I agree whole heartedly! As an ED and ICU nurse, the very thought of trying to accept a current Med/Surg assignment makes me shake with fear! Sure, I could do it, but certainly not to the level of comfort and expertise that a seasoned Med/Surg nurse could. We currently float our registry first-before any facility staff are floated. This is an important factor in "taking care of your own" first. As a new manager of a nursing registry, I fully support the premise that facilities should take care of their staff first and request from their agencies/registries the types of nurses they need. If an agency can't provide med/surg coverage, maybe the facility needs to look at a new agency! As to your final comment-I've been looking for the past 20+ years on how to teach common sense! I've always said that I'd rather have a diploma nurse who has common sense and "gut instinct" than a master's nurse who can write one heck of a research grant but can't decide if a patient is breathing or not.
Recently at our facility the ER nurses have been pulled to the floors and ICU. We are already under staffed, but it does not seem to matter. Even while I had 2 new orientees they pulled one of my seasoned nurses to ICU to relieve someone else. Of course this is all happening with overflow patients in the ER. It makes for some very interesting nights!
In our hospital ICU nurses are not pulled to the M/S floors primarily because they are two different specialties. While a M/S RN does not have the technical expertise to manage the monitors, equipment and drips, the ICU RN does not have the generalist expertise to be able to manage a larger patient load with a broader range of diagnoses and related teaching. It just makes sense. In fact, the thought of either specialty floating either place is down right scary. I'd be just as nervous about an ICU RN in M/S as I would in the opposite situation. However, the tele nurses and the M/S nurses do float between the two departments. Neither one likes to do this because it's outside the comfort zone. I do know that actually the float nurse tends to get the easier assignment with fewer admits because that will make their comfort level go up and they will require less assistance on an already busy unit. I have noticed that there is a definite territoriality among specialties. I have witnessed several instances in which critical care/ED RNs have insulted M/S RNs as "just a M/S nurse, so what do you know?". I have heard LDRP RNs say they work harder than any other department because of the volume of deliveries. I have heard Rehab nurses criticize Med/Surg nurses because they don't spend as much time doing psych-social support as the Rehab nurses do. I have seen M/S nurses criticize CC/ED nurses for lack of teaching skills or Rehab nursing for being "boring". I guess what I'm trying to say is that each and every area of nursing is a specialty. There is no "general" nursing. There is a definite skill set required of each, and floating in an emergency situation is to be expected, but should only occur with adequate support and resources. This nursing shortage will continue to stretch our creativity and resourcefulness to the limit and we need to work together with the patient as our center of focus. Whenever we are required to have a float RN in our unit, we assign a resource person to that nurse for reference and assistance, and they get the lower acuity assignment with less activity anticipated (admits, discharges, transfers, etc). There is still much grumbling on occasion, but thus far it has been a solution to an increasingly difficult staffing dilemma.
This happens on almost a daily basis . The problem is staffing will do anything to just staff the hospital . They don't care if someone works 8 -12 hour shifts in a row!! They will call anyone they can get to come in. If they get an ICU RN who will only work in ICU they will float another staff member. also they float a staff member to another department leaving ICU short staffed. This is happening more and more to us. I hate to float, but if we are overstaffed I understand , but not in the other two instances mentioned above.
I have seen units that dump the worst pts on the float nurse and it never made sense to me. Like biting the hand that feeds you, dumping on the person that comes to help.
I am an Ob nurse and I used to work a hospital where we would get pulled if census was low. Imagine a OB nurse getting pulled to Tele.. well it happened. For me it wasn't a big issue since I had worked tele in that hospital before switching to OB. But most of the nurses had never been anywhere but ob. The good thing was that the Tele nurses were good and would have us be med nurse or some other support position.
For the last 3 years I have been a nursing instructor in a ADN program. I think the MI nsg student should copy her posts and refer back to them in about 5 years from now.. be interesting to see how she feels thenNursing programs stress the correct and the optimal. Once you get out on the floor you face the real. The real is that you focus on what is needed to work your particular floor and the rest of the info fades, It can be revived yes but it isn't at your finger tips. The real is that knowing where things are on the unit and having the policies and procedures in your head double your efficiency..and not having it doubles your workload. The real is that no matter how much training you recieve, if you don't use it every day your brain is going to file it away under "Not Important"
Do floor nurses at your hospital get pulled to the ICU? To me this is one of the most blatant double standard in many hospitals. ICU nurses refuse to be pulled to the floor when their census is low and are given the option of staying at home or going home if they are already at work. Instead of sending the nurse home, why can't this nurse at least float to the floor to help out with admissions and stat orders? Now if a floor nurse refused to be pulled to the ICU, well that would be considered insubordination in many hospitals, and that nurse more than likely would be written up. Why do you think such a double standard exist?
Where my wife works, she can get pulled to the progressive care unit, or ER Holds, but that's it. She works in a union shop in New Jersey. They've tried pulling nurses to med/surg in the past and the ICU nurses wouldn't have it. Floating rules were written into the next contract and have been there ever since.
Two points for union representation there.
Andrew Lopez, RN
http://www.nursinga2z.com
Hey, if you want to develop a policy stating that ICU nurses can not be pulled to the floor that is your choice. Do not expect the floor nurses to be pulled to the ICU unless they volunteer to go. It is only fair.
Re: ICU nurses pulled to general floors
I worked the floor for 8 years before going to ICU. I can remember getting an ICU float and you'd have to hear them whine for the first 4 hours of the shift. They'd complain about being pulled off their unit and how taking 5 patients is much harder and blah, blah, blah.
Then I went to ICU. When we'd float, I'd hear the nurses whine about going and I thought, get over it already. But, after being there for 6 months, I started to see the picture. We would be down there bustin our butts, traiging pt's out to get the sicker ones in. And in the meantime, we're getting calls from the floors asking how to do this or that. I, myself, started to get irritated. We were busting our butts and who was helping us? Nobody. Nobody from ER came, nobody from anywhere came. Very frusterating. So, yeah, from that standpoint alone, floating to another unit from ICU sucks. And we do tend to get the crap assignments. We get the crazy guy in 4B that gets out of restraints, kicks and bites because everyone else is tired of having him. We also get the little lady in 2A that is incontinent and refuses a foley. We don't neccesarily get the "sickest" pt's but we get the ones that everyone else is tired of having. Which, usually means we're walking from one end of the hall to the other. Hourly meds and anything else they can think of. So yeah, I do have a problem with floating.
And being pulled to mothercare or pedi? Omg! Totally out of my element!
I don't mind helping other nurses, I really don't. But, it's hard to really want to go outside your unit when you know you're going to be crapped on ya know? Most nurse managers say that it doesn't happen, that we're not treated badly; they just don't know.
Anyhow, that's my take on it.
angee74
I am also a unionized ICU nurse and floating is covered in my contract, which it should be. If I float, it is as a 'floater/helper' and I am NOT to be assigned patients. The only way an assignment can be given is if the nurse is crosstrained and fully oriented to the other unit, which is how it should work.
This floating stuff with full assignments is for the birds. From a LIABILITY standpoint alone, I would think a nurse to be a fool who accepted float assignments without adequate training/orientation.
The problem with so many nurses is they have LSE and compete. This issue is not about competition and 'who's better' it is about SAFE CARE.
Nurses need to grow some cajones and stand together and stop caving to the hospital's demands. They will not help you when you're sued for patient neglect...it will be all YOUR fault if you took an assignment you weren't qualified for.
Would you want a gastroenterologist doing your heart surgery? Of course not.
And no gastro would ever think of giving cardiac advice...from a LIABILIY and SAFETY standpoint. Those out there who thought we should all float without question, feel free to do it yourself; but I hope you have the number of a good malpractice attorney cuz you will likely need it.
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