This staffing solution provides new nurses with a path to success.
By Cheryl Muffley, MSN, RN-BC and Suzanne Heath, MS, BSN, RN-BC
As the nursing profession strives to advance care delivery, it’s faced with many challenges, including adequately educating nurses and effectively managing staffing and retention issues. We need new, innovative solutions to effectively deal with these challenges. Christiana Care Health System (CCHS) developed a unique medical nurse float pool to support medical nursing units by decreasing overtime costs and managing unpredictable staffing needs.
Although the program outlined here is not currently in use because CCHS has recently started hiring nurses directly into a float pool, we describe it so that other organizations seeking innovative solutions can consider this option.
The CCHS medical nurse float pool program included novice nurses (new RNs), solved staffing challenges and provided new nurses with supportive, confidence-building bedside training.
The floating solution
Floating is considered an efficient staffing technique, using available nurses rather than calling nurses in to work and paying overtime. However,nov when staff RNs are expected to float from their home unit to another unit, they often express dissatisfaction caused by stress and anxiety. This dissatisfaction can lead to frustration and high turnover rates. CCHS, a Magnet®-recognized system with two hospitals and a level III trauma center headquartered in Newark, DE, established the medical nurse float pool to make the most effective use of staff, reduce nurse dissatisfaction with floating, and continue to provide quality patient care.
CCHS medical nurse float pool staff received 4-week assignments, based on existing vacancies and leaves of absence. Unlike traditional float pools, the CCHS float pool nurses didn’t float to various locations on a daily basis. And because the nurses on the medical units realized that they’d be short-staffed without the floating staff, the floating nurses consistently reported that when they arrived they were welcomed by the unit staff, which usually set the tone for the assignment. The floating nurses also reported that the units typically placed them in assignments that were less challenging, which made them more comfortable with floating.
The float pool and novice nurses
CCHS offers a variety of nurse residencies for new RNs, including a 16-week medical nurse residency program (MNRP) that combines hands-on clinical experience with in-depth classroom learning. During the MNRP, nurse residents are randomly assigned to orient on four different medical units between our two campuses. When they complete the residency program, the nurses have built a strong foundation for nursing practice in a fast-paced, challenging environment. While in the MNRP, nurse residents had the option of being hired onto one of the medical nursing units or into the medical nurse float pool after completion of the residency.
Although medical nurse float pool staff were assigned to units within their clinical specialty, new nurses are at risk of feeling incompetent, insecure, and alienated. In addition to facing an overwhelming list of milestones they’re expected to accomplish during their first year of practice, the float pool nurses also faced the challenge of attempting to successfully adapt to working on a different unit every 4 weeks. Although the MNRP offered the nurses a structured, supportive orientation environment, high patient acuity and complex care delivery can make it difficult for any new nurse to feel comfortable, gain self-confidence, and begin to independently use what they’ve learned.
In addition to developing clinical decision-making and leadership skills at the point of care, novice nurses, especially those hired into the medical nurse float pool immediately after orientation, benefit from participation in educational programs that support their commitment to practice as bedside nurses. These programs provide the opportunity to increase clinical skills, knowledge, and self-confidence. By design, the CCHS medical nurse float pool accomplished this by offering a unique pathway that promoted the development of competence and critical thinking skills, offered group support, provided a solid foundation in medical nursing skills to guarantee safe and quality patient care, and facilitated a smooth transition to the organization’s culture.
Float pool training
A learning needs assessment was administered to nurses as they transitioned from the MNRP to the float pool. Training included monthly structured sessions, with content customized to float pool nurses’ needs and that facilitated learning from practice. Curriculum was based on Patricia Benner’s Novice to Expert model, focusing on quality outcomes, evidence-based practice, patient safety, and leadership skills. In monthly staff meetings, nurses received updates on current service-line and organizational information. Additionally, time was allotted for discussions about specific patient care situations, which provided an opportunity for team building and reflection on clinical practice.
Path to nursing success
The medical nurse float pool established clinical competency, offered group support during the transition from novice to competent nurse, and facilitated retention of skilled nurses. Because of the variety of clinical experiences, the nurses became valuable members of the healthcare team. (See CCHS medical nurse float pool outcomes.)
CCHS medical nurse float pool outcomes
Additionally, the float pool offered an avenue for nurse managers to solve staffing challenges with clinically strong nurses. As a result, CCHS medical nursing units gained experienced bedside nurses who were prepared to become leaders and were committed to the organization, which led to quality patient and family-centered care and positive patient outcomes.
The authors work at Christiana Care Health System in Newark, Delaware. Cheryl Muffley is a nursing professional development specialist and Suzanne Heath is a nurse manager.
Benner P. From Novice to Expert: Excellence and Power in Clinical Nurse Practice. Menlo Park, CA: Addison-Wesley; 1984.
Good E, Bishop P. Willing to walk: A creative strategy to minimize stress related to floating. J Nurs Admin. 2011;41(5):231-4.