Refused to float without orientation ...Terminated

[SFnrs]

I recently accepted a travel assignment for an ICU position that turned out to be Trauma heavy (I have little experience in this area). I met with the director of ICU and we discussed my moving my contract to TCU. I was more than happy to do so. After completing my orientation of 2 shifts...I showed up ready to get to work. Approximately 3 hours into my shift I was told that I would be floating to a Med/Surg floor. I explained that I hadn't worked medsurg and hadn't been oriented. This was an 8 hour shift, so I told the charge nurse I didn't feel comfortable taking that assignment but would gladly go orient so I could be available for any future needs they may have. I also offered to float between the 2 floors and do admissions. I was told that I had to discuss it with the Nurse Manager who they got on the phone. I again explained that going from ICU to TCU then to Med/Surg without orientation in one week was too tall of an order for even the most seasoned of nurses. I was very respectful and even used the words "I mean no disrespect but no prudent nurse would take an assignment without having been oriented to a floor." I also asked him what he would do if someone asked him to work a floor he hadn't had experience with in 9 years without orientation. His reply.... "turn your pts over to the nurse following you and you wont be coming back here or to ICU."I mean When this all started I called my recruiter and did so a couple of times throughout the evening as this situation unfolded. The next day I received my termination notice and the nurse manager blatantly lied...he said that I refused to float and that HE offered me the chance to do admissions and I said NO!!!!I cannot describe how shocked I am. The night supervisor who was in attendance when this all took place knows the truth as I asked her directly if I could do admissions. My problem .... I find myself over a thousand miles from home with no job! I need some advice!

[BostonTerrierLover, BSN, RN]

If I had one dollar for everytime my contract hospital's assignment looked like the contract I signed, I would have: $1.

THAT SAID, I LOVE TRAVEL NURSING, AND I HAVE LEARNED A TON ABOUT NEGOTIATION PRE-ASSIGNMENT.

[NurseLoveJoy88, ASN, RN]

I don't know what to say. I'm praying that you receive clarity and have your problem resolved soon. I can't imagine what you are going through.

[79Tango]

As a manager I would have called your company and asked them to send me someone a little more versatile. We pay alot of money for travelers and the last thing I need is to be worrying about orientating an ICU RN to the MedSurg floor for 1 shift.

[withasmilelpn]

I've always wondered why many agency positions didn't have orientation before hand. I mean - why have orientation at all then for your hired staff? No need for inservices then either, right? It's not important at all that your nurses follow company policies, are competent or efficient. As long as a nurse went to nursing school - a nurse is prepared for whatever you throw at her. Right? Works great treating nurses as a body to put where you want when you want them - until you get sued. Safety matters. Orientation is important for many reasons. And I did Agency work - I know what I speak of.

[PeaceonearthRN]

I agree! He falls into the "I deserve to be (fill in the blank).

I'm glad you have a happy ending. No nurse should be abused

for asking for orientation. God Speed.

[Flare, ASN, BSN]

I am glad everything worked out for you. I understand that ICU nurses don't like to be floated to med-surg, but at the end of the day - you are intellectually capable of taking care of med-surg if you are capable of taking care of icu patients. That being said - of course a mini-orientation to any unit you work on is in order - even if it's nothing more than Omni is here, clean utility there, the code to the break room is #### and Jess is in charge if you have any questions, but that should go without saying. As a shift admin, i have had agency nurses refuse shifts. I've had ICU nurses refuse to go to stepdown because they thought they weren't contracted to. I found that in my hospital that's rarely the case. Know the terms of your contract.... even carry it high lighted if you think it may become an issue.

[nursedejuan]

I'm a PACU nurse... They have "asked" us occasionally to go help in ICU and even the floor... I'm more comfortable going to floor then ICU, but I recover the same patients that they get alot... So I should be able to do it... Someone on the floor or ICU can take 10minutes and show me the differences in paper work.. And they never give us the really sick patients.... We are ACLS and BLS, we get told the whole "a nurse is a nurse" Which I don't agree that floor nurses can be pulled to ICU or even us.... But a ICU/PACU nurse should be able to handle a less critical area.. In the end taking care of a patient is the same, just paperwork is different..

And Im thinking about traveling, and some of yall are scaring me.... Im more nervous about picking wrong company

[BostonTerrierLover, BSN, RN]

CAN YOU THROW US AN UPDATE OP?

:no:just worried about how it's going now

Hope everything is going ok.

[wanderlust99]

It really depends on the hospital. I am floated all the time. But, some hospitals offer orientation to the places you will float...with those hospitals I can refuse to float to places I haven't been oriented and that seems acceptable because they orient you to other units. Some hospitals just don't float ICU nurses to tele, love those places. Others don't give a ...., they hire ICU nurses because we can are most useful with their staffing, we have the abilitiy to work ICU and tele and medsurg. A tele nurse can't work ICU, but an ICU nurse does have the know how to work tele....yes, it's different and not fun, but you do have the ability/knowledge. It's a pain in the ass to float and I still feel nervous but it's totally doable. Actually, depends on the pt to nurse ratio. In CA it's 4 to 1, so while it's a huge pain it's not that bad.

[NedRN]

Sure, administration would like nurses to be treated generically and all specialties are interchangeable. Management is all about business, not good patient care. If I was in medsurg as a patient, I would love to have an ICU nurse be my nurse - if it was 1:1, or 1:2. Otherwise, no way. Completely different organizational skills - many floors in many states are 1:8 or worse. Floors that are better usually have less support staff. Might be able to stumble through, but is it safe? With no orientation? Not even Pyxis access? Get real here guys. I don't want a nurse with no orientation taking care of me, or my mother. Nor would I want my mother in such a hospital that thinks that way at all.

Both the hospital and the agency now admit that the nurse was right, so why the lack of support for this nurse? As best I can tell reading this thread, the comments about the (bad) judgment shown by the OP ICU nurse are by administrators and medsurg nurses. Medsurg nurses have a darn hard job, and it is very different from ICU. There is no need for bad blood between the two specialties, and indeed they are both specialties that require a lot of recent exclusive experience to be good at (excepting super nurses). Without recent experience, or an extensive orientation (weeks to months), a nurse cannot just float at a manager's whim. It is not safe, or prudent. Frankly, I don't care what they do at 20 bed hospitals (nurses working all departments), for even those have (or should have) the judgment to ship patients they can't safely handle.

[dorie43rn]

Why is no one listening???? She was willing to float! She didn't know the floor, she just wanted to be shown the floor! Imagine floating to a floor you've never seen or been on in your nursing career. What will you spend you time doing? You will be bugging all the nurses as to where this is and where that is, and then they will hate you. All she asked for was a small introduction to that floor. Any new staff nurse hired at that hospital would get that, why shouldn't a travel nurse?

[NedRN]

I got that she was willing to work outside her specialty with an orientation (not sure how much was needed). She talked about just doing admits. But if you were referring to my post, I was only addressing the several posters who seemed to believe that an ICU nurse could float at a moment's notice without orientation to areas outside her specialty. That can even includes other ICUs. Some ICU nurses have only done medical ICUs. Asking them to do trauma (in this particular incident), or open heart recovery is completely inappropriate without an extensive orientation. As is asking someone who has worked only in ICU for 20 years direct from school to take on 8 medsurg patients without orientation.