can you refuse an assignment?

Nurses General Nursing

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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.

Specializes in Maternal - Child Health.
Ugh...NM....help out?Not on this floor. Her statement to staff was that she does not "do" pt assignments. Meaning would not take a team.

This was brought up to her boss, the director of cardic/ICU. Diector stated that,"She won't take a team because she doesn't know how." This true, heard it with my own ears at astaff meeting with the director. Sorry about thegrammer. Typing with one hand.

No additional staff was available to send to us. The charge on this shift, did not take a team either. This was not an isolated incident. This type of staffing was utilized on a daily basis. Charge nurse went to NM and said I was being uncooperative when I mentioned that I was overwhelmed with assignment. NM came barging out of her office with anasty attitude and said I could not refuse the pt. It was a no win situation.Had not taken report on new pt yet, at this point. I was very frustrated and wasn't sure what I should or could doI ended up taking the pt after feeling like I was being pressured to do so. Needless to say, I worked a fourteen hour shift that day.

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.

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Specializes in cardiac.
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.

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Specializes in CCU,ICU,ER retired.

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.

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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?

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Specializes in cardiac.
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?

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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.

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Specializes in cardiac.

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.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

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.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

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.

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Specializes in Psychiatry, Case Management, also OR/OB.

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???

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

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.

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Specializes in cardiac.

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.

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