Travel and Floating

Argo · Mar 26, 2016

I would tread lightly, your the bottom of the nurse food chain there. I'd request to float as little as possible but take what I get. If you want the assignments as a traveler and the experience then it just has to be the way the hospital wants it to be. The only caveat is if you do not have the skill set for the assignment they are floating you to.

NedRN · Mar 26, 2016

Your best bet is to nail down expectations and probabilities in the interview with the manager before you accept any assignment. Some will lie or mislead, but you can turn down anything with red flags for you. That said, floating will make you stronger and ideally be a professional challenge you find exciting. It is not a question of if anyway, but when and where. If you cannot adapt, perhaps the security and stability of a staff job is better.

I don't know how to sugarcoat the above, but it sounds harsher than I intend. Everyone has their comfort zones, and travel may already be stretching yours.

I enjoy stretching myself professionally, it gives me great work and personal satisfaction. I work in the operating room, and in well over 20 years now, I have never turned down an assignment. Let me tell you, when you get plopped into a C-section in the Virgin Islands with no orientation (another traveler refused for just that reason which is very rational - and most OR nurses have never even seen a C-section), and in conditions never seen in the mainland, it is definitely a challenge. Not only was I circulating the operation, but I had to assist the receiving pediatrician at the same time (never seen that in 20 years of traveling and I was very happy that neither the newborn or mother coded) and had to footprint the newborn (also a first), but also draw cord blood from the placenta into test tubes for the lab and label the tubes and placenta, and do a full count of instruments and sponges before the surgeon closes (not a long procedure.

That is completely anecdotal and may not sound relevant to you, but stay with me here. I don't know if you get how challenging that was, but take my word for it - I did several more sections there and they were no longer challenging, just very busy - but still not safe by any reasonable standards. Here is how you can prepare for floating:

if you start picturing what you would do in a worst case scenario, you will be much more prepared if you get plopped into something out of your comfort zone. First, ordinary challenges first. Refuse to float without some orientation to the unit, and make sure the cases assigned are not ICU is full kind of cases. That would include vasoactive drips, ventilator dependent patients, perhaps end stage liver disease (I'm guessing here - you might know better). Refuse those patients. Other ordinary challenges are impossible patient ratios. Don't even try to get everything done, figure out what is most important and prioritize, prioritize. Keep moving while you are prioritizing.

The worst case scenario for you is probably a code which has to be rare in ortho hospitals. Picture what you would do in a code. Make sure you know BLS inside and out. Prioritize your actions. Is there a code team? How do you trigger an emergency response? Most hospitals have some sort of alarm system in every patient room for use by patients, family and provider. Or you may need to use a phone number that you learned in orientation or is on your badge. Picture it and you will do better than 95 percent of those in such a first time ever event.

Fire, or earthquakes/tornados are other rare events that can happen without floating of course. Visualize how you would handle it. All those mnemonics you learn in every orientation will actually help you now if you don't panic, PASS, RACE et cetera.

Practice visualizing what you will do in imaginary situations will also help make you more efficient and effective every time you walk into a patient room and survey the scene (as taught in BLS/ACLS). You will quickly visualize automatically what to do with your spidey-nurse sense and plan your actions.

As long as I am being long winded, let me take this to the most valuable visualization exercise of your career. Your skills, knowledge, and experience are not the most important part of job success. Floating and emergency skills are not the most important. People skills are the most important asset to any profession, but particularly in nursing's unique place in hospital hierarchy. Visualize what you will do and how you will react professionally to confrontations with peers, management, patients and family, assistive personnel, physicians, and new culture clashes, and you will excel. I'd like to know more myself but I know enough to know how important this is to successful careers. I'd love to know what ED nurses know about de-escalation techniques and crisis management. They should teach fundamentals in orientation.

Work2Live · Mar 26, 2016

Thanks for the input. I always appreciate your advice, NedRN. I hate to say it, but I'm not looking for a challenge. That is the primary reason why I stay in orthopedics. Spine surgeries and total joint replacement are pretty routine from a nursing perspective. I don't like surprises. I also like that many orthopedic surgeries have positive outcomes. I guess that I need to simply view each shift as 12 hours that separates me from my bed and my personal life. Again, thank you for the input.

NedRN · Mar 26, 2016

Nothing wrong with that. It still doesn't hurt to prepare for floating as you will float. You can minimize chances of floating by making sure your recruiters know your stance, and will attempt to find assignments that can put no floating in the assignment contract (most agencies and hospitals won't be willing, but it is possible). Feedback online is unreliable but worth a shot, but your best bet if you enjoy traveling in general outside work to really hammer the issue during your interview. This will raise flags to the manager, but tell her that while you are a strong nurse, you strongly dislike working outside your specialty (like an ortho surgeon isn't about to do an appendectomy). Don't commit during the interview (OK to say you are very interested) and state you have to check with your agency about assignment details. Replay the interview (in your head) and see if you can pick up anything from the language or tone that makes you wonder if this is a good fit for you.

NedRN · Mar 26, 2016

Another new traveler proclaimed aloud yesterday that her contract states that she doesn't float. The walls had ears and the manager and director called me today saying that they heard secondhand and thirdhand that I made that remark. I corrected them, but it makes me concerned that I'll be floating the majority of my time. Thanks.

I had a response to this that I forgot in my overtime first reply. I suspect management is more concerned about negative statements from staff than floating itself. From management's perspective, this is a first step towards bad morale and poor performance, if not outright recalcitrance. Such discussions should not be held among staff, or if you must, one on one where no one can overhear. Likewise, a discussion about an assignment should be held privately with a manager where no one can overhear.

In poorly managed hospitals where patient ratios are bad and floating is rampant, floating could be a big management issue. Fostering a good work culture by staffing well, managing morale, and limiting floating altogether is optimal, but rare. Floating is a must to handle the varying census and acuity though, a necessary evil.

By the way, the ortho specialty forum (I assume there is one here) may be able to offer tips about floating avoidance. If there is a specialty certification, obtaining that may add more weight to your insistence to do solely what you are most competent to do.

Work2Live · Mar 26, 2016

Thanks, again. I am a certified orthopedic nurse. So, I use that to my advantage when trying to secure an orthopedic assignment.

As for the morale, I had nothing to do with the comments made by the other orienting traveler. Her contract DOES say no floating and that's her business to sort it out with the facility. I cannot fathom why a facility would agree to that, but, considering how poor the communication seems to be between the agencies and the facilities, I imagine that they simply don't look over the contract closely enough.

NedRN · Mar 26, 2016

I know it wasn't your comment, but you sounded worried about floating so I tried out a possible different context about that comment for you.

It is not uncommon for a recruiter to put no floating in a traveler's "assignment letter" either ignorantly, or completely fraudulently and hope it works out. It is rare for a hospital to agree to it, but it depends on stuff, and it can be changed simply on the similar "assignment letter" or confirmation that the agency sends to the hospital. It doesn't usually require amending the facility contract. If changed in the agency confirmation to the hospital, it is binding on the hospital. But the manager may be unaware of that stipulation, or the agency may be unwilling to enforce that stipulation. So you can see how that ends up badly with all parties not understanding why what they thought were clear communications failed - often leading to terminated assignments. Not uncommon to read exactly that happening on travel nurse forums.

Thus the most important thing you can do is confirm it directly with the manager during the interview, avoiding other communication issues (but using them as well).

Maevish, ASN, RN · Apr 9, 2016

After many bad experiences floating on assignment, I specifically told a manager in the interview (when he asked about floating) that I would possibly go to OB if they needed, but I wanted to stay in the ICU. He said ok. He hired me on for 13 weeks. He then told my agency that I'd said I would float to tele, which I hadn't, then I came to work one night and he'd called another ICU nurse in from home to work so I could "orient" on Med-Surg. I said that I was more than willing to go down and help by giving meds or breaks (which no nurse takes legally at this hospital and I mean NEVER, because of how they staff), but the supervisor wasn't happy. I did it and wanted to finish the shift, but she sent me home early because I "didn't want to be there". That wasn't true as I'd offered to help out, but that wasn't good enough. I'd gotten the shaft too often and like having my license too much to want to risk being unsafe in an already unsafe situation. I didn't hear anything else about it after that, but I'm assuming that's just because they can hardly keep people here when word gets out. On assignment I can do without breaks on one in 10 times, but between losing my license because I was in a ridiculously unsafe environment instead of keeping it and sticking it out somewhere I'm just uncomfortable, I'll take the latter (though still unsafe since there's no backup on hand).

guest769224 · Apr 9, 2016

I specifically told a manager in the interview (when he asked about floating) that I would possibly go to OB if they needed, but I wanted to stay in the ICU. He said ok. He hired me on for 13 weeks. He then told my agency that I'd said I would float to tele, which I hadn't, then I came to work one night and he'd called another ICU nurse in from home to work so I could "orient" on Med-Surg.

So how is a traveler to avoid floating if even the nurse manager can't be trusted? Does "no float" have to be explicitly spelled out in a contract in order for it to be honored? Yeesh.

NedRN · Apr 9, 2016

It is all about probability. Your recruiter may know about floating history on a particular hospital or floor. Hammer it during the manager interview. Don't work at hospitals such as Kaiser that are notorious. Check on forums if the hospital uses a lot of travelers. Attempt to put it in the contract. But nothing is foolproof.

The downside to being anti-floating is you are not as valuable to the manager or hospital. Simple fact. That can cause you to lose assignments while still shopping, and get terminated.

A better approach is learn to love floating. It is a challenge that will make you a better, much more organized nurse. Skills that allow you to have everything done Q4 and ready to report off your current patients and take a completely new full patient assignment makes you a better nurse and more efficient. When you have a no floating situation, this now allows you more non-clinical time for your breaks, quality time with patients, or helping staff nurses (which gets you brownie points, great evaluations, and lowered chance of being terminated for any reason).

If you have limited experience, say less than 2 years, and have never floated before, it is best to practice avoidance of such assignments. Otherwise, experience floating will be good for you.

That is not to say that floating benefits patient care, it doesn't (other than by improving nurse skills). A new primary care nurse Q4 is not good for continuity of care or really knowing how your patients are trending.

guest769224 · Apr 9, 2016

Well I agree with all you said, but that really defeats the purpose of traveling in a designated specialty, right? If I wanted to travel as a med/surg nurse, I would take contracts that were dedicated to that. If I sign up for an ICU contract, and spend less than half the assignment in the ICU, that just seems dishonest and misleading.

Then againâ€¦I understand the dictum that as a travelerâ€¦we are expected to do what's best for the facility. Caught in the middle it seems.