The 'F Word' in nursing, Floating, and what a travel nurse should know - Atlas All Access 105

Rich Smith: In my years of experience, travel nurses like one F word and they really dislike another F word. On today's episode, we talk about the one they don't like, floating. Atlas All Access starts now.

Adam Collette: Ooh, I like that.

Rich Smith: You like that?

Adam Collette: That was good.

Rich Smith: Just came up with it like that.

Adam Collette: That was good.

Rich Smith: So they do like to say the F word a lot.

Adam Collette: No doubt.

Rich Smith: They do not like this F word. So let's start from a recruiting standpoint and then, did you read my questions ahead of time that I sent to you?

Adam Collette: No.

Rich Smith: No. Awesome. Good.

Adam Collette: No.

Rich Smith: Okay. So let's start, at least from a recruiter standpoint, broaching the subject of floating with a travel nurse. Because there's a whole lot of different ideas on what should or shouldn't happen out there online, what really happens?

Adam Collette: Yeah, and I think for the most part when people say, "Oh, I worked with a travel nurse and now I want to be a travel nurse," the first thing they do is go onto an online forum and you start scrolling down and the first ... out of ten first post is somebody got canceled and then five people got floated to units that they didn't think they should. And then so now, they were ready to jump off the bridge and be a travel nurse, and then now they're scared and everything. So I think it's a very common question on there, and I think it's a very important question because obviously your nursing license is the most important thing on this, as well as your safety and those kinds of things.

Adam Collette: But I think the biggest thing on this is having an honest conversation during an interview. We can talk about it of what you are comfortable in doing as a med surge nurse. No, you shouldn't be floating to an ICU probably, unless you have experience in that or other things. So I think the most important thing is having the discussion with a manager. Asking one, if I'm going to float, one, how often? Is it travelers are first to float, is it everybody floats in rotation, everybody takes a turn? Who do I talk to if I don't feel comfortable of where you're telling me I am going to float, and those kinds of things as well.

Rich Smith: So I think we'll touch on each one of those and get into a little more detail. But I think overwhelmingly, the question does a travel and or float? The answer's yes.

Adam Collette: Yeah, it's most likely you're going to. I think the more specialized you are as a nurse, a CV PICU nurse or a CV OR or just the OR in general, even sometimes the ICU and the ER, those are more specialized where you can't really take an ER nurse and go put them in the OR. You can't put a NICU nurse and go put them on an ICU unit.

Rich Smith: Right.

Adam Collette: You can't float across those. Now can you go be helping hands in a hospital or one of those things as well? Absolutely, but I think where people most of the time get floated is in the realm from the ICU to the PCU step down, to the tele floors, to the med surge. Are you going to float down one level? Are you going to float all the way from an ICU all the way down to a med surge floor, from going from two patients to five, six, seven patients on there.

Adam Collette: And nurses ... I don't agree that nurses can do all those things. I think when you're used to having one, two patients and you get five, six, you're definitely be a different nurse and not ... you're more apt to make mistakes.

Rich Smith: Right. No, and I think that's one of the things I've learned over the years too, is that making sure those ratios are consistent wherever you go. Now, it wouldn't be unexpected for that ICU nurse, who is generally a one-to-one, one-to-two, to go to a telemetry floor where you maybe have four to four-ish.

Adam Collette: Yep.

Rich Smith: I mean, I guess that's a safe ... If you're just watching monitors, reading strips, not that I'm taking anything away from that, but having four patients is maybe ... that's acceptable.

Adam Collette: Yep.

Rich Smith: But yeah, you're right. An ICU nurse may be going to the ER, a NICU nurse may be going to the PICU if they have that experience.

Adam Collette: Yep.

Rich Smith: It's not just a leap to think, "Okay, the kid's a little grown up, so they can go from that to the other."

Adam Collette: Yep.

Rich Smith: That doesn't necessarily happen that way.

Adam Collette: No, not at all. I think the important part of that too is after having that conversation in an interview, is to also get your recruiter, the client manager and, obviously, your compliance team involved as well. Because if you are going to be floating from an ICU to an ER on a consistent basis, you need to have both an ICU and an ER skills checklist on file with your agency.

Rich Smith: Right.

Adam Collette: I think that's a super important piece to talk about, just for the sake of we are keeping you joint certified on our joint commission, and then also if and when something bad does happen, if we don't have those checklists in place, it makes yourself and your agency at fault at that point in time of not having the correct credentials.

Rich Smith: There's exposure there.

Adam Collette: There's definitely exposure on there. So, even if you're like, "Hey, I'm the most comfortable nurse," you still need to have that skills checklist on file with your agency as well.

Rich Smith: So let's talk about that a little bit. What if you're asked to float to an area ... So you're a travel nurse, or maybe you're in a staff position, I don't know, where you're asked to float where you don't have that skill set. How do you have that conversation?

Adam Collette: Yeah, I think the first thing that most people do is text their recruiter and say, "Hey, they're making me do this. What do I do?" And that's fine and your recruiter needs to respond pretty quickly to you and help you out. But in the same sense is, you need to stand up for yourself, and it's not ... There's a right way and a wrong way obviously to do everything. And throwing the clipboard on the ground and storming out of the room and making a scene is not going to help your case in that, but pulling the manager aside and just saying, "Hey, I just really don't feel comfortable. Is there another spot that I can go? I'll take my turn another day if there's a different option. Hey, do you want to just call me off for the day if you don't need me on the floor? I'll just take one of my call offs, but I don't feel comfortable going to that neuro step down unit because I don't have any neuro experience," or whatever.

Adam Collette: But it's handling it properly, having an honest conversation of, "Hey, I just don't feel comfortable." And I don't think anybody's ever going to get mad about that. I just really, really don't.

Rich Smith: No. When it comes to patient safety, I think they're going to ... they'll agree with you, in most cases. Now shorthanded is shorthanded. And I get it, that happens a lot. And there are some situations where they're going to push back on you and say, "No, we're shorthanded in that unit, you can just take admissions," or whatever that unit does, the basic level or whatever. So I think it's understanding your skillset, being honest with yourself, and then being honest with your manager about your skillset and if it puts patients in danger, then you've got to step up and say, "I can't do this."

Adam Collette: Correct.

Rich Smith: That's okay.

Adam Collette: Correct. There's nothing wrong with that.

Rich Smith: Right.

Adam Collette: Nothing wrong with that at all.

Rich Smith: At the same time, you can also be an advocate for your other travel nurses maybe that you work with. If they get asked to float and they're not comfortable with it and maybe you have that skillset, you volunteer to be that traveler. I've seen that happen multiple times.

Adam Collette: Absolutely.

Rich Smith: "Okay, I do have this, I've seen this before. I can do this. I'll take it. She doesn't have the skillset. She's never done it before." So be that advocate, step up. No one likes to float, but that other travel nurse is going to thank you in the end.

Adam Collette: Yep. For sure.

Adam Collette: I think another big thing that I was thinking about is also think about the size of hospital that you're going to or you're interviewing at. I think if you're at a big level one trauma, mass general in Boston, you're probably not going to float a ton down. It's a huge hospital, there's a ton of IC units. But you go to like a small, Brattleboro, Vermont 50 bed hospital, you're probably more apt to float across a couple different floors just because you might be one of two, three travelers at that hospital that they're going to utilize in a different. So in the back of your head when you're submitting to jobs, I think it's important to probably think about, "Hey, if I don't want to float, I might want to submit to bigger hospitals that I probably don't have the possibility of floating on more often." I mean, from the client manager side, would you agree with that?

Rich Smith: Absolutely. Yeah, I think 100%. You're going to have more ... you'll float more into like ... How many different med surge units would there be say in a mass general? I mean there's going to be quite a few different and very specialized. You will float to those probably, whereas the smaller hospital, you're going to float to units maybe that you've never touched before, ever. So I think that plays into the next question, how do you prepare for this? As a traveler, how do you ... skills checklist aside. I mean, understanding maybe where you could go, and I think you touched on it already, asking in the interview.

Adam Collette: Yeah, asking in the interview and having an honest question. I try to prepare people and tell them, "Hey, if I'm going to float, how often does that happen? If that happens, where does that go?" And if you are super particular on your skills, in the interview, even ask the manager. If you want it in writing, ask the manager when they put the offer over, "Hey, I understand I'm going to float to a step down four west, can I go ahead and put that in my contract? Is that the only place that I'm going to float to?" And as long as they're okay with that, and so then when you get to the hospital on week four and they asked you to float to the neuro unit on ... you kind of have some skin in the game to go back to the manager and say, "Hey, this is the options that you kind of said sure I would float to."

Adam Collette: And as a recruiter, I would be more than happy to put that into a work order on there. But if you don't have that conversation and you just want me to write some random clause in there of, "Hey, no floating to any other units other than this," it's just not going to happen.

Rich Smith: It's not going to happen, right.

Adam Collette: A recruiter, a company, a vendor, unless you don't have that conversation in an interview, we have no leg to stand on in the fight of getting you to not float to those places.

Rich Smith: Well, and my last question is understanding what the hospital contract says about floating for travelers, and then understanding what your work order says about floating on your contract.

Adam Collette: Yep.

Rich Smith: And that's a conversation you have with your recruiter from the time that you know you're going to interview, through that last day of your contract or until you start. And then you can talk through it as your contract goes on, especially if something is written in there about that.

Adam Collette: 100%.

Rich Smith: So, it's a difficult subject, it's one that causes some heartburn.

Adam Collette: Yeah, it does. You do one, two, three travel crown tracks, you're going to float of some sort, way. And I think people that are like, "Oh, I'm never going to float," or, "I'm just not going to do it," it's going to happen and it's going to become a crutch on your travel. It's either going to make you super, super mad or a lot of people just embrace it and they learn new skills and it gives them a couple extra things we can put on a resume of they floated to a step down unit and took some different drips and some different meds and now I have the experience to do this. I love putting that stuff on resumes.

Rich Smith: They pay attention to that. The people they interview pay attention to that type of thing. And then it's going to key on ... especially in this hyper competitive market that we're in right now, that could make the difference of whether you get that or somebody else gets it.

Adam Collette: And then a lot of the times if you are open to it, I mean there's big hospital systems that have float pool nurses that, "Hey, we want somebody that is willing to float ICU, PCU across the board." Even in NICU, PICU, I've seen a lot more needs recently of they want somebody that's comfortable to float to a PEDs unit, work in PICU, work in a NICU and those things as well. So I think in the travel world, you're starting to see it, that they're looking for people that are more willing and open too. Just because that's the case, doesn't mean that you have to. Stand your ground, be who you are, be confident in your skills and don't do something that's going to risk your license or your future in the nursing field.

Rich Smith: Right. Your recruiter is your lifeline. If you ever get into that situation, where maybe you're either not comfortable with it or something is happening that maybe just isn't within your scope of work, talk to your recruiter. They're your advocate while you're on a contract.

Adam Collette: Absolutely.

Rich Smith: Adam, thank you.

Adam Collette: Yeah, no, great topic. I love that.

Rich Smith: Good topic, the F word.

Adam Collette: The F word.

Rich Smith: See you next week.