Case Study – Float project



P (Population of interest): ____New Graduates and orientees__________

I (Intervention of interest): ____Floating individuals during the orientation time period_____________

C (Comparison of interest): ___N/A_____________________________

O (Outcome of interest): ______Impact on patient satisfaction, retention, cost and patient safety_______________

T (Time): _________During the first three months_____________________________

Articles |Who Involved |What Occurred |Where Completed |

When |

Why |

How |

Consistencies |

Gaps | |New Graduate RNs in a Float Pool (Crimlisk, McNulty, Francione |39 new graduate RNs enrolled in a “Float Pool Program” |New education program developed

• Criteria for inclusion in new “Float Pool Program” given |500 Bed inner-city hospital |1999 |Alleviate staffing shortages

• Promote and develop transition of new graduates into professional nurses

• Move away from traditional practices

• New nurses offered motivation and energy to practice

• Right training and education = RN become valuable asset for facility

• Retention issue |4-5 month orientation (1 mth medical, 1 mth surgical, 6 wks float pool, 2 wks specialty units)

• 3 orientation phases included clinical and class

• Weekly/biweekly meetings

• Post orientation evaluation |Detailed description of program provided

• Results provided – retention rates, satisfaction rates, and overall suggestions |Did not provide insight into what we were looking at

• Floating time of new RNs after orientation

• Affect on non-float nurses

• Retention rate of other nurses

| |Effect of Nurse Staffing and Antimicrobial-impregnated CVC infections in ICU patients |Patients in ICU with CVC |* Determine variables influencing CVC infections in ICU patients |ICUs in several hospitals |1997-1999 |To determine hospital infection rates, identify areas of improvement, and need for advanced technologies in infection prevention

|Data collected by IC practitioners using standardized collection forms |Found that patients being cared for by float nurses were more at risk for CVC infections, perhaps due to a lack of training in such care |Float nurses not defined

• Dealt very little with floating and orientation issues

| |The Wild Blue Yonder |Any staff nurses floating to unfamiliarly units

The authors and her clinical supervisors |Insufficient staffing causing nurse to float to unfamiliar area and told to act as nurse’s aides

Author floated to ICU without orientation, instructed to work as NA, Legal still a RN, |Acute care facility

Assumption is a hospital setting with an ICU |Working extra shift as float after completing routine shift

Per-August 2000; |Short Staffing

Intended to express author’s belief about floating nurses to units without providing adequate orientation results in problems with patient safety |As result of nursing shortage and current float policy

Author’s own experiences and conversations. |Nursing shortage resulting in use of floating as solution to short staffing

Writing documents consistency of feelings voices. |Lack of policy/procedure governing floating resulting in unsatisfactory work environment for nurses and unsafe conditions for patients

Strictly personal and opinionated

| |Floating: Managing a Recruitment and Retention Issue |Any staff nurse floating

West Virginia University Hospital used staff and float pool RNs |Insufficient staffing causing nurses to float either to unfamiliar areas resulting in increased rates of RN/LVN turnover at facility

Float using unassigned RN and floor RNs on a rotating basis |Acute care facility

West Virginia University Hospital |Floating at beginning of shift as solution to short staffing

8/2000 |Short staffing due to high rate of RN/LVN nursing turnover

d/t low retention, low patient satisfaction, low RN stress satisfaction |As result of nursing shortage and high rate of turnover due to dissatisfaction with floating policy

Improved by increasing 10% pay to float nurses by 10% per hour, used a resource person for the floated nurse, used a float log, written responsibilities from the floor that expected from the floor for the nurse to do; feedback to managers |Nursing shortage resulting in use of floating as solution to short staffing

Success from nurses |Lack of policy/procedure governing floating resulting in unsatisfactory work environment for nurses and unsafe conditions for patients | |Said Another Way: Our Obligation to Float |N/A |N/A |N/A |N/A |To defend floating as a short term fix to the nursing shortage and promote patient safety |Review of professional literature, electronic resources, nursing textbooks, statements from AACN, Joint Commission, Sigma, legal cases, and personal experiences |Discussed out obligation to float as an ethical and patient safety issue; used credible sources to justify statements; opposition to floating was addressed with suggestions for improvement; offer proper orientation as staffing allows |Doesn’t suggest how we are to pay for the extra orientation | |Summary of findings:

• Definition of “float” needs to be clarified

• Legality of working as an “aide” when licensed as an RN

• Validated prior understanding and perceptions about floating

• Structured policies and procedures related to findings need to be in place and initiated during orientation

• Only two of the articles reviewed were true research projects, the rest of the articles were information

• Validated the increased comfort level – stated with idea they will be floated

Application of findings to evidence-based practice that validates/changes policies and procedures:

• Need to evaluate the efficacy of float nurses in regards to infections and morbidity/mortality rates

• Clean up orientation process prior to floating – ensure knowledge based

• Patient safety and nurse comfort levels must be paramount

• Validated policy as written – full outline of orientation to be given at orientation, discuss policy and procedure for floating at orientation, 3 to 4 months prior to floating

• Orientees – regardless of experience upon hire are novices for a while due to change of setting

• Stress comes up when individual knows they are the next to float

• During orientation, all nurses will be told that they will eventually be required to float

• Suggestions for next steps

o Tool related to assessment of readiness to float

o Float policy needs to be revised

o Identification of resource float person on each unit – potential research project

Reference List

Alonso-Eshanove, J., Edwards, J.R., Richards, M.J., Brennan, P., Venesia, R.A., Keen, J., Ashline, V., Kirkland, K., Chou, E., Hupert, M., Veeder, A.V., Speas, J., Kaye, J., Sharma, K., Martin, A., Moroz, D., & Gaynes, R.P. (2003, December). Effect of nurse staffing and antimicrobial-impregnated central venous catheters on the risk for bloodstream infections in intensive care units. Infection Control and Hospital Epidemiology, 2412), 916-925.

Crimlist, J.T., McNulty, J.J., & Francione, D.A. (2002, April). New graduate RNs in a float pool: An inter-city hospital experience. JONA, 32(4), 211-217.

Kane-Urrabazo, C., (2206, April/June). Said another way: Our obligation to float. Nursing Forum, 41(2), 95-101.

Kany, K., (2000, August). The wild blue yonder. American Journal of Nursing, 100(8), 79.

Kirchhoff, K.T. & Dalh, N., (2006, January). American association of critical-care nurses’ national survey of facilities and units providing critical care. American Journal of Critical Care, 15(1), 13-27.

Robert, D. (2004, June). Editorial: Competence increases comfort for float nurses. Medsurg Nursing, 13(3), 142.

Rudy, S. & Sions, J., (2003, April). Floating: Managing a recruitment and retention issue. JONA, 33(4), 196-198.

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