The "F" word....Floating!

juzme · Apr 4, 2011

to answer your question, sorry no. But if it is telemetry, I know of nurses who refused and it was allowed. The thing is, if you feel you can not give safe care, i.e. telemetry unit, you must tell a supervisor. hmmmm...when I worked for a LARGE hospital they had started floating and the word was, a nurse is a nurse is a nurse......except ICU and ER of course...I use to do 12 hour shifts and would get pulled(to float)every 4 hours sometimes...needless to say, my nerves were shot! every unit was different in how they were set up. I can't tell you how much time was wasted looking for stuff! Even the aides were pulled, so some of them were just as lost as me and we would look for supplies together. Some units were new, some were old....no consistency whatsoever. That was the main reason I left hospital nursing.

tntrn, ASN, RN · Apr 4, 2011

If you hadn't said you are in Indiana, I would be pm'ing you to see if you are one of my co-workers. We have the same issues where I work, and I am an OB nurse with 34 years experience.

When we float, they "try" to assign us a half load of 4 patients (and they are tryig to increase that lately) and the "try" to give us female patients with issues that we might also have on our floor (gall bladders, for example). But the last time I floated I had 3 ortho cases! Luckily, nothing awful, but I would have to have ask for reassignment had it been something I knew nothing about.

They put us and our licenses in jeopardy, but these poor patients! They don't have a clue that we know nothing about what kind of care they should be getting.

NewTexasRN · Apr 4, 2011

I know how you feel too. I had a traumatic experience when I was pulled to a critical neuro floor. I had 2 pts going down. I wasn't taught how to suction a pt. Most of them are on telemetry. I couldn't tell you if the person is in V-tach! So scary. I was praying just to get through the night!!!

3dayRN · Apr 4, 2011

I hate to float, always have always will. I know some nurses on my floor who always complain when we have a float that doesn't know something. They always say well he/she is a nurse no matter where they work. That's not how I feel. I work on stepdown and have to float everywhere except ER. I work with adults so I will NEVER feel comfortable working on OB or peds. Luckily I have only had to relieve a nurse there for her lunch break and had to only deal with the mothers on OB. Management needs to realize nurses don't refuse to float because they are being difficult it's because sometimes it is just not safe. (so glad I have my float in for the week so I should be good for awhile :))

bastet35 · Apr 4, 2011

From everything that I am reading, including specific case studies, the ANA has formally stated that the "nurse is a nurse" idea is no longer valid, due to the complex technological environments of modern hospitals and nursing facitilites.

Also, from my readings, you should only float if you have been oriented to that unit.....proper orientation would be considered the normal orientation that an RN, new to the facility, would receive, based on his or her level of experience....in my hospital, a nurse with no Med/Surg experience should receive a MINIMUM of 90 days, full time orientation. We are given NONE. The cases have also said that you, as an RN, are responsible for any assignment that you take.....your acceptance of the assignment is the equivelant of saying "I have been oriented and am competent to give proper care to these patients." If anything bad happens, you are 100% liable and the hospital will not back you up. Essentially, you are supposed to refuse. If the hospital puts disciplinary action against you, you have grounds for legal action against them. On the other hand, if you refuse to be oriented, the hospital does have grounds to dismiss you. Both of these scenarios are backed by case studies.

Even if you just float as a CNA, you are still fully liable as an RN. So, if you walk into a patient's room functioning as a CNA and do not recognize a problem, you are liable.

This frightens me. If you refuse, you are seen as insubordinate and a trouble maker. If you accept, you risk hurting someone, getting sued (and the hospital isn't going to support you if you are), and possibly loss of your nursing license.

Wow.

bastet35 · Apr 4, 2011

AND a 2004 JCAHO report "Systems Analysis: Ensure that your float staff and contracted staff are providing safe care" states that over HALF of all sentinal events have a direct correlation with float staff who were not properly trained or oriented.....JCAHO apparently holds a pretty firm stance on this issue....that floating should only occur in a dire emergency, the staff should be oriented and directly supervised by an experienced staff member from that unit. I find it amazing that if this statistic is true, and JCAHO recognizes it, other organizations do not stand up and speak out.

Would you want an Orthopedic doctor doing open heart surgery on you? I sure as heck wouldn't....but, hey, that doc had a cardiac rotation 30 years ago in medical school, so he should be able to do it, right?

tntrn, ASN, RN · Apr 4, 2011

AND a 2004 JCAHO report "Systems Analysis: Ensure that your float staff and contracted staff are providing safe care" states that over HALF of all sentinal events have a direct correlation with float staff who were not properly trained or oriented.....JCAHO apparently holds a pretty firm stance on this issue....that floating should only occur in a dire emergency, the staff should be oriented and directly supervised by an experienced staff member from that unit. I find it amazing that if this statistic is true, and JCAHO recognizes it, other organizations do not stand up and speak out.
Would you want an Orthopedic doctor doing open heart surgery on you? I sure as heck wouldn't....but, hey, that doc had a cardiac rotation 30 years ago in medical school, so he should be able to do it, right?

Sure....just show him where the OR is, and he's good to go. We get a pointed "orientation." The med room is pointed out; the supply room is pointed out...you get the picture.

From what you are sharing here, I have a whole new bunch of things to say about floating next time we negotiate. Thanks for some great insight.

linearthinker, DNP, RN · Apr 4, 2011

I have always refused to float. I just clocked out and went home. My last hospital made everybody float everywhere, except me, b/c I was the only one with balls enough to say no.

MunoRN, RN · Apr 4, 2011

You sound capable of writing a good letter about the situation complete with sources, although rather than the administration I would address the letter to your BON (and CC your administrators).

LoveMyBugs, BSN, CNA, RN · Apr 4, 2011

The hospital I worked at when I was a CNA had a float resource nurses. As a CNA you could be floated anywhere, but for a nurse to float they had to be in the float pool, which ment that they got orienatation in the ED, ICU, and some time in the L&D unit before they could be floated. They in turn got paid a lot more, and staffing would pull them everywhere during the day.

I remeber talking to one nurse, she initally triaged the patient in the ED, was pulled up to ICU where she recived the patient, and later on that week she was working the med/surg floor and D/C said patient, put unless you are in the float pool you can not be pulled anywhere

JSlovex2 · Apr 4, 2011

I used to be ok with floating to another unit and working in the role of a CNA....however, after doing further research, I am noticing that if you are working anywhere in the hospital, you hold the accountability as an RN, even if you are only doing CNA tasks.

when the rubber meets the road, if you are working as a CNA there is another RN who is assigned to that patient. THAT RN is going to be ultimately responsible for that patient's care. if THAT RN asks you to do something that's in a RN's scope and you drop the ball then of course you would be responsible. BUT if the RN who is assigned to that patient does something wrong (like giving the wrong dose of meds, for example) then it would be HER and not YOU who would be responsible.

if you're working as a CNA, you shouldn't take on any tasks that a RN would normally do. if the RN who is assigned to that patient asks you to start an IV or administer meds you should refuse although you could offer to ASSIST.

i personally would go to my supervisor and discuss this issue. i would want to know FOR SURE if my license would be on the line even if another RN was in charge and i was acting as a CNA. i would request to see and sign documents stating that i am not responsible for the patient when acting as a CNA. i would think if a patient were to code then as a RN you would be required to act as such even if you were working as a CNA, BUT i don't think in general under normal circumstances you would be responsible for patient outcomes while acting as a CNA.