can you refuse an assignment? - page 2

My previous DON stated to me that we could not refuse an assignment. Now....I'm confused. I thought the Nursing Practice Act stated that we had the "right' to practice safe nursing. Other staff... Read More

  1. by   mamason
    Quote from Jolie
    I am sorry for your situation. If there are other options (other units or facilities), I would begin to investigate a job change, and prepare to leave on good terms.

    I will never again work on a unit led by a manager who refuses to do patient care. I am speechless that your unit is led by a person INCAPABLE of patient care.
    I must clarify that I no longer work at this facility. I guess I should have posted better as to not mislead anyone. I was mainly looking for insight as to how to handle this former situation as professional as possible. After this incident and many others similar to it, I was under the impression that I could not refuse a pt. I was confused about it. I have not been a nurse that long. I think it really "bites" that you can get fired over refusing an unsafe assignment. There should be a law against it.
  2. by   Dalzac
    The nurses on our med-surg floor had routinely had hardly enough nurses and definately had no cnas enough for safe care. one morning they came in with 2 call-ins and it meant taking 10 pts each and only one cna for the entire floor.
    They refused report and went to the lounge and refused to come out unless they got enough help. NM came down and had to call an an agency for help.
    They had enough help from then on.
    I have refused to take badly infected pts. since the hubby is severly immunosuppresed. and I am too but not to the degree of my husband. I never really got in any trouble. Just a couple of raps on the knuckle.
  3. by   flashpoint
    I never liked taking unsafe assignments either, but if you don't, who will? What do you do when there are already twenty patients, the nurse manager has already worked 20 hours straight, two nurses called in, no one will come in, and the ER is hopping with potential admissions? We don't have an agency pool anywhere nearby...all of our agency nurses are on thirteen week contracts...there isn't an agency that we can call on short notice. The closest hospital is 75 miles away and when we were slammed, you could count on them being just as busy...and in the eight years I was there, we never went on a "no admit" or divert status...we just kept piling them up...put patients in the halls, put two patients in rooms designed fo rone, held patients in the ER, and put patients in rooms that had once beem patient rooms, but had been converted to offices, storage, or whatever. When everyone is overloaded and there is no one who can or will come in, what choice do you have but to cowboy up and do the best you can?

    It's not right and our patients deserve better, but someone has to take care of the patients...who will do it if we refuse?
  4. by   mamason
    Quote from cotjockey
    I never liked taking unsafe assignments either, but if you don't, who will? What do you do when there are already twenty patients, the nurse manager has already worked 20 hours straight, two nurses called in, no one will come in, and the ER is hopping with potential admissions? We don't have an agency pool anywhere nearby...all of our agency nurses are on thirteen week contracts...there isn't an agency that we can call on short notice. The closest hospital is 75 miles away and when we were slammed, you could count on them being just as busy...and in the eight years I was there, we never went on a "no admit" or divert status...we just kept piling them up...put patients in the halls, put two patients in rooms designed fo rone, held patients in the ER, and put patients in rooms that had once beem patient rooms, but had been converted to offices, storage, or whatever. When everyone is overloaded and there is no one who can or will come in, what choice do you have but to cowboy up and do the best you can?

    It's not right and our patients deserve better, but someone has to take care of the patients...who will do it if we refuse?
    I understand where you are coming from.
    but, that does not give a facility the right to jeopordize their employee's professional license by expecting their nurses to work in unsafe conditions. Should something happen, who do you think is going to get blamed?
  5. by   flashpoint
    What is a hospital supposed to do? If patients need admitted, they need admitted...if there is no other hospital to send them to, there is no other hospital to send them to. Do we just stop admitting because we are short staffed? There are places that might be able to do that, but small towns in western Nebraska with small hospitals that are 75 miles apart, it doesn't. I wish there were some sort of solution to this problem...better pay might help...doctors using more discretion with admissions might help...being perpetually overstaffed might help. Nurses can't simply be conjured up with a wave of a magic wand...when there no one to do it, we have no choice except to do the best we can.

    I used to work with a nurse that refused to take more than five patients...point blank, no questions asked, no exceptions...it was really hard to work with him when we were busy and everyone had eight or nine patients. The rest of us would have liked to refuse more than five, but we also understood that there was no one else to do it. He was eventually terminated.
  6. by   mamason
    OK...I realize that nurses do not appear via waving a magic wand. It would be nice if they could. What I'm talking about is taking care of 6,7,8 pts with high acuity levels. It wasn't just an isolated incident. I understand that pts need to be taken care of. But, my question is at what cost? If you stand up for yourself and state that the assignment isn't safe, then I guess your not a team player? And no, I wouldn't expect fellow nurses to take a heavier pt load than myself. That would be unjust.
  7. by   SmilingBluEyes
    I have come to observe it's not uncommon to have a unit headed by a manager who has no grasp on patient care (either has not done it for eons or has no bedside skills) and therefore, will not "do" patient care.

    This is true for many reasons----I think admin's hire managers who they feel will simply do their bidding and also, it's very hard to run/manage a unit AND do patient care, as well. Only so many hours in a day/week.

    Not saying this is right; but it's how I understand the problem. It stinks for those of us who deal with this or have in the past.
  8. by   SmilingBluEyes
    It's a horribly complicated problem. And I don't see it getting better------patients in med-surg units are sicker than ever, with multiple co-morbidities going on--- and staffing does NOT reflect acuity, in so many units. That is a problem w/many ratio laws/propositions. Numbers just don't tell the story. We are fighting this constantly in our OB unit----they (admins) don't seem to get we are like a mini ED and cannot control what is brought directly in our doors, and how acute the case may be. Staffing is dangerously on edge very often due to this fact---and cost-cutting is always the catchphrase of the beancounters in charge.

    So yea--- Very painful, and frightening trend for the future---one I don't see reversing anytime soon, as we (nurses and even doctors) are NOT in control in the hospitals, but the insurance companies and lawyers ARE.
    Last edit by SmilingBluEyes on Sep 26, '06
  9. by   CaseManager1947
    This the situation that happened to me: I was working GeroPsych unit, and the census was 19 confused, suicidal, depressed, or psychotic elders. Myself and one other RN were assigned to work that day. Somebody had been given vacation day, and somebody called off sick. That meant 10 patients for one of us and 9 for the other. No unit secs on weekends. If i'm lyin' I'm dyin'. I paged the Manager on call, and informed her I would be documenting this as unsafe staffing ratios. She smiled at me over the phone (I guess), told me she knew that already. What a horrible day. We had to do all the meds, vitals, treatments, hygiene - everything. No body came in to help... and people wonder why folks leave???
  10. by   SmilingBluEyes
    Oh and the answer to your question?

    Yes you can refuse an assignment. But you may be prepared to lose your job over it. Not right, not what you would want to hear, but it's fact. You never HAVE to take a dangerous assignment. But you have to be prepared to take a STAND.
  11. by   mamason
    I appreciate everyone's honest answers. I may not agree with everyone of them, but,that's what makes this site so interesting. As far as losing a job over refusing an unsafe assignment... I think I'd rather risk my job rather than being responsible for causing harm to a pt. I know it's easy to say that now. I believe that if nurses continue to work short staffed in high acuity areas, then the facility will start to expect that situation as the norm.
  12. by   Ruby Vee
    [font="comic sans ms"]years ago, i was working an oncology floor. there were 15 patients and two staff -- usually an rn and an aide. this particular night there were two rns -- myself and and orientee. the nursing supervisor came around and said i needed to float to micu to do charge. their charge nurse had called in sick, and the only nurses they had were agency -- and they were good, experienced nurses but they couldn't do charge. she wanted me to do charge in micu, my orientee to do charge on our floor, and she'd float us an aide from the micu. (this was years before my first icu job! i'd never even seen the inside of an icu.)

    when i refused, the supervisor told me "don't worry, i'm making the staffing decision so it's my license."

    i told her that if i screwed up, it was my license, too.

    she then told me that if i refused the assignment, she'd have my job.

    "i'd rather lose my job than my license," i said.

    miraculously, she found another staffing solution for the micu, and she never tried to push me around again. it could just as easily gone the other way, and i would have been looking for another job. but you have to draw the line for yourself, you have to draw it somewhere, and you have to stand up for yourself!
  13. by   James Huffman
    Quote from mamason
    My previous DON stated to me that we could not refuse an assignment. Now....I'm confused. I thought the Nursing Practice Act stated that we had the "right' to practice safe nursing. Other staff members said the same thing. I would be interested in hearing other's opinions on this. This has bothered me ever since the statement was made to me. And no, I did not refuse the assignment. I was only questioning the safety of the assignment.
    I'm not familiar with the Illinois practice act (the one you're under, I'm assuming) but there are a couple of general things we need to keep in mind.

    First is, generally speaking, under a nurse practice act, you (as a nurse) don't have "rights," but you have responsibilities. One of those responsibilities is to provide safe, responsible, professional care. Your DON is wrong: it is a professional responsibility to decline assignments that put patients in unsafe positions, where you, as the nurse would be ultimately responsible for the patient being under unsafe care.

    I am sympathetic with those nurses who have spoken about unsafe conditions, and taking extremely difficult assignments. However ... you -- as a nurse -- are not the one who has the ultimate responsibility for making sure there are enough nurses. This is the hospital's responsibility. I can guarantee you that if it came down to a complaint before the BON, you would not have the hospital there to tell about how they had too many patients. One thing we can be sure of is that when we tolerate unsafe staffing, we will get more of it. When a situation happens more than once, it becomes, not an emergency, but a situation that needs dealing with.

    In an unsafe situation, the nurse must be prepared to stand ground, and -- as an earlier post suggested -- must be prepared to be fired. ALWAYS, always, it's better to be fired than to lose one's license. Likewise, in an unsafe situation, the nurse must stand up, state precisely that you WILL NOT ACCEPT this assignment, and not back down. Do not whine, do not complain, do not cry. Just say no. Period. After having said that, mentally tune out the whines, threats, or whatever else your manager may say to you. It's the manager's job to ensure safe staffing levels. If the manager doesn't do that, or can't do that, it is not your issue. Make the hospital and nursing administration do their jobs.

    Nurses sometimes talk about emergency situations, but the situations described here are not aftermath-of-terrorist-attack times. These are just times when -- to be frank -- the hospital administration has chosen not to do their jobs, and nurses are being asked to cover administration backsides.

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