Floaters

Today I floated to the Medical floor. It was my first time working on a different floor. When they are short staffed on one floor and overstaffed on another, the hospital administrator asks for nurses to go from their home floor to another floor to work. It’s not popular. I knew I’d have to do it eventually so I figured I might as well get my feet wet. I’m glad I did. It also means I won’t have to float again for a while, until my time comes up. We all have to rotate on floating assignments. Most people hate to float.

I had a lot of variety this week so far. Monday I went with IV team for 8 hours before coming back to ICU and taking a patient. I had an opportunity to follow someone from IV team around and get experience sticking people. It was good because I haven’t done many since I got out of school and I got some good tips from the IV team nurse. That was by choice, our educator suggested I do it and I finally got an opportunity because we had a low census that day and plenty of nurses.

This morning I went in and we were having a potluck for one of the travelers who had his last day on he unit today. I brought a big dish of food for it and we were in group report. Again we had a low census and I got assigned to “projects” which meant I could do anything that needed to be done- finish education projects, study for the CCRN exam, or help out as needed. The educator needed some paperwork done and I was going to do it.

I went into the break room to get rid of my stethoscope and junk I carry in my pockets for patient care and the night charge nurse was going home and we talked for a while. Then I went out to the front to get started on grading papers for the educator and suddenly the charge nurse came up and told me they needed someone to float to Medical. I said I would do it. I’ve been thinking about it lately, that it would be interesting to see what it’s really like on the floors. I also knew I would get my turn over with for a while.

It was already late, going on 8:00 so I knew I’d be behind. I got upstairs and found out that they have just written reports and the night nurses had already gone home so all I had to go on was this sheet of paper with some sketchy information about each of my three patients. One was in alcohol withdrawal, one was a renal patient, and one was a cute little old lady who wanted to go home and had to pee every 15 minutes.

And then after I got my report sheets, the charge nurse came up and told me, oh, by the way, you have a student with you too. Most people hate to have students. It slows them down. But I thought it would be fun. I look at it as an extra set of hands. I spend the whole day talking to myself as I go through my daily tasks so what difference would it make if I was talking to a student?

I found out you only have to assess your patient once a shift, they don’t have rounding, and they have most of their medications due at 8 am so once the morning rush is over, it’s a matter of getting caught up on charting in between interruptions for patients to go to the bathroom.

And that’s all it was. Three patients, one assessment, some medications, the aides do vitals and accuchecks, and all you have to do is check the chart and look for new orders as they come up, and answer the call lights if the aides haven’t gotten to it already. They had great aides on the floor for day shift so it was easy. I got to spend lots of time with my student, gave him opportunities to take out IVs, give meds, ask questions, and get his homework done.

The hardest part was not knowing where anything was and then not knowing the routine. For example, when the transporter came up to take my patient to X ray it didn’t even occur to me that they don’t do X rays on the floor like they do in ICU. There was some paperwork I had to print off that I didn’t know about. And that when they go off the floor they needed their little telemetry boxes taken off. And other little things.

I was busy most of the day until the end of the shift. It was all busywork though. Mostly charting and checking in on my patients. I am sure I checked my patients a lot more than the floor nurses did, because I’m used to being in there all the time. I was quite bored. I would say it was accurate to describe it as being a waitress. I was really disappointed when the student had to leave at 2:30 to go to his class conference because I didn’t have anyone to talk to anymore! All I could do was check on the patients and chart.

The most challenging thing I had to do all day was do alcohol withdrawal assessments on my one patient every two hours and then every four hours once he wasn’t in danger of DTs anymore. That was new, but I had it down after two times. They have to have a double check with another nurse if you’re giving meds. Seems like they hardly ever get to do things based on nursing judgment.

I think the charge nurse was ready to strangle me by 11:00 because I had so many questions. I tried asking the floor nurses but most of the time they were so busy chatting with each other or didn’t know the answer. I noticed they also eat a lot of junk food. They had this big tray of cookies that they went through in minutes and there was a big sheet cake in the break room that got devoured.

During lunch I went down to ICU and went to the potluck. They had some excitement down there, there was a code and some other crazy stuff was happening. I thought, it’s a good thing I’m on medical because the code probably would have been my patient. He was an admit from the ED and I bet I would have had him as my patient if I didn’t float.

I am so glad I work in ICU. On the floor, the call lights alone, going off all day long constantly would drive me insane. I am going to have that sound echoing in my head for a week. Then it was hard to know what was going on with your patient because you weren’t doing the vitals or in and out of the room constantly, and there was hardly any information in the report, and there was no time to look up the patient’s history early in the shift so I didn’t feel I had a handle on that at all. I think that was what made me the most uncomfortable. I kept checking orders all day but there wasn’t the kind of communication with the doctors that we have in ICU so I felt totally detached from the whole treatment plan. I didn’t like that either. I like to know what’s going on with my patients.

When my one patient came back from the OR where he had a dialysis catheter put in (we do those on the floor in ICU) he pooped all over himself and of course it was at shift change, right at 3:00, when the 8 hour people change shifts. No one around to help. I got poop on my wrist, too. Shit.

And then to top it off around 4:00 I walked in on my alcohol withdrawal patient to find him masturbating. I am not kidding. I walked in the room to reassess him for the alcohol withdrawal scale and I am not used to knocking, we just walk into patient rooms in ICU. I didn’t even realize what he was doing until I started to wrap the blood pressure cuff around his arm to take vitals. I apologized but went about my business. I don’t even think he remembered that he was doing that because he didn’t even stop or react when I walked in. He was slightly out of it, and all I could think of when I realized it was wanting to say, “Put that thing away!” That only happened one time before when I worked as an aide and accidentally walked in on a patient.

By 7:00 I was tapping my feet, bored out of my mind and wanting to go home, and the nurses coming on for night shift were slower than dog snot. I was waiting and of course, it never EVER fails, the patients all want to go to the bathroom at change of shift. Both my alcohol withdrawal masturbating guy and my little old lady wanted to go to the bathroom at the same time. It’s change of shift, 7:15 and I want to go home and no aides are around to help. I am sure the only reason my third patient didn't have to go at that time was that he had no urine output. And he already got me on the wrist at 3:00 shift change.

Finally I got out of there and went downstairs and caught the scoop on what happened in ICU all day. I’m not sure if I would have been better off in ICU or not today. But it’s over, I survived my first floating assignment. Now I have two days off and then I work 4 out of 5 days starting this Saturday, followed by 5 off.

And this beer I just opened tastes so good.

Peace, love, and floaters,

Towanda, ever so thankful to be ICU RN