In an era of staffing shortages, floathing has become an expected part of nursing for both permanent and supplemental providers

While this approach fulfills immediate short-term needs, floating to a different specialty or subspecialty presents nurses with a new set of challenges. It not only requires the ability to adapt to new procedures and protocols, depending on the unit, but it may also involve caring for more patients at different acuity levels. In the following discussion, a seasoned acute care executive and staffing agency representative offer some floating strategies to help foster harmony among staff yet assure that the delivery of care is never compromised.

Addressing floating issues A recent online survey by Healthcare Traveler reported that 41 percent of over 300 respondents considered floating polices a major contractual concern. To avoid surprises and misunderstandings down the road, facility managers and staffing personnel feel it is essential to address floating requirements prior to employment. Cindy Hafenstine, director of the travel division for Health Specialists, Inc, based in Lenexa, Kansas, states, "We usually work with the hospitals on an individual basis to determine what their floating policies are for travelers. To which units will they be floated and how often will they be required to leave their units? Will they rotate with the regular staff or will they be the first to float?

"This information is readily available to the potential candidate, so during our interview—and the traveler's interview with the hospital representative—the mobile provider can make inquiries about specific units and responsibilities. As a result, the nurse understands expectations and is assured a good fit. No one is put at risk. After an offer is extended and a nurse accepts, we specify when, where, and how often the traveler will be floated. We make a point to confirm all the details with the nurse and the hospital, and put any floating guidelines in both contracts so there is no confusion."

Kathryn K. Scott, RN, coordinator of patient relations and the traveler program at Children's Hospital Boston (CHB) in Boston, Massachusetts, emphasizes that, at CBH, nurses float to a unit only if they have the appropriate skills. "We are very, very concerned about safety issues and we will not float core staff or travelers unless they have the capabilities of caring for the patients. For instance, we would never send a traveler who is working on a medical floor to a critical care area or the operating room or the PACU. On the other hand, if a nurse comes into our cardiac intensive care unit, it is possible that he or she would be sent to the regular med/surg intensive care unit."

When asked if it is likely for a critical care nurse to float to another department or specialty unit, Ms. Hafenstine replies, "If a hospital makes such a request, we ensure that the nurses know up front and we determine if they are willing and able to float to other floors. We only allow travelers to float to similar units in which they have experience. For example, a general ICU nurse without the proper credentials, such as NRP, could not float to a neonatal ICU. Often, because most critical care nurses are accustomed to working with one or two seriously ill patients, they prefer not to float to a med/surg or telemetry unit where there is an increase in patient workload and a drastically different pace." Adds Ms. Scott, "It would be a rare occasion if we floated a critical care nurse to a med/surg unit."

Floating expectations It is not so rare, however, for travelers to be the first to float. They are often chosen before permanent staff because of their vast experience and strong clinical skills. In particular, mobile providers are accustomed to facing new clinical settings and this adaptability makes them uniquely suited to floating. "What I have discovered," claims Ms. Scott, "is that travelers arrive with a variety of experience. At other assignments, they may have been placed in a number of units, so they come prepared and possess the right attitude. Still, with both permanent and supplemental staff, insecurities can surface because they are more comfortable working in familiar settings."