| Course | NSG 423 Policy, Trends, & Ethics in Nursing |
|---|---|
| Unit | Unit 6 |
| Paper type | Staffing and safe practice position paper |
| Length | About 1,090 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 423 Unit 6
Floating Medical-Surgical Nurses to a Step-Down Unit for Full Assignments Without Cross-Training Should End: A Position Argued From the Shift
Student Name
Department of Nursing, Herzing University
NSG 423: Policy, Trends, & Ethics in Nursing
Instructor Name
February 26, 2026
Floating Medical-Surgical Nurses to a Step-Down Unit for Full Assignments Without Cross-Training Should End: A Position Argued From the Shift
The Practice
At a composite 280-bed community hospital, when the 20-bed step-down unit is short of nurses, the house supervisor floats a nurse from a medical-surgical unit to take a full step-down assignment of three or four patients. The patients on the step-down unit are on continuous cardiac monitoring, and some are on titratable infusions such as diltiazem or heparin, or have recently been weaned from intensive care. Medical-surgical nurses receive no orientation to the step-down unit and have not completed its competency validation for rhythm interpretation or titratable drips. Over the last quarter, a medical-surgical nurse was floated to the step-down unit on 31 of 90 night shifts, according to the staffing office's records.
The Other Side at Its Strongest
The case for the practice deserves a fair statement. Every nurse floated is a licensed registered nurse, and licensure does not distinguish between units. When the step-down unit is short, the alternatives are worse: step-down nurses taking five or six patients each, or closing beds and holding patients in the emergency department, where their care is also compromised. Floating is how every hospital meets variation in demand, and nurses who float gain skills. Most floated nurses manage well, and no serious harm has been traced to floating on this unit. Requiring cross-training for every nurse who might float would be expensive and would reduce the pool of nurses who can be moved when needed. And experienced medical-surgical nurses already care for patients on telemetry on their own units.
The Position
Floating medical-surgical nurses to take full step-down assignments without cross-training should end. Floated nurses who have not completed the step-down competencies should be given assignments matched to what they are validated to do, and the hospital should build a cross-trained float group large enough to cover the step-down unit's predictable shortfalls.
Answering the Other Side
On licensure: licensure establishes a minimum; it does not establish competence for every patient population. Professional staffing principles call for assignments that match a nurse's competence as well as patients' needs (American Nurses Association [ANA], 2020), and the hospital's own step-down unit requires its nurses to complete rhythm and titration competencies before taking a full assignment. Holding floated nurses to a lower standard than the unit's own staff is inconsistent on its face.
On the alternatives: the choice is not only between a floated nurse with a full assignment and no nurse at all. A floated nurse can take patients whose needs match medical-surgical competence, such as patients awaiting transfer to a medical floor, and can take on tasks such as admissions paperwork, vital signs, and turning, while step-down nurses keep the patients on titratable drips. That is still help, and it is help the floated nurse can give safely.
On the absence of known harm: no traced serious event is not evidence of safety. In the staffing office's survey last month, seven of the twelve medical-surgical nurses who had floated to the step-down unit said they had been assigned a patient on an infusion they had never titrated, and four said they had been unsure how to respond to a rhythm change and had to find a step-down nurse. Near misses of this kind are how harm announces itself before it happens. More broadly, patient outcomes are sensitive to nurse staffing and qualifications; in a nine-country European study, higher patient loads per nurse went with greater odds of patients dying in hospital, and a higher proportion of nurses with a bachelor's degree with lower odds (Aiken et al., 2014). Competence for the specific patients is part of what makes staffing safe.
On cost: cross-training a float group is a known, budgetable cost; a serious event from a missed arrhythmia or a mistitrated heparin drip is an unbudgeted one. Research on temporary and supplemental nurse staffing has examined how nurses less familiar with a unit relate to safety outcomes, with results that vary by setting (Bae et al., 2010); the uncertainty argues for caution, not for assuming safety.
What a Floated Nurse Experiences
The argument is made from the shift, and the shift has a human side that numbers miss. A medical-surgical nurse floated at 7 p.m. arrives on an unfamiliar unit, receives report on three monitored patients, one on a diltiazem drip, and is told where the crash cart is. The monitor tech calls with a rhythm change at 11 p.m.; the nurse is not certain whether it is atrial flutter or an artifact and does not know the unit's titration protocol well enough to act. The step-down nurses are busy with their own four patients. The floated nurse spends the night anxious, asking for help repeatedly, and leaves at 7 a.m. resolved not to accept a step-down float again. In the staffing office's survey, several nurses described exactly this, and two said they had called in sick on nights they expected to be floated. The practice therefore also costs the hospital in the goodwill of the nurses it depends on for flexibility. A float system nurses trust, because assignments match what they can do, is more flexible in the long run than one they avoid.
What Should Replace the Practice
Three changes. First, an assignment rule: a floated nurse who has not completed the step-down competencies may care for step-down patients who are not on titratable infusions and who are awaiting transfer to a lower level of care, with a named step-down nurse as resource, and may take tasks but not full assignments of monitored, unstable patients. Second, a cross-trained float group: twelve medical-surgical nurses who volunteer complete the step-down unit's rhythm and titration competencies and four supervised shifts; they become the first to float to step-down, with a differential. Third, a trigger for escalation: if neither a cross-trained nurse nor adequate step-down staff is available, the house supervisor and the step-down charge nurse jointly decide whether to limit admissions, rather than placing an unprepared nurse in a full assignment.
What It Would Take to Change My Mind
Evidence that floated, uncross-trained nurses on this unit have outcomes, including near misses, no different from those of step-down nurses, collected systematically rather than inferred from the absence of reports, would weaken the position. So would evidence that the proposed assignment rule causes more harm through unit overload than the current practice. Both can be measured, and the proposal includes a six-month review of near-miss reports, step-down admission holds, and float nurse surveys.
References
Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., Diomidous, M., Kinnunen, J., Kózka, M., Lesaffre, E., McHugh, M. D., Moreno-Casbas, M. T., Rafferty, A. M., Schwendimann, R., Scott, P. A., Tishelman, C., van Achterberg, T., & Sermeus, W. (2014). Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study. The Lancet, 383(9931), 1824-1830. https://doi.org/10.1016/S0140-6736(13)62631-8
American Nurses Association. (2020). ANA's principles for nurse staffing (3rd ed.). American Nurses Association.
Bae, S.-H., Mark, B., & Fried, B. (2010). Use of temporary nurses and nurse and patient safety outcomes in acute care hospital units. Health Care Management Review, 35(3), 333-344. https://doi.org/10.1097/HMR.0b013e3181dac01c
The Herzing NSG 423 Unit 6 instructions
Unit 6 asks you to argue a position on a staffing practice. Expect to describe the practice, state the opposing view at its strongest, state your position, answer each opposing point, describe the practice's effect on nurses and patients, propose an alternative and say what would change your mind. Students often ask how to argue fairly and what evidence counts. Stating the other side well makes your argument more credible. Use research on staffing and outcomes and professional principles. Propose a workable replacement, not just an objection. Name evidence that would change your view, which shows the position is reasoned rather than fixed.
How this NSG 423 Unit 6 example is built
The argument opens with the practice described neutrally: when and how step-down shortages are filled from medical-surgical units. The other side section gives the strongest case for floating, including licensure, coverage and fairness among staff. The position section states the claim plainly. The answers section responds to each point with evidence, such as studies linking nurse expertise and staffing to outcomes. The experience section describes a floated nurse's shift, from unfamiliar drips to an unknown monitor system. The replacement section offers three changes, including cross-training and an assignment rule that keeps uncross-trained nurses to selected patients. The mind-change section names evidence that would weaken the position. Fairness throughout makes the position persuasive to a staffing committee.
Reading the NSG 423 Unit 6 rubric
Herzing's rubric for a staffing argument typically covers description of the practice, the opposing view, the position, answers to objections, use of evidence, the proposed alternative and openness to evidence. The opposing view and the answers to it draw the closest reading, since a strawman weakens everything that follows. Practice points reward a neutral description. Evidence criteria look for staffing research and professional principles applied to the specific practice. Alternative points go to a workable replacement with rules a manager could apply. Openness earns credit when the evidence that would change the position is named. The floated nurse's experience is often credited when tied to safety. Professional tone toward managers is expected. Aiken's staffing research and ANA's principles support the argument.
NSG 423 Unit 6 help: mistakes that cost points
A Unit 6 staffing argument often weakens by presenting the other side weakly. Another frequent problem is objecting without proposing an alternative. Students often rely on feelings about floating without evidence. Licensure and competence are confused. The patient's perspective is missing. Evidence that would change the position is not named. The argument blames managers rather than examining the practice. Cost of cross-training is ignored, though a committee will ask. Unit-specific skills, such as titrating drips, are not named. Finally, state the other side at its strongest, because graders reward an argument that wins against the best case, not the weakest.
Get a NSG 423 Unit 6 example written to your instructions
Send the Unit 6 instructions and the rubric from your NSG 423 classroom, and describe the practice the argument should defend. We write a custom example built on one specific practice, with sourced and dated evidence, the opposing case at full strength, a position stated plainly and its cost named beside it. First custom sample free, back within 24 to 48 hours.
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NSG 423 Unit 6 questions, answered
Can I use figures from my own facility?
Keep internal numbers, incident data and anything identifying a unit out of what you hand in. Published sources, state agency reports and peer-reviewed studies carry the argument without that exposure and can be cited properly. Where you want the texture of your own setting, describe the pattern generally and mark it as your observation rather than presenting it as measured data.
How should state requirements be handled?
As things that differ, and as things you verify. Staffing law, mandatory overtime rules and whatever protection attaches to refusing an unsafe assignment vary by state and by employer, and some places have none at all. Name the state your argument addresses, say where you read the requirement, and check your own board and workplace policy before relying on either.
Does the argument have to reach the bedside?
In this course, yes, and it is the most common place these papers fall short. A position defended entirely with national figures and organizational language never shows what changes for the nurse on shift. Land it on a specific practice, then say what somebody taking report at the start of a shift would experience differently if it were adopted.
Where can I find a free NSG 423 Unit 6 sample paper?
Read the complete NSG 423 Unit 6 staffing argument here at no charge, the case against uncross-trained floating with the other side stated fairly. Ask for a custom argument on another staffing practice.
Is it safe to float nurses to units they are not trained for?
Licensure sets a minimum, but competence for a specialty unit comes from training. This sample argues that full step-down assignments for uncross-trained nurses should end and proposes cross-training and limited assignments instead.