with non-clinical people who will point out that we accept new grads into these units - why not an experienced nurse who just does not happen to have experience on this unit? I would concentrate on Benner's theory and the idea of competency & mentorship. The data ought to extend to any other type speciality unit in theory, since "a nurse is a nurse" is not always appropriate, regardless of what the background education was.

[HouTx, BSN, MSN, EdD]

I think it's a great idea! Much more satisfying for your pedi staff. But you need to do some serious staffing analysis before making the change. These days, your plan had better be budget neutral or you are going to get shot down quickly.

Basically, you need to make sure you have sufficient pedi FTE for your average census. Probably 80% full time & 20% part time, but you would need to begin with looking at your weekend positions and work backward from there. If possible, also analyze your workload patterns - are there certain times of the day that are heavier than others - like post op admits from 10 am to 4 pm? If so you may want to get creative with your shifts.

On those days when you have high census, you would need to be prepared to either call in your part-timers or float volunteer nurses from other floors. I would suggest flipping into a team mode and using the non-pedi nurses as a pedi nurse 'extender' rather than have their own patient load -- much safer and more satisfying for everyone.

Good luck with your plan. Keep us posted on your progress.