Scared to float

[Kay KRNC]

I work in a small hospital who has been in financial strain for about a year. The oldest and newest problem is that they want to float all RNs when possible to keep costs down. I have been a mother baby nurse most of my career. I am willing to help as I can when I can, but am unwilling to take a patient load. I do not feel it is in the patients best interest. I have been told because I have RN behind my name that qualifies me to do required work. Yet when I say that they would not ask a Med-surg nurse to take an OB patient I am told it is not the same. I am looking for evidence base practice on this and how it affects the patients. I need professional information on how to fight this silly battle and be an advocate as well as keep myself safe. Any suggestions,readings, articles would be helpful. Thanks

[JustEnuff2BDangerous, BSN, RN]

I agree that it is not the same to float an OB nurse to a med-surg floor as it is to float a med-surg nurse to an OB floor, strictly on the bounds that OB is considered a specialty area. As a med-surg nurse I wouldn't have the first CLUE about how to dose Pitocin, how to read fetal monitoring strips, or how to assist a doctor in delivering a baby.

I do believe it is unfair of them to assume, however, that just because you are a RN means you know how to do med-surg nursing, especially if you have been in OB for a long time. I do think that with some orientation you would feel more comfortable with med-surg and be able to handle most, if not all, situations. I think it is unsafe to your patients and unfair to you to put you on a med-surg floor without any orientation. If they insist you float to med-surg, I would suggest you insist on four to eight weeks of orientation with the option to opt out of any remaining orientation once you feel prepared.

[mamamerlee, LPN]

Insist on a minimum 3-5 day orientation to any unit that you might be floated to. I have always thought it is unreasonable to ask nurses to care for patients that are far outside of their usual area. Ask them to float some OR nurses when the census is down in surgery. Etc. Like you said, m/s nurses don't come to OB or the nursery.

[pers]

At my facility being floated to other units is very common. Few people like it since it definitely requires going outside your comfort zone but it's accepted practice.

If I am floated to OB (I work telemetry) I would be expected to take patients but they would factor in that I can't read a fetal monitor (just as they can't read my tele strips) and someone else would do that task for me or I wouldn't be assigned a patient with that need.

The only exception made for nurses who float to my unit from more specialized areas (OB, all of the ICUs and ED) is that they do not take more than 4 patients (our normal load is up to 8). They are expected to ask questions for things they don't know but most nursing tasks are still familiar to them. They can pass meds, do basic assessments, simple dressing changes, start IVs, provide comfort measures, check off charts, etc. We wouldn't give them a patient going for a heart cath or CABG the next day (or one who just returned either) anymore than I'd be expected to take care of a woman in active labor.

If you really are willing to help, I would suggest finding out what type of patients you are going to be expected to care for and what that care entails. Sometimes we'll get a float nurse who is uncomfortable with taking patients at all and rather than giving her a group of patients we make her a floor float. She'd help out other nurses by passing meds, checking off charts, answering lights, assisting with admissions, whatever someone else needs to lighten their load that doesn't require anything beyond basic nursing skills. It's a difficult job because you have to assist all the other nurses so they can take a heavier patient load but if you aren't comfy taking patients yourself it's a nice option.

[Redhead28]

If it is now policy you are not going to beat it. Many hospitals have floating policies. Ask for an orientation to the unit and request a "buddy" someone that can show you around and answer questions. Most of the time the receiving unit is grateful for the help and give the most stable patients to the floating nurse.

[suanna]

You are illistrating one of the main reasons our nursing department unionized. It wasn't for better pay, or pie-in-the-sky benifits, but for patient safety issues like the one you point out. If pt safety isn't #1 at this hospital I would start looking for another position. Most of the hospitals in my area have a "float policy" that at least restricts the places a nurse can float and the responsibilities of the nurse when floating to another unit outside of thier usual area of practice. In nursing today we cannot hope for a NO-FLOATING policy, but realistic expectations and clearly defined responsibilities are a must. Hospitals that don't recognize at least some stratification in thier various departments of nursing are the ones that tend to save money by having almost all new grads as thier staff. Once someone gets a little experience they flee these hospitals like the plague. If that sounds like the way your hospital is headded- get out asap.

[wooh, BSN, RN]

I agree that it is not the same to float an OB nurse to a med-surg floor as it is to float a med-surg nurse to an OB floor, strictly on the bounds that OB is considered a specialty area.

Totally disagree. Med-surg IS a specialty. I've seen floats to med-surg be totally lost handling half of a med-surg load of "easy" patients, more lost than I've been floating to their units with a full but "easy" load. And I'm not a super-nurse, just flexible (probably the med-surg in me.) OP has every reason to be worried.

Ask for orientation. When they see the cost of orienting nurses, it may end up being not the money saver they think it is!

A "nurse is a nurse" attitude is dangerous and all too common amongst the penny pinchers that only see nurses as a pox on the bottom line. When you inevitably get floated (because the bean counters are in charge), don't be afraid to ask all the questions you need to ask.