Split-Shift Floating

[CameToSlay]

I am currently on an assignment where I am sometimes asked to switch units mid-shift (4 hours on one unit, 8 hours on another). Sometimes, I am asked to do this not out of an emergent need, but rather because an 8-hour shift staff nurse or per-diem nurse picking up a shift prefers not to work on a certain unit (and this facility has been short-staffed frequently as of late).

The split is done between a step-down unit, and a telemetry unit where the patient ratio can go up to 8 patients at night-- and that is the floor where nurses do not want to pick up shifts, so I have been asked to float there to pick up 7 patients and then receive an admission, after taking care of step-down patients for the first 4 hours.

I do not feel comfortable doing this again, as it is simply too much, and there is too high of a risk that something will be missed. I cannot properly assess and care for 8 telemetry patients (one of whom is always an admit) when I am always getting there late due to completing duties in step-down (and I refuse to cut corners, as this facility does audits). This floating mid-shift is never done by staff (I am on 12 hour shifts and they are on 8 hour shifts), and as there are no other travelers on my night shift, no one else is doing it.

My contract does have a float policy, but it does not specify mid-shift floating. I am planning to refuse the next time I am asked to float mid-shift to care for 8 patients because a staff nurse or per diem nurse coming in for their shift does not want to work that unit, and I am even prepared to be sent home for refusing (and also I don't think they would do that due to short staffing), as I feel strongly that it is that unsafe with those ratios. Have any experienced travelers encountered a similar situation? Any advice would be appreciated!(and please not just 'suck it up', as that is what I have been doing, and it is just unsafe to continue.)

[josbarRN]

Your post brings back bad memories: I have worked at two hospitals that informed me that, "as a travel nurse, you can expect to get floated to another unit before a permanent nurse will get floated".

At Hospital#1, I was unprepared for how aggravating that rule would become. This particular hospital actually had nurses charting in three, yes *three* separate places: in the computer, on a chart outside the patient room and in a chart at the front desk. This assignment also found me caring for a patient who had meds due every hour and was in Contact Isolation so I had to don gloves and gowns every hour and it made it hard to care for my other four patients. I was assigned this patient for three days straight (which spared the permanent staff). My assignment was changed once his isolation was stopped and his med frequency lessened. Then came the dreaded float day: four hours into my shift, I was getting floated, so I had to catch up my patient care, chart in all three places, give report to an oncoming nurse, go to the next unit and get report on five new patients...and four hours later, you guessed it: I had to catch up on what I was doing, chart, give report to another nurse, float to yet another unit and get report on a new group. I had enough of Hospital #1 and it was the only time I cancelled an assignment before my 13 weeks was completed.

Four years later, at Hospital #2, I was again told that I would be first to float as a travel nurse. Over three months, there were only two occasions where I worked back-to-back shifts on the same unit and, at least once every other week, I got floated in mid-shift, usually to replace a nurse who had only picked up an 8-hour shift. Fortunately, all the charting is electronic and peers had shown me "shortcuts" to charting by exception.

I have a background in Psych and have learned that "Frustration = Expectations minus Reality". So, keep your expectations low: remember that that if your unit was *the bestest place to work in the entire world", nurses would be flocking to work there and they would not need travel nurses. I keep my expectations realistic so as not to become frustrated with the hospitals. Thirteen weeks can go by very quickly.

So decide how you will do three things every shift:

1) Arrive with a smile on your face

2) Make at least three other people smile during your shift and

3) Leave with a smile on your face.

Then you will find that you can handle anything they throw your way.

[CameToSlay]

Thank you for the great response! Things are going a lot better now.

[NedRN]

Congrats on surviving! You are now a stronger nurse and traveler.

[RN/WI, ADN, BSN, MSN, RN, APRN]

I am so glad things are better for you!