Staff Management And Nursing Assignment

[LisaCam]

I work in ICU and Our manager is trying to cross train tele or DOU nurses to work in ICU as needed. I think it’s unsafe and create lot of drama since those nurses who are cross trained would not want to go back to their home unit. It’s also not safe for some body who just got trained to go back and forth between ICU and tele or DOU. I think becoming a safe ICU nurse takes time and experience. The management just wants to control nurses without having to create new positions. I just need more arguments. What do you think?

[RNperdiem, RN]

Early in the pandemic, a lot of the floor and stepdown nurses were given a few shifts in the ICU with a preceptor to learn about ICU nursing.

This plan was existed in a time of unknowns about Covid. If we faced crisis conditions in the hospital and ICU beds became an issue, we would be able to transition to a type of team nursing with the floor nurses handling routine tasks like giving meds, and the ICU nurses would be able to handle the ICU part. 

Luckily this plan never was used, but it showed that some planning about worst case scenarios was thought about. 

[Been there,done that, ASN, RN]

" I just need more arguments." Save your breath. You have no authority in this program.

[LovingLife123]

What’s DoU?

[SummerGarden, BSN, MSN, RN]

OP, what do you mean unsafe?  If nurses receive the proper training and competencies, how is this unsafe? 

My hospital did something similar during the first 3 surges of COVID, where they only cross-trained current and former ED and ICU RNs who worked as telemetry nurses for the organization.  As of surge 4 the program has expanded to a permanent training program to allow experienced telemetry nurses who wish to transition to the ICU an opportunity to do so.  This has not shown to be "unsafe".

I agree with "Been there, done that", you are not actually in charge and neither are your coworkers.  Be kind and embrace your new coworkers who are going to transition to the ICU in which you work. Be a positive role model to your coworkers, who are creating "a lot of drama" by championing this change.

[LisaCam]

it's unsafe because they train them and send them back to their home units. they use them as needed. it takes time to develop critical thinking and experience for becoming an ICU nurse. you can't just train a nurse and think she is going to be independent and use her/him as a float nurse. I don't need advice of kindness from anyone. training and ED nurse or former ICU nurse is way different from training a tele or dou nurse who has no experience in ICU. Plus, they are not creating new positions, they just want to use these nurses as float nurses without having the benefit of float nurses. I just asked a question. I don't need your hate speech

[Emergent, RN]

Hate speech, LOL! Isn't that a Federal offense? Call in the FBI!

[Wuzzie]

On 11/26/2021 at 3:54 AM, LisaCam said:

What do you think

I think we need to know a lot more about how they plan to implement it which you have left out.

[RNperdiem, RN]

You say in your original post "you need more arguments".

Unfortunately what you would really need to stop the floating is  not more arguments, but more power. As a staff nurse, you don't have that power to determine float policy. (Unless the CEO or DON is a relative or close personal friend and you can pull strings behind the scenes)

The power you do have is to decide to look elsewhere for employment if you decide that this floating move is something you cannot tolerate.

[socal212, CNA]

My hospital has been using tele nurses to help in the ICU since covid started.  When we don't have enough ICU nurses, they form a team assignment with a tele nurse and take on 3 or 4 patients.  The tele nurses do things like help bathe/turn, pass meds, draw labs, assessments on the non-intubated patients....the things they do on the floor.  At first it was rocky and everyone was miserable, but it's actually become a very good system.  We hired on a lot of the tele nurses as core ICU staff.  Some don't want to transfer, and will just float when told to.  And some are beloved and I trust them more with patients than some of the travelers we get in the ICU.  It honestly really sounds like you just don't want to work with tele nurses, or else you wouldn't care that it may create drama.

[JKL33]

6 hours ago, socal212 said:

It honestly really sounds like you just don't want to work with tele nurses, or else you wouldn't care that it may create drama.

Eh, I think that's a too-easy answer/accusation. It really flat-out ignores the fact that administration often comes up with plans and even when they are potentially reasonable plans, they aren't necessarily well thought out or executed. It's often just "we're doing this and we better not hear any complaining about it." And then we all wait to see how it's going to pan out. This preemptive concern expressed by the OP can often be observed in places where staff is leery due to ridiculous and/or unsafe things they've experienced from frequent initiatives/changes.

The OP has a point and the OP will turn out to be correct that this is a bad idea unless there is a plan and commitment on the part of administration that these people are going to receive adequate training and exposure for the work they are expected to periodically do. It could work out very well, as you have observed at your workplace--but that entails a degree of commitment and resources that many places are not willing to afford the situation.

However, I agree that none of this is for the OP to worry about, the OP doesn't need more arguments, the OP should stay out of it and should do nothing but be kind and helpful to those being trained. The OP should speak to their supervisor if there is an actual problem (such as being expected to assume inappropriate legal responsibilities for under-trained staff).

[JBMmom, MSN, NP]

My hospital came up with this exact same plan and it was a nightmare. Originally the float nurses were going to be part of a team working with one of the unit nurses, so one unit nurse would have 4-6 patients with 2 float nurses working with them as someone else described. As nurses in the unit we were not told to train anyone, we were told that they had education sets to complete and then they would be on the floor with us. 

What ended up happening, when COVID hit our unit and we were short staffed, they sent the float nurses down to take full assignments. Some of them flat our refused and some of them were overwhelmed because we were so short we couldn't help as much as we normally would have, and they NEVER received the appropriate training. It was awful. Since then a couple have floated to the unit often enough that they eventually got comfortable enough with a lighter assignment, but we have to make sure they're not open to admit or have the more challenging patients. Last month they tried to send down a float that was last in the unit last January, she refused.

I think the team approach might have worked out well if that's what was actually implemented. Instead, they got an abbreviated orientation for these nurses under "emergency situation guidelines so we would have enough bodies"- a direct quote from my manager. It's not fair to those nurses or the patients, but it's what's happened. To the OP, good luck with your situation, I sympathize with your position but agree that you will likely have very little influence over it.