Float Nurse Checklist – Everything You Need to Stay Organized (on any unit)

Float Nurse Checklist – Everything You Need to Stay Organized (on any unit)

📝 Float Pool Nurse Checklist

Throughout my nursing career, I’ve had the opportunity to work in a variety of high-acuity settings that shaped my skills. I created this comprehensive float nurse checklist for new float pool nurses to ensure quality patient care. Let me know your thoughts!

Personally, I began my nursing career in surgical-trauma critical care (2020), caring for patients requiring intubation, central lines, and end-of-life support. From there, I transitioned to a GI unit, where I contributed to patient education initiatives focused on diabetes management, post-op surgery recovery and specialized dietary needs.

Later, I joined Mayo Clinic, spending three years on a high-acuity Cardiac-Transplant unit. I managed complex recoveries following open-heart surgery, transplants, LVAD placements, and valve replacements—supporting patients from ICU transition to discharge. During this time, I also served as a Preceptor and Quality Improvement Team Leader, leading initiatives such as a Kaizen event and a Six Sigma project.

These experiences prepared me well for the Float Pool, where I embraced the variety of units and the dynamic nature of each shift. Some days, I was even deployed as House Resource, supporting resource management and staff with challenging assignments.

What are your strategies for staying grounded and effective in a constantly changing environment?

🔄 Beginning of Shift

  • ✅ Verify ID band, code status, IV site, and pump settings

  • 🖥️ Log into EPIC: Set up Summary Display → Meds Given, PRNs, Trends, LDAs

  • 📂 Locate code cart, unit resource folder, paging system, fire response plan

  • 🔎 Review: Orders > Handoff > Notes > Precautions

  • 🛏️ Room setup: Safety, equipment (lift, SCDs), specialty mattress

  • 🧠 NIHSS & neuro checks (orientation, pupils, hand grips, heel-to-shin, etc.)

  • 🔊 Set ECG alarm alerts, confirm telemetry connection

  • 🧪 Note required labs (ex. INR), imaging (CXR), and protocols

  • 🧾 Print and document ECG (monitor rhythm changes)

  • 🧠 Goals for shift: Patient/family input → whiteboard → document POC

  • 📚 Stroke education: NIHSS, VTE prophylaxis, Massey test

💊 Medication Management

  • ✅ 5 Rights: Right patient, drug, route, time, dose

  • 💉 Ensure correct route is ordered (PO vs GI)

  • 📈 Run electrolyte protocols (K+, Mg, Phos)

    • Recheck K+ 1–2 hrs after admin

    • K+ before Lasix to avoid depletion

  • 📌 Label tubing:

    • Continuous: q96hr

    • Intermittent: q24hr

  • 💻 Micromedex/Trissel’s for compatibility

  • 🔐 Store insulin pens + meds properly

🫁 Respiratory & Cardiac

  • 🔄 Check cardiac monitor regularly

  • ⏱️ Q4 VS: HR, BP, RR, SpO2, temp, pain, MEWS

  • 💬 Document waveform changes

  • 📝 Smart Disclosure: Analyze, alarms, waveform, strip, save, name

  • 💡 Home O2: Use .homeoxygen smartphrase + document in summary

🚶Mobility & ADLs

  • 🔄 Reposition at least every q2h + chart

  • 🚶Ambulate at least 3–5x/shift (assist colleagues too)

  • 👕 Document ADLs, time in room, activity/nutrition assistance level

  • 🧼 Ensure catheter care is done + education (every shift)

  • ♿ Consider PT/OT consults (Braden <18, rehab needs)

  • 📦 Discharge planning: HHC, SNF, HSC

  • 🛏️ Specialty bed charting if utilized (document every shift)

🧠 Neuro

  • 👁️ Call RRT: vision change, arm drift, speech, balance

  • 🪢 Restraints:

    • Non-violent: q2h checks, new order q24h

    • Violent: Hourly checks, new order q4h adult/q2h teen/q1h infant

  • Fall risk: Hester Davis tool

  • 💥 Know fire plan/code/RRT response process

📦 Documentation & Communication

  • 💬 Communicate patient goals to team

  • 📔 Use sticky notes/smartphrases to flag issues for team review

  • 📥 Report refusals (e.g., Heparin) to team providers

  • ✏️ Document provider communications

  • ⌛ Review charting: I/Os, goals, ADLs, care plan

  • 🧍Add progress note or event summary (ADT > Events > Whereabouts)

  • 🖨️ Print rhythm strips with identifiers & signature > add to patient's chart

  • 🔐 Ensure timecard accuracy

  • 🧾 Document pain (esp. Tylenol/PRNs) + use proper tool (e.g. FACES)

🏥 Admission

  • ✅ Release signed & held orders

  • 👥 2-RN skin check

  • 🛏️ Connect VS monitor, SpO2, Telemetry (ensure connection to chart)

  • 📋 Admission questions + Columbia Suicide Scale

  • 📂 Introduce "Patient Rights" & Welcome folder to patient

🛫 Discharge

  • 🚪 Escort via designated discharge doors

  • 🧴 D/C IV, resolve care plan/education

  • 💊 Med review + wound care orders

  • 🧠 Re-educate: Stroke book, PHQ9, daily weights

  • 📉 Remove old orders, confirm d/c with medical team

  • 📝 Document discharge note with consults & follow-up

🧠 Mid/End of Shift

  • 🔄 Verify all infusions, drips, and rhythm trends

  • ⏱️ Full VS Q4; ensure MEWS, pain tools, and reassessments completed

  • 📈 QTc, PR, QRS: Document every shift or with changes

  • 📑 Use Epic’s Incident Reporting or Compass for unresolved issues

  • ✅ Reflect: Who or what needs follow-up? By when? Why? 

🤝 Teamwork & Closed-Loop Communication

  • ☎️ RRT *10000 or 9# or 888

  • 🗣️ Use whiteboard, vocera, sticky notes for updates

  • 🧭 Assist coworkers when possible: Know their rhythms/breaks

  • ⚕️ Ask for feedback, mentor students and new staff, co-sign

  • 👂 “Let me check and come back” for questions I don't have the answer to

  • 📬 Ask providers about pending orders, clarity on plan

🧰 Resources

  • ⚕️ Charge RN

  • 🔧 Float Resource RN

  • 📱 Vocera reminders

  • 📘 Education tools: Micromedex, Uptodate, SmartHub

  • 🗨️ Nurse Leadership team + compass reporting

🎓 Student Nurse Precepting

  • ✅ Set expectations, allow hands-on leadership

  • 🖊️ Student edits documentation

  • 📝 Co-sign all entries

 

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