As we all know, being proficient in a unit previously unfamiliar to us takes more than just general orientation and computer training. Patient populations present a whole different “world” when it comes to nursing.
In one of our recent negotiation sessions with Encino management, the CNO greeted our 121RN Bargaining Team by saying, “an RN is an RN is an RN,” meaning a nurse should be able to float anywhere in the hospital.
Yes, all RNs have the same basic training. However, an RN who works in ICU would have a difficult time in the ER if a pediatric patient or pregnant woman walks through the door. ER RNs are trained to take care of all types of emergent conditions, whereas ICU RNs are concerned with specific patient care delivery and competencies in clinical judgment.
There are also RNs working in some units who would suddenly have patients on ventilators or who have to work with patients who have tracheotomies, scenarios they have not encountered for years or even since they were in nursing school.
These are very different kinds of nursing and the hospital should recognize that sending an RN through PALS or other specific training and a brief orientation doesn’t mean an RN meets clinical competency.
Our RNs need a thorough education, including workplace experience, on the procedures and patient population of a particular unit before they are competent. Our current contract says that RNs will only care for patients for which they are qualified and competent, but when a patient walks through the door, the RN is expected to provide care.
Many of us are willing to float… we just want adequate education and training prior to being floated. For those RNs who are uncomfortable with floating due to liability concerns and lack of exposure to different patient populations, we have proposed the structure for a voluntary Float Team to be created within our contract.
Management wants the ability to float in the following clusters:
- ICU / CCU / ER
- PACU / CCU / ICU
- Med/Surg / Sub Acute / Same Day Surgery / Mental Health Unit
The only units that would not be subject to floating are Surgery and the GI Lab.
Our Union proposed a Float Team with the following clusters:
“The hospital will establish a Float Team for RNs who are willing to float within their float cluster. Float Team RNs will be trained in all areas of their cluster and meet theoretical and clinical competencies. The length of orientation shall be by a consensus of the unit director, the preceptor and the orientee.
Orientation and training will include but not be limited to:
ER / ICU / CDU / PACU / OR / GI Lab – Orientation will include completion of such courses as: Critical Care, Emergency Nursing, Post Anesthesia, Advanced Arrhythmia, Surgery Nursing, GI Nursing, Pediatric and Neonatal care and assessment and all required certifications.
Med Surg / Sub Acute / Mental Health / Same Day Surgery – Orientation will include such classes as: MAB, Ventilator Management, a basic EKG, Med Surg review and tacheostomy care. The length of orientation shall be determined by a consensus of the unit director, the preceptor and the orientee.
When an RN has met all the requirements of the Float Team, she/he will receive a 5 percent differential on the days she/he floats.”