When our unit census is low I am required to float to other nursing units. What can I do to ensure clients receive safe care? Can I refuse to float?
Floating to other units to support the delivery of services is a common practice, which can lead to anxiety. When you are assigned to float to another area, it is important to consider the following points:
- Typically, nurses are hired by an organization and not a specific unit. As a result, you have a contractual obligation to provide care to clients within the organization; this is not limited to the unit where you are generally assigned.
- The standards of practice and code of ethics apply to nurses in all practice settings including when you may be re-assigned to float to an unfamiliar unit.
- Nurses are accountable to meet their standards of practice by providing safe, competent and compassionate care at all times, regardless of practice setting.
Can I refuse?
The refusal of an assignment in an unfamiliar practice setting is only justified when the risk of harm to a client is greater by accepting the assignment than by refusing it. If you choose to refuse an assignment for any reason, you must inform your employer of the reason for refusal, document the decision-making process and provide the employer with enough time to find a suitable replacement. For more information on refusing assignment see the following documents:
- Abandonment Practice Guideline (CRNNS)
- The Professional Practice Series: Duty to Provide Care (CLPNNS)
Rather than refusing an assignment due to a perceived lack of competence, you should negotiate the work assignment with your manager. This should be based on your individual scope of practice and your competencies. Every nurse has many entry-level competencies (e.g., carrying out client assessments, taking vital signs, assisting clients in activities of daily living) that can be used any practice setting.
Working to your scope of practice
Accepting the assignment to float does not mean you are obligated to practice beyond your level of competence. Nurses must not work outside of their scope of practice or independently engage in client care if they do not have the competencies to do so. Nurses have an obligation to inform employers when they are asked to deliver care beyond their level of competence or individual scope of nursing practice. You must recognize when you have passed the limits of your knowledge, skills and/or judgment. In addition, you must know when and where to request assistance or additional support.
If you are asked to float to a clinical area that is unfamiliar to you, it is recommended that you follow these steps:
- Ask the charge nurse or an experienced nurse for a brief orientation to the physical layout of the unit
- Meet with the charge nurse to discuss your assignment. Inform the charge nurse of the care that you are competent to perform and care that you do not have the knowledge or skill to perform. You should then collaboratively develop a plan for the shift.
- Request an experienced nurse to be partnered with you for the shift.
- Establish a plan for regular communication with the charge nurse and/or partnered nurse.
If you have any other questions about floating or another area of practice, please reach out to a CLPNNS Professional Practice Consultant at PracticeConsultant@clpnns.ca.