Under what circumstances can a nurse LEGALLY refuse an assignment? - page 2

For instance- a nurse is reporting to work in a hospital. She feels her pt load is too large for her to be able to provide safe care- OR- a nurse is assigned to an area where she does not feel... Read More

  1. by   Havin' A Party!
    Quote from Hellllllo Nurse
    ... med-surg... nurses were routinely assigned 13-15 pts each, no CNA, no unit clerk...
    Wow!!!

    Who's attracted to that place??? What's the hourly rate??? $100 / hr???
  2. by   CSLee3
    You mentioned Texas, well in this fine state we have "Safe Harbor" laws. If you claim "Safe Harbor" all wheels stop turning and administration needs to be called and THEY are the only ones who can resolve it, not the charge nurse. (house superviosr would be considered admin)
    Under this law you can refuse treatment or assignment if you feel you cannot safely complete the task or a danger exists, etc. There is reporting to the board involved here so be careful. As much as we all hate Jhaco and their policies, they set the standards in courts of laws. There is no way they can say you can care for 13-15 patients and do it safely with no help from other staff.
    "Keep up the fight"............
  3. by   CherryRN
    Never protect your JOB.

    Always protect your LICENSE.

    You can get another job. You can't get another license.
  4. by   mattsmom81
    Nurses shouldn't guess or speculate about such things...get a copy of your very own Nurse Practice Act and be sure. If its not clear, write your BON and specifically ask.

    Personally I feel its my duty to refuse new admissions if my unit is not staffed to handle them; and I HAVE refused to accept a grossly unsafe assignment. Like mentioned, we may lose our job but will keep a license. (Its happened to me twice and I quit both timess...who wants to work for someone who doesn't care about staffing safely?)

    Hospitals prefer 'yes men' on their staff but we send a strong message when we say 'no', and we all must find our limit regarding what we will take responsibility for and what we won't. I know some nurses who cower and think they have no right to protest or refuse unsafe assignments; but this may backfire on them someday; and blind acceptance simply encourages the facility to do it again and again...since the nurses will 'take it'.

    My nurse attorney tells me in Texas if we file specific assignment under protest letters with our management team, the hospital assumes some responsibility if the nurse wishes to 'do her best' in the unsafe situation. But the way today's hospitals operate, the NURSE may well end up under the microscope here ...and end up a scapegoat.

    Cynic that I am; I don't expect a facility to back me up if push comes to shove. They will happily sacrifice a nurse to cover their arse; I've seen it happen.

    Its an individual decision. I don't judge a nurse who says no, in fact I don't think nurses say 'no' nearly enough. We have walked the safety line so long that varying degrees of inadequate staffing is business as usual in many places.
  5. by   Euskadi1946
    Quote from LarryG
    Seems a bit exaggerated.

    If the assignment is totally unrealistic, the facility will certainly encounter several prob's they'd rather not have to deal with.

    As stated above, a lot of this is situational -- all depends on the specific particulars.
    About a year after I had graduated from nursing school I was working the 3-11 shift at a long term care facility. On my shift I had 1 LPN and 1 CNA for 28 residents. Luckily I finished my assignment on time and was waitng for an LPN, who was working at the Jail, to come and relieve me. 11:30PM, no LPN, 12:30 AM no LPN so I called the Nurse Manager about the situation and was very upset that I had called her. I told her that I had been very busy, my shift was over and I wanted to go home but could not leave until I got some relief, and the LPN who was scheduled to come in at 11:00 PM hadn't shown up yet. We had called her at the Jail and they stated she had left at 10:30PM, called her at home, no answer. The manager wanted me to start calling around to find a relief so I did. Still no sign of the LPN and no body else wanted to come in. Called the Manager 1:00AM and told her what the situation was. Still she refused to come in. Finally at 3:00 AM the LPN comes waltzing in stating that she had gone out with friends after work and had lost track of the time. Told how very thoughtful of her not to call and let us know!!! (This was in Reno, Nevada, a 24 hour town). Gave her report, put down 4 hours over time, filled out an incident report, took copies of it and put the original in the Manager's office. The next morning I get a call from the Manager to come in to her office, she want's to talk to me. This was my day off of course so I went in. She told me that there was no way in the world she would pay me the overtime because I was a salaried employee to please never call her in the middle of the night again. I proceeded to tell her that I would take a copy of the incident report, a copy of the staffing grid, with a copy of my time card to the Labor Board and the BON and would notify every TV Station within a 100 miles regarding the horrible working conditions and how she treated her nursing staff. She did cut me my check with the time and a half and two weeks severance pay and told me never to come back again. I said my pleasure. I still sent a copy of the incident and the staffing grid to the BON. The last I heard, that LPN who was supposed to relieved me is still working there. I lost a lousy job but kept my license and my integrity intact because I refused to abandon my pts.
  6. by   wjf00
    Quote from CeCiRN
    About a year after I had graduated from nursing school I was working the 3-11 shift at a long term care facility. On my shift I had 1 LPN and 1 CNA for 28 residents. Luckily I finished my assignment on time and was waitng for an LPN, who was working at the Jail, to come and relieve me. 11:30PM, no LPN, 12:30 AM no LPN so I called the Nurse Manager about the situation and was very upset that I had called her. I told her that I had been very busy, my shift was over and I wanted to go home but could not leave until I got some relief, and the LPN who was scheduled to come in at 11:00 PM hadn't shown up yet. We had called her at the Jail and they stated she had left at 10:30PM, called her at home, no answer. The manager wanted me to start calling around to find a relief so I did. Still no sign of the LPN and no body else wanted to come in. Called the Manager 1:00AM and told her what the situation was. Still she refused to come in. Finally at 3:00 AM the LPN comes waltzing in stating that she had gone out with friends after work and had lost track of the time. Told how very thoughtful of her not to call and let us know!!! (This was in Reno, Nevada, a 24 hour town). Gave her report, put down 4 hours over time, filled out an incident report, took copies of it and put the original in the Manager's office. The next morning I get a call from the Manager to come in to her office, she want's to talk to me. This was my day off of course so I went in. She told me that there was no way in the world she would pay me the overtime because I was a salaried employee to please never call her in the middle of the night again. I proceeded to tell her that I would take a copy of the incident report, a copy of the staffing grid, with a copy of my time card to the Labor Board and the BON and would notify every TV Station within a 100 miles regarding the horrible working conditions and how she treated her nursing staff. She did cut me my check with the time and a half and two weeks severance pay and told me never to come back again. I said my pleasure. I still sent a copy of the incident and the staffing grid to the BON. The last I heard, that LPN who was supposed to relieved me is still working there. I lost a lousy job but kept my license and my integrity intact because I refused to abandon my pts.
    Outstanding! If more nurses act as you have, working conditions will improve for all of us.
  7. by   Hellllllo Nurse
    CeCiRN,

    You did the right thing.
    Great post and advice.
  8. by   Hellllllo Nurse
    Quote from LarryG
    Wow!!!

    Who's attracted to that place??? What's the hourly rate??? $100 / hr???

    My pay was $19.00/hr.
    Of course, I was told when I was hired that staffing was one nurse to six pts.The place even runs ads on TV trying to recruit nurses, in which they claim their ratio is 1:6.
    When I was trying to leave the place, I called another local hosptial which was running an ad for nurses in the paper. This hospital came right out and told me on the phone that their nurse to pt ratio on med/surg was 1:13.

    There was a unit clerk and CNA on the unit where I worked, but they were instructed by the charge nurse not to assist me or my pts in any way. A co-worker overheard this converstation and informed me. Of course, she said she would deny having heard anything if I filed a complaint or went to mgmt in any way.
    This charge nurse actually functioned more as an asst. to the NM. He had been recruited from The Phillipines by the hospital in the 1980s.

    One noc, the evil charge nurse berated me for assessing my pts, saying "You don't have time for that." He advised me to "copy last shift's assessments."
    This nurse had a thing against caucasions and women.
    He refused to help me with my first ever transfusion. I was given 3 to do on 3 pts, simultaneously. When I asked other staff to asisst me (Remember I'd never given a transfusion before) they sheepishly told me that the charge nurse had told them that I needed to prove myself to him, and that they were not to help me.
    When I went to my NM, I was told I was the first person who'd ever complained about him. She didn't believe me.
    However, I learned that almost every white nurse who'd been hired in the last few years had left. Some Canadian nurses had broken their contracts and forfeited bonuses to leave. Another "white" nurse who quit just before I did, was recruited from Minnesota and paid $35./hr per diem rate for full time. She was so desperate to leave, she quit without another job and as the sole bread-winner for her family. She now works for a medical malpractice attny helping pts to sue docs and hospitals.

    I was the only "white" nurse left on the unit, on my shift. The unit was mostly male, as well, as this charge nurse preferred working with males.
    Any women working on the unit were usually very young, very passive and very pretty, as this nurse preferred those traits in female nurses. He basically had the NM totally fooled. She relied heavily on him. She made many of her decisions as boss based on this guy's word.
    I had never wittnessed such screwed up dynamics in my life.
    I was a new grad RN when I worked at this place. This was my first hospital job as a nurse.

    Mgmt assigned a special "staff theme" every month. The month I left, the theme was "respect for co-workers."

    When I've talked to other nurses about the things I saw and experienced at this hospital, they generally have a hard time beleiving me. A couple have even replied with statements such as "Come on. You're exagerating. That can't be true."
    I quit three years ago, but I'm still bothered by how awful my experience was. I guess you could say I'm haunted by it.
    Last edit by Hellllllo Nurse on Jul 6, '04
  9. by   kayleighac
    Okay I have a situation that I would like everyone's opinion on.
    I am an LVN in the state of CA. Today I had a patient refuse care from a CNA. We tried talking to her, and she would not change her mind, she requested to have a different CNA. So I used my best judgment and I decided to give this patient to a different CNA. The reason I chose the CNA that I chose was because she had the closest round to this particular patient. She works down the same hallway while all the rest of the CNA's are in different hallways in different parts of the facility. She has also worked with her in the past and knows this patient well and the patient likes her. The CNA that I tried assigning to her refused to accept the change. I was going to just switch patients...so that the two CNA's still have the same amount of patients. She still refused to accept the assignment change. Now, me being the charge nurse, I ultimately have the decision in the end on who gets what assignment. I did not appreciate the CNA arguing with me in the hallway refusing to take a patient. My RN supervisor and I decided to write her up because this is the second time this has happened with this CNA in a completely different situation.
    I think about it this way: She gets paid to be here and do this job. Patients can refuse care from a nurse but we cannot refuse care to a patient unless it's a special circumstance such as the patient threatening the staff, which doesnt happen to be the case here. She just doesnt want to take care of this patient because its not a part of her normal round, and she doesnt like it when a change is required, basically because its an inconvenience to her. Nothing is ever perfect, and when we do get special requests from patients, we have to try to work around them. If my RN supervisor gave me an assignment to do, I would not dream of refusing it unless I had very good reason to. I would never think of arguing with my boss or supervisor about work that they give me. This is what we get paid for. Does anyone agree with me???
  10. by   Mr Ian
    Quote from kayleighac
    Okay I have a situation that I would like everyone's opinion on.
    I am an LVN in the state of CA. Today I had a patient refuse care from a CNA. We tried talking to her, and she would not change her mind, she requested to have a different CNA. So I used my best judgment and I decided to give this patient to a different CNA. The CNA that I tried assigning to her refused to accept the change.
    Totally agree the CNA is out of line.

    However, it's worth checking in with the CNA to find her/his reasons for refusing - rather than assuming it's cos it's an unscheduled change.
    I'm thinking that perhaps she has a problem with the other CNA and, even tho it was the pt that requested a different CNA - why was that?

    One thing I know is good CNAs do not like to pick up other bad CNAs because that's like punishment for being a good CNA.
  11. by   Mr Ian
    Quote from Hellllllo Nurse
    When I've talked to other nurses about the things I saw and experienced at this hospital, they generally have a hard time beleiving me. A couple have even replied with statements such as "Come on. You're exagerating. That can't be true."
    Sounds more like the CN is a sociopath and rules by the rod.

    I'll cautiously comment on the cultural aspect - as there are still a lot of ethnic cultures where male domination exists. But I think from your description this guy is going beyond what is culturally explicable.

    Asking you to prove yourself on blood transfusions is beyond belief.

    If you were still there I'd offer you tips on how to get rid of him. As you're not - I'll simply say, you are out of that place now and nothing in your thinking seems odd to me at all. It was a wrong place.
  12. by   Straydandelion
    Quote from pnurseuwm
    So it's almost like a Catch-22 thing, huh? So you mean to say that if (for example) a nurse manager wants to "get rid of" a particular nurse, all they have to do is to create a situation (like giving the nurse 15 cases) in which the nurse MUST refuse to protect her license, but she will DEFINITELY be fired and out the nurse manager's hair who wanted her to leave in the beginning?
    Also, you say that jobs come and go, but being fired has GOT to look bad on a resume when you're searching for a new job!
    I actually had something similar happen once, either "work the assignment or leave" (I felt it was an unsafe assignment not going into too many specifics) ..I chose the latter, so officially wasn't "fired", but "quit"
  13. by   MickyB-RN
    <<She was so desperate to leave, she quit without another job and as the sole bread-winner for her family.>>

    This is the position I feel I am in, unsupported and unsafe. I am also the sole bread-winner for my family but I have no choice, I don't feel safe most evenings anymore. ugh

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