Addressing floating and patient safety

Discussion On Priority Actions To Take When Floating

Participation Requirement: You are required to post a minimum of three (3) times in each discussion. These three (3) posts must be on a minimum of two (2) separate days. You must respond to the initial discussion question by 11:59 p.m. on Wednesday. On additional days, respond to your peers’ posts as well as additional faculty posts. Responses to peers must be posted by 11:59 p.m. on Sunday each week a discussion is due.

Step 1: Read the following articles

American Nurse Association. The American nurse. On less familiar ground. Strategies aim to reduce random floating, improve the experience. August 31, 2017. (Attached to discussion) (Links to an external site.)

Brown T. Nurses are talking about: floating and rapid response duty. Medscape Sunday September 17, 2017. http://blog.diversitynursing.com/blog/nurses-are-talking-about-floating-and-rapid-response-duty (Links to an external site.)

Davies K. Advance healthcare networks for nurses. Float assignments. Nursing advisor. http://nurseadvisormagazine.com/nurse-advisor/in-the-breakroom/float-nursing-to-reduce-healthcare-costs/ (Links to an external site.)

Nurse.com. Do registered nurses have to float to areas where they have not been trained or feel comfortable working? Is this legal? December 11, 2013. https://www.nurse.com/blog/2013/12/11/do-rns-have-to-float-to-units-where-they-have-not-been-trained-or-feel-comfortable-working-is-this-legal/ (Links to an external site.)

O’Connor K, Dugan LJ. Addressing floating and patient safety. RN Nursing February 2017-Vol 47-Issue2-page 57-58 doi:10.1097/01. NURSE.0000511820.95903-78. https://journals.lww.com/nursing/Fulltext/2017/02000/Addressing_floating_and_patient_safety.15.aspx#:~:text=%20Addressing%20floating%20and%20patient%20safety%20%201,nurses%20may%20perceive%20floating%20negatively%2C%20it%27s...%20More%20 (Links to an external site.)

RN responsibility when floating to new patient care unit or assigned to new population. https://www.rn.ca.gov/pdfs/regulations/npr-b-21.pdf (Links to an external site.)

Priority Actions to take when Floating

Floating is defined as “the reassignment of staff from one nursing unit to another based upon the patient census and acuities”. Floating is difficult and has always been a problem for nurses but safe patient care is always the goal. Floating is a reality that often cannot be avoided, particularly in the hospital setting. Floating may cause anxiety, stress, overwhelming, scary, draining, dissatisfaction, disruptive, and feeling of frustration even to a very experienced and skillful nurse to be pulled to work on a unit outside her/ his comfort zone. This might be caused by discomfort from unfamiliarity related to diverse patient population, staff, unit, and the processes to a work on a different department. Working in unfamiliar area makes nurses uneasy by not knowing what to expect. Yes, they know how to take care of the patients but without proper orientation to the unit/ area one will be floating is not easy. Whenever staff members are sent to float to an unfamiliar unit, it is expected that at least they will be able to perform the basic assessment and skills.

What Should the Registered Nurse Do When She/He Has to Float?
Before accepting patient assignment when floating to a different unit…

Make sure you have the necessary knowledge, judgement, skills, and ability to provide the required patient care. The nurse should not accept any patient care assignment he/ she is not competent to deliver the care but instead accept limited assignment of nursing care duties you can utilize your current competence.
Remember that the department you are floating will be glad to have you to help them decrease their patient work load. You will be responsible for your own actions and will be the one to face disciplinary action by a State Board of Nursing if you are not competent to perform the assignment delegated to you.
Talk to the Charge Nurse of the unit you are floating if you refuse the assignment being given to you and discuss the reason of your refusal. Let him/ her know that you are there to help but they should give you patient assignments that you are competent and comfortable to handle. The Charge Nurse of your permanent unit may be able to help you as well in talking to the unit you are floating If they insist for you to take the assignment. You may seek the help of the Nursing Supervisor. You can write an incident report to cover yourself.
According to American Nurses Association (ANA), “Registered Nurses must have the professional right to accept, reject, or object in writing to any assignment that puts patients or themselves at serious risk for harm.” The Joint Commission on floating clearly states that when an employee is asked to float to a different unit, that unit must be similar to his or her own and that the nurse must demonstrate competencies specific to that unit. Furthermore, the assigned employees should be floated to areas of comparable clinical diagnoses and acuities.

Initial Discussion Assignment:

You are a nurse on a medical-surgical unit that is currently well staffed with each nurse at a 3:1 ratio. There were two call outs in the oncology unit and it is your turn to float. The charge nurse informs you that you are being floated to the oncology unit and that you have been assigned to care for four patients.

Your discussion posting must address all of the following issues:

Summarize the concepts of floating that were addressed in the attached articles.
What steps would you take in this scenario to ensure a safe transition into the unfamiliar unit?
Why are these steps important?
What are some of the legal ramifications that can occur if you accept an assigned that is out of your scope of practice?