Patient Assignments for Float Nurses

Many hospitals have nurses that make up “float pools.” These nurses float from unit to unit, based on staffing needs created on units due to medical leave, sick calls, increased patient acuity and surges in census.

The nurses who work in these float pools generally have years of nursing experience and tend to be well-rounded in their nursing expertise. Their nursing backgrounds can include medical, surgical, cardiology, etc. They also tend to have good time management skills and can handle changes in their assignments with ease.

The independence and understanding of the organization in which they work are also qualities many float nurses possess. In order to build upon these strengths, it is crucial to consider appropriate patient assignments.

Check the Time 

Although float nurses are well-rounded and able to care for all types of patients, many times they are essentially a Band-Aid for units with staffing problems, i.e., a quick way to solve an immediate staffing issue.

Yes, they are experienced nurses but their experience lies in being “generalized” and not “specialized.”

So then, what types of things should charge nurses consider before making patient assignments that include a float nurse?

First, consider the amount of time that a nurse will be floating to your unit.

Many times float nurses only come to a unit to do a portion of a shift. For example, the unit may only have a nursing shortage from 7 p.m.-11p.m., thus they only need a float for a four-hour period.

In this short amount of time the float nurse is responsible for all documentation related to assessments and medication passes. This does not allow a lot of extra time for complex patient situations, admissions and discharges.

Beware Admissions

It can be difficult for float nurses to handle admissions, largely depending on the complexity of the patient being seeking care. Giving the float nurse a less complex admission will allow them to complete necessary paperwork in a potentially short amount time.

More general admission diagnoses, such as pneumonia or urinary tract infections, are better for the floats to take because the care for these patients tends to be more standardized and their plans of care are easier to follow. They may not know the best way to take care of those admissions that are unit specific patients.

For example, admissions with specialized cardiac drip medications that need to be titrated are better cared for by a unit-specific nurse who is familiar with the many aspects of the protocols that are linked to those drips.

Concerning Unit-Specific Patients

In general, unit-specific patients are better cared for by staff who are trained for those specific aspects of the patients’ diagnoses and or disease process and who are more familiar with their more complex plans of care.

Similarly, patients who are already admitted would best be cared for by those same unit specific nurses.

Occasionally, however, there is no way to avoid a float nurse receiving a patient on their assignment that is unit specific, and in those cases the most stable of those patients would be appropriate for float staff.

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Modern Family

Patients with complex family issues are also better cared for a unit specific staff nurse that is familiar with their complex family dynamics.

Some of these families are looking for continuity of care from certain nurses that know their loved ones situation and prefer to see those familiar faces. This is more helpful with communication between the patients’ family and the floor staff. Assuring continuity of care can help increase patient satisfaction.

Take for instance, the case of a patient admitted to a med/surg unit for gastroparesis.

The patient and daughter were very demanding and particular with the care they wanted and were labeled as “needy” by the staff on the unit where, due to the complicated nature of her diagnosis, the mother remained on this unit as an inpatient for two months.

As a result, the unit-specific staff consistently assigned this patient to float pool staff when they worked on the unit because many of them needed a break from caring for this patient and her family.

Meanwhile, due to the lack of consistency of staff caring for this patient, limit setting was very difficult and the patient and daughter became increasingly upset with staff who didn’t know their situation or structure of their care.

As her stay progressed, multiple members of the interdisciplinary team had been consulted, and upon deeper investigation of her stay it was ascertained that the patient had a significant weight loss over the course of just a few weeks and no one had noticed because of the lack of consistency in care.

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Most Valuable Players

Float nurses are a valuable resource for safe and effective staffing. These are just a few simple things to consider when making an assignment for a float nurse.

Asking yourself, “who is the best person to be caring for this patient?” will help ensure a proper patient assignment for both float staff and unit specific staff and can simplify shift to shift report. These guidelines can also be used when making an assignment that includes a float nurse from another unit.

Working together is the only way all staff involved receives the best from each other and are then able to give their best to their patients.

References
Larson, N., et al. (2012, Jan-Feb). Staffing patterns of scheduled unit staff nurses vs. float pool nurses. MedSurg Nursing, 21, 27-39.

Jessica LeRoux is a med/surg nurse working on the STAR Team (float pool) at Hartford Hospital, Hartford, Conn.

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