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Workplace Rights

American Journal of Nursing - August, 2000 - Volume 100, Issue 8

The Wild Blue Yonder
Should nurses be floating to unfamiliar units?

by Katherine Kany, MA, RN

Q. Because of insufficient staffing, I recently worked an extra shift in the ICU—where I had never worked before. My supervisor said I should just function as a nurse’s aide. Is this a safe practice?

A. No, because you were probably tired from your first shift, working with a busy ICU staff, given an abbreviated orientation, and not aware of the location of the emergency equipment or medication. Unfortunately, in today’s health care environment, staff floating to other units is increasingly relied on as a solution to insufficient staffing and the shortage of experienced nurses.

Although supervisors will argue that the unit can’t function without additional staff, nurses who are inexperienced or unfamiliar with a unit can often cause extra work for unit staff. And even the most well-intentioned and cautious floating nurse can miss subtle changes in vital signs, lab results, or neurologic status that the experienced unit nurse would recognize and react to immediately.

Ultimately, floating staff compromise a nursing priority—patient safety. The third plank of the Code for Nurses states, “The nurse acts to safeguard the client and the public when health care and safety are affected by incompetent, unethical, or illegal practice by any person.” To meet that ethical mandate, and to best protect patients, nurses should express concern when they’re asked to float to units on which they have no experience.

There’s another reason to share your concerns with your supervisor—your professional license could be at risk when you float. You may be ostensibly acting in a nurse’s aide role, but as a registered nurse you are still accountable for the care provided. The third interpretive statement of the fourth plank of the Code for Nurses states, “Nurses are accountable for judgments made and actions taken in the course of nursing practice. Neither physicians’ orders nor the employing agency’s policies relieve the nurse of accountability for actions taken and judgments made.”

Concerns about floating assignments should be documented on an incident-report form or on an unsafe-staffing or assignment-despite-objection form to ensure that unethical hospital practices and your objections to this dangerous work practice are recorded.

Another option is to negotiate floating provisions into collective bargaining contracts. These provisions ensure that the practice is conducted within certain limitations and only when the nurse has been properly oriented. In some cases, nurses are limited to floating back and forth between similar units or between units that care for the same patient at different points during hospitalization. For example, neonatal ICU nurses might be oriented to care for neonates in the thoracic or surgical ICU, or nurses may work on the labor and delivery and postpartum units interchangeably, a common arrangement in many hospitals.

If you’re not in a collective bargaining organization, you can work with your unit manager to find more appropriate ways to cross-train and orient nursing staff so they can handle emergencies.

Recognizing the dangers that result from the growing use of floating as a staffing solution, the ANA House of Delegates issued a report, Identifying Adequate and Appropriate Registered Nurse Staffing Levels Where Health Care Services Are Delivered, at its June meeting, and called for the ANA to create a policy for appropriate staff floating. According to the report, this would be achieved by identifying the criteria and conditions that would need to be met before a registered nurse could work on any unit other than her own.

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