Once again I found myself in the position of charging and being told one staff member (not specified) would have to float to another unit. This was not floating to a like unit - it was going from ours (psych with a med-surg component) to a cardiac floor.
One staff member has worked there on several occasions, having been oriented to float throughout the house. The other nurse and myself have never worked on the other floors. I said the logical thing would be to send that staff member. She was upset (understandably, I think - few people like to float) and called the house supervisor. Claims that the super told her we would need to "take turns" floating. I told her she could do what her comfort level allowed, but I would not be accepting an assignment on a unit I had no familiarity with and endanger pt's due to my utter lack of experience in that specialty. Period.
She wound up not having to go there (went home instead - said that on further inspection they decided that they in fact had the correct number of staff without her, and that she'd like the day off.) I should add that I later found out that the original situation arose because the house super had called off a person on the other unit (who wanted a day off) to float our much less experienced nurse (our census was low.)
Who here has refused an assignment, and with what reaction? Is this common *everywhere* to try and force you into roles you are not equipped to fill?
Thanks for the explanation figr8out. Like I said, I don't mind floating to PP, peds or the nursery because I have been oriented and practiced there recently. I get offended when I float to a med-surg floor and people think I should be able to work there like any other nurse. I worked med-surg for a whole three months after grad and things have changed since.
And like I said, NO NURSE HAS EVER floated to our floor without being a current employee on our unit (which means they have had an orientation and training to the area). If we are short, we're short. Period. We don't get anyone to even help with vitals or IVs because a woman in labor is apparently a terrifying thing;) That's one reason I don't have a problem with being assertive when I float and not taking a team assignment. That and the fact that I can get called back to L&D anytime during the shift if a preggo walks in!
Hello everyone, I could not help myself I work as the night shift Float nurse in a small rural hospital. My first statement is I never float I run!!!!!LOL On a serious note though I was hired to do Resp. care since RT are in short supply around here anyway, take last night for instance I come to wk at 7p as usual get report on the pts I am required to take on med-surg, b-4 report is over the ED is paging me to draw bld gases, OB wants me to cover while they are in a delivery, and ICU needs an ECG. this continued all night long. Just as it does every day. Now take into consideration that it was either sink or swim I never recieved any orientation to any of these units besides hands on I begged pleaded demanded training and all I got was your a fast learner and you will be okay. I cant even begin to describe the fear I felt when I first began this job. Lucky for me I wk with a very tight knit group who took me under there wings and taught me the things I needed to know also we are a small facility of only 94 beds, I agree that there needs to be more training and orientation I just found out that adm. hired a new grad to become my relief. At least when I started I did have some expierance with critical care. I don't know what the solution is to the "float" prob. is However to quote one MD I wk with, "I know you have to learn lets just hope that the pts understand why, due to cutbacks and all, that they are going to get an med-surg nurse to assist in their surgery" No pun intended to the Med surg nurses out there, I know how hard yall wk.
Firstly, I'd like to comment as to WHY so many competent, educated, experienced nurses are scared to death when they hear YOU HAVE TO FLOAT TODAY! There IS something to that!!! All the reasons listed for not wanting to float are valid and no one is listening! Very easy for administration to sit in their comfortable offices and dole out outrageous assigments without blinking an eye. Their focus is MONEY. No doubt about it.
It would be easy, Fgr8out, if we all felt like you. We don't. We are being asked to do a job we are NOT qualified to do. I often wonder what our CEO would do if he was made to 'float' to say, Worldcom. to 'fill in' as the CEO that night!!! After all isn't a CEO a CEO? The 'basic's are just not enough to risk losing a life, harming a person or losing your license. I wouldn't want my podiatrist to do my cardiac catheter, who would? And docs know all the ABC's and basics too. The subtlies of being capable of recognizing a potential disaster takes experience. And a short orientation isn't going to cut it either. I don't want to be oriented to a med-surg floor today, after 15 years in ICU, and then be expected to function in 6 months when asked to float there, just because I completed a little check off list 6 months ago.
I handle 2 usually 3 pts. in ICU and appreciate that I would never be able to handle and multi task 10 patients on a med surg unit. That's a gift. I don't have that gift or experience anymore. Asking to just help out or take a smaller pt. load because I feel inadequate just doesn't work when the 34 bed floor has 1 staff RN, 1 LPN and ME , the float! The regulars are alreadyfamiliar with more than half the patients on the floor. I know nobody and have to start from scatch. I don't like it, never will. Reverse is also true, if we are short in ICU and have 13 pts, 3 staff members and 1 med surg float how in the heck can we divide it so that she gets a more stable ratio. Someone is stuck having 3 or 4 CRITICAL patients because the stable ones have to be given away. THAT is scarry and patients suffer.
All that said, I want to remind us of who is to blame in all of this, THE ADMINISTRATION. They don't hire enough nurses, send people home, keep cutting, cutting, cutting.
I know all the popular complaints in the media for nursing - mandatory overtime, nurse/pt ratio, outdated salaries, etc. I think we ALL ought to start focusing on the very unsafe and frequent use of floating as administrative solution to save more
Administrations motives are always $$$$, aren't they??
LOVE the idea of asking the CEO if he would be comfortable floating to CEO another corporation today.... he MIGHT see our point....(but we could probably kiss our job goodbye....LOL!)
I've complained a lot on this forum about nurses needing to set boundaries/limits, and I have pizzed a lot of people off (particularly ER nurses, when I refuse admissions due to unsafe conditions)
We MUST set boundaries....administrators will push and push and it's up to us to say 'NO MORE'.
Floating the unecessary evil! Our hospital has a critical care float
pool and they pay those nurses more money to go to anywhere
they send them! But- the rest of us still have to take our turns
"floating" by "turn". I had been there for quite a few years-the only way I could get out of it was to do asst.lead(they don't have to float) Why not have a critical care float pool- and a med-surg
float pool? Some people actually do like the thrill-but at least it could be in some related area.
Sure we can all do tasks, so can monkeys! Why don't we train monkeys to take VS, and float them instead??
Seriously, if I was on a floor and couldn't push an unfamiliar IV drug, and another nurse did it for me, is that where the responsibility ends?? What about monitoring the side effects of those drugs? Would you know to watch for widening QT interval? Or do you just know enough to recognize sinus vs not-sinus rhythm. And what about the nurse who does give the drug? If I were giving a pronestyl loading dose, I would be uncomfortable leaving the monitoring to a float. Yes, we can teach people, but it's not easy when other pt's are crashing, a DNR just died, and you want to be there for the family, usually when a nurse is floated, there is already a busy unit, and it is hard to pin someone down to get an OTJ orientation. This is where a good nursing education department comes in.
I never said I wouldn't help out where I was comfortable, or that I wouldn't help a nurse who was floated, I am simply advocating for an orientation. It's been 21 years since I graduted from nursing school, and I haven't stepped on an OB or psych unit since. I am no supernurse, I know my limits.
Hey, if I had to choose between having an extra set of hands (even if it's only to assist with basic stuff) and have NOBODY...I would choose the extra set of hands. If anything, they can do CNA type work, or secretary type work, answer phones... things familiar to them. I don't mind doing these types of things in OB IF I am being helpful to the OB nurses. I don't look at myself as a 'trained monkey' here.....
Some days we are so understaffed we have to be grateful for what we can get...and I am. Nurses today have had to learn to be very flexible and be problem solvers with our short staffed conditions.
No it's not a perfect situation but I don't see those much anymore.
We do the best with what we've got some days.
Finding that 'line' where we say 'NO' is a personal decision. And of course we are obligated to educate managers about the dangers of relying on this type of floating on a daily basis...as it is much better to have a fully oriented group offloaters who are comfortable on several units....we all prefer this I'm sure. :)
Hey, if I had to choose between having an extra set of hands (even if it's only to assist with basic stuff) and have NOBODY...I would choose the extra set of hands. If anything, they can do CNA type work, or secretary type work, answer phones... things familiar to them. I don't mind doing these types of things in OB IF I am being helpful to the OB nurses. I don't look at myself as a 'trained monkey' here.....
:eek: I deserve to be thrashed for that stupid comment mattsmom, you make an excellent point. But, if I came onto a floor and volunteered to be the unit secreatry type for the night, my concern is, if something bad happened, wouldn't all parties working be liable if it was b/c of poor staffing, or inadequate monitoring? That's where I am coming from. I could see a lawyer making mince meat of a nurse in a witness stand who said, "I was only doing tasks." My feeling is, if yoou are an RN, and you are on a unit, and you have accepted responsibility, you also have liability.
We have a closed unit and do not have to float out of ICU if we don't want to. We have the option of taking a day off if we have a low census, or of working on another unit. None of our specialty units have to float, but we also do not get help from the other units when our census is high or staffing is short. We cover our own. On occassion, someone from the telemetry unit or stepdownunit has come in to ICU to help out, but they never have an assignment. Instead they do tasks like IVs and signing off orders. Some of the med surg units are very resentful of the fact that we do not have to go work on their floors when they are busy and we are not. Of course, these are the same people who think ICU is eay because we only have two patients.
I usually will go out to the floors. Most of our staff simply refuses to float. I don't mind floating, and I have never been asked to do anything that I am not comfortable with. I will sometimes work on the floors even if it is not my turn to go if I know the floor is really short staffed.
We also have a system for keeping track of who's turn it is to either take a day off of float. It seems to be getting more complicated though. We actually have a twelve page policy that outlines every detail of our self containment policy.
In our OB/Nsy unit, the only place other nurses float is to the postpartum floor. We, however, are expected to cover every other unit in the hospital. If there is an influx of pts, we cover our own unit. One time we had so many pts we were drowning in labor, postpartum, nsy, and nicu. One of the OB docs asked why there weren't more nurses coming in to help. We explained to him that all the nurses on the unit that could possilbe come in were already there (our unit manager had just worked labor for 30 hours straight and had gone home to bed for a while) and the hospital said there was no one to float to our unit. The OB got really angry and said that if there was no one that could float, then he would go and get the DON to work labor:chuckle
Needless to say, a nurse from OR was magically transported to work postpartum so that nurse could come back and do labor:cool: Since then we have been getting more help with nurses and aids from the other units, but we still float more out than in. I agree it is a dangerous practice. We have all been oriented to med/surg for 2 days, but we are floated to all areas of the hospital and many of us haven't been oriented to other places. When I float, I only do tasks because sometimes I am the only labor nurse in the hospital.
I know what you mean, Labornurse...when I float out of ICU I don't like to take an assignment either, cuz when a patient goes bad in house or one comes into the ER, it will be mine. So... it's less complicated for everyone for me to task rather than take a full assignment, knowing I can get pulled away any minute... :)
If I can help out in another unit without compromising safety, I generally will try to help them, because next time it may be ME needing help in ICU and I want them to reciprocate. :)
Hoolahan, you may be right about the legal risks....any legal nurses out there who can advise us???
:eek: 
The OB got really angry and said that if there was no one that could float, then he would go and get the DON to work labor:chuckle
fergus51
6,620 Posts
Thanks for the explanation figr8out. Like I said, I don't mind floating to PP, peds or the nursery because I have been oriented and practiced there recently. I get offended when I float to a med-surg floor and people think I should be able to work there like any other nurse. I worked med-surg for a whole three months after grad and things have changed since.
And like I said, NO NURSE HAS EVER floated to our floor without being a current employee on our unit (which means they have had an orientation and training to the area). If we are short, we're short. Period. We don't get anyone to even help with vitals or IVs because a woman in labor is apparently a terrifying thing;) That's one reason I don't have a problem with being assertive when I float and not taking a team assignment. That and the fact that I can get called back to L&D anytime during the shift if a preggo walks in!