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View Poll Results: Should nurses have to float?
Yes 5 19.23%
No 21 80.77%
Voters: 26. You may not vote on this poll

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Old 01-24-2008, 02:59 PM
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Default Should nurses have to float??

Here's an easy poll - two little choices

I personally loathe floating. Sometimes it isn't so much the patients you have to take care of - it's not knowing anyone you work with. It's like your first day of work all over again.

Nursing has gotten more complex, though, too. It seems like there's a different procedure for discharging patients every time I float somewhere else. (We don't discharge patients from ICU very often!)

Time management is so different for each floor. I have a much different focus taking care of two really sick patients in ICU than I do juggling 5 patients on the telemetry floor. It can be really difficult to switch gears.

Sometimes I spent an inordinate amount of time just trying to find stuff. The charting is different and takes me twice as long. Twice as long x 3 more patients than I'm used to =

I think floors need to fend for themselves, staffing-wise. Are there any other professions that have highly trained employees switching roles all the time?

I guess the thing that makes me the angriest is that as ICU nurses, we float out all the time when we're overstaffed. But NO ONE floats to us. When the chips are down in ICU, we get on the phone and call people in. Somehow we've always managed to get through, shift by shift. I think it's a bit unfair - just as soon as we ICU nurses get through a busy run of shifts (days, weeks, sometimes of people working unbelievable overtime) and empty out the unit, the other units are all filled up and we get NO BREAK because we're floating every extra nurse we have to other floors!

I guess this was a partial vent. It's very irritating to work one's butt off to cover one's unit and then have to float out once you get a chance to take a break.
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Old 01-24-2008, 03:12 PM
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No way, nurses should never be forced to float. As a psych nurse, I refuse to float to a med/surg floor. Sure, the hospital can fire me, but I'll still have my nursing license when I go out and look for more work.

MJ
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Old 01-24-2008, 03:54 PM
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Well, as an ICU nurse, I was forced to float to both Adult Psych AND Child Psych.

Child Psych is a very, very scary place.

After that float, I probably would have refused to ever go again.
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Old 01-24-2008, 05:11 PM
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The only time I didn't mind floating was when I worked in critical care and they needed a nurse on the gyn side of the ob/gyn floor. The women were essentially healthy but post-op and did not require a lot of care. In fact, if that was the float area, I'd offer to go so that it wasn't my turn when the icky floors wanted a float.

I got so used to the unit that they started letting me do the post-partum side, too! : )

But we are talking waaaaaaaay back in the '80s. Things are much different these days in terms of acuity. Most of what the post-op women had are now done as outpatients.
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Old 01-24-2008, 07:49 PM
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When I first read the question, I thought Yes, why not. But reading your responses it has got me wondering. The experiences of floating that I have experienced were that like wards were floated. So if you were in Oncology you were floated with general medical. Ortho was floated with surgical gyne. I agree with this floating, but not the type that you are all talking about.
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Old 01-25-2008, 12:40 AM
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OK. The paper-pusher in me is going to ask a question or two:


Would floating be more agreeable if a formal inservice with competencies was required before floating?

Would mandatory cross-training be acceptable?

Should each unit be closed?

If no RNs should be compelled to float, how do we staff the hospital? Should each unit maintain a pool of on-call staff? Should participation in this pool be mandatory (and thereby result in working over and above regularly scheduled hours)?

Does a no-float policy mean that no one may float? If so, should benefits (medical/dental/vision insurance, education dollars, etc) be tied to the hours scheduled or actually worked?

I think a unit-specific pool from which to pull would be great. But how to accomplish this? Most of us work because we have bills to pay, so I would hate to send home an otherwise competent RN from Department A just because I have to use the on-call pool of Department B.

See? I told you I was going to ask paper-pushing questions. I hope you can help me out here.

Now about my place of employment: Nurses float. Sort of. Labor/Delivery/Postpartum is a closed unit. No one floats out unless they want to. And they manage their own staffing - unless they are not successful upon which time I get involved. The ED and the locked psych unit self-staff and no one floats out. Ever. I get involved only if they are not successful in staffing. OR, PACU and ENDO self-staff and I never hear from them. ALL the rest - ICU, Intermediate Care, medical, oncology, pediatric, surgical and ortho - float when and where as needed. But not without having issues. I submit the following only slightly exaggerated assessment of the fully competent RNs who float during my watch:

- ICU RNs dislike taking care of non-critically ill children if for no other reasons than 1. the children are not unconscious, and 2. the parents stay in the room and expect the RN to talk to them.
- Oncology RNs are afraid of the medieval gadgets of ortho and are shocked at the heavy labor involved.
- Tele RNs are not aggressive enough in treating the pain and nausea of oncology patients.
- Peds RNs get palpitations when considering telemetry patients and even in the best of times stutter when saying, "Adenosine," "Wenckebach," and "catecholaminergic polymorphic ventricular tachycardia."
- Medical RNs turn all squeamish when confronted with a fresh post op.
- Very, very few RNs are able to float to ICU with confidence (theirs or mine!).
- AND, ANNNNNDDDDDDDDD, core stafff in every unit complain about RNs floating in because it means they will have to explain stuff.

So what is a poor, weekend night House Sup to do?

HELP!!

Joy

Last edited by LesleyJoy; 01-25-2008 at 05:36 AM. Reason: increased clarity in my hyperbole
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Old 01-25-2008, 05:43 AM
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A large trauma center that I used to work for had a "flex team. I was on it, and loved it. The team nurses were either critical care or acute care. CC nurses could float to any ICU, acute care to any floor except pedi and L&D. We were all given 2 weeks orientation, (6-12 hour shifts) on each unit, so you learned where things were, charting differences, met the staff and the docs. You never knew where you were working until you got in that shift, didn't have to be involved in the floor 'politics, and the staff was usually glad to see you, as they knew you'd been oriented. The flex team nurses also got a $4 an hour bonus for working the flex team. You needed at least a years' med surg experience. I did get to float to psych if they needed help, but I had worked that unit for 5 years, so they were comfortable with me being there. Once the flex team was up and oriented, no floor nurse ever floated again!

Bev
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Old 01-25-2008, 09:17 AM
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Thanks, Bev, for mentioning Flex Nurses. We do have them here, but far too few of them!

BAH! The only thing I like about staffing is the opportunity to orient nurses to their area(s) of interest, and giving people the day off (or an extra shift) when they want it.

BAH! And again I say, BAH!!

Joy
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Old 01-25-2008, 01:12 PM
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Would mandatory cross-training be acceptable?

No, we already have that.

Should each unit be closed?

Yes. I think each unit should be closed.

If no RNs should be compelled to float, how do we staff the hospital?

How do you staff the "closed" units? The ER? L&D? Don't they have periods of high census? How are those units fundamentally different from any other unit?


Should each unit maintain a pool of on-call staff? Should participation in this pool be mandatory (and thereby result in working over and above regularly scheduled hours)?

How do ER and L&D do it? For us in ICU, we do not have on-call nurses. When we are understaffed, we call nurses in. We start at the top of the list of staff and work our way down. We give a (small) incentive to working over-status. We make deals (come in today, get Friday off... worry about Friday on Friday). We ask nurses to stay over - for 4, 8, or 12 hours. Staffing problems always get solved. Why can't other floors do this??

Does a no-float policy mean that no one may float? If so, should benefits (medical/dental/vision insurance, education dollars, etc) be tied to the hours scheduled or actually worked?

I've no idea. Hadn't thought about it. I would think that if people WANT to float, they could.

I think a unit-specific pool from which to pull would be great. But how to accomplish this? Most of us work because we have bills to pay, so I would hate to send home an otherwise competent RN from Department A just because I have to use the on-call pool of Department B.

Make floating optional then. Ascertain whether nurses want to float and make a notation somewhere (on the staffing call list, maybe?) If someone needs to be floated, float them. Leave those of us who don't want to float alone.

Now about my place of employment: Nurses float. Sort of. Labor/Delivery/Postpartum is a closed unit. No one floats out unless they want to. And they manage their own staffing - unless they are not successful upon which time I get involved. The ED and the locked psych unit self-staff and no one floats out. Ever. I get involved only if they are not successful in staffing. OR, PACU and ENDO self-staff and I never hear from them.

Why can't every floor be like ER, L&D, OR, and psych?? I'm not being a smarta**. I really want to know what these floors do that other floors can't do. In fact, I was really looking forward to your answer because of your sup-ness

But not without having issues. I submit the following only slightly exaggerated assessment of the fully competent RNs who float during my watch:

- ICU RNs dislike taking care of non-critically ill children if for no other reasons than 1. the children are not unconscious, and 2. the parents stay in the room and expect the RN to talk to them.
- Oncology RNs are afraid of the medieval gadgets of ortho and are shocked at the heavy labor involved.
- Tele RNs are not aggressive enough in treating the pain and nausea of oncology patients.
- Peds RNs get palpitations when considering telemetry patients and even in the best of times stutter when saying, "Adenosine," "Wenckebach," and "catecholaminergic polymorphic ventricular tachycardia."
- Medical RNs turn all squeamish when confronted with a fresh post op.
- Very, very few RNs are able to float to ICU with confidence (theirs or mine!).
- AND, ANNNNNDDDDDDDDD, core stafff in every unit complain about RNs floating in because it means they will have to explain stuff.

There you have it!! NO ONE LIKES IT! Not even the floor receiving help! It stresses out the nurses who are FORCED to work with situations that they are not comfortable with, thereby increasing the chance of error. Families can sometimes tell if their nurse is not fully up to par with what they're doing - I personally would not want a peds nurse taking care of my elderly grandfather on a tele floor! Why send someone to a floor that they are terrified of? Why set someone up like that? As nursing and medical care and patients have become more complex, it's gotten harder and harder to adapt to another environment within the hospital while remaining confident, comfortable, or even competent. Forgive the exaggeration, but to me it's like floating a fireman out to the police department! They are two completely different jobs. There is no reason for an onco patient to suffer through pain because they got stuck with an ortho nurse that day.

So what is a poor, weekend night House Sup to do?

Thorough cross training for those who want to float. Fostering a sense of community within EACH unit so that when the secretary calls for staff, they want to come in and help out their fellow nurses. Hiring money-hungry people Having an adequate float pool is the best option, I think. I know that none of these options are easy to implement, especially with the nursing shortage. But I'd also argue that job dissatisfaction caused by floating may be contributing to the dwindling numbers of bedside nurses (among other things, of course)
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Old 01-25-2008, 02:29 PM
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Whew! Geena! Thanks so much for your post. Let me see what I can do to answer.

(Joy) Would mandatory cross-training be acceptable?

(Gena) No, we already have that.

(Joy) Should each unit be closed?

(Geema) Yes. I think each unit should be closed.

(Joy) If no RNs should be compelled to float, how do we staff the hospital?

(Geena) How do you staff the "closed" units? The ER? L&D? Don't they have periods of high census? How are those units fundamentally different from any other unit?

(Joy) The managers of ED, L&D, OR, PACU, and ENDO devote a tremendous amount of time to staff development and retention. The latter three, in fact, are so specialized that these units have chosen to become completely independent from the rest of the nursing pool. The ED and L&D only call me if they have a staffing issue they cannot solve themselves. I can usually find someone confident and competent to help. If all else fails, I lend a hand or the manager comes in, but this certainly is not optimal!!

(Joy) Should each unit maintain a pool of on-call staff? Should participation in this pool be mandatory (and thereby result in working over and above regularly scheduled hours)?

(Geena) How do ER and L&D do it? For us in ICU, we do not have on-call nurses. When we are understaffed, we call nurses in. We start at the top of the list of staff and work our way down. We give a (small) incentive to working over-status. We make deals (come in today, get Friday off... worry about Friday on Friday). We ask nurses to stay over - for 4, 8, or 12 hours. Staffing problems always get solved. Why can't other floors do this??

(Joy) L&D have scheduled on-call RNs, in particular NICU and Delivery RNs. The ED really tries to ensure all shifts are filled. In the rare event that another person is needed, the charge RN does his/her level best to find another nurse who is fully autonomous in the ED. IF that fails - and it rarely does - I am called. I usually have someone in house who likes working in the ED and wants more time there. During those (thankfully rare) transient times when the ED is overrun with patients I will either find someone to help for awhile or I will actually help-out myself.

(Joy) Does a no-float policy mean that no one may float? If so, should benefits (medical/dental/vision insurance, education dollars, etc) be tied to the hours scheduled or actually worked?

(Geena) I've no idea. Hadn't thought about it. I would think that if people WANT to float, they could.

(Joy) I think a unit-specific pool from which to pull would be great. But how to accomplish this? Most of us work because we have bills to pay, so I would hate to send home an otherwise competent RN from Department A just because I have to use the on-call pool of Department B.

(Geena) Make floating optional then. Ascertain whether nurses want to float and make a notation somewhere (on the staffing call list, maybe?) If someone needs to be floated, float them. Leave those of us who don't want to float alone.

(Joy) Now we are getting into union issues. The union rules dictate the least senior floats. Talk about eating our young!!! If the least senior is not competent in the needed area, I sometimes have unpleasant discussions with groups of nurses about who will and who will not float out. I refuse to float an RN into a dangerous situation. Instead, I tell the RNs to chose from among themselves those who are competent to float out. Then, when it is possible, I later orient the least senior to other departments. So far, I have not had one grievence filed with the union about my decision-making in this regard.

(Joy) Now about my place of employment: Nurses float. Sort of. Labor/Delivery/Postpartum is a closed unit. No one floats out unless they want to. And they manage their own staffing - unless they are not successful upon which time I get involved. The ED and the locked psych unit self-staff and no one floats out. Ever. I get involved only if they are not successful in staffing. OR, PACU and ENDO self-staff and I never hear from them.

(Geena) Why can't every floor be like ER, L&D, OR, and psych?? I'm not being a smarta**. I really want to know what these floors do that other floors can't do. In fact, I was really looking forward to your answer because of your sup-ness

(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.

(Joy) But not without having issues. I submit the following only slightly exaggerated assessment of the fully competent RNs who float during my watch:

- ICU RNs dislike taking care of non-critically ill children if for no other reasons than 1. the children are not unconscious, and 2. the parents stay in the room and expect the RN to talk to them.
- Oncology RNs are afraid of the medieval gadgets of ortho and are shocked at the heavy labor involved.
- Tele RNs are not aggressive enough in treating the pain and nausea of oncology patients.
- Peds RNs get palpitations when considering telemetry patients and even in the best of times stutter when saying, "Adenosine," "Wenckebach," and "catecholaminergic polymorphic ventricular tachycardia."
- Medical RNs turn all squeamish when confronted with a fresh post op.
- Very, very few RNs are able to float to ICU with confidence (theirs or mine!).
- AND, ANNNNNDDDDDDDDD, core stafff in every unit complain about RNs floating in because it means they will have to explain stuff.

(Geena) There you have it!! NO ONE LIKES IT! Not even the floor receiving help! It stresses out the nurses who are FORCED to work with situations that they are not comfortable with, thereby increasing the chance of error. Families can sometimes tell if their nurse is not fully up to par with what they're doing - I personally would not want a peds nurse taking care of my elderly grandfather on a tele floor! Why send someone to a floor that they are terrified of? Why set someone up like that? As nursing and medical care and patients have become more complex, it's gotten harder and harder to adapt to another environment within the hospital while remaining confident, comfortable, or even competent. Forgive the exaggeration, but to me it's like floating a fireman out to the police department! They are two completely different jobs. There is no reason for an onco patient to suffer through pain because they got stuck with an ortho nurse that day.

(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.

I must say I learned to do this at the expense of a patient in the ortho department who was being cared for by a peds nurse. After listening to her off-hand comment about the "drug-seeking behaviors" of one of her patients, I read the man's chart. Then I went to the nurse to explain in detail about the dynamics and types of pain associated with open hip fracture repair. She was appalled at what she did not understand about pain managment. I was appalled at what I did not know about house suping and staff development.


(Joy) So what is a poor, weekend night House Sup to do?

(Geena) Thorough cross training for those who want to float. Fostering a sense of community within EACH unit so that when the secretary calls for staff, they want to come in and help out their fellow nurses. Hiring money-hungry people Having an adequate float pool is the best option, I think. I know that none of these options are easy to implement, especially with the nursing shortage. But I'd also argue that job dissatisfaction caused by floating may be contributing to the dwindling numbers of bedside nurses (among other things, of course)

(Joy) Cross training - YES! Fostering a sense of community within each unit - YES! Hiring money-hungry people - Well... sometimes money is too expensive to be earned. Having an adequate float pool - YES!!

Staffing here is more than a little tricky given the union issues. Very clear boundaries are set for sending people home. For instance, if Department A needs more staff and Department B has too many for acuity/census, I cannot send Department B staff home (assuming they are competent in Department A, that is) in favor of calling in other Department A staff. I do make every effort, as I mentioned, to staff according to competency. I also take into account the personal preferences of RNs in assigning floats.

I would very much to see each unit have a couple RNs on-call for each unit for each shift. The problem here, though, is money. On-call folk are paid at time and a half plus.

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.

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

Joy

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