Floating in nursing is the practice of temporarily reassigning a registered nurse from their home unit to another area within the hospital to address immediate staffing needs. Understanding the mechanisms, professional implications, and safety considerations of floating is important for nurses and hospital administrators.
What Floating Means in Nursing
Floating, sometimes called “pulling,” is the temporary relocation of a nurse from their regularly scheduled unit to an area experiencing an unexpected surge in patient volume or staff shortage. The nurse performs duties required to maintain patient care continuity, often due to staff call-ins or patient flow fluctuations. This practice is distinct from a permanent transfer, as the nurse always returns to their original unit for subsequent shifts.
Nurses are expected to only accept assignments that fall within their professional competency and established scope of practice. For example, a nurse from an outpatient clinic would not typically be floated to an adult intensive care unit. The goal is to maximize staff utilization while maintaining safe, high-quality care.
Why Hospitals Implement Floating Policies
Healthcare facilities implement floating policies to maximize staff efficiency and ensure appropriate coverage across all operational units. Since patient census and acuity levels are constantly changing, a static staffing model is impractical for managing sudden peaks in demand. Floating allows administrators to dynamically shift human resources to areas of immediate need, maintaining a consistent nurse-to-patient ratio.
These policies also manage unexpected staff absences, such as sick calls, which can destabilize a unit’s staffing plan. Relying on internal floating is also a cost-control measure, as it is significantly less expensive than calling in high-cost agency or travel nurses to fill immediate staffing gaps.
Different Structures of Floating Assignments
Mandatory Internal Floating
Many hospitals include mandatory internal floating as a condition of employment for nurses hired to specific units. Under this structure, a nurse is required to float to another unit when their “home” unit is operating at a low census. The hospital typically rotates the assignment among eligible unit staff to distribute the floating obligation fairly, often based on a pre-determined schedule or inverse seniority. This model is common in facilities aiming for high staffing flexibility without the added expense of dedicated float teams.
Dedicated Hospital Float Pool
A dedicated hospital float pool consists of nurses hired and trained with the understanding that they will not have a permanent home unit. These nurses report to a central administrative office and are assigned to a different unit each shift based on the facility’s overall needs. Float pool nurses often receive higher base pay, differential pay, or specialized benefits to compensate for the demands of constant change and adaptability. They are typically experienced and highly skilled, requiring proficiency in a wide range of clinical areas.
Cross-Training and Service Line Floating
Cross-training and service line floating limits a nurse’s movement to units that share a similar patient population, equipment, or medical specialty. For example, a nurse working on a general medical unit might be restricted to floating only to a telemetry floor or a similar medical-surgical unit. This approach maintains a high level of clinical expertise and reduces the safety risk associated with assigning nurses outside their domain of practice. The facility provides orientation to the unit routines and safety procedures to all staff within their designated float region.
The Advantages and Disadvantages of Floating
Floating offers professional advantages that contribute to a nurse’s career trajectory. Nurses gain exposure to a wide variety of medical conditions, patient populations, and procedural protocols across the facility. This exposure fosters skill diversification, making the nurse more versatile and marketable for future roles.
For those in dedicated float pools, compensation is structured with higher pay or bonuses, recognizing the demand for adaptability. Working in varied environments also provides an opportunity to observe different leadership styles and organizational cultures, preventing the professional stagnation that can accompany long-term tenure on a single unit.
The disadvantages center on the psychological impact and safety concerns associated with a lack of familiarity. Nurses report increased stress and anxiety due to the uncertainty of assignments. They must rapidly adapt to unit-specific protocols, equipment locations, and nuances of the electronic health record (EHR) system, which is mentally draining.
This lack of familiarity can lead to feelings of being unsupported by regular unit staff. The highest risk occurs when a nurse is assigned a patient load whose complexity exceeds their proven clinical experience, creating a potential for error. Floating is a source of dissatisfaction that can lead to low morale and increased turnover rates.
Strategies for Handling a Floating Shift
Initial Orientation and Workflow
A safe floating shift begins with immediate preparation upon arrival at the assigned unit. The first step involves asking the charge nurse for an orientation to the physical environment. This orientation should cover the location of emergency equipment, such as the crash cart, the nearest supply room, and a review of the unit’s emergency codes and rapid response team activation procedures.
It is also important to clarify the unit’s workflow for documentation, especially any unique aspects of the electronic health record system. Differences in medication scanning, charting requirements, or order entry must be identified quickly. The nurse should also understand the unit’s communication structure, including who to contact for assistance with patient issues or procedural questions.
Assessing Patient Assignment and Competency
The nurse must obtain a clear understanding of their assigned patient load, including the total number of patients and the acuity level of each assignment. If the assignment includes procedures or medical management outside the nurse’s proven clinical competency, the nurse should immediately communicate this limitation to the charge nurse. For instance, a nurse from a general medical floor should not accept an assignment requiring continuous renal replacement therapy (CRRT) management if they have not been trained.
Setting Boundaries and Safety
Setting professional boundaries is a proactive strategy for maintaining safety and effectiveness. This involves asking for a designated staff member to act as a resource person for unit-specific questions and ensuring the assignment does not violate the legal scope of practice. By being clear about limitations and seeking clarification, the nurse ensures they provide the safest possible care, mitigating the risk inherent in a new environment. If the assignment is still deemed unsafe, the nurse may submit an “assignment under protest” form, documenting the task and the reason for their concern.
Professional Responsibilities and Scope of Practice
The professional responsibility of a floating nurse is governed by their state board of nursing’s legal scope of practice and ethical guidelines. Nurses have the right and obligation to refuse an assignment if they believe accepting it would place a patient at serious risk of harm. This refusal must be based on a lack of clinical competence or the assignment being outside their legal scope of practice, not personal preference.
When faced with a questionable assignment, the nurse must immediately escalate concerns to the charge nurse, nursing supervisor, or hospital administration, clearly articulating the specific risk. The nurse should verbally and in writing inform the supervisor of the discrepancies between the required competence and their own knowledge and skills. This communication should be documented, outlining the nurse’s limitations and the rationale for refusal. The nurse’s ultimate duty is patient advocacy, ensuring every task performed is within the boundaries of their current training.