"I am sorry - I refuse to float to Peds!"

[abbaking]

It was my time to float the other night and I was to float to pediatrics. No way Jose!

I have never felt comfortable with children and my specialty has always been with the adult population.

I stood my ground and refused pediatrics.....they said my assignments wouldn't be that bad - 3 infants and 2 older kids - NO! THE ANSWER IS NO!

I would rather be budgeted home that work with kids.

If I was a patient on an adult unit I would not want a neonatal or peds nurse caring for me after a major procedure......I think its safe to say that a child would feel uncomfortable in the hands of an adult nurse.

Sorry if that offends peds nurses, but i can't and i wont work peds.

[BluegrassRN]

My facilities will float anyone anywhere but the assignment is adjusted to acknowledge the lack of specific skills. If I were sent to a peds floor, I would have older patients or not have a patient load and instead "float" doing general tasks. Same is true if I were pulled to OB. In the ICU I'd get the most stable patients and in the ER I would primarily do transport and routine tasks (IVs, foleys, etc) rather than actual patient care. When nurses from these areas are pulled to my unit (tele) the same is true, they don't take the same patient load and don't work with the same expectations.

This is how my facility handless, as well. When we float, we receive the least acute patients, those most like the ones in our home unit, or we float around and help by doing admissions, passing meds, getting VS, etc.

I don't mind floating. I learn something, meet some new people, and it keeps life interesting. I have not every floated and felt unsafe in another area. Maybe it's because I've been at this hospital for a looooong time and therefore know everyone, but I have always felt supported by the charge nurses and other staff when I've floated. If I have a question or a concern, I ask.

[pagandeva2000, LPN]

I can understand it. If you have not touched pediatrics since school, it may not be safe. Doses of meds have to be calculated, not recognizing signs and symptoms from a patient that may not be able to communicate with you...the list is endless. I would have been intimidated and would have probably said no, also.

I work in Ambulatory Care (clinics) at my hospital. I have not been oriented to the pediatric clinic. They have a boatload of vaccinations that they have to receive, of course. Once I floated to one of our off-sites with my nursing supervisor; I worked medical and OB, she did peds. It was awful busy for her, so, I offered to ASSIST and said to her that I wanted for her to coach me along, because who knows? One day, I may be transferred to pediatrics. Now, it would not be a choice of mine, but, I told her that I wanted to feel/practice safely. She did come with me, and thank goodness. I would have been confused on which vaccination to give based on age, etc... Totally different considerations. And, you may not know what you'll experience once you actually go to that unit. You may have worked with some witches who dumped everything on you, not assist, etc... I would not have taken the chance either. But, I would sure ask for an orientation there since it seems that they are indiscriminate on where they will float you.

[abbaking]

I want to thank you all for your support.

Side information - Aside from my nephew, I have never held any children/babies before. Pediatrics utilizes completely different medical equipment that in the adult med/surg units and Its been a LONG time since nursing school. You'vw heard the term "Use it or Lose it" - I don't remember what an infants normal vital signs are. I don't remember the medication rights for infants. I don't remember pediatric assessments.

Of course my manager told me "You will float were you are needed". Fine, I told her. Since she has 30+ years eperience as an RN, she is obviously more qualified to float to pediatrics than I am. I told herthat I am not risking my job, license or life because a unit is short a nurse. If they needed a pediatric RN, they should dish out the extra $$$ and call up a registry RN.

[Altra, BSN, RN]

good for you, that was good nursing. what get's lost by those who say you should

"just go"- is the patient advocacy. your responsibility to safely care for your patients should always outweigh staffing problems.

floating is only 1 option, why not transfer patients to another hospital or call in registry, or hold patients in er. if any nurse feels not competent on the unit-just refuse to go.

i agree that the op did the right thing. the prevailing attitude of, "a nurse is a nurse" (essentially a highly skilled day laborer) will continue until we challenge it.

however, i take issue with the bolded part of the post above.

holding patients in the er is not the answer, for many, many reasons which have been discussed ad nauseum in the emergency nursing forum.

[pedinurse35]

Just a suggestion, but before refusing to float, consider calling or going to the peds floor first and speaking to the charge nurse. Tell her your concerns and ask her if there is anything you can do that would be assisting them but wouldn't put you in a position of having to do things you aren't comfortable doing. I once floated to an adult floor and was scared to death, knowing I wouldn't know any of the meds, much less dosages or IV drip rates! I expressed my concern and volunteered to do anything else, no matter what, and I was assigned to empty foleys and do nurses aide work for the shift. I didn't mind one bit, since I was able to help out short-staffed (stressed) nurses, and I learned new things in a way that didn't jeopardize my license. If I was a charge nurse, I would appreciate that. Now, IF you try that the charge nurse still demands you be responsible for total patient care, then you would have to refuse, like you did, but it would look much better than refusing before giving the peds staff a chance. :)

[llg, PhD, RN]

This is the type of problem that should be discussed BEFORE it happens. Plan ahead. If you don't feel comfortable floating to other areas of the hospital, then you should be discussing this with your manager and devising a plan that will allow you to help out when needed -- but in a way that will be safe. Ignoring the possibity that you might be asked to help out another area (such as peds or OB or OR etc.) and just hoping it will never happen is not a good idea.

My hospital (a children's hospital) has addressed this issue as an institution. We have guidelines as to what can be reasonably expected and what cannot be. We don't expect peds nurses to take full assignments in the NICU and we don't expect NICU nurses to take assignments on peds floors, etc. We have identified tasks that all nurses can reasonably be expected to do that would be helpful -- and possibilities for shifting staffing around to accommodate such isses.

The key is to plan ahead and be sure the leadership has appropriate plans in place and reasonable expectations.

[SaltyNurse]

I'm sorry for you. So much of nursing is scary. Anytime you float to a new unit it is scary. You will and can stay in your safe unit. You can stay safe and secure as you see newer grads, and co-workers, go on to different and vaired careers. Move into charge nursing, work in out-patient surgeries, clinics, etc., you will be all safe and secure in your unit until it change, closes, and only nurses who have had experience in different units or GASP even have worked pediatrics will be asked to stay on and don't let the door hit you on the way out.

Honestly I understand your fears, but this was a pediatric unit. Not the Pediatric Intensive Care Unit. You won't believe how much you can grow, how many fears you can overcome, how much you can learn, if you say, I'm scared, but I'm willing to try.

Hogwash. There is a reason that nurses have to demonstrate unit specific competencies after undergoing an orientation period. It's called patient safety.

We don't grab the nearest general urologist when we're short on pediatricians. The same logic applies.

Hospitals/organizations that are willing to float anyone anywhere with a license and a pulse are egregiously irresponsible.

When your unit is short and you absolutely cannot get another RN who is qualified to work with that population, and no one is willing to stay over, perhaps then the charge nurse (unfortunately) will have to take some patients, and wouldn't it be nice if the unit manager and/or director stepped up to the plate (as one would think is appropriate for that level of responsibility)?

[SaltyNurse]

Just a suggestion, but before refusing to float, consider calling or going to the peds floor first and speaking to the charge nurse. Tell her your concerns and ask her if there is anything you can do that would be assisting them but wouldn't put you in a position of having to do things you aren't comfortable doing. I once floated to an adult floor and was scared to death, knowing I wouldn't know any of the meds, much less dosages or IV drip rates! I expressed my concern and volunteered to do anything else, no matter what, and I was assigned to empty foleys and do nurses aide work for the shift. I didn't mind one bit, since I was able to help out short-staffed (stressed) nurses, and I learned new things in a way that didn't jeopardize my license. If I was a charge nurse, I would appreciate that. Now, IF you try that the charge nurse still demands you be responsible for total patient care, then you would have to refuse, like you did, but it would look much better than refusing before giving the peds staff a chance. :)

That's a nice thought, but if you're floated to a unit and are only able to help out doing tasks that are within the scope of an aide, then the RNs on that unit are still shorted. And in that scenario, it would be much more cost-effective to bring on an extra aide rather than have an RN (with RN wages) doing aide work.

And I agree with another poster who stated that floating guidelines/restrictions should already established as policy. And they shouldn't compromise patient or RN license safety!

[newwavegirl89]

:yeah:kudos to you for standing your ground. i would not take report too for that assignment . there are policies at my hosp now where nurses r not put in that position(although it wasnt always like that). my 2nd job at an after hrs clinic they tried to put me in that same position. i work adult family prac and tried to have me as the only licensed to cover BOTH peds and adult! no way! u and i worked TOO hard for our licenses! i can totally relate!

[featherzRN, MSN]

I would have grumbled a bit but done it if the kids were older/adolescent. No WAY would I go to a unit to take care of infants! As other posters have said, I haven't a clue what to do with a baby. I'm 40 years old and have held a baby maybe twice since nursing school. I don't know what they eat, how to feed them, the meds, and I certainly could not start an IV. Would you want me around YOUR infant?

[netglow, ASN, RN]

I'd probably do what the OP did... Kids and babies have always worshipped me... IDK why. But I am sure that would be the least of the OP's anxiety. Think of it, he'd be having to look up EVERYTHING. Ya just don't retain it all. If all were just on oral meds... maybe.

I could see me hang'in with the babies just a little too long :redpinkhe, 2ndwind, would ya let the parents hold that baby?! NO!

[CrunchRN, ADN, RN]

Good for you. 1st do no harm as they say. Children are NOT little adults. It is very inappropriate of them to ask you to float there without any peds training.