What’s Causing the Change in Nurses’ Attitudes about Floating?

The root cause of the shift in attitudes regarding floating to non-home units is deceptively simple: instead of making floating a command, make it a choice. 

When staff feel that they have to float, whether it’s because they have the lowest seniority, it’s their turn to float or their manager chose to send them to another unit, there can be resistance to working a shift in a non-home unit. This is especially true when the mandatory floating happens at the last minute. However, with the right circumstances in place, there’s a new phenomenon happening called self-directed floating. Self-directed floating occurs when staff proactively request open shifts outside of their home unit.

Self-directed floating can provide staff autonomy, and research has found that an increased sense of autonomy can reduce turnover and decrease staff burnout1.

So, how are some hospitals making the transition from mandatory floating to self-directed floating?  Here are some common characteristics in health systems where self-directed floating is more prevalent:

  • Organization-wide Visibility: In order for staff to want to float, it needs to be easy for them to see what shifts are available in other units that they are qualified to work. That requires automation that can connect employees who have the right skills with open shifts, making it possible for staff to engage in self-directed floating. It’s also important for managers to have easy access to the skills and competencies of the workforce, as well as information about the current workload and overtime status, so they can make data-driven and safe staffing decisions.
  • Choice: Self-directed floating requires providing employees with the autonomy to choose to work available shifts in other units. There must be a way for the nurse to indicate their interest in working particular shifts outside of their home unit.
  • Participation: A positive self-directed floating experience takes committed participation from leadership, management and staff. That starts with tools and systems that make it possible to see and choose open shifts across the enterprise. But, that’s just the beginning. Making sure that employees have the tools, information and support they need when working in non-home units is necessary for a health system that wants to create a culture of floating.
  • Consistency: When employees are frequently moving between different units, it makes sense to have standardized staffing policies, especially regarding overtime and any incentives offered for picking up shifts. It’s also important for floating staff to feel welcomed on the unit so they have the desire to come back again. For example, some orientation and equitable staffing assignments can make the experience more positive and productive for both floating and home unit staff.

The trend towards self-directed floating was uncovered when data for 182 facilities that were using a cloud-based staffing solution was analyzed. The facilities, ranging in size from 25 to 979 licensed beds, represented 22 states. The analysis found that an unintended consequence of implementing a flexible approach to staffing was that nurses were consistently choosing to float2.

Over a decade ago, the IOM report “Keeping Patients Safe: Transforming the Work Environment of Nurses” noted that the quality of patient care is directly impacted by the degree to which nurses are active and empowered participants in making decisions about their patient’s plan of care and by the degree to which they have an active and central role in organizational decision-making3. Self-directed floating is one strategy that allows staff to have an instrumental role in decisions that impact the organization and the patients they care for.

Self-directed floating can also have other positive effects on the entire organization. When staff consistently and effectively float to other units, silos begin to break down. That can lead to a cross-pollination of ideas enterprise-wide as well as better standardization of nursing practices.

To learn more about self-directed floating, check out the 20-minute webinar, “Collaborative Staffing: How Open Shift Management Fulfills Needs.”

 

 

 

1 Weston, Marla. “Strategies for Enhancing Autonomy and Control Over Nursing Practice.” OJIN: The Online Journal of Issues in Nursing. 2010; Vol. 15, No. 1, Manuscript 2.
2Schulman, Cheryl A., et al. “Self-directed floating: Nurses are accepting its benefits.” Accessed October 2, 2015. http://www.modernmedicine.com/modern-medicine/news/modernmedicine/modern-medicine-feature-articles/self-directed-floating-nurses-a?page=full
3Armstrong, Kevin, et al. “Structural Empowerment, Magnet Hospital Characteristics, and Patient Safety Culture.” Journal of Nursing Care Quality. 2005; Vol. 21, No. 2, 124-132.

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