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DOI
https://doi.org/10.63853/KCFQ5281
Description
INNOVATION & LEADERSHIP
Background: Critical care float pool nurses possess broad clinical expertise and flexibility to support a wide range of patient care areas across the organization. Their familiarity with multiple units, patient populations, and
established relationships with provider teams helps them to facilitate timely and effective clinical support. Acute care staff regard critical care nurses’ judgment with high respect, enhancing interdisciplinary collaboration and trust. Because of a rising patient acuity and census, there is risk for failures in escalation of care, with 16% of serious pediatric adverse events linked to delays is escalation (Sosa et al., 2022). Critical care nurses can play a pivotal role in supporting bedside teams and reinforcing escalation protocols, as evidenced by proactive rounding on “watchers,” high risk patients. This positions these nurses to uniquely enhance escalation pathways and contribute to improved patient outcomes.
Implementation: In a large urban free-standing Level 1 pediatric trauma center, the Critical Response Outreach Support (CROS) nurse was developed to support nurses in early recognition and intervention, escalation processes, and team communication. This role was piloted over six months using experienced critical care float pool nurses in a phased approach. Prior to go-live, these nurses attend a comprehensive training program that consists of didactic lectures, simulated code documentation, and a hospital-wide scavenger hunt designed to enhance familiarity with the institution and the placement of critical resources such as crash carts and automated external defibrillators. CROS nurses served as clinical mentors, assisted with escalation events, and contributed to hospital-acquired condition prevention.
Evaluation: Preliminary outcomes for this role are very positive with nurses reporting a high level of real-time support and education, with 89% stating there is value in this role. This role also supported early controlled transfer of patients, so interventions could be started proactively, with only 3 of 67 controlled transfers needing a further level of escalation of care upon arrival to the intensive care unit. Given the success of the CROS role, it is being fully implemented to support nurses and patient safety. The CROS nurse represents a scalable, evidence-informed strategy to improve pediatric patient outcomes while fostering a culture of continuous learning and interdisciplinary collaboration.
Publication Date
11-24-2025
Disciplines
Pediatric Nursing
Recommended Citation
Anderson, Amanda; Kelley, Caroline; Moore, Mary; Phillips, Carlie; and Westbrook, Krista, "We Float So You Don’t Sink: Implementation of Float Nurse Support Role" (2025). 2025. 45.
https://scholarlycollection.childrens.com/nursing-anf2025/45
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This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
