Ethical or legal?

[chevyv]

I'm researching an ethical dilemma. I would like to know if it's a legal or ethical stand to accept or decline a patient assignment that the rn feels is unsafe. Ie: Too many patients or patients assigned that rn is not comfortable with (skill wise) or just an unsafe pt load (too many critical pts or pts going south so to speak).

Its an important topic which I'm just not sure if its really ethical or more legal. Thanks for any input and opinions. :bowingpur

[southernbeegirl, BSN, RN]

at my facility, if you refuse an assignment, it's the DON's policy that you be walked to the timeclock and clocked out. she will then fire you and turn you into the BON for abandonment.

wonder if thats legal?

[chevyv, BSN, RN]

I understand that if you clock in and then refuse that could be abandonment. If you refuse before you clock in, then its not. Either way, I could see a facility firing that person. Not sure if thats legal, but I bet they would 'find' enough to get rid of them sooner rather than later. I was thinking there might be an ethical angle to that, but I guess that would be more of a pt safety issue. According to the ANA (if I'm reading it correctly), the nurse can write it up, but it doesn't offer a safe haven as far as refusing and keeping your job.

[RNAnnjeh, MSN, CNS]

I thought of this situation after being in a meeting this afternoon.

There have been some babies born with multiple life-limiting conditions who have eventually had a tracheostomy tube inserted as they kept extubating themselves while on the ventilator. Does adding an artificial airway, and all of the associated complications improve their quality of life and give families false hope when they already have a poor prognosis?

Feel free to PM me if you would like clarification/more information.

[Atheos]

at my facility, if you refuse an assignment, it's the DON's policy that you be walked to the timeclock and clocked out. she will then fire you and turn you into the BON for abandonment.

wonder if thats legal?

It is not illegal.

However, there IS a difference between JOB abandonment and PATIENT abandonment.

Clocking in and leaving is JOB abandonment. Not one BON that I have seen will touch that. It is an employment issue.

Patient abandonment requires accepting responsibility for that patient. Basically, if you get report OR take responsibility for the assignment you are stuck.

The DON can report all she wants. The BON won't touch it. She is either ignorant of the law or trying to intimidate nursing staff, who also tend to be ignorant of the law.

[chevyv, BSN, RN]

That is a very good one. I've heard nurses discuss if its really in the babies best interest to keep on attempting to save them. I'm going to look into this. I've done some research on preemies and the controversy surrounding how young is too young, but I'm more interested in checking into this topic.

Thanks!

[Antikigirl, ASN, RN]

I don't know if this will help, but in my hospital we have a nurses union and they have forms to fill out when we have unsafe patient ratios. They don't take long to fill out, and go directly to the Union that goes over them and sends them back to the hospital to fix and get a plan of action...

I find, however, this only works well if all the nurses on that shift complete one! We have done this several times and it is laxing a bit..then goes up...we do it again...and so on and so on...but it does help a bit!

[NeoNurseTX, RN]

I understand that if you clock in and then refuse that could be abandonment. If you refuse before you clock in, then its not. Either way, I could see a facility firing that person. Not sure if thats legal, but I bet they would 'find' enough to get rid of them sooner rather than later. I was thinking there might be an ethical angle to that, but I guess that would be more of a pt safety issue. According to the ANA (if I'm reading it correctly), the nurse can write it up, but it doesn't offer a safe haven as far as refusing and keeping your job.

I've never been in a hospital that you receive report THEN clock in. We always clock in first.

[chevyv, BSN, RN]

Yes, I agree clocking in is what most people do first. In another thread here a nurse went through something similar and now checks the assignment before she clocks in. When I worked in LTC, the assignment was out on a desk by the time clock. That way everyone knew their assignment before they clocked. I was a cna at the time so I never understood why it was out. It was union and was part of the contract, so they must have had some issues at some point in time.