The intent of this position statement is to reaffirm the nursing profession’s responsibility to monitor staffing effectiveness for the protection of the public from unsafe and ineffective nursing practice, especially during times of floating.
It is the position of the New York State Nurses Association that:
Floating to unfamiliar units is a common practice in many healthcare settings, especially in a climate of staffing shortages and fluctuating census. This practice poses concerns regarding patient safety and liability for both the professional nurse as well as the facility. According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), “…inadequacy of orientation and training was identified as the most common root cause of more than half of all sentinel events reviewed” (2004, p. 5). JCAHO requires all accredited organizations to ensure that “…all staff providing patient care and services on behalf of the organization are properly oriented to their jobs and the work environment before providing care, treatment, and services” (JCAHO, 2004, p. 5).
Regardless of the setting, professional nurses must maintain clinical competence and must be held accountable for their nursing judgments and actions. The nursing profession requires “…a life-long learning commitment and willingness to update skills to competent current practice standards…. A lack of knowledge does not excuse the nurse from accountability and responsibility for patient safety and welfare” (Gardner, 1997, p. 55). Each nurse is responsible and accountable for their practice and should use professional judgment when determining competence. At no time should a nurse practice with negligence, incompetence, or perform tasks that he/she has no knowledge of or has not been educated to perform (§ 29.1, Regent’s Rules of Unprofessional Conduct).
Registered nurses must have the support of management at both the operational and executive level in order to competently meet the needs of a varying population of patients in a rapidly changing, technological environment. According to the American Nurses Association (ANA), healthcare facilities should have policies in place that reflect their value and commitment to the profession of nursing enabling nurses to practice in a manner consistent with their scope of practice. The ANA also recommends that facilities should have documented competencies for nursing staff for those activities that they have been authorized to perform, including temporary staff. In addition, there should be a systematic plan for the cross-training of staff expected to float to ensure competence (2005).
Although RNs are licensed generically and not by specialty areas of practice, the ANA recommends ‘shifting the nursing paradigm from an industrial model to a professional one’ that would allow for a more realistic focus on the complexity of nursing duties and levels of nurse competency that are needed to adequately provide quality patient care (ANA, 2005). No longer is a ‘nurse-is-a-nurse-is-a-nurse’ mentality acceptable in a technologically advanced and multifaceted healthcare system. Staffing determinations should be based on the intensity of care required by the patient population and the level of experience, competency, and mix of the staff available to provide care.
In order to facilitate safe, quality patient care by RNs who are adequately trained and competent to care for an assigned group of patients, and to ensure that the rights of RNs are upheld within their legal scope of practice, the New York State Nurses Association recommends that:
The RN should:
The supervisor should:
The healthcare facility should:
Reviewed/revised by NYSNA’s Council on Nursing Practice 06/02/06 and 12/01/06. Approved by the Board of Directors on 06/08/06 and 01/23/07.
Note: The use of the term “patient” anywhere in this document is intended to be generic and refers to the recipient of nursing care.
American Nurses Association. (2005). Utilization guide for the ANA “Principles for nurse staffing”. Silver Spring, MD: Author.
Gardner, S. L., & Hagedorn, M. E. (1997). Your practice and the law. Holding nurses accountable. AWHONN Lifelines, 1(1), 55-6.
Gobis, L. (2001). Workplace rights. The perils of floating. American Journal of Nursing, 101(9), 78.
Higginbotham, E. (2002). Advice of counsel. When you believe an assignment exceeds your expertise. RN, 65(6), 72, 74.
Iowa Board of Nursing. (2003). Iowa Board of Nursing position statement: nurses floating to other health care areas. Des Moines, IA: Author.
Joint Commission on Accreditation of Healthcare Organizations. (2004). Systems analysis. Ensure that your float staff and contracted staff are providing safe care. Joint Commission Perspectives on Patient Safety, 4(7), 5-6.
Kany, K. (2001). Workplace rights. Policy vs. reality. American Journal of Nursing, 101(5), 87.
Mustard, L. W. (2002). Perspectives. The paradigm shift in RN staffing in hospitals: corporate responsibility and institutional liability. Journal of Nursing Law, 8(2), 31-4.
New York State Nurses Association. (2005). NYSNA position statements. Nurses rights. Retrieved March 24, 2006, from http://www.nysna.org/programs/nai/practice/positions/positions41.htm.
New York State Nurses Association. (2005). NYSNA position statement. RN staffing effectiveness and nursing shortage. Latham, NY: Author.
New York State Nurses Association. (2005). Nurses’ rights & responsibilities. What to do in unsafe patient care situations. Latham, NY: Author.
Sullivan, G. H. (1995). Legally speaking. When assignments don’t match skills. RN, 58(4), 57-8, 60.
The University of the State of New York, the State Education Department, Office of the Professions. (2003). Nursing guide to practice. Albany, NY: Author.
For more information on nursing practice, contact NYSNA's Education, Practice and Research Program at 518.782.9400, ext. 282 or by e-mail.