Refusing to float

[NurseKC123]

I wanted to get ya lls opinion on refusing to float. The reason for the floating is because other units aren't properly staffed. Example: full time and prns ask off on the same day and everyone gets it, therefore no one is covering the floor. I work in OB/pediatrics and have never refused a float but currently it has been happening all the time! Our floor is ALWAYS staffed appropriately therefore we feel like sitting ducks when we notice other floors aren't covered. The floors needing to be covered most are medsurg and swingbed. Both of which are completely opposite of OB and pediatrics. What would the consequences be if one refuses to float??

[nutella, MSN, RN]

Some places will give the nurse a choice of using paid time off but that also means that you drain your hours.

If your floor is the quasi float pool for the hospital and med/surg it means that they are complying 100% with good and safe staffing on your floor/area (if it includes labor and delivery they do not want to loose that income due to low popularity because of staffing...). But it means that otherwise the hospital does not have a contingency plan that is sufficient in dealing with the usual up and down in census and staffing. Heck - they might not even plan sufficiently for those times of high census and low staffing... which is questionable.

Also, if the hospital is not doing well financially, they will not establish a float pool or hire sufficient staff and instead float staff around which "safes" them money as float pool nurses usually get paid something extra for the inconvenience and willingness to float.

Bottom line is that you can and have to refuse unsafe assignments. What you guys can do is to talk to your manager and request that if one of you has to float that the supervisor/manager/ charge nurse calls that floor and reminds them that certain patients should not be assigned as you guys lack proper experience and/or training.

Other strategies are to be super nice when you float as floor will be more willing to give you a "good" assignment instead of dumping everybody on you.

Most hospitals will float nurses nowadays but your floor should not become the floating pool - perhaps you guys can keep a running list of how often how float and ask the manager how it compares to other floors and what strategies the hospital has in place to deal with staffing issues to get a better understanding of what is going on. Unfortunately, maternal/child is very popular and they know that they will find replacement staff with no problems, giving you less leverage.

[Been there,done that, ASN, RN]

As your administration feels it is "SAFE" to float your specialty to cover other units.. you have no choice.

Whenever I was floated to an area that I knew I couldn't handle, I wrote up a safety report ( handed to supervision before accepting the assignment) each and every time to cover my assets.

Don't forget to make a copy.

[morte, LPN, LVN]

As your administration feels it is "SAFE" to float your specialty to cover other units.. you have no choice.

Whenever I was floated to an area that I knew I couldn't handle, I wrote up a safety report ( handed to supervision before accepting the assignment) each and every time to cover my assets.

Don't forget to make a copy.

sending that to the law firm that the hospital uses for lawsuits might not be a bad idea...

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

As a med-surg nurse, in my opinion, it is very difficult to maintain staff on these floors because of what med-surg has become. When I first entered nursing, doctors, nurses, hospital administration were in control and respected. Now, it appears that everyone other than us are controlling how we do our jobs. If we don't take the legally-addicted drug addict to the brink of death with those drugs (and back again), their pain wasn't controlled during their hospital stay, the satisfaction scores plummet, and so do the reimbursements. There goes the help! Again, my opinion based on reports from staff meetings/memos/emails, it's more of the disgruntled population that completes these surveys as it appears the happier ones get on with life and file these survey slips in the garbage with the other junk mail.

I could go on forever about what nursing has become on the floors, but I won't. We all know that if the floors were a great place to work, no one would mind being floated there. Nurses come, get that experience in more ways than one, and then move on.

How did I deal with being floated? I became a float nurse! No more mandatory meetings unless they were hospital-wide for all employees, including physicians; no more issues with getting time off as I set my own schedule, meaning that after I meet the minimum hours of my contract, I work as much or as little as I want and usually take a full week off every 3 weeks but NEVER sign up for full time hours unless a tropical road trip is on the horizon; no more getting caught up in the politics of what's happening on each unit; and the pay is outstanding!

When I couldn't deal with even that anymore, I accepted a full time job in the community and now float only one day per week on my only self-scheduled day of the week at the hospital for the same great pay.

I refuse to say that hospital (med-surg) nursing is only going to get worse; but what I will say is that it's not going to get any better. You just have to make it work for you. In doing so, you make it work for your patients.

[Libby1987]

How many shifts are you floated per pay period?

How many serious medical errors/incidents have been made as a float?

[BittyBabyGrower, MSN, RN]

We get a 3 day unpaid suspension for refusal. That being said, our hospital moved to floating only within that service. Maternal-child only floats NICU-PICU-Nursery-Peds. OB is

closed. Med-surg to med surg, adult ICU-other adult ICU/ER.

We we used to do whole house floats and it was awful. I was sent to burns, cardiac, med surg and surgical ICU. Hello, I work with babies, but the thought was we were ICU nurses, sure but a preemie is not a little

adult! I would tell the charge

nurse that I needed a resource person and made it quite

clear what I could and could not

do. I did feel bad for them

but I had to make sure I kept my license safe.

[Wile E Coyote, ASN, RN]

Most of my unit (ICU) also felt like we were the hospital's float pool. Every holiday, most paydays, etc. we ended up staffing all over the place. Our manager spent enough staff meetings getting his butt chewed by us that he was motivated to convince the Ivory Tower to allow us to close our unit. We now either choose to take pdo or voluntarily float to ER as a resource nurse if they ask for help.

[NuGuyNurse2b]

How many shifts are you floated per pay period?

How many serious medical errors/incidents have been made as a float?

At my place, we keep a log of pulled nurses. So if on Saturday (cause it usually happens on weekends when no one is there) I get pulled, I come on on Sunday, it'll be your turn, then if it continues into Monday (which it usually did) then someone else. And if it happens enough, in a pay period, you could've been pulled 3-4 times.

[NotYourMamasRN]

In one of the hospitals I worked in, it was written into our job description is a sneaky way that floating was part of the job and a mandatory evil. I learned this when I was asking to not be floated to a certain department that I did not feel comfortable in. I can imagine that practice is a part of all job descriptions. So I would think a flat out refusal could end in losing your job or disciplinary action.

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

How many shifts are you floated per pay period?

How many serious medical errors/incidents have been made as a float?

I wouldn't think there would be a significant difference in med errors if pre-established protocols are followed. In speaking for myself, I would say that caring for an adult patient (medication-wise) would be much easier than caring for a pediatric patient. In peds (again, definitely NOT my area of expertise), those weights have to be continuously factored into a lot of medications, right...the whole kg to pounds/ounces and how it equates to milligrams/grams, etc.??? I&Os require weighing diapers and and comparing that to what was given orally and parenterally, right? (Honestly, I don't know as I've never worked with kids in my 30 years of nursing). In adults, the primary drugs involving weight on the general floors are heparin (titratable by the floor nurse with protocol in hand and witness by a second nurse) and lovenox (dosage established by the physician and/or pharmacist). But I feel the exact same apprehension when I'm floated to ICU and ER. I make sure it's understood that I'm strictly med-surg and what my limitations are.

As for floating from floor to floor, the biggest problems that I've encountered are the mouths of the patients and their families. Excessive non-nursing, non-life-threatening demands takes up too much of our time (gotta keep that patient and his family smiling), and as a result we are almost always in too much of a hurry, which can lead to simple mistakes. A series of these simple mistakes can lead to the major ones. An example would be that while performing these simple-but-never-ending petty requests, an abnormal lab result is not reviewed and acted upon in a timely manner. As a result, a diabetic is not treated accordingly, or a vancomycin is hung instead of held, or a heparin drip is not restarted when it should have been...simply because that darn cup of coffee had been requested during change of shift and could not wait a second longer; or Sallie Sue didn't want her dinner when it was served, she wants it now (while you're trying to get your assessments done), but now it's too cold to eat and the tech just cannot walk away from that code brown next door, or a family member is on the phone and they absolutely cannot call back, when they only wanted to know if mama had a bowel movement 2 days ago when she had that laxative. Factor in a patient that is actually going bad, with those patients and families who couldn't care less that other people are lying in beds as well, then the errors are already made or in the makings even before the floater arrives.

Just my two cents....coming from a floater who has enough critical thinking skills and common sense to realize that some things are too much of a coincidence to be a coincidence. Some assignments are actually hand-picked. But if there is an awesome manager or charge, the assignment will be modified appropriately and one shift's housekeeping issues (passing ice, emptying trash, straightening beds, answering questions [some can ONLY be answered during normal business hours], etc) won't ALWAYS carry over into the next shift.

Does anyone besides me remember when disturbing the nurse administering medications was fireable (or strong disciplinary) offense? Those were the good ole days! The charge nurse handled all phone calls and did the trouble-shooting with families and physicians, and other departments. The only thing floor nurses had to do was tend to and take care of the patient.

[AutumnApple]

As a travel nurse, I was always first to float. That's just how it goes.

Refusing to float would have meant no renewal for sure and possibly a bad reference.

I refused to float one time. I was not at all qualified for the unit. In hindsight I'd have done it different.

Truth about floating I eventually learned is: The unit you are going to is not happy about it either.

They have to make sure you are able to take care of the patients, which usually requires you being given a favorable assignment. You have to be oriented to the unit. There is an endless list of inconveniences for you and them alike.

Best policy: Float, be pleasant with the new unit and point out when you can't do something right away.

I honestly never had issues with people trying to take advantage of me or telling me to do things I couldn't.

[futuredermNP]

Hi nursekc133!

Before you receive report you can review the assignment, the acuity and patient load and refuse the assignment citing the Nurse Practice Act. But your reasons must relate to patient care or your nursing license being jeopardized (I would only use this if you really feel it's necessary). The reasons you stated don't seem to fall under that category. Other than that just call the nursing supervisor and speak with him or her to try and work it out.