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DOING IT BETTER
Putting research into practice
Creating a guide for float nurses
By Tina Crowell-Grimme, BSN, and Lois A. Garner, CNA, BSN, MS
EVEN AN EXPERIENCED FLOAT
nurse can encounter overwhelming chal-
lenges in an unfamiliar unit, as can any
nurse working in a unit new to him. To
help these nurses keep their heads above
water, we launched a project called
Bringing Excellence to Variability
(BEV) in our 522-bed Magnet facility.
(The acronym also honors the projects
originator, Bev Martin.)
In this article, well describe how we
developed a program to orient novice
nurses and to keep our expert float nurs-
es up-to-date on 21 patient-care units.
For float nurses (or any nurse whos
not familiar with a particular unit), get-
ting answers to simple but important
questions can be time-consuming and
frustrating. To tackle this problem, we
sought feedback from our float staff to
identify the areas they were most con-
cerned about. We then consolidated this
information into a questionnaire that
covered four major topic categories. Here
are sample questions from each category.
Admission, transfer, and discharge.
Do your doctors have a dependable rou-
tine for visiting patients? What patient-
education pamphlets do nurses routinely
give to the patient on admission? What
unit-specific information do you want
float pool nurses to know?
Communication. How do you know
who your pharmacist for the day will be
and how to page him? If the doctor
needs to be called, does the primary or
charge nurse routinely call? Does the
charge nurse review all labs?
Routines. Where can nurses find the
most recent telemetry strip? Are nurses
expected to remove sutures? Whats the
system for break coverage? Where in the
station can nurses keep drinks?
www.nursing2007.com
Storage. Where do you store personal
protective equipment (PPE)? Telemetry
electrodes? I.V. supplies?
Using this questionnaire, we conducted
informal interviews with nurses, nursing
assistants, and unit secretaries in each
unit. We learned from staff the units rou-
tines for postop dressing changes, location
of recent lab results, and physician-specific
discharge instructions. Nursing assistants
helped new nurses find supplies such as
extra pillows, slide boards, and biohazard
bags. Unit secretaries explained how to
access the resident on-call list online.
Once the unit surveys were complete,
we began identifying patterns and varia-
tions. We sorted the information into two
categories, unit-specific and hospital-
wide. Examples of unit-specific informa-
tion included meal times, patient-
education materials, and national quality
measures that apply to mainly that unit.
Hospital-wide information included prac-
tices that are consistent in similar units.
For example, medication administration
records (MARs) are kept in patient med-
ical records in the intensive care units; in
the medical/surgical units, MARs are kept
in binders on the medication cart.
This method of organizing our infor-
mation let us condense a vast amount of
data into a usable form. To verify the
accuracy of our data, we asked each unit-
based educator to review her units infor-
mation and make revisions as needed.
Our next step was to create workable
tools. We developed a 19-page Float
Nurse Orientation packet, which in-
cludes mostly hospital-wide information,
such as stocking flu vaccines, communi-
cating with pharmacy, and validating
physician orders. We arranged topics in
alphabetical order for quick reference.
Using a similar standardized format, we
also developed a unit-specific information
sheet for each nursing unit. Items listed on
this sheet include location of PPE and
patient-care supplies, and meal times.
We put both tools on our float pool
Web site on the hospitals intranet. Each
item has its own link. A nurse can down-
load all or any part of the information.
Weve received encouraging feedback
about the effectiveness of our project.
When we surveyed the 27 nurses in the
float pool to evaluate the usefulness of
our tools, 56% of them responded that
theyd used the tools at least once. Of
those responding whod used the tools,
93% said the tools were helpful and
accurate.
These results indicate weve made pro-
gress toward meeting our goals and that
we need to promote the use of our tools.
Although weve completed our initial
project, we need to ensure continuous
improvement. We plan to evaluate and
validate clinical practice issues in each
unit and update our Web site regularly.
We believe that when bedside nurses
continue to improve care, well achieve
our goals of optimal patient outcomes,
safe patient care, and excellent service to
our nursing units.
RESOURCES
Crimlisk JT, et al. New graduate RNs in a float
pool: An inner-city hospital experience. Journal of
Nursing Administration. 32(4):211-217, April 2002.
Murphy JD. Flawless Execution. HarperCollins
Publishers, 2005.
Roberts D. Competence increases comfort for float
nurses. Medsurg Nursing. 13(3):142, June 2004.
System analysis: Ensure that your float staff and
contracted staff are providing safe care. The Joint
Commission Perspectives on Patient Safety. 4(7):5-6,
July 2004.
Tina Crowell-Grimme is a staff float nurse and Lois A.
Garner is a clinical nurse-manager for resource and sup-
port services at Kettering (Ohio) Medical Center.
December | Nursing2007 | 17