Nurses’ Floating Experience Catherine Hennessy, RN, BSN Nyack Hospital Nyack Hospital Located approximately 25 miles northwest of New York City 373 Bed Community Hospital (Licensed) Types of Patient Care Units Medical Intensive Care Unit (11 beds) Surgical Intensive Care Unit (11 beds) Cardiac Stepdown Unit ( 30 beds) Pulmonary Stepdown (23 beds) Oncology (36 beds) Medical/Surgical (37 beds) Orthopedics (31 beds) Pediatrics (23 beds) Mother/Baby/Newborn Nursery (46 beds) What is ‘floating’? Nursing staff members are assigned to work on a patient unit other than their own in order to provide staffing to: Cover sick calls Increase staffing to ensure safe assignments Meet emergency staffing needs Provide flexibility in staffing Who can ‘float’? All nursing staff members who provide patient care can float to any patient care area in the hospital within their scope of practice Registered Nurses Patient Care Associates Administrative Associates Where staff ‘float’? Nurses ‘float’ within ‘clusters’ (determined according to scope of practice) Critical care cluster Medical/Surgical cluster Mother/Baby OB/GYN cluster Governed by Union Contracts New York State Nurses Association (NYSNA) 1199 (Ancillary Staff) Background Floating to unfamiliar units common practice in many healthcare settings Staff dissatisfaction/morale problems related to floating Breaches in standards of practice Patient safety and liability for staff member and facility Affect on patient satisfaction Increased turnover Task Force Participants Task Force Leader Associate Chief Nursing Officer Nursing Supervisor/Nurse Manager Day/Night Shift RNs Representatives from all patient care units Methods “Floating Task Force” Literature Review to determine best practice Reflective Journaling Survey “Floating Tool” Resurvey Task Force Recommendations Determining Who needs to float?? Continuity of patient care Patient safety Float the need to float Experience Float is greeted on assigned unit by Nurse Manager or Charge Nurse Float tool is reviewed together Floating Survey The last time floated Name of nurse in Charge Nurse Manager Co-workers AA PCA Case Manager Dietitian Patient Meal Time Lounge Lock Combination Code Cart Location Medication Room Lock Code Clean Utility Room Lock Code My Break Time Acuity of Assignment Unit Floated to Primary Unit Staff Participants Day / Night Shift Representatives from all patient care units Positive and negative attitudes Results of Survey: Comments Positive Greeted by staff on receiving floor Felt needed on floor Made difference on floor felt part of a team Had assistance from staff on receiving floor Assignment ‘reasonable’ Negative Assigned most difficult patients Did not get break or lunch Got first admission Did not know where anything was located Told ‘This is what we deal with all of the time on this floor’ Results of Survey (Pre) Last Time Nurse Floated 50 45 40 Last Year 35 Last Month 30 Last Week Yesterday 25 Today 20 15 10 5 0 Today Yesterday Last Week Last Month Floated Nurse Knew Change Nurse Name Last Year 60 50 40 No Response No 30 Yes 20 10 0 Yes No No Response Results of Survey (Pre) 14 12 5D 4D 10 4M ICCU 8 3M MICU 2D 6 Mother/Baby ICN 4 L&D SICU 2 0 1 Units Floated To 18 16 5D 4D 14 4M 12 ICCU 3M 10 MICU 8 2D Mother Baby 6 ICN 4 L&D SICU 2 0 1 Name___________________ Unit______________ Ext______ Nurse Manager: __________________________________________ Nursing Supervisor: _________________________ Beeper: ________ Charge Nurse: __________________________________________ Resource Nurse: __________________________________________ AA: __________________________________________ Assigned PCA: __________________________________________ Case Manager: ___________________ Ext. __________Beeper: ______________ Physical Therapist: _________________ Ext. ___________Beeper: ____________ Respiratory Therapist: ______________ Ext. __________ Beeper: ____________ Dietitian: ___________________ Ext. ___________Beeper: _____________ Patient Meal Times: Breakfast:__________ Lunch: _________Dinner: _________ Combination numbers: Medication room: __________________ Clean Utility Room: __________________ Staff Lounge: __________________ Emergency Supplies Location: Code Cart Intubation Tray Staff Members Names: RNs: _______________ __________________ ________________ ________________ PCAs: ______________ _________________ _________________ ________________ Break Times: ___________ _______________ ____________ Resurvey Distributed the same “Floating Experience” Tool with two additional questions Have you used the “Floating Tool? Was it helpful? Results of Survey (Post) Resurvey Results Days 40 35 30 Yes Day Shift 25 No Day Shift 20 N/A 15 10 5 0 Nurse In Charge AA Dietician Lounge Combination Clean Utility Room Break Time Assigned Accuity Was it Helpful? Results of Survey (Post) Resurvey Results Nights 35 30 25 20 Yes Night Shift No Night Shift 15 N/A 10 5 0 Nurse In Charge AA Dietician Lounge Combination Clean Utility Room Break Time Assigned Accuity Was it Helpful? Results of Survey (Post) Units Floated From (Post) 14 5D 12 4D 10 4M ICCU 8 3M MICU 6 2D Mother Baby 4 ICN L&D 2 Units Floated To (Post) SICU 0 1 14 5D 12 4D 10 4M ICCU 8 3M MICU 6 2D Mother Baby 4 ICN L&D 2 SICU 0 1 Results Hospital has hired nurses for a “Float” Pool Decreased number of nurses who float Decreased overtime Conclusion Continue with Task Force Develop unit-specific “Float Tools” Utilize float pool Thank You!!! Thank you!!!