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. Typically, nurses are hired by an organization and not a specific unit. This means that you have a contractual obligation to provide care to clients within the organization, which is not always limited to the unit where you are generally assigned.

Employers have the responsibility to ensure they deliver safe and quality healthcare services to the public within their resources and as such, have the right to re-assign you to another unit. As you are obligated to take action when client safety may be compromised, in accordance with your Standards of Practice, your employer has an obligation to re-assign you if inadequate staffing on a particular unit puts clients at risk.

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 your decision-making process and provide the employer with enough time to find a suitable replacement. While there are justifiable reasons to refuse an assignment, they are very specific. Click here to read more about these situations. You should also be aware that an unjustified refusal of assignment, puts clients at more risk, which is in direct opposition of your standards of practice.

Accepting the assignment to float does not mean you are obligated to practice beyond your individual level of competence. Rather than refusing an assignment related to perceived lack of competence, you should negotiate the work re-assignment with your manager based on your individual capacity and scope of practice.

Every LPN has many entry-level competencies (e.g., client assessments, taking vital signs, medication administration[1] and assisting clients in activities of daily living) that can be applied in any practice setting. You are expected to practice according to your Standards of Practice at all times.

Floating can create anxiety. You can minimize this by considering the following:

  • Meet with the charge nurse when you arrive to discuss your assignment. Let them know the care that you are competent to perform and things in which you may need assistance with or do not have the knowledge and/or skill to perform.
  • Collaborate with the charge nurse to develop a plan for the shift.
  • Ask for a brief orientation to the physical layout of the unit.
  • Request to be ‘buddied’ with an experienced nurse for the shift.
  • Establish a plan for regular communication with the charge nurse or your buddy.

Click here and go to page 23 to review a case scenario regarding floating.

[1] Recognizing medication administering with an unfamiliar client population may be more time consuming, medication administration through the application of the ‘The Rights of Medication Administration’ as a safety framework is an entry level competency for all LPNs.