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September 14, 2012

Member asks: What is the best strategy for floating fixed nurses across different units?

Daily Briefing

Recently, a member came to us asking how to best float fixed nurses across different units in order to best meet spikes and dips in patient volumes. Should nurses float throughout the hospital or just through particular units?  The HR Investment Center’s John Workman responds:

Maximizing overall nursing department flexibility does not require maximizing the flexibility of every individual nurse. 

Asking nursing staff to float across the hospital, whenever and wherever needed, would clearly create tremendous flexibility to better match staffing levels to patient demand.  However, in practice, such a strategy is difficult to execute and may burn out nursing staff. 

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Creating a “cluster-unit” structure

In our experience, many organizations have successfully created "clusters" of two to three similar units, sometimes called “sister units.” Staff nurses are only asked to float across units within their established cluster.  This approach has two main advantages:

    1. Staff satisfaction: Staff generally do not like floating of any kind, but floating across similar units with similar patients tends to be less stressful for them. Furthermore, if nurses consistently float across a small number of units, over time they will become more accustomed to working with those staff and not feel as much of an outsider in the group.

    2. Less training required: This model reduces the need for cross-training nurses to operate in different settings, saving training time and resources.

Layering types of float nurses

Of course, an entirely cluster-based model does not maximize overall staff flexibility.  Staffing needs driven by surges in patient demand could only be filled with nurses within the cluster, and such resources may not always be available.  As such, many organizations operate on a "mostly cluster" strategy. That is, the vast majority of nurses float only across two to three similar units. This provides nearly all the flexibility needed on a day-to-day basis.

However, an additional layer of "super-floats" are often included as back-up. This small group comprises fulltime, fixed nurses—typically no more than few dozen—capable of moving across any unit as needed. In practice, organizations rarely need to pull nurses from outside the cluster, so super-floats are not used that often.

Incenting participation in 'super-float' groups

In an effort to bolster participation and satisfaction, one organization we worked with turned their super-float program into a special honor. In this model, only nurses nominated as excellent caregivers are eligible to participate, and they go on to receive special cross-training (again, viewed as an "honor" when it's only offered to a few people).

In addition, members of this group are compensated an extra dollar per hour when serving as a super-float. Since they are used only sparingly, this represents a small investment.

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