Ask a Travel Nurse: What would happen if a traveler were MADE to float to an area in which they were not comfortable?

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This week, I wanted to follow up my last posting in regard to floating to different units. A reader contacted me and asked me about floating as a travel nurse. After my reply that “floating” seemed to come with the territory, I was also asked, “What would happen if a traveler were MADE to float to an area in which they were not comfortable?”

My initial response is that no one can MAKE you float. A charge nurse or a nursing supervisor might tell you that you have to float, but in the end, it is always your decision whether or not to accept.

The reason I am touching on this is because, one, I know of many travelers that have accepted a float to a unit in which they were uncomfortable, and two, I have been placed in that exact position myself. Most of the time, the traveler comes through the shift unscathed. However, what would happen if that were not the case?

When practicing nursing, especially as a traveler, YOU must always be the sole protector of your license. A charge nurse or supervisor mandating a float is simply looking for staff to fill their immediate need. It is your responsibility to let them know if you do not have the experience necessary to practice safely in the environment in which they wish you to work. When it becomes tricky is when your objection falls on deaf ears.

Let’s look at the following scenario:

Your charge nurse comes to you and says that you need to float to the pediatric unit for the night (my own worst nightmare). You are expected to take a patient assignment, but are assured that you will receive “stable” patients. You tell the charge nurse that you have never worked with peds and don’t feel comfortable with the float. She then tells you that travelers are always the first to float and that you MUST report to the pediatric unit to work (not a very nice situation, but one that might sound familiar to many travelers out there). What would you do in this situation?

First, remember that there is a difference in the things that we MUST do and the things that we AGREE to do. First, clearly state the reasons that you do not wish to float. It is not simply that you don’t want to have to float, but that you feel uncomfortable with your ability to deliver safe care in an environment in which you have no experience. In a perfect world, that should be all that needs to be said. However, we all live in the real world where it is seldom perfect.

If your rationale does not change the mind of your charge nurse, work up the chain of command and contact the nursing supervisor. Once again, clearly explain the reason that you do not feel that it is safe for you to float to that particular unit.

If the nursing supervisor does not agree, then you have a few options. Unfortunately, the option most often chosen is to go ahead and accept the float; I would strongly discourage this. I know I worked hard for my nursing license and I assume you did too. Exactly how many times in your career do you want to put your license on the line and just cross your fingers hoping that nothing bad happens?

The next option is a bit of a bluff, but one that I have used successfully. If you have told the nursing supervisor your objections, and she still insists that you float, tell her that it is under HER responsibility that you are doing so. Inform her that to cover yourself, you will need to fill out an incident report in which you formally document that you informed her that you did not have experience in this area and believed the float to be unsafe. Tell her that it will then be HER responsibility should anything “bad” happen because you were made to float to a unit outside your scope of practice. In my instance, this was all it took for the supervisor to realize that her unsafe request might have grave consequences and she relented.

However, if this does not work, you must understand that filling out an incident report will probably not absolve you of responsibility if something bad were to happen. It’s simply an effort to make the nursing supervisor accountable for a decision that she probably already knows is a bad one.

If everyone is still insistent that you accept the float, then you have a tough decision to make. You can try going further up the chain of command and speaking to your unit manager or even someone in administration. However, if neither the charge nurse nor the nursing supervisor has listened to your reasoning, I don’t know that you will find sympathetic ears any higher up. You may simply have to refuse the float and accept the consequences. Even if those consequences were to be the termination of your contract, you will be able to secure another contract; if something bad happened while you were practicing in an area in which you had no experience, would you be able to secure another license if yours were revoked?

Travel nursing can be a wonderful profession, but it certainly requires independence above what is normally required of a healthcare professional. Often, YOU are the only one safeguarding your license and you have to be willing to stand up for yourself, especially when placed in a potentially dangerous situation. Above all else should be the desire to deliver your care in a safe manner.

Please feel free to leave a comment below for others to read if you have had a similar experience while traveling.

Find yourself a career that fits

About the Author:

Hello everyone. I’m a travel nurse originally from Ohio who graduated in 1993 from Mount Carmel School of Nursing in Columbus. I completed a critical care fellowship at Riverside Methodist Hospital in 1994 and started traveling in that specialty a year later. My first travel assignment was in Maui and since that time I have completed close to 40 different contracts in various states with multiple travel companies. I am the author of Travel Nurse’s Bible (A Guide to Everything on Travel Nursing), in addition to my writings here and in the pages of Travel Nursing publications such as Healthcare Traveler Magazine and American Nurse Today. I am presently on assignment in Phoenix, AZ and travel anywhere from six to eleven months of the year.

5 Comments on "Ask a Travel Nurse: What would happen if a traveler were MADE to float to an area in which they were not comfortable?"

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  1. Epstein says:

    This is the EXACT reason why you MUST have in your contract which floors you can and will float to… the ones that you are competent in. For instance, “Sam hereby agrees to float to other floors of competenncy, which include: Medical, Surgical, Rehab, Telemetry, and Psychiatric. Related to lack of training and safety concerns, he will not be required to float to Oncology, ICU, or Pediatrics (ones that you will absolutely not float to.” THEN, if the hospital floats you to a floor which you are not competent to work, then just remind that that is a breach of contract on THEIR part, and you will not be returning. Worked for me in Washington State.

  2. David Morrison says:

    Epstein brings up a good point that I also advise in my book on travel nursing (as well as other things you should always have in your travel contract). However, you may still have these stipulations in your contract and that will NOT stop the hospital from trying to float you to units outside those you specify (which has happened to ME several times despite having it written into my contract).

    To simply tell a hospital that they are in breach and not return is a BIG deal and advice that should not be followed unless you truly understand the consequences (both professionally and financially). All situations will not be the same. If I walked on a contract every time I have been floated to a unit outside what it stipulates in my contract, I doubt many agencies would work with me. However, if the situation is unsafe and could cost you your license, then you might not have any choice.

  3. Betty Ann says:

    Hi David:

    I agree completely with your advice about float to different unit that a nurse did not have an experience. However, you suggested that fill out the incidence report which made the nursing supervisor to be accountable for her dangerous and unsafe decision , then accept assignment. I think a nurse should not do that. Why shouldn’t nurse do that because she/he is a primary care giver and give direct pt care. If something happened she is the one who is resposible for this pts. Is it the same concept that if the pharmacist dispensed the wrong dosage by miscalculation, a nurse administer the medication, she is the one who is accountable for her action, not the pharmacist. What if a doctor order wrong meds or wrong dose, and the pharmacist missed to question that, and a nurse administer meds to pt. Who is accountable for this mess? Not the doctor, not the pharmacist. To the State Board: a nurse. Over all, we are nurses, we must stand up for our pt’s safety. We are pt’s avocate. Pt are helpless, they depend on us and trust us as nurses to take care of them. Our most ultimate in nursing care is providing an excellent and best care for our pts based on experiences and knowledges we have gained in our specialty that will save our pts lives. If we accept the assignment in a particular floor that required a specialty, and we are unable to do that, we are cheated our pts. Over 10 years working in the US, I have been standing by my pts, fighting for them, caring for them and having a nerve to chalenge doctors to save my pts lives in many cases. I would not accept the assignment in this case. First of all, you mentioned travel nurses should protect their licences, I think it is selfish to say that. What’s about protect pts safety and their lives? It happened to me 4 years ago, when I got a local travel contracts, the charge nurse sent me to ICU which I had never trained or worked in ICU. Not only I did not have experiences in ICU, but also no ACLS. (It was expired 1 years ago). I told the charge nurse I could not work in ICU and she called the nursing supervisor. This nursing supervisor came to the unit and said: “You have no choice, you either go to ICU or you go home.” I said to her “Yes, I have choice, I go home, you can work in ICU tonight”. I left the hospital, went home and broke the contract. I felt good by doing that. I have been practiced safely for over 10 years, and I have saved so many lives because I do care about patients and their well beings and that is the reason I come to work everyday.

  4. David says:

    Betty. When I received notification of your post, I had to go back and read my own advice because from what you were quoting, it did not sound like advice that I would give. In fact, it was not.

    You took issue with me advising someone to fill out an incident report stating that the nurse would STILL be responsible for their actions. However, I clearly state that “filling out an incident report will probably not absolve you of responsibility if something bad were to happen”.

    I think you misunderstood this tactic as simply that: a tactic to push back against unfair treatment. This is a trick that has worked for me and therefore enabled me to keep my job. It would be wonderful to be able to maintain the high standard of patient care you spoke of, but that often comes at such a very high price that makes the situation such a dilemma.

    If you would, could you please elaborate on the entire situation? When you walked off your contract, what price did you pay for such action? What did your travel company say? Did they levy any penalties? Did you have to tap into savings for the lost work and having to abruptly travel to the next assignment or home? It’s unfair to simply tell readers to refuse and walk out without telling them the price they would pay for doing so.

    Additionally, any of us who have traveled for any period of time have been put into a situation where we questioned those placing us in that situation. Those above us play fast and loose with situations that could cost us our license and that is the immediate thing we all think of when being put into such a situation. It’s not selfish for me wanting to protect my license to be able to continue to work in a career I love (and where I can continue to help that many more people).

    Without knowing a specific situation, it’s easy to judge from the outside. I don’t know your specific situation, but it would be easy for me to say that you were only thinking of self preservation when you refused to go to ICU. What if the ICU was extremely short staffed and they had several tele patients that were able to move, but the hospital had no tele beds. They had a nurse that would have been able to safely come in and take care of those patients, but she went home because she refused to float to ICU. Doesn’t that put those patients at risk? See how easy it is to judge a situation without knowing the full extent.

    Bottom line is that you should always consider patient safety when practicing. Built into our nursing license is the agreement that we will act in our patient’s best interest and we will advocate for their safe care. So when someone makes an argument that they are protecting their license, aren’t they also saying they are protecting patient safety?

    Most of us know when to draw the line. If I were made to float to OB, sure I would initially refuse. If I was told that I would only be taking vitals and assisting other nurses, I might very well accept knowing that I could ease the work of others to do more specialized tasks. If I was then asked to keep an eye on a fetal heart monitor to look for early or late decelerations, I would wholeheartedly refuse as this would clearly be outside my comfort zone and outside of my scope of practice.

    Nursing is rarely black and white. We all exist in continuing shades of grey. You should not be afraid to branch out a little from your normal comfort zones, but you also need to know your limitations and when you are in over your head.

    Again Betty, if you would be so kind, please let us know how your travel company reacted and what that process entailed.

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