Who Here "Floats" to Other Units

[Ted]

Hello -

I'm almost sure that this topic has been started sometime, somewhere on this bulletin board. But I'm no stranger to repetition and so I guess I'm presenting this topic again.

But this topic was inspired by a very brief discussion, on another thread, on floating.

I work for a very small, community "Critical Care Access" hospital. My main unit is ICU/CCU. However, I also float to Med/Surg, ER, Maternity (mainly to feed the babies and change their diapers), do PACU, and do "Ambulance Runs" for patients needing more extensive cardiac-respiratory monitoring and/or IV med titration (my favorite "float" of all because of the Dunkin Donut run after the transfer). In the past, I have done ALL of the units during one 12-hour shift! Not often, but I've done it.

So. . . Who here also floats? Where do you float to? What's your favorite place to float to? What's your "dreaded unit" to float to?

Here's to all of the floaters! Cheers! :cheers:

:)

[wooh, BSN, RN]

When I was at a community hospital, I floated everywhere except L&D. And I technically should take that back, they got slammed one day, we were slow, so I went over there and basically was a runner/helper and did some secretary work for them.

A bigger hospital, you get so specialized. You get to be an expert at everything about your little specialty. Smaller hospitals, you get to know a little about a lot of stuff.

[Ted]

. . . A bigger hospital, you get so specialized. You get to be an expert at everything about your little specialty. Smaller hospitals, you get to know a little about a lot of stuff.

Worked both at a big teaching hospital and (now) a small community hospital. This statement is spot-on!!

:)

[dscrn]

Warm bodies suffice, til the you know what hits the fan,,,then it's "you should not have accepted the assignment if you were not comfortable...{

[dscrn]

Yikes does not begin to describe it. Was floated from OB to Ortho-of course, I got the only pt with a trach,,and a fresh total hip almost at change of shift...still remember "protocol Aand protocol B drugs...still have NO idea of what the devil the orders were about...thank God for unit secretaries!

[Perpetual Student]

Yep, but just to outpatient surgery. I do all the discharge type stuff after hours when they're closed anyway, so it's not a hardship. It's kind of nice to get to do the admissions occasionally, as it gives me a chance to do some IV sticks.

I'd actually like the opportunity to float to other units instead of taking low census.

[SoldierNurse22, BSN, RN]

Yep, all over. I'm from oncology, but I float to postpartum, L&D, ortho, med surg...and med surg is BY FAR the most dreaded unit!

[beeker]

I am a new grad and I was told we can float after 6 months. I am terrified to float! They have a renal floor, an oncology floor, a stroke floor, and a med surg floor I can float to. I currently work on Ortho/Neuro. I know when others float to our floor, they like it. When our people float to the other floors, they hate it.

[Guttercat, ASN, RN]

"Floating" is the evil I wish had died with 60's music.

[Do-over, ASN, RN]

Technically, I can float anywhere but L&D, but the unit is chronically short-staffed so that is where we always end up.

Would rather not. I have never gotten an orientation and have just learned as I go...

[HazelLPN, LPN]

We had floating "clusters". Critical care nurses only floated to critical care units, medical only floated to medical, surgical to surgical and nobody floated to ER or OR. Of course, if the nursing supervisor deemed it a staffing emergency, you could be mandated to float out of your cluster. As an old MICU nurse who was used to having one or two patients...or every once in a blue moon three patients...one of which will go up to the floor soon....I always felt very disorganized up on the floors. When the floor nurses were mandated to the ICUs, they were not used as a full RN or LPN unless we had very easy assignments and/or they were comfortable in critical care. Instead, we would "PIP" them which stands for "partners in practice" where two nurses would take three patients on 1:2 care. The floor nurses generally couldn't give any critical care drugs or touch the drips....and were not comfortable with tubed patients, but certainly could help out in many ways. My favorite place to float was SICU because they used to be one ICU when I started and I was equally comfortable there...it was a nice change from the chronic type MICU patient who often never got any better.

Once I became a PICU nurse, my favorite place to float was NICU..so much that I became one of their contingent nurses. Mind you, I was great with 2 stable vents or three nice feeder growers. Complex chronics and micropremies need a real NICU nurse, not an adventerous PICU nurse. The worst place to float? Short term surgery. It seemed like the place where the most cranky nurses in the hospital all ended up working. I remember after one shift where I ran my behind off while the RN "covering" me sat and ate popsickles at the desk. Never once did she say "thank you for coming, I'm sure its much different than the PICU, let me know how I can help". She just cosigned my discharge teaching forms without even looking at them. A few months later, I read in the hospital's newsletter that she was named "surgical nurse of the year".

That was my final float to short term surgery..and I never felt bad that I wasn't ever named "critical care nurse of the year" by the hospital.

[Bortaz, MSN, RN]

we have to if needed, yes. I recently floated to Pedi, but they had overflow gyn surgicals, so I took those.

Overflow gyn surgicals in PEDI? What the hell? If I worked in that Pedi dept, I'd for sure refuse those patients. In what way is a pedi nurse qualified to care for gyno surgical patients?

I work NICU, and we have to float to Pedi and PICU. We've been really low census in NICU lately, and we've been floating a LOT. Some of the nurses on over-staffed day shift are being floated sometimes 2 days out of 3.

I go when it's my turn, but I don't like it. It's making me dislike my job (a job that I previously LOVED and was passionate about). We have not been properly oriented to those units, and the charge nurses there think "Hey, he's an ICU nurse, he can handle any crazy assignment we give him! Give him 5 peds patients and make him first admit!"

I refuse to jeopardize my license, because I'm getting old and it's too late to start a new career. So, since I don't have PALS or ACLS, I refuse to take any patient over 1 year old. My NRP covers me up to one year.

When nurses float into my NICU, we assign them usually 2-3 feeder/growers. A lot of them won't take babies that are on CPAP, HFNC, or if they have ABs or a PICC line. We never have them admit, either. They've been heard to call floating to the NICU a "vacation day" because their load there is so easy. These same nurses expect NICU nurses to bend over and take the crappiest assignment they can give when we go to Peds or PICU.

I didn't realize I was this aggravated by this subject. It truly is leading me to seek employment elsewhere, though, because it's become ridiculous. I went into the NICU right out of school. NICU nursing is like no other specialty. Being a NICU nurse DOES NOT qualify you to work anywhere else.

As someone said: I don't know the meds, I don't know the diseases, I can't properly assess a patient that isn't a NICU baby. I know nothing about an 18 year old seizing patient with CP. Just like THEY don't know how to handle that 23 weeker I admitted.

[Esme12, ASN, BSN, RN]

I have worked for Union and Non-union facilities. I have worked at academic centers and critical access as well as an LTAC.

It surprises me that people are surprised that little hospitals exist and it doesn't surprise me that union hospitals are adversarial/restrictive to floating. I am surprised that we as nurses don't stay better educated about what goes on in the profession. It is typical that each nurse believe that every hospital is like their hospital and everything nation wide is done exactly the same. It varies widely.

Nurses are creatures of habit. We are OCD about habit and routine and dislike the unusual intensely because in our little OCD routine lies safety. When we are amongst the familiar the likelihood or making a mistake when chaos occurs is less than when amongst the unfamiliar. When we float we are thrown out of our familiar environments and we are terrified we will make a mistake and hurt someone. We become so anxious, we are emotionally and physically drained by the end of the day. We don't have our support system to help us and floating becomes the anxiety producing hated entity that it is.

If more administrators would take the time to understand the reasons behind the resistance, I think there would be much better solutions that could be explored and instituted to the benefit of everyone involved.......especially the patients. After 32 years I realize that is nothing but a pipe dream , I worked at a wonderful place once who decided that a happy nurse is a productive nurse, a productive nurse is a good nurse, a good nurse takes very good care of her patients, and a well cared for patient is a happy, healthy patient. But that was a long time ago.

We floated only to "like units" or units that we were crossed trained on....ICU to IMCU/PCU/Tele or the ED IF, and that was a big IF, you were crossed trained. If you crossed trained to an acute area LIKE THE ED, ICU, PACU.....your floating obligation was fulfilled. Tele/PCU were crossed trained for med surg, ortho and TCU (transitional care unit) Surgery, OB, and the nursery/NICU were "closed" units and only would accept crossed trained nurses to care for the less acute patients in that area. Pedi had to have a Ped certified nurse on duty at all times.

Critical Access hospitals/small hospitals have the most flexible staff. The whole hospital is like one floor and they are all friends. They are specialists in all areas and can function just about anywhere and do anything. While a tough place to work due to very little resources you are a jack of all trades. The staff are very flexible and are very highly trained because of this....they used to working under amazing conditions. But they can also bicker like children.

Union facilities can be difficult to navigate. Most of them have LONG histories and culture of aloof administrators dictating to the "lowly" staff and a long history of placing the nurses in difficult situations with little or no training. Once the Union starts that adversarial relationship intensifies. The administration REALLY doesn't like being told what to do and continue to behave badly. The nurses are more that willing to make them pay and torture them with unsafe staffing reports.....which I never did see now they benefitted anyone and what actually happened to them. But they do have very strict floating policies....not that the nurses are any happier to float.

Floating is a necessary EVIL....I just wish that administration would uinderstand how to make it amlicable and safer for everyone. But that costs money and we all know the last thing, in this day and age, administration wants to do is spend money on nursing.