Nurses’ Floating Experience

1. Nurses’ Floating Experience Catherine Hennessy, RN, BSN Nyack Hospital

2. 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)

3. 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

4. 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

5. 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)

6. 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

7. Task Force Participants • Task Force Leader • Associate Chief Nursing Officer • Nursing Supervisor/Nurse Manager • Day/Night Shift RNs • Representatives from all patient care units

8. Methods “Floating Task Force” Literature Review to determine best practice Reflective Journaling Survey “Floating Tool” Resurvey

9. 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

10. 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

11. Staff Participants • Day / Night Shift • Representatives from all patient care units • Positive and negative attitudes

12. 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’

13. Results of Survey (Pre)

14. Results of Survey (Pre)

15. 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: ___________ _______________ ____________

16. Resurvey Distributed the same “Floating Experience” Tool with two additional questions Have you used the “Floating Tool? Was it helpful?

17. Results of Survey (Post)

18. Results of Survey (Post)

19. Results of Survey (Post)

20. Results Hospital has hired nurses for a “Float” Pool Decreased number of nurses who float Decreased overtime

21. Conclusion Continue with Task Force Develop unit-specific “Float Tools” Utilize float pool

22. Thank You!!! Thank you!!!