*Original post released on 11/28/2020
Floating to a unit you’re unfamiliar with, whether intentionally or involuntarily, can be quite intimidating. You likely won’t know who your co-workers will be, where anything is located on the unit, and sometimes, you may not even know where the unit itself is located. Especially as an ICU nurse, it can be all to easy to get comfortable with your home unit…patients usually transfer TO your unit (not the other way around) and even when you do transfer out, it’s likely to a telemetry unit. Another factor that makes this difficult for ICU nurses in particular is the heavy reliance on access to an array of supplies and equipment. Many of the units I floated to were makeshift ICUs where a different unit would temporarily be used as a place to care for critically ill patients. This forces you to utilize a little ingenuity in adequately and safely caring for your patients. In this article, we’ll discuss how to handle the float initially, tips for adjusting, and how you can turn the situation into a truly positive experience professionally.
First thing’s first, figure out where you’re going, who is in charge of that unit, and what your job expectations will be in that setting. In my experience, there were times where I would simply be extra “helping hands” for the nurses with assigned patients. This is not an excuse to slack off but, rather, an opportunity to make lighter work for everyone involved. Another aspect to note is that some units also have different charting requirements. Inquire about this early into the start of your shift. If you think your assignment to the unit is out of your realm of experience and may result in an unsafe situation, disclose this to your charge nurse ASAP and before you head to that unit.
Next, you’ll want to make sure you’re oriented to the unit itself. Know where emergency equipment is located throughout the entire unit, where clean and soiled utilities are, linen carts, med room, ECG monitors when applicable, etc. If you want, you can even get report first and ask the off-going nurse for a quick tour of the unit. As you walk through the floor, be sure to jot down any of the key codes for locked areas. At one point, we had so many emergency relief nurses constantly rotating throughout the units in our facilities that we ended up taping codes to the door. For pre-Covid times, this would be highly taboo.
Afterwards, and trust me on this, you’ll want to make a few friendly contacts on the unit…especially if you don’t recognize anyone initially. This means introducing yourself to others, learning names, offering your assistance, and generally being outgoing. As the saying goes, “You’ll get more bees with honey than with vinegar.” Later on in your shift, you might need assistance from someone in providing care for your patients. Maintaining a mutually beneficial working relationship will make the work environment that much more pleasant and efficient for all parties involved.
One of the major reasons floating to a new unit can be stressful is because you’re forced to be in a new environment and learn again. If you know and expect this from the situation, it’s not necessarily an aspect of floating that you can change. What you can change is your attitude; come in with an open mind, ready to learn, and ready to feel like a novice again. Don’t let this change in assignment disrupt your usual nursing routine. YOU STILL KNOW HOW TO BE A NURSE, and if they didn’t have confidence in your abilities, you wouldn’t be floating.
Take comfort in knowing that you’ll more than likely be helping a unit that is short staffed. This means that regularly staffed members of that unit will be extremely grateful for your assistance and any expertise you might bring to their unit. Be kind and supportive. Also be cautious about complaining and emitting a negative attitude; such an attitude won’t be appreciated and may not be tolerated given current nursing circumstances.
If the unit is a converted unit, it’s highly likely that there may be fewer resources and monitoring than you’re used to having available. Sometimes this can foster unsafe situations, and it will be your responsibility to recognize and escalate that to your charge nurse. Admit when something is beyond your scope of practice or realm of experience. Safety is more important than someone’s ego. And remember, it is YOUR nursing license after all. Be sure to double check your patient’s orders, note physicians’ preferences, charting requirements, norms for that unit (Ex: vitals parameters for a cardiac patient may be different than those for a neuro patient), and cross check all running drips with their respective orders. Make sure anything running on your IV pumps is programmed correctly, set for the appropriate weight if weight-based, and within the order parameters for the patient’s current status. Consider making a nursing note of all IV drips/rates, tube feedings, ventilator settings, ETT/NGT/OGT markings, and vitals while also noting which nurse you received report from. Doing so will protect your nursing license, make note of your initial assessment, and the patient’s status at the time of change of shift. Make this note directly after receiving report, ESPECIALLY if you feel your charting may be deferred.
All in all, treat this opportunity as a challenge and testament to your nursing skills, intuition, and patient advocacy. When growing and developing as a nursing professional, it is crucial to form and maintain a sense of resiliency. If you look at the assignment with the attitude that it’s providing an opportunity to cultivate nursing skills that can take you anywhere – grad school, charge nursing, administrative nursing, etc. – your time on the unit will be much more enjoyable and rewarding. The possibilities for skill enhancement are endless with float nursing! You just have to be receptive and willing to be “new” again. I sincerely hope this article helped give you a few things to keep in mind when floating so you can do so with ease and grace.