NEW HORIZONS
Float pool nurses come to the rescue By Laura Lebanik, BSN, BA, RN, CPN, and Stephanie Britt, MSL, BSN, RN, CEN, NEA-BC
Adaptability is key At the beginning of each shift, most nurses have an idea of what their day will look like and know what’s in store for them. While patients may change from day to day, most of them have similar diagnoses.
GREYTOWN /iSTOCK
HOW CAN HOSPITALS best address nursing vacancies due to fluctuations in patient census and staff illness, family events, vacations, and temporary leaves? Who takes care of the patients affected? At the large metropolitan pediatric hospital where the authors are employed, these needs are met by members of the nursing float pool. These talented nurses and unlicensed assistive personnel are trained to work on multiple units throughout the hospital, allowing the hospital to adapt to the ever-fluctuating needs of its patients. (See A deeper dive into the pool.) Although literature about the successful implementation of nursing float pools is limited, this hospital has identified many benefits of this pool. In particular, the cost savings of using in-house staff in place of traveling nurses are substantial. According to estimates, using nursing float pools may reduce total nursing labor costs by 2% to 5%.1 Because personnel costs are the largest item in hospital budgets, this represents a huge savings. Besides costs, both the quality of patient care and overall patient safety are improved by the use of float pool personnel.2 Float pool nurses also aid in increasing employee morale by reducing the amount of floating required by regularly scheduled nurses.2 This article focuses on the key characteristics needed for nurses in the float pool: adaptability, knowledge, optimism, communication, and focus.
50 l Nursing2015 l March
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
March l Nursing2015 l 51
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
These nurses work with the same team members, and they already know how to get around the unit and the hospital and where to find supplies. This isn’t the case for the typical float pool nurse. In the pediatric hospital, patient assignments may range from providing nursing care for preemies in the neonatal ICU (NICU) to teenagers in rehabilitation. Because the medical, emotional, psychological, and spiritual needs of pediatric patients vary greatly, adaptability is crucial. On any given shift, float pool nurses must adjust their skill sets to meet the challenges of patient assignments that are subject to change at a moment’s notice. Each shift comes with its own surprises. For a float pool nurse working a 12-hour shift, this might mean having an assignment for 4 hours in one unit, being floated to another unit for the next 4 hours, and then being moved again for the last 4 hours. Patient assignments may range from extremely complex care in the ICU to the triage approach of the ED to the relative quiet of the NICU. In addition, these nurses could face the serendipity of taking a patient down to the main lobby for discharge, then being unexpectedly handed the car keys by an expectant
father trying to get his wife to the labor and delivery unit, and having to call security to assist with parking his car. Float pool nurses are expected to be prepared to take on all such challenges with courtesy and enthusiasm. Expert knowledge Most units determine assignments using a synergy model: the right nurse for the right patient. Such a model matches a patient’s characteristics with a nurse’s competencies and elicits cooperative action by involving all parties—patient, staff, and family—as they work toward a common goal. Because float pool nurses work in various locations within the hospital, including the ICUs, they’re expected to have expertise in all areas of nursing care. Given their broad spectrum of knowledge, float pool nurses are in a unique position to adjust to any given assignment and to be the right nurses for their patients. For example, in the pediatric ICU (PICU), most patients are endotracheally intubated and sedated, requiring intensive monitoring and interventions; in contrast, in the NICU, most patients require a minimal stimulation environment in order to overcome the complexities of their preterm arrival. Pediatric float pool nurses must be
A deeper dive into the pool A float pool exists to meet the operational needs of hospitals, clinics, and other nursing care areas within its system. Just as these operational needs vary from place to place, so does the float pool’s configuration. Our float pool supports a large metropolitan tertiary/quaternary medical center with ever-expanding services and patient care needs. Our team, which receives benefits, is a hybrid of full-time, part-time, and p.r.n. staff divided into four main teams: pediatrics; med-surg, cardiac, and women’s care; critical care; and ED. Although we require teammates to have skills and experience in at least one of these areas of competence, we also look for additional skills that can be used when needed, such as labor and delivery and cath lab experience. Orientation to the float pool is tailored to the needs of individual teammates based on their previous experience and the areas to which they’ll float. Nurses are given assignments based on the competencies they possess. Our nurses enjoy the variety of their float pool assignments and their reputation as “jacks of all trades.” Because float pool nurses are required to possess a myriad of experience and competencies, they may command a higher rate of pay. The additional cost, however, is outweighed by the contributions they make to the overall quality of care provided, a key factor in overall patient satisfaction.1
aware of these differences and have the flexibility to move between these units with ease. This ability to move between units can afford a unique opportunity for continuity of care. Very few nursing positions let a nurse provide care for a child in the ED, then later in the PICU, and, finally, give the same child and family discharge instructions from the pediatric medicalsurgical unit 3 weeks later. Float pool nurses have expanded opportunities to hone their skills and to develop new competencies in diverse areas due to their wide-ranging assignments. To meet the educational needs for a wide variety of patients, float pool nurses need to use their considerable autonomy to keep up with certifications, continuing education, and hospital-wide process changes. Optimism: Glass half full Full-time employment as a float pool nurse requires a degree of optimism. Float pool nurses are usually warmly welcomed on their assigned units because the clinical nurses would be shorthanded without them. While some nurses may bristle at the idea of a temporary placement, float pool nurses enjoy the variety of challenges and situations into which they’re placed. In fact, this variability, the exposure to new approaches in patient care, and the feeling of independence is what attracts nurses to the float pool.2 There’s never a dull moment. Communication and focus Float pool nurses become sources of information and conduits of best practice. By interacting with healthcare providers and advanced practice nurses throughout the organization, float pool nurses are in a unique position to advocate for their patients, particularly those with complex conditions. Through prior experience on different units, float pool nurses can often serve as gatekeepers, linking a patient with the best-available staff
52 l Nursing2015 l March
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
and resources. In this arena, excellent communication skills, both written and oral, are a vital necessity. Similar communication skills extend to the float pool nurse’s interaction with other personnel such as charge nurses, physical therapists, and nurse managers. With such a wide range of assignments, the float pool nurse must be able to retain focus. This requires an awareness of the unique challenges and opportunities of each unit. After receiving report on their patients, float pool nurses must organize themselves mentally to provide excellent care. Being organized requires being familiar not only with the practical side of the unit (supplies, personnel, codes to locked rooms), but also with each unit’s current goals and initiatives to benefit the hospital and the organization as a whole. Lean management techniques are employed by many progressive healthcare institutions to introduce new patient-centered approaches, facilitate change, and attempt to decrease wasteful duplications.3 Daily nursing team huddles are a way in which current initiatives and goals are conveyed to staff. A visual management board on every unit can be used to outline program priorities, along with ideas for unit improvement projects, and current issues that need to be addressed with management. Another way in which float pool nurses become aware of initiatives and goals is through shared governance. Float pool nurses are in a good position to participate in shared governance because they see different performance improvement (PI) projects throughout the hospital. They’re expected to participate in PI activities related to their nursing roles and patient care. For example, if one unit is trying to develop a protocol for decreasing urinary retention after indwelling catheter removal to decrease catheter-associated urinary tract infections, float pool nurses are
expected to participate in the trial of the new protocol. These float pool nurses can then bring information learned to the unit-based shared governance council; the shared governance council can determine whether the particular initiative would be useful on other units throughout the hospital. If a PI initiative is extended to other units, float pool nurses can help these units implement the new process. While focus is important on an institutional and a unit level, it’s critically important whenever the nurse interacts with the patient, beginning with receiving report. Even though this face-to-face routine at the bedside is similar throughout the hospital, some differences may be based on the acuity of patients and the patient population. The key to reporting in any hospital unit is clear, concise communication between individuals, whether they’re float pool nurses or regular staff. Concentrated listening, follow-up questions, clarification of unit policies, and adjunct procedures such as safety checks at the bedside allow both nurses to best manage patient care with the highest degree of continuity possible. Float pool nurses must take time to assess patients and review all medications because any new signs, symptoms, or issues could be significant to bring up during multidisciplinary rounds. This means clearly understanding patients’ diagnoses and current complaints so that the limited interaction with those patients really counts in their overall care. This attention to detail lets float pool nurses focus solely on the patient’s needs without the competing distractions of unit politics, staff compatibility, and personal agendas. This degree of heightened patient focus sets the best float pool nurses apart. Pros and cons Float pool nurses work to create moments that connect them to their patients. While they may have only a
few hours to do this, they’re critically aware that this is why they became nurses in the first place. As with any nurse, this may involve untangling a jumble of tubes to allow a patient to get to the bedside commode. It could mean placing a premature infant in the arms of new parents for their first cuddle. Or it could be educating a family member for the 100th time and finally seeing evidence of understanding. These moments ground float pool nurses to their work and remind them that this vocation is as much a gift as a career. Sometimes this role comes at a price. Float pool members aren’t always recognized for creating exceptional moments in patient care because that recognition typically belongs to member of the patient’s unit. The reward these nurses receive comes from pride in their work. Rising to the top Float pool nurses are in a unique position to make a difference within the hospital. Moving from assignment to assignment, these nurses serve as messengers of best practice. Each day they step into the unknown with the assurance that their role is a vital one in the lives of those they serve. ■ REFERENCES 1. Mendez de Leon D, Stroot JA. Using nursing resource teams to improve quality of care. Healthc Financ Manage. 2013;67(8):76-83. 2. Larson N, Sendelbach S, Missal B, Fliss J, Gaillard P. Staffing patterns of scheduled unit staff nurses vs. float pool nurses: a pilot study. Medsurg Nurs. 2012;21(1):27-32, 39. 3. Ben-Tovim DI, Bassham JE, Bolch D, Martin MA, Dougherty M, Szwarcbord M. Lean thinking across a hospital: redesigning care at the Flinders Medical Centre. Aust Health Rev. 2007;31(1):10-15. RESOURCE Dziuba-Ellis J. Float pools and resource teams: a review of the literature. J Nurs Care Qual. 2006; 21(4):352-359. At Carolinas Healthcare System in Charlotte, N.C., Laura Lebanik is a pediatric float pool RN at Levine Children’s Hospital and Stephanie Britt is the nurse manager of the central division float pool. The authors have disclosed that they have no financial relationships related to this article. DOI-10.1097/01.NURSE.0000460715.73128.ea
March l Nursing2015 l 53
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Float pool nurses come to the rescue By Laura Lebanik, BSN, BA, RN, CPN, and Stephanie Britt, MSL, BSN, RN, CEN, NEA-BC
Adaptability is key At the beginning of each shift, most nurses have an idea of what their day will look like and know what’s in store for them. While patients may change from day to day, most of them have similar diagnoses.
GREYTOWN /iSTOCK
HOW CAN HOSPITALS best address nursing vacancies due to fluctuations in patient census and staff illness, family events, vacations, and temporary leaves? Who takes care of the patients affected? At the large metropolitan pediatric hospital where the authors are employed, these needs are met by members of the nursing float pool. These talented nurses and unlicensed assistive personnel are trained to work on multiple units throughout the hospital, allowing the hospital to adapt to the ever-fluctuating needs of its patients. (See A deeper dive into the pool.) Although literature about the successful implementation of nursing float pools is limited, this hospital has identified many benefits of this pool. In particular, the cost savings of using in-house staff in place of traveling nurses are substantial. According to estimates, using nursing float pools may reduce total nursing labor costs by 2% to 5%.1 Because personnel costs are the largest item in hospital budgets, this represents a huge savings. Besides costs, both the quality of patient care and overall patient safety are improved by the use of float pool personnel.2 Float pool nurses also aid in increasing employee morale by reducing the amount of floating required by regularly scheduled nurses.2 This article focuses on the key characteristics needed for nurses in the float pool: adaptability, knowledge, optimism, communication, and focus.
50 l Nursing2015 l March
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
March l Nursing2015 l 51
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
These nurses work with the same team members, and they already know how to get around the unit and the hospital and where to find supplies. This isn’t the case for the typical float pool nurse. In the pediatric hospital, patient assignments may range from providing nursing care for preemies in the neonatal ICU (NICU) to teenagers in rehabilitation. Because the medical, emotional, psychological, and spiritual needs of pediatric patients vary greatly, adaptability is crucial. On any given shift, float pool nurses must adjust their skill sets to meet the challenges of patient assignments that are subject to change at a moment’s notice. Each shift comes with its own surprises. For a float pool nurse working a 12-hour shift, this might mean having an assignment for 4 hours in one unit, being floated to another unit for the next 4 hours, and then being moved again for the last 4 hours. Patient assignments may range from extremely complex care in the ICU to the triage approach of the ED to the relative quiet of the NICU. In addition, these nurses could face the serendipity of taking a patient down to the main lobby for discharge, then being unexpectedly handed the car keys by an expectant
father trying to get his wife to the labor and delivery unit, and having to call security to assist with parking his car. Float pool nurses are expected to be prepared to take on all such challenges with courtesy and enthusiasm. Expert knowledge Most units determine assignments using a synergy model: the right nurse for the right patient. Such a model matches a patient’s characteristics with a nurse’s competencies and elicits cooperative action by involving all parties—patient, staff, and family—as they work toward a common goal. Because float pool nurses work in various locations within the hospital, including the ICUs, they’re expected to have expertise in all areas of nursing care. Given their broad spectrum of knowledge, float pool nurses are in a unique position to adjust to any given assignment and to be the right nurses for their patients. For example, in the pediatric ICU (PICU), most patients are endotracheally intubated and sedated, requiring intensive monitoring and interventions; in contrast, in the NICU, most patients require a minimal stimulation environment in order to overcome the complexities of their preterm arrival. Pediatric float pool nurses must be
A deeper dive into the pool A float pool exists to meet the operational needs of hospitals, clinics, and other nursing care areas within its system. Just as these operational needs vary from place to place, so does the float pool’s configuration. Our float pool supports a large metropolitan tertiary/quaternary medical center with ever-expanding services and patient care needs. Our team, which receives benefits, is a hybrid of full-time, part-time, and p.r.n. staff divided into four main teams: pediatrics; med-surg, cardiac, and women’s care; critical care; and ED. Although we require teammates to have skills and experience in at least one of these areas of competence, we also look for additional skills that can be used when needed, such as labor and delivery and cath lab experience. Orientation to the float pool is tailored to the needs of individual teammates based on their previous experience and the areas to which they’ll float. Nurses are given assignments based on the competencies they possess. Our nurses enjoy the variety of their float pool assignments and their reputation as “jacks of all trades.” Because float pool nurses are required to possess a myriad of experience and competencies, they may command a higher rate of pay. The additional cost, however, is outweighed by the contributions they make to the overall quality of care provided, a key factor in overall patient satisfaction.1
aware of these differences and have the flexibility to move between these units with ease. This ability to move between units can afford a unique opportunity for continuity of care. Very few nursing positions let a nurse provide care for a child in the ED, then later in the PICU, and, finally, give the same child and family discharge instructions from the pediatric medicalsurgical unit 3 weeks later. Float pool nurses have expanded opportunities to hone their skills and to develop new competencies in diverse areas due to their wide-ranging assignments. To meet the educational needs for a wide variety of patients, float pool nurses need to use their considerable autonomy to keep up with certifications, continuing education, and hospital-wide process changes. Optimism: Glass half full Full-time employment as a float pool nurse requires a degree of optimism. Float pool nurses are usually warmly welcomed on their assigned units because the clinical nurses would be shorthanded without them. While some nurses may bristle at the idea of a temporary placement, float pool nurses enjoy the variety of challenges and situations into which they’re placed. In fact, this variability, the exposure to new approaches in patient care, and the feeling of independence is what attracts nurses to the float pool.2 There’s never a dull moment. Communication and focus Float pool nurses become sources of information and conduits of best practice. By interacting with healthcare providers and advanced practice nurses throughout the organization, float pool nurses are in a unique position to advocate for their patients, particularly those with complex conditions. Through prior experience on different units, float pool nurses can often serve as gatekeepers, linking a patient with the best-available staff
52 l Nursing2015 l March
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
and resources. In this arena, excellent communication skills, both written and oral, are a vital necessity. Similar communication skills extend to the float pool nurse’s interaction with other personnel such as charge nurses, physical therapists, and nurse managers. With such a wide range of assignments, the float pool nurse must be able to retain focus. This requires an awareness of the unique challenges and opportunities of each unit. After receiving report on their patients, float pool nurses must organize themselves mentally to provide excellent care. Being organized requires being familiar not only with the practical side of the unit (supplies, personnel, codes to locked rooms), but also with each unit’s current goals and initiatives to benefit the hospital and the organization as a whole. Lean management techniques are employed by many progressive healthcare institutions to introduce new patient-centered approaches, facilitate change, and attempt to decrease wasteful duplications.3 Daily nursing team huddles are a way in which current initiatives and goals are conveyed to staff. A visual management board on every unit can be used to outline program priorities, along with ideas for unit improvement projects, and current issues that need to be addressed with management. Another way in which float pool nurses become aware of initiatives and goals is through shared governance. Float pool nurses are in a good position to participate in shared governance because they see different performance improvement (PI) projects throughout the hospital. They’re expected to participate in PI activities related to their nursing roles and patient care. For example, if one unit is trying to develop a protocol for decreasing urinary retention after indwelling catheter removal to decrease catheter-associated urinary tract infections, float pool nurses are
expected to participate in the trial of the new protocol. These float pool nurses can then bring information learned to the unit-based shared governance council; the shared governance council can determine whether the particular initiative would be useful on other units throughout the hospital. If a PI initiative is extended to other units, float pool nurses can help these units implement the new process. While focus is important on an institutional and a unit level, it’s critically important whenever the nurse interacts with the patient, beginning with receiving report. Even though this face-to-face routine at the bedside is similar throughout the hospital, some differences may be based on the acuity of patients and the patient population. The key to reporting in any hospital unit is clear, concise communication between individuals, whether they’re float pool nurses or regular staff. Concentrated listening, follow-up questions, clarification of unit policies, and adjunct procedures such as safety checks at the bedside allow both nurses to best manage patient care with the highest degree of continuity possible. Float pool nurses must take time to assess patients and review all medications because any new signs, symptoms, or issues could be significant to bring up during multidisciplinary rounds. This means clearly understanding patients’ diagnoses and current complaints so that the limited interaction with those patients really counts in their overall care. This attention to detail lets float pool nurses focus solely on the patient’s needs without the competing distractions of unit politics, staff compatibility, and personal agendas. This degree of heightened patient focus sets the best float pool nurses apart. Pros and cons Float pool nurses work to create moments that connect them to their patients. While they may have only a
few hours to do this, they’re critically aware that this is why they became nurses in the first place. As with any nurse, this may involve untangling a jumble of tubes to allow a patient to get to the bedside commode. It could mean placing a premature infant in the arms of new parents for their first cuddle. Or it could be educating a family member for the 100th time and finally seeing evidence of understanding. These moments ground float pool nurses to their work and remind them that this vocation is as much a gift as a career. Sometimes this role comes at a price. Float pool members aren’t always recognized for creating exceptional moments in patient care because that recognition typically belongs to member of the patient’s unit. The reward these nurses receive comes from pride in their work. Rising to the top Float pool nurses are in a unique position to make a difference within the hospital. Moving from assignment to assignment, these nurses serve as messengers of best practice. Each day they step into the unknown with the assurance that their role is a vital one in the lives of those they serve. ■ REFERENCES 1. Mendez de Leon D, Stroot JA. Using nursing resource teams to improve quality of care. Healthc Financ Manage. 2013;67(8):76-83. 2. Larson N, Sendelbach S, Missal B, Fliss J, Gaillard P. Staffing patterns of scheduled unit staff nurses vs. float pool nurses: a pilot study. Medsurg Nurs. 2012;21(1):27-32, 39. 3. Ben-Tovim DI, Bassham JE, Bolch D, Martin MA, Dougherty M, Szwarcbord M. Lean thinking across a hospital: redesigning care at the Flinders Medical Centre. Aust Health Rev. 2007;31(1):10-15. RESOURCE Dziuba-Ellis J. Float pools and resource teams: a review of the literature. J Nurs Care Qual. 2006; 21(4):352-359. At Carolinas Healthcare System in Charlotte, N.C., Laura Lebanik is a pediatric float pool RN at Levine Children’s Hospital and Stephanie Britt is the nurse manager of the central division float pool. The authors have disclosed that they have no financial relationships related to this article. DOI-10.1097/01.NURSE.0000460715.73128.ea
March l Nursing2015 l 53
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
