How to Create a Supportive Work Environment for Float Nurses

Structures to support the development and growth of float pool nurses are essential to strengthening the appeal of float pool participation. Many new graduates were eager to join Princess Alexandra Hospital’s first float pool. For new grads, a float pool provides the opportunity to be employed at a major health center, exposure to different clinical areas, and part-time hours to assimilating to the RN role and work environment.

Leaders at PAH developed a program within the float pool specifically for these new graduate nurses. They trained these nurses using a portion of government incentive funding earmarked for hiring newly graduated nurses. This helped new graduates feel more confident practicing across the hospital.

They used the other portion to train experienced nurses as graduate clinical facilitators. These facilitators provide 24/7 support for nurses in the float pool. In addition, the facilitator position also provides exposure to a wide array of specialist competencies.

Leaders at the Cleveland Clinic wanted the float staff to have all the training and certifications necessary to operate as full staff members and share the organization’s culture. They created two types of float pools with built-in supports to help float nurses feel a sense of belonging.

1. The Enterprise PRN Cleveland Clinic Staffing Resources (CCSR) is a highly specialized float pool composed of specialty RNs who fill vacancies as needed across all sites. Not considered full-time staff, these nurses are required to work only one shift every 60 days and can choose their own schedules.
2. The Main Campus Permanent Float Pool, comprised of RNs and PCNAs, are nurses who fill last-minute staffing needs for the main hospital only, and shifts are assigned by the staffing office. They are on staff as “expert generalists” and are required to work 48 hours every six weeks.

Dedicated managers oversee each float pool, while a “unit” of float nurses form a council to oversee their practice environment.

Even with the robust float pool options outlined on the previous page, Cleveland Clinic float nurses still faced challenges.

Float nurses frequently felt disengaged and struggled to adapt to their assigned units. As part of the float pool’s shared governance work, Cleveland Clinic's nursing leaders developed a strategy to integrate float nurses immediately upon arrival to their assigned units. Leaders piloted this support program on a unit with high utilization of float nurses.

Making support resources simple and easily accessible is critical to ensuring that permanent staff and float nurses actually use them. There are three key elements that make up Cleveland Clinic’s float nurse support model:

1. Each unit has a “float ally” on a shift—a nurse designated by the unit’s manager. The ally serves as the point person for float nurses. The float ally greets each float nurse upon arrival, provides a tour of the unit, and stays connected throughout the shift.
2. At the beginning of the shift, the ally gives the float nurse a packet with all the information needed to function on the unit, including the name and phone number of the float ally and a unit-specific point-of-care checklist. (See the float ally job description on page 11 of the PDF.)
3. At the end of the shift, the float nurse receives a note of appreciation from the unit manager or float ally. The float pool manager also receives notice of the recognition. (See an example of these notes on page 10 of the PDF.)