Can You Refuse A Patient Assignment

Had An Incident Last Week Where I Work, Small Hospital With Nursing Home Included In Which A Man Well Known To This Facilty Came In Seeking Psychiatric Help. (we Do Not Have The Capacity Or Doctors To Care For This Specialty). He Had Homicidal Ideations In The Er, Hx Of Being Bipolar, Hopped On Every Known Drug But Heroin. Stated In Er He Would Kill Everyone There In Er If Cops Were To Become Involved. So As The Story Goes He Was Admitted To The Floor Dx Recurrent Headache(which Obvously Had Since He Was So Jacked On Drugs) And Homicidial Ideations To The General Med/surg Floor For A 1:1.
Many Other Things Happened To Long To Write But What I Am Wondering Is If I Could Under The Nursing Practice Act Refused To Accept This Patient Under My Care With Such Statements And With The Potential To Harm Everyone That May Have Been In That Hospital At The Given Time?
Your Advise Would Be Greatly Appreciated.

My first instinct on reading this is that you could certainly try to refuse the assignment but i doubt you would get very far. As a med-Surg nurse you should be able to deal with a patient with a recurrent headache. Also you should have had at least some pysch training (it is mandated that you ask about thoughts of suicide or self-harm here at our hospital). So essentially you are treating his pain, monitoring his detox, and assessing for underlying symptoms that could cause headache - stroke, meningitis, etc.

If such a patient had been admitted at my facility I would have had a quick talk at the start with him - essentially emphasizing the fact that if he threatened anyone here I would call the police. If he threatened to hurt anyone here because I call the police i will restrain him and then call the police. You can't let crazy dictate your treatment or limit your options - it never works out.

Finally I am betting, since my ER has tried this a time or two, that since no beds were available in surrounding psych units that the ER did not want to be stuck with this patient they came up with a handy medical diagnosis to get him admitted - I have had them say we want to admit with hypokalemia (K is 3.2) simply because they don't want to watch him themselves.

Hope this helps

Pat

I'm sorry but "have a quick talk at the start with him" is not the answer. Having worked with this type of patient, I know that reasoning doesn't work....they are mentally ill and have lost the power of reason.

Therefore, it it mandatory that the police be called.

And yes, the nurse has the right to refuse this patient based on what the law terms as a "reasonable expectation" that violence will occur and of course, lack of training in the area of psychiatric nursing.

The correct action in the ER would have been to call law enforcement and I'm at a loss as to why this wasn't done.