P (Population of interest): ____New Graduates and orientees__________
I (Intervention of interest): ____Floating individuals during the orientation time period_____________
C (Comparison of interest): ___N/A_____________________________
O (Outcome of interest): ______Impact on patient satisfaction, retention, cost and patient safety_______________
T (Time): _________During the first three months_____________________________
Articles
Who
Involved
New Graduate
RNs in a Float
Pool
(Crimlisk,
McNulty,
Francione
39 new
graduate
RNs
enrolled in
a “Float
Pool
Program”
Effect of
Nurse Staffing
and
Antimicrobialimpregnated
CVC
infections in
ICU patients
Patients in
ICU with
CVC
What Occurred
Where
Completed
Why
How
Consistencies
Gaps
 New education
program developed
 Criteria for
inclusion in new
“Float Pool
Program” given
500 Bed
inner-city
hospital
1999
When
 Alleviate staffing
shortages
 Promote and develop
transition of new
graduates into
professional nurses
 Move away from
traditional practices
 New nurses offered
motivation and energy
to practice
 Right training and
education = RN become
valuable asset for
facility
 Retention issue
 4-5 month orientation
(1 mth medical, 1 mth
surgical, 6 wks float
pool, 2 wks specialty
units)
 3 orientation phases
included clinical and
class
 Weekly/biweekly
meetings
 Post orientation
evaluation
 Detailed
description of
program
provided
 Results
provided –
retention rates,
satisfaction
rates, and
overall
suggestions
 Did not
provide
insight
into what
we were
looking
at
 Floating
time of
new RNs
after
orientatio
n
 Affect on
non-float
nurses
 Retention
rate of
other
nurses
* Determine variables
influencing CVC
infections in ICU
patients
ICUs in
several
hospitals
1997-1999
To determine hospital
infection rates, identify
areas of improvement, and
need for advanced
technologies in infection
prevention
Data collected by IC
practitioners using
standardized collection
forms
Found that
patients being
cared for by float
nurses were
more at risk for
CVC infections,
perhaps due to a
lack of training
in such care
 Float
nurses
not
defined
 Dealt
very little
with
floating
and
orientatio
n issues
The Wild Blue
Yonder
Any staff
nurses
floating to
unfamiliarly
units
The authors
and her
clinical
supervisors
Insufficient staffing
causing nurse to float
to unfamiliar area and
told to act as nurse’s
aides
Author floated to ICU
without orientation,
instructed to work as
NA, Legal still a RN,
Acute care
facility
Assumption
is a hospital
setting with
an ICU
Working
extra shift
as float
after
completing
routine
shift
PerAugust
2000;
Short Staffing
Intended to express
author’s belief about
floating nurses to units
without providing adequate
orientation results in
problems with patient
safety
As result of nursing
shortage and current float
policy
Author’s own experiences
and conversations.
Nursing shortage
resulting in use
of floating as
solution to short
staffing
Writing
documents
consistency of
feelings voices.
Lack of
policy/proce
dure
governing
floating
resulting in
unsatisfactor
y work
environment
for nurses
and unsafe
conditions
for patients
Strictly
personal and
opinionated
Floating:
Managing a
Recruitment
and Retention
Issue
Any staff
nurse
floating
West
Virginia
University
Hospital
used staff
and float
pool RNs
Insufficient staffing
causing nurses to float
either to unfamiliar
areas resulting in
increased rates of
RN/LVN turnover at
facility
Float using unassigned
RN and floor RNs on
a rotating basis
Acute care
facility
West
Virginia
University
Hospital
Floating at
beginning
of shift as
solution to
short
staffing
8/2000
Short staffing due to high
rate of RN/LVN nursing
turnover
d/t low retention, low
patient satisfaction, low
RN stress satisfaction
Nursing shortage
resulting in use
of floating as
solution to short
staffing
Success from
nurses
Lack of
policy/proce
dure
governing
floating
resulting in
unsatisfactor
y work
environment
for nurses
and unsafe
conditions
for patients
Said Another
Way: Our
Obligation to
Float
N/A
N/A
N/A
N/A
To defend floating as a
short term fix to the
nursing shortage and
promote patient safety
As result of nursing
shortage and high rate of
turnover due to
dissatisfaction with
floating policy
Improved by increasing
10% pay to float nurses
by 10% per hour, used a
resource person for the
floated nurse, used a float
log, written
responsibilities from the
floor that expected from
the floor for the nurse to
do; feedback to managers
Review of professional
literature, electronic
resources, nursing
textbooks, statements
Discussed out
obligation to
float as an
ethical and
Doesn’t
suggest how
we are to
pay for the
from AACN, Joint
Commission, Sigma, legal
cases, and personal
experiences
patient safety
issue; used
credible sources
to justify
statements;
opposition to
floating was
addressed with
suggestions for
improvement;
offer proper
orientation as
staffing allows
extra
orientation
Summary of findings:

Definition of “float” needs to be clarified

Legality of working as an “aide” when licensed as an RN

Validated prior understanding and perceptions about floating

Structured policies and procedures related to findings need to be in place and initiated during orientation

Only two of the articles reviewed were true research projects, the rest of the articles were information

Validated the increased comfort level – stated with idea they will be floated
Application of findings to evidence-based practice that validates/changes policies and procedures:

Need to evaluate the efficacy of float nurses in regards to infections and morbidity/mortality rates

Clean up orientation process prior to floating – ensure knowledge based

Patient safety and nurse comfort levels must be paramount

Validated policy as written – full outline of orientation to be given at orientation, discuss policy and procedure for floating at orientation, 3 to 4
months prior to floating

Orientees – regardless of experience upon hire are novices for a while due to change of setting

Stress comes up when individual knows they are the next to float

During orientation, all nurses will be told that they will eventually be required to float

Suggestions for next steps
o Tool related to assessment of readiness to float
o Float policy needs to be revised
o Identification of resource float person on each unit – potential research project
Reference List
Alonso-Eshanove, J., Edwards, J.R., Richards, M.J., Brennan, P., Venesia, R.A.,
Keen, J., Ashline, V., Kirkland, K., Chou, E., Hupert, M., Veeder, A.V., Speas, J., Kaye,
J., Sharma, K., Martin, A., Moroz, D., & Gaynes, R.P. (2003, December). Effect of nurse
staffing and antimicrobial-impregnated central venous catheters on the risk for
bloodstream infections in intensive care units. Infection Control and Hospital
Epidemiology, 2412), 916-925.
Crimlist, J.T., McNulty, J.J., & Francione, D.A. (2002, April). New graduate
RNs in a float pool: An inter-city hospital experience. JONA, 32(4), 211-217.
Kane-Urrabazo, C., (2206, April/June). Said another way: Our obligation to float.
Nursing Forum, 41(2), 95-101.
Kany, K., (2000, August). The wild blue yonder. American Journal of Nursing,
100(8), 79.
Kirchhoff, K.T. & Dalh, N., (2006, January). American association of criticalcare nurses’ national survey of facilities and units providing critical care. American
Journal of Critical Care, 15(1), 13-27.
Robert, D. (2004, June). Editorial: Competence increases comfort for float nurses.
Medsurg Nursing, 13(3), 142.
Rudy, S. & Sions, J., (2003, April). Floating: Managing a recruitment and
retention issue. JONA, 33(4), 196-198.