Avoid headaches: Plan ahead using pool nurses
Simple help lists and incentives can ease the pain
After more than a decade of debate and misery, nursing administrators are still wrestling with the wisdom of using float or pool nurses to staff critical care units (CCUs). The medical literature appears certain about one thing: Nursing pools and experienced floaters help in a pinch.
"But overall, they yield marginal benefits," says Gina Bergmooser, RN, a shift supervisor in nursing services at Grace Hospital in Detroit. This is not news to ICU managers. Sometimes inexperienced floaters even get in the way, Bergmooser notes.
As a result, some veteran managers such as Bergmooser have adopted a none-too-surprising but realistic view toward using nursing pools and floaters. With personnel shortages running high in critical care, it’s inevitable that CCUs will have to rely more on outside help. Why not try to make the adjustment less difficult for both the unit and the temporary RNs?
Over the last decade, several practical strategies have been aimed at facilitating this view. But in reality, except for some occasions, CCUs bother little to plan ahead when anticipating shortages that will require pulling in floaters, Bergmooser notes.
Caught in a bind, most supervisors simply pull nurses from other floors. Or at worst, they resort to expensive agency personnel at the eleventh hour.
This "shotgun approach" to seeking remedies is responsible for many of the problems associated with using floaters, says Amy Strzalka, RN, MSN, a liver transplant coordinator and former nurse manager at the cardiac care unit at UNC Hospitals in Chapel Hill, NC.
"Let’s face it, if you have to pull a nurse from another floor, in effect you’re using a pool nurse," she says.
Why not plan ahead, develop a flexible nurse resource pool, and take time to adequately nurture and adapt nurses in the pool to your unit’s demands?
According to Bergmooser and Strzalka, when these steps are combined, they are certain to work better than taking impromptu turns at calling other floors or nurse registries asking for help. But they require initiative, planning, and maintenance.
Here’s how these measures would work:
• Assess your floater’s potential.
It’s difficult enough getting full-time salaried nurses to work your unit. But concentrating on incentives in getting nurses from other units and part-timers to form the pool may pay dividends, says Strzalka. It takes effort to find such personnel. Yet, many nurses are willing to work part-time or prefer working on certain shifts. Again, it’s a matter of searching them out, which requires planning and patience.
Then again, money is an incentive, if your department can spring for it and pay floaters more than they might get elsewhere.
"Money is always a great incentive," Strzalka notes. Of course, it’s difficult with cutbacks and budget constraints, but if you need the staff money will attract any of us, she adds.
• Determine your existing and future levels of need.
Except for the occasional periods of mass sick calls or staff turnovers that leave you seriously under-staffed, the unit will likely know its staffing needs by the week or month, Bergmooser says.
The pool should be looked at as a reserve, not a permanent nursing assignment resource. Therefore, managers should be able to predict ahead of time their propensity for spot shortages and their corresponding dependency on a pool nurse.
Weekends, evenings, or nights might be the time of greatest exposure. By anticipating these events and making mental notes about staffing for those shifts, supervisors won’t be caught short in most cases, Strzalka says.
Management isn’t likely to allow you to staff up permanently in this manner, but for high-risk occasions, the pool will serve as an ace up the sleeve, she adds.
• Fit the floater to the task.
Assess the floater and develop a long-term relationship with that individual, Strzalka adds. Charge nurses can plan ahead by discussing a potential floater’s experience and skill levels.
If the individual possesses the minimum qualifications for the CCU, the charge nurse can find an assignment suitable for that individual. Perhaps the floater can help with taking vitals or transferring patients, which require nursing skills but not necessarily critical care expertise, Strzalka notes.
What’s important is to bring the floater into the unit’s culture and cultivate a lasting mutually beneficial relationship with the person. But again, Strzalka notes, this takes an investment of time and effort from management.
• Be realistic.
Determine the effect the reliance on a pool nurse will have on your unit’s ongoing, long-term staffing needs. If you need additional permanent personnel, the resource pool will be a disappointment because it was not designed to offer nurses full-time employment, Bergmooser says.
• Guide the floater’s integration to the unit.
The process can begin with a brief orientation. Two years ago, Bergmooser devised a help list to facilitate "a smooth unit-to-unit transition" for nurses pulled from other departments. The list, Shared Staffing Help List, was actually an information fact sheet that serves as a transitioning tool to brief outside nurses on the specific duties required in the unit.
The tool also helps prospective floaters and unit supervisors determine whether the pool nurse’s skills and experience fit the responsibilities of the unit, Bergmooser says. One of the virtues of the help list, according to Bergmooser, is that it can be fashioned in any desirable way but also covered the essentials.
The essentials consist of background unit information, shift-report formats, charge responsibilities, and nursing documentation requirements. But the list also contains information of personal interest such as break times, lunch hours, locations of restrooms, nursing supplies, and medical equipment.
These secondary "issues may not seem important, but they help to familiarize the [pool] nurses with what to them must be an unfamiliar place, and helps break the ice by showing that management has thought of almost everything," Bergmooser says.
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