This is part 19 of the Nursing Research Challenge.

The Article: Good, E. & Bishop, P. (2011). Willing to walk: A creative strategy to minimize stress related to floating. Journal of Nursing Administration, 41(5): 231-234.

Big Idea:  Nurses within Aultman Hospital, an 808-bed level II trauma center and Magnet® facility, expressed their frustration and concerns about an age-old issue – floating to another nursing unit – to their executive nursing leadership. For those unfamiliar, floating, also referred to as pulling, is a staffing strategy that makes nurses work on another unit if their home unit is staffed accordingly. Changes with staff calling in to work or an increase in the number of patients within a unit make floating a common staffing strategy that often causes great amounts of stress for nurses for numerous reasons including working with different patients and healthcare team members, understanding the processes and layouts of the new units, and working within an entirely different culture from the nurse’s home unit. Caring for people is hard enough; compound that with working with people and things you do not know makes it even more stressful.

The executive nursing leadership team not only listened to the nurses’ concerns, they acted on them. In 2005 the facility implemented a “no-pull rule” and the “Willing to Walk” program in which nurses actually have the choice to work on a “sister” unit, if needed, without consequence of their decision. In addition, Aultman Hospital nurses came up with several more creative staffing strategies such as a specialized float pool and financial incentives for part-time nurses to pick up additional shifts.

Survey Says!: Aultman Hospital’s staffing methods have increased nursing autonomy, which has improved nursing satisfaction scores. Thanks to their efforts, they have not utilized per-diem nurses since 2007, and they have reduced their use of agency nurses, which is a cost-saving strategy. Their nurse turnover rates remain below other Magnet®  hospitals’ average turnover rate.

Quotable: “There is much written describing the responses of nurses who are floated or pulled from their assigned units. Common descriptors elicited from nurses who are pulled include anxiety producing, stressful, dissatisfied, and disruptive [references]” (p. 231).

“A transformational leader who sees the importance of autonomy for nursing staff is a positive influence on retention and nurse satisfaction…A manager who is willing to support new ideas and processes from direct care staff helps build job satisfaction that can result in increased engagement and retention” (p. 234).

So What?: This study is a great example of how staff nurses can dramatically improve a hospital’s bottom line. It also indicates how nurse leaders can impact and liaise between suggestions and recommendations to systems changes.