Abstract
Nurse staffing plans that are flexible and adaptable can enhance the resilience of healthcare organizations, ensuring that they are better equipped to meet the fluctuating needs of patients.1 Floating is a common flexible nurse staffing strategy, yet its effects on nurse-sensitive indicators (NSIs) remain largely unexplored. Nurses have expressed concerns about floating and patient safety.2-3 Floating unit-based nurses are associated with increased occupational stress2-6 and burnout,5 which can act as mental distractions impacting NSIs.6 The study aimed to evaluate the effects of two distinct forms of floating: nurses from dedicated float pools and unit-based nurses temporarily assigned to other units. Using a cross-sectional, secondary data analysis methodology, the study focused on float nurses’ relationships with four NSIs: Falls, Hospital-Acquired Pressure Injuries (HAPI), Central Line-Associated Bloodstream Infections (CLABSI), and Catheter-Associated Urinary Tract Infections (CAUTI). Data was collected from 25 critical care and medical/surgical units across three hospitals from April 2023 to April 2024, utilizing the National Database for Nursing Quality Indicators (NDNQI) and existing nurse staffing records. A logistic regression analysis revealed two key findings: float pool nurses were associated with a decreased risk of HAPI (OR 0.96, 95% CI 0.92-0.99) and CLABSI (OR 0.93, 95% CI 0.88-0.99). In contrast, increased frequency of unit-based floating correlated with a higher risk of HAPI. While float pool nurses were not associated with elevated NSI risks, frequent floating of unit-based nurses may negatively impact patient outcomes. Recommendations include standardized tracking of floating practices within current NSI tracking databases, strengthening float pools, and future longitudinal studies to refine staffing policies.
Notes
References: 1. Griffiths P, Saville C, Ball JE, Jones J, Monks T. Beyond ratios - flexible and resilient nurse staffing options to deliver cost-effective hospital care and address staff shortages: A simulation and economic modelling study. Int J Nurs Stud. 2021;117:103901. doi:10.1016/j.ijnurstu.2021.103901
2. Ahmed FR, Timmins F, Dias JM, et al. Floating to intensive care units: Nurses' messages for instant action to promote patient safety. Nurs Crit Care. 2023;28(6):902-912. doi:10.1111/nicc.12907
3. Lafontant MP, Blevins D, Romer C, Ward PG. Exploring nurses' feelings on floating: A phenomenological study. Nurs Health Sci Res J. 2019;2(1):21-29. doi:10.55481/2578-3750.1025
4. Buckley L, Berta W, Cleverley K, Medeiros C, Widger K. What is known about paediatric nurse burnout: a scoping review. Hum Resour Health. 2020;18(1):9. doi:10.1186/s12960-020-0451-8
5. Tuominen OA, Rantalainen T, Löyttyniemi E, Rehnbäck K, Lundgrén-Laine H, Salanterä S. Investigation of the causes and effects of stress in nurses working 'floating shifts'. Nurs Manag. 2022. doi:10.7748/nm.2022.e2044
6. Salvador RO, Gnanlet A, McDermott C. The impact of the use of employee functional flexibility on patient safety. Pers Rev. 2020;50(3):971-984. doi:10.1108/PR-10-2019-0562
Sigma Membership
Iota Mu
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Cross-Sectional
Research Approach
Quantitative Research
Keywords:
Workforce, Policy and Advocacy, Float Nursing, Patient Safety
Recommended Citation
Stephens, Catherine; Verklan, M. Terese; Norton, Juanita; and Walker, Danielle, "Float Nurses’ Association with Nurse Sensitive Indicators: A Cross-Sectional Study" (2025). International Nursing Research Congress (INRC). 69.
https://www.sigmarepository.org/inrc/2025/presentations_2025/69
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Float Nurses’ Association with Nurse Sensitive Indicators: A Cross-Sectional Study
Seattle, Washington, USA
Nurse staffing plans that are flexible and adaptable can enhance the resilience of healthcare organizations, ensuring that they are better equipped to meet the fluctuating needs of patients.1 Floating is a common flexible nurse staffing strategy, yet its effects on nurse-sensitive indicators (NSIs) remain largely unexplored. Nurses have expressed concerns about floating and patient safety.2-3 Floating unit-based nurses are associated with increased occupational stress2-6 and burnout,5 which can act as mental distractions impacting NSIs.6 The study aimed to evaluate the effects of two distinct forms of floating: nurses from dedicated float pools and unit-based nurses temporarily assigned to other units. Using a cross-sectional, secondary data analysis methodology, the study focused on float nurses’ relationships with four NSIs: Falls, Hospital-Acquired Pressure Injuries (HAPI), Central Line-Associated Bloodstream Infections (CLABSI), and Catheter-Associated Urinary Tract Infections (CAUTI). Data was collected from 25 critical care and medical/surgical units across three hospitals from April 2023 to April 2024, utilizing the National Database for Nursing Quality Indicators (NDNQI) and existing nurse staffing records. A logistic regression analysis revealed two key findings: float pool nurses were associated with a decreased risk of HAPI (OR 0.96, 95% CI 0.92-0.99) and CLABSI (OR 0.93, 95% CI 0.88-0.99). In contrast, increased frequency of unit-based floating correlated with a higher risk of HAPI. While float pool nurses were not associated with elevated NSI risks, frequent floating of unit-based nurses may negatively impact patient outcomes. Recommendations include standardized tracking of floating practices within current NSI tracking databases, strengthening float pools, and future longitudinal studies to refine staffing policies.
Description
This study reveals unexpected differences between float pool and floated unit-based nurses' associations with non-reimbursable serious hospital-acquired conditions. These findings challenge nurse staffing assumptions and offer vital insights for optimizing nursing assignments and enhancing patient care.