Floating to the ICU: A Safety Checklist for Nurses

For some nurses, floating to the intensive care unit (ICU) from the medical-surgical (med-surg) unit can be nerve-racking to say the least. Uncertainty, combined with a lack of confidence and experience, can create a situation that leaves some clinicians treading water instead of entering the ICU at full stride.

For nurses who feel unprepared—or even scared—to float to the ICU, having a clear orientation framework can act as a critical safety net.

That "You're floating to ICU from med-surg" call

The feeling in the pit in your stomach when the staffing office calls or your charge nurse walks over and mentions, "We need you to float to the ICU."

Your imagination begins to race. Rows of monitors with lines that are unrecognizable, the rhythmic hiss of ventilators, and the constant "beep" of titrated drips that you’ve never even touched. “I don’t know the vents,” you think. “I’ve only seen a Swan-Ganz catheter in a textbook. This isn't safe!”

Feeling this way?

Let's be clear: Your anxiety is warranted.

The ICU is a different world where the margin for error is much smaller. While this environment is high-stakes, floating to the ICU from med-surg can be accomplished safely if there is a clear plan.

A 10-point checklist is available to use every time you float. We’re going to examine how to handle your ICU assignment, what to do when floating to the ICU, what to say, and how to protect your patients and your license from the moment you clock in.

Your pre-shift script: What to ask before arriving

Is it safe to float to the ICU?

If done properly, yes. The greatest leverage for a med-surg nurse floating to the ICU exists before they physically step into the unit and accept a patient handoff.

When told that you are floating, do not say "Okay" and hang up. Use this script to gain clarity:

"What is the specific patient assignment you have in mind for me?"
"Will I be taking a full patient load, or will I be acting as a 'helping hands' nurse?"
"Who will be my designated 'buddy' or resource nurse on the unit?"

Clarity is the key. In the world of healthcare, ambiguity is the enemy of safety. Be polite yet firm when insisting on clarity.

The 10-point on-the-unit safety checklist

Think of this as a practical float nurse survival guide—designed to help you stay safe, confident, and within scope every time you float.

Once you arrive, follow the 10-point checklist step-by-step.

1. Find the charge nurse immediately

First things first, before putting your bag away, looking at a computer, and certainly before walking into a patient’s room, locate the ICU charge nurse.

They are the "air traffic controller" of the unit. Establish communication immediately to move on to steps 2 and 3.

2. Use your communication skills

The most important part of your float nurse ICU checklist is communication. You must clearly define your role and capabilities. Here is an example phrase that you can say to the charge nurse:

"Hi, I'm [Your Name], floating from med-surg. For patient safety, I need to be clear about my competencies. (Mention your capabilities and what you are not capable of or comfortable with). I am here to care for med-surg-level patients or to assist the primary nurses."

By communicating your capabilities and comfort levels to the appropriate personnel in regards to patient safety, you shift the conversation from your personal comfort to professional standards.

Furthermore, this helps the charge nurse make safe decisions for task delegation.

3. Confirm your assignment

What can a med-surg nurse do in the ICU?

A safe assignment for a med-surg nurse floating to the ICU is usually "med-surg-appropriate" patients. Often known as "ICU borders." These patients are stable enough to be moved to a different unit but remain in the ICU due to the lack of beds available elsewhere.

4. Clarify the "helping hands" role

If the unit isn’t giving you your own patients, but rather asking you to work in a "helping hands" role, request a list of specific tasks you are expected to accomplish.

“Am I responsible for all vitals and blood sugars?”
“Am I co-signing blood and meds?”
“Am I the primary person for turns and baths?”

Knowing your "lane" and staying there prevents you from taking on high-acuity tasks you aren't qualified to handle.

5. Identify your "buddy"

In the ICU, you cannot be an island unto yourself. Stay informed and ask the charge nurse, "Who is my go-to person for questions?"

Get specifics, ask for a name and room number. Asking the charge nurse for a secondary resource is always a good idea; your “buddy” may be very busy, and having an alternative option is valuable.

6. Know the location of critical supplies: “The Big 3"

Knowledge equals confidence. Make sure to familiarize yourself with the locations of medical equipment and supplies that you utilize during your shift, especially these 3:

The crash cart: Identify its location and confirm that it is fully stocked.
The glucometer: Locate it early so blood glucose checks can be completed per ICU protocol.
IV/flush supplies: Find where these are stored, as IV access and maintenance are frequent tasks.

7. Learn the code procedures

Calling for assistance in the ICU may differ from your regular unit.

You need to know:

"How do I call a code blue here?"
"How do I call the rapid response team in an emergency?"

Knowing is half the battle; having the right information can be the difference between a timely intervention and delayed patient care.

8. Review and recognize the monitor alarms

ICU monitors will be tailored to each patient. Knowing the clinical configurations for each person is essential to providing quality patient care. After getting your assignment, ask the patient's previous nurse during the shift hand off (or your buddy) to review the monitor settings with you.

Ask:

"Which alarms are routine for this patient?”
“Which alarms mean I need to get you immediately?"

Ensuring you are informed is your best defense against being in a position where missing an assignment leads to a patient not receiving the required care.

9. Review the 12-hour "to-do" list

Don't get bogged down in the patient's 30-day medical history. For a med-surg-level patient in the ICU, focus on the immediate 12-hour goals. Here are some example tasks for a med-surg nurse in ICU:

Titrate O2 to <4 L/min
Ambulate in the hall
Monitor neuro checks Q2H

Know what is expected of you and keep your attention focused on the duties entrusted to you.

10. Document "float nurse" status

For the duration of your shift, all your charting notes should state clearly your float nurse status. This will create a clear, professional record of your qualifications, scope, and expectations.

How to safely say “No”

The goal is to perform the duties you are capable of, not to put yourself and patients at risk, especially in situations involving unsafe staffing or inappropriate floating assignments.

If you are assigned a task that is outside of your capabilities and/or scope of practice, you should say no. You can say no safely, and without gaining a reputation of not being a team player. Here’s how:

“Thank you for trusting me, but I am not competent to (insert task here). It is outside of my capabilities and would be unsafe for the patient. What I can do, however, is (insert a few options here, i.e., take the stable border in room 12, help with vitals, patient turns, blood sugars…). Which would be most helpful?”

The key takeaway here is that saying no to what you can’t do should always be followed up with what you can do. This sets boundaries while still signalling you are willing to help out.

Also read: Can a nurse refuse a patient assignment? Know your options

You are a med-surg nurse, not an ICU nurse

Floating to the ICU can be inherently stressful, but it doesn't have to be overwhelming. The goal of your shift isn't to be a hero or to master critical care in a day.

Your job is to be a safe, critical-thinking, and diligent med-surg nurse who provides high-quality care to the appropriate patients while performing tasks for a med-surg nurse in the ICU and supporting the ICU team to the best of your abilities.

Utilize this checklist. Trust your instinct. If something doesn’t feel right, let it be known. There is zero shame in asking a "basic" question in a complex environment. Just remember, it is okay to say, "This is outside my scope of practice."

By setting boundaries and staying focused, you can finish your shift knowing you safely did your best while still helping your colleagues during a staffing crisis.

Take control of your professional career with Nursa

Taking everything that was mentioned above into account, a float shift in the ICU will inevitably be less daunting. Refusing to float to ICU may not be an option according to your facility's policies, but if the ICU isn't your thing, you can always take control of your career and schedule with our Nursa platform.

Control when and where you work, make sure the staffing gaps you fill are where you feel comfortable and capable of fulfilling your tasks with confidence.

Sign up with Nursa today.

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Floating to the ICU: A 10-point safety checklist for nurses

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