Floating with Confidence: Addressing Competency and Safety Concerns Professionally
Table of Contents
Picture this: It’s your turn to float, and the supervisor informs you that you’ll be assigned to an area that you're not comfortable with due to a lack of experience in that specialty.
As a traveler, I’ve had to become accustomed to floating — it’s part of the job; however, there are times when floating is safe, particularly when you’ve demonstrated competence in providing care to specific patient populations, conditions, or procedures. On the other hand, there are situations where floating can be unsafe. It’s crucial to know your own areas of competency and limitations when it comes to providing safe patient care.
Staying safe and confident when floating outside your specialty
Floating to unfamiliar areas is a significant responsibility that directly impacts two critical factors:
Patient safety: Floating into a new specialty without the necessary experience or training could compromise the quality of care you provide, putting patients at risk. It’s essential to recognize when you're not equipped to handle the specific needs of a patient population, as this can lead to errors, delays in treatment, or even patient harm.
License/certification risk: When working outside of your scope of practice or competency, there’s a potential risk to your professional license or certifications. Being asked to perform duties beyond your level of expertise could lead to mistakes that may not only jeopardize patient safety but also expose you to legal or regulatory issues.
Understanding these risks is vital in ensuring both safe patient outcomes and the protection of your professional credentials. Regularly assess your abilities and know when to seek assistance or express concerns.
👉 Learn more about Nomad’s float policy.
Competency and orientation
Demonstrated competency is essential when floating to other specialty areas. Additionally, unit staff should provide orientation, which should be documented (e.g., using a float orientation checklist). This documentation should become part of your record.
Be mindful of your scope of practice; it may vary depending on your license/certification and state regulations. Always work within your scope, and speak up if you're being asked to work outside of it.
💡Pro tip: Before starting your assignment, review the state-specific scope of practice to ensure you're fully aware of your responsibilities and limitations.
Listening to your inner voice
One day, I was asked to float to Oncology during a Medical Surgical Float assignment. I stayed open-minded while taking report, but then I got that pit in my stomach when I learned I would be administering chemotherapy. At that point in my career, I had never given chemotherapy, and I knew right away that this would not be safe for the patients or myself. It’s essential to recognize your abilities and limitations.
Listening to your inner voice isn’t about saying, "I don’t feel like floating." It’s about safety. Knowing your strengths and weaknesses is a key component of being a healthcare professional. Depending on the situation, it might require reaching out to expert sources to ensure safe patient care.
Expert sources reference sheet
Expert Source | Situation(s) |
Policies/Procedures | When you need clarification on facility-specific protocols. |
Micromedex or Lexicomp | When you're unsure about medication administration or potential adverse outcomes. |
Pharmacy Department | When you need medication expertise, especially regarding dosage or interactions. |
Department Manager/Supervisor | When floating feels unsafe due to lack of experience in the area. |
Charge Nurse | When you need a quick consultation about patient care or unit protocols. |
Educator | When unfamiliar with specific procedures or equipment. |
Lab/Blood Bank | When handling complex lab orders or blood transfusions. |
Respiratory Therapy | When the patient requires advanced respiratory care. |
A Colleague with Competence | When you need peer support or guidance on how to perform unfamiliar tasks. |
The Provider (MD/NP) | When a physician or nurse practitioner’s input is needed for complex care decisions. |
Source: Nomad Health
Tips for when to seek assistance
When you haven’t used a piece of equipment before. If you're unfamiliar with equipment or procedures, ask for a demonstration or support from someone who is experienced.
When you’re unsure about a medication, whether it’s about administration or patient monitoring. Consult resources like Micromedex, Lexicomp, or the Pharmacy Department if you’re uncertain about medication dosages, interactions, or potential side effects. When you haven’t worked in the assigned area. If you lack experience in a particular specialty or unit, seek help from colleagues or supervisors to ensure safe and effective care. When you need clarification on policies or procedures. If you're unfamiliar with facility-specific protocols, consult the policies and procedures manual or ask your supervisor for clarification.
When you encounter unfamiliar patient conditions. If you're faced with a condition or treatment you're not familiar with, it’s important to consult with a colleague, educator, or department lead/charge.
When you feel uncomfortable with a task or procedure. If a task feels beyond your current competency, don't hesitate to ask for assistance from someone with more experience.
Seeking assistance early prevents errors, reduces risks, and ensures that you provide the best care possible.
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Escalating concerns about floating
As healthcare professionals, we often sense when something isn’t right, whether it’s a change in a patient’s condition or a situation that feels unsafe. It’s important to trust these instincts and escalate concerns promptly. Failing to act increases the likelihood of preventable harm. Trust your gut and take action using an evidence-based communication tool.
The TeamSTEPPS CUS tool offers a simple and effective way to raise concerns.
TeamSTEPPS CUS Tool:
C = Concerned
U = Uncomfortable
S = Safety Issue
👇 Watch below:
© Used with permission from the American Hospital Association.
Nurse Example:
C = Concerned: "I’m concerned about floating to the Intensive Care Unit (ICU) because I don’t have experience with the level of care required for critically ill patients."
U = Uncomfortable: "I’m uncomfortable managing the complex ventilator settings and invasive monitoring that are standard in this unit."
S = Safety Issue: "This creates a safety issue for both the patients and myself, as I might not be able to provide the level of care required."
Sonographer Example:
C = Concerned: "I’m concerned about performing a high-risk fetal echocardiogram in this department, as I have not been trained specifically in this procedure."
U = Uncomfortable: "I’m uncomfortable using the specialized equipment for this test because I haven’t had adequate orientation on it."
S = Safety Issue: "This could create a safety issue if the procedure is not done correctly, leading to inaccurate results or delayed diagnosis."
How supervisors make decisions
Supervisors typically review clinician’s qualifications, skills, and competencies in order to make an informed decision about floating. This ensures that assignments match the clinician’s capabilities while keeping patient safety and quality care in mind.
Best practices for communicating concerns
Assume positive intent. Take a deep breath and re-center how you plan on addressing your concern. The facility has a shared goal of providing patients with safe care. Consider the possibility of missed information when the decision was made.
Use a professional tone and frame your concerns within a safety context. Example: “Thank you for informing me that I’ll be floating to the Neuro Step Down. I have a concern that I won’t be able to safely provide care in that area due to my lack of competency with post-op neuro patients.”
Offer alternative solutions. Example: “I understand that staffing is tight, and I’m happy to float to another area like Telemetry or CCU if that’s helpful. I can even assist in the ED with patient admissions.”
Always express gratitude for understanding. Example: “Thank you for understanding. I’m here to help in any way possible, but I want to ensure patient safety and protect my license/certification.”
What to Avoid
Making assumptions about the facility’s knowledge of your skills or competencies.
Refusing an assignment—instead, use the professional guidance provided above to address concerns. Refusal can be seen as insubordination and might lead to assignment cancellation or licensing issues.
What to do if you’re told you must float
Travlers are often asked to float. If you’re required to float, take extra precautions:
Exercise caution: Be mindful of the situation, accept report when you have the ability to provide safe, competency-based care. Take a thorough report asking questions about the patient’s baseline and plan.
Ask for a unit orientation: Get the lay of the land. Ensure you have access to all essential rooms and equipment. Where is the code cart? Post-partum Hemorrhage cart (as appropriate)? Where are the fire extinguishers and exits? Provider contact list?
Introduce yourself to the team: You need new buddies to ensure a successful shift.
Seek assistance from expert sources: Don’t hesitate to ask for support. Use the table above.
Ask questions: Clarify anything you’re uncertain about. Asking clarifying questions is a good thing.
Escalate the situation: Reach out to your Nomad Navigator. A member of our clinical team will reach out to you to provide support and guidance. Our navigators are made up of experienced clinicians who understand the challenges of floating, because we have been there!
Document everything: Complete an incident report and email or print a copy for yourself if you feel there are safety implications.
Effective strategies for managing competency concerns when floating
When floating to unfamiliar areas, it's essential for travel nurses and allied health professionals to recognize their competencies and limitations to ensure patient safety and protect their license.
Trusting your instincts and seeking expert guidance, whether from colleagues, supervisors, or specialized departments helps navigate these situations. Using a communication tool like TeamSTEPPS CUS allows you to escalate concerns professionally, fostering a culture of safety.
It’s important to avoid assumptions and never refuse assignments outright; instead, communicate your concerns respectfully and offer alternatives. Prioritizing safety, seeking support, and documenting your actions are key to managing floating assignments effectively and responsibly.