Ha ha - I am one of those money hungry people. My agency is actually an internal agency that only serves Johns Hopkins, so basically, they pay me a higher wage to float within the hospital.

And guess what? I'm not digging it at all, even though I've almost doubled my hourly wage.

I don't think nurses should ever have to float as a matter of policy, and I wouldn't work for a hospital that required me to float. (Easy for me to say that though, because I live in an area with about a bazillion hosptals to choose from.) It should be by choice, and the floaters should get a higher hourly wage to float.

Great discussion!!!

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I am the only one here (hands up) that said that people should have to. This is partly because during my clinical time it was a requirement. My contract might have given my job title but my job was to work within the hospital / community trust. We never tended to get sent where we weren't competent to go and sometimes it was just cover for breaks etc. When I worked as a district nurse (home care) we moved around the patch to cover each other as a matter of course.

Having voted yes, I actually wonder if people should be made to do it. Even though I never had any choice (unless it meant working extra).

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Julie
http://www.lifeinthenhs.wordpress.com

I had to laugh at these - I've heard all of these over the years!

We are a closed unit (ER) as are Labor/Delivery, OR and ICU. We do our own staffing and we fill in our own gaps, go home when things are slow and come in when things are nuts.

There would be a few things I can think of that would make floating a bit more palatable.

1. Floors that are consistent in their lay-out, so that supplies and medicines are found in the same place in all units.

2. Offer a differential for shifts worked outside of the "home" unit. Pay for orientation shifts to other units.

3. Or, have all units responsible for their own staffing in toto, and the manager deals with sick calls.

4. Instead of a "float pool", have a list of nurses throughout the facility that are willing to float to any area they are competent to fill. Then if one of those nurses are on duty in a unit that needs to down-staff (or off-duty and willing to come in), they are used to staff the other units. If a unit needs to down-size and the nurse is not on the willing-to-float list, they risk being cancelled.

The problem, as I see it, is that unlike the old days, we are out of nurse-as-interchangeable-staff era. Things are so specialized these days, patient care is so acute that I'm not sure you can safely interchange nurses. Some of us old warhorses (like me) can probably manage no matter where we go, but younger nurses (those with less experience) aren't necessarily able to safely function in an area they are not experienced in.

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(Joy) I've answered about ED, L&D, and OR, but the same answer applies to psych. These departments take such pride in their specialty and are so accountible that it is marvelous to see. I do not believe the idea to "close" the other units has occurred to anyone yet.

(geena) That's very surprising to me. They could maybe even have "sister" units where one unit floats to another, but nowhere else.

(Joy) Well, like I said, I never float out a nurse who is not competent in the needed area. Never. I learned long ago to check up on the floats very early and throughout the shift to see how they are doing. I also ask the Charge RNs to ensure that any fine points of patient care are not missed.


(geena) That's awesome - but I can guarantee that not ever supervisor is like you!

If every department was 'closed' (no one floated in or out), then staff would accept the occasionally uncomfortable responsibility of self-staffing. This would result in some people working fewer or more hours than they would ordinarily like to work, and would also result in more autonomy of practice within each unit. Would this lead to greater staff satisfaction and retention? Perhaps.

(geena) I believe it would. It works for us.

What other ideas do you all have for ensuring staffing that meets both acuity/census and RN preference?

(geena) Joy, thank you for taking the time to answer so thoroughly I think Kim and someone else mentioned giving people differentials for floating out. I think that's a GREAT idea.

And as I said (or meant to say) in my original post - maybe I wouldn't be so opposed to floating out if we had someone float in when times got tough for us, but that is not the case. We are expected to staff ourselves, and then staff the rest of the hospital. We never get the benefits.

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Currently I work in a rural facility where we have to cover every area regardless (ER, ICU, Med/Surg, OB, Peds). That's part of being a rural RN adn something you have to deal with.

That being said............

When I worked strictly med/surg as a newer nurse, I HATED to float. It scared the crap out of me. I hated not knowing where stuff was, how to properly care for specialized patients, etc.

Now, I would love to float. But I have so much more training in every area so my personal comfort level greatly influences that decision. I've learned how to become more adaptable, and how to do so quickly.

I don't have any answers to the questions raised, but just thought I'd throw my 2 cents in.

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Julie

My Blog ER RN

Well....This is a very hot subject. Being a Nurse for 25+ years I've worked all kinds of units. ICU's, ER's, PCU's, Stepdowns, and Med-Surg Units. Some were "closed" units but the majority of them were "open" or floating units. And yes I'll admit I'm a 1st line manager(charge nurse), so I may have a different view of this. Nothing is worse than calling everyone on the floor staff list, and you are still 2 nurses short. You just overwork the staff when that happens. It's not that easy to get your own staff to come in at the drop of a hat. People have set lives, and are involved in activities outside of work. Attending school, child care issues, adult care issues, just wanting some time off from work. Where I work we have a good $$ program for pre-scheduled OT, and on the spot OT. Each area also has "sister" units. We are a rather large hospital so I guess it's easier to have "sister" units. It goes along Service Lines, Cardiac, Neuro, Peds, Ortho and also the level of care. I have also found how you treat the staff who float into your unit is one of the most important things you can do. Welcome the nurse, they are here to help you. Give a tour of the unit, including the breakroom and bathrooms. Assign them to a "buddy" a regular staff nurse who's assignment is near their's. Like "Carepairs" which we practice on our unit. We introduce them to their buddy and cover expectations of the unit for patient care. And don't forget to check on them several times during the shift, make sure they are OK. Help them feel welcome. It makes a difference.

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In the hospital in which I work, we have what they call "service areas" which are areas that provide similar but not exactly the same type of care.

I work the Emergency Department. The Emergency Department never floats out because we don't ever have enough nurses to do so and our documentation is so different than any other place in the hospital.

We do have a "Critical Care Pool" who some are cross trained to come to the ED and work as a functioning member of the unit. Some of these nurses are wonderful, and others I'd rather have them spend the day in the break room. When all is said and done, in a 30 bed unit that is only staffed with 3 nurses, I need some more nurses....some that at least have some critical assessment skills.

No, I'm sure nobody likes to float, but if it is my likes vs. the patient's care....float it is.

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