Ethical or legal?

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    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
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  3. 19 Comments so far...

  4. 3
    I know you are specifically asking for RN's but it has been my experience from talking to BONs that it IS legal to refuse an assignment for ANY reason. Until the RN actually accepts the assignment many BONs consider it an employment issue and not under their purview.

    I think the ethics of the refusal depend on the reason why the nurse is refusing.
    canoehead, herring_RN, and chevyv like this.
  5. 2
    Quote from 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
    In the state's that I am licensed in, it is an RN's duty to decline an assignment they do no have the skill or training for.

    As for patient load, that's another thing. Wish there was a way to legally decline that.
    canoehead and chevyv like this.
  6. 2
    Quote from loricatus
    In the state's that I am licensed in, it is an RN's duty to decline an assignment they do no have the skill or training for.

    As for patient load, that's another thing. Wish there was a way to legally decline that.
    Check with your BON but I believe that comes under safety, too. Decline away.
    chevyv and canoehead like this.
  7. 2
    Quote from Vito Andolini
    Check with your BON but I believe that comes under safety, too. Decline away.
    That's right. I don't have the SKILLS or the TRAINING to take care of 4 ICU patients (or 15 med/surg, or whatever). So there you go.
    Blee O'Myacin and chevyv like this.
  8. 1
    Quote from Vito Andolini
    Check with your BON but I believe that comes under safety, too. Decline away.
    Correct. It is legal and within your rights to decline an assignment where you feel the patient load is unsafe.
    chevyv likes this.
  9. 2
    Quote from elizabells
    That's right. I don't have the SKILLS or the TRAINING to take care of 4 ICU patients (or 15 med/surg, or whatever). So there you go.
    Good way to look at that. I wish in the ER that could be done. The patient's just show up in your district and you have to deal with it. There is no option to get report and no one to decline the patient to. If one of the patient's code, the other's can be left unattended; yet, are technically still your responsibility, no excuses (I have been told).

    In Texas, there is an option called 'safe harbor' that can be used when the patient load is unsafe. It only allows you to keep your license if a patient comes to harm from the particular unsafe assignment; but, it does nothing to eliminate the unsafe assignment. In fact, if you file the safe harbor form with the BON, you will lose your job (common knowledge).

    The only way to keep staffing at a safe level is to have cooperative managment who understands patient safety issues. I would love to find such a place. PS: I am not talking about California, as the only state to have staffing guidelines.
    Blee O'Myacin and chevyv like this.
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    this lpn had worked ob/gyn as an cna and on her first job they thought that she was an experienced nuse and assigned her 6 labor patients two were pre eclampic [sp] she refused the assignment d/t lack of experience and they fired her on the spot
    really a rough start to a career but she bounced back and got another job within a few days
    lpnflorida and chevyv like this.
  11. 1
    It is also entirely possible that one's ability to handle loads and acuity can fluctuate based on one's personal going-ons from day to day. Even though I am a nursing student, I would much rather be unjustly terminated from employment than unnecessarily risk my license or a patient's well-being.
    chevyv likes this.
  12. 0
    Thank you everyone for your input. I'm attempting to find and research an ethical dilemma that is different from the ones that most of my classmates will be reporting on. I so wanted to do something different than euthanasia or taking a stand on letting infants born before 23 weeks die or going all out to save them knowing they may need permanent care......that sort of the more common well known topics that the other 20 people in my class are going for. I'll keep working on it! Thanks again all


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