Transcript Floating 1
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 the need to float
Who needs to float??
Continuity of patient care Patient safety
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 35 30 25 20 15 10 5 0 Today Yesterday Last Week Last Month Last Year Last Year Last Month Last Week Yesterday Today
Floated Nurse Knew Change Nurse Name
60 50 40 30 20 10 0 Yes No No Response No Response No Yes
14 12 10 4 2 8 6 0
Results of Survey (Pre)
5D 4D 4M ICCU 3M MICU 2D Mother/Baby ICN L&D SICU 1
Units Floated To
8 2 0 6 4 18 16 14 12 10 1 5D 4D 4M ICCU 3M MICU 2D Mother Baby ICN L&D SICU
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?
40 35 30 25 20 15 10 5 0 Nurse In Charge
Results of Survey (Post)
Resurvey Results Days
AA Dietician Lounge Combination Clean Utility Room Break Time Assigned Accuity Was it Helpful?
Yes Day Shift No Day Shift N/A
35 30 25 20 15 10 5 0 Nurse In Charge
Results of Survey (Post)
Resurvey Results Nights
AA Dietician Lounge Combination Clean Utility Room Break Time Assigned Accuity Was it Helpful?
Yes Night Shift No Night Shift N/A
14 12 10 2 0 8 6 4
Results of Survey (Post)
Units Floated From (Post)
1 5D 4D 4M ICCU 3M MICU 2D Mother Baby ICN L&D SICU 4 2 0 14 12 10 8 6
Units Floated To (Post)
1 5D 4D 4M ICCU 3M MICU 2D Mother Baby ICN L&D SICU
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