Can You Refuse A Patient Assignment

I, too, wonder why this client wasn't transferred to a psych facility under petition for involuntary commitment -- I've been a psych nurse for 20 years, and have never heard of a disposition like the one you describe.

Yes, you have the right to refuse a patient assignment if you truly believe that you are unable to provide safe care for the patient, either because of the workload or because you lack the skills/knowledge to provide for the patient's needs. However, were you really unable to provide safe care to him, or did you just not want that kind of patient on a med-surg floor? I agree it was an inappropriate admission, but I'm not sure you would be covered under your Nurse Practice Act if your rationale for refusal was that admitting him to the unit might put others in danger. Did anyone higher up than the staff nurses talk to the admitting doc about what other possibilities had been considered, and staff concerns about having that patient on the med-surg unit?

I agree that inappropriate admissions to your floor are a medical staff issue -- your hospital must (is required by CMS to) have a medical staff peer review process that could look at this situation and make a determination about whether the physician involved handled the situation appropriately. Nursing leadership at your hospital can take this situation to the medical staff and request a review.

I'm sure this man is not the only client who has ever presented to your ED with psych needs; what is your hospital's process (is there a process) for getting psych evaluations does and determining appropriate disposition? If there isn't one, there needs to be ... Either the hospital administration or the medical staff could/should develop such a policy (hint -- it would not involve admitting acute psych patients to a med-surg floor with a phony dx like "recurrent HAs" ... )

Thanks, for the responses. This patient was evaluated by a Crisis worker who further infuriated him and made a bad situation even worse. They tried to get the pt into numerous faciltities but was turned down or said they had no beds. The pt would have had a dual dx being bipolar and a drug addict and many facilities do not accept that type of patient according to the crisis worker. There is from what I have been told going to be a Root/Cause analysis done on this so this won't be the last thing I hear from this situation.
My point with accepting this pt was his homicidal ideations, anger, drug abuse and possibly harming himself, staff or pts/residents and then I would be responsible in some way for his actions, no security or police involvement in the hospital. To me just my opinion when some threatens to kill they should be taken to jail no matter what the threat and charged not putting innocent people in danger because the dr doesn't want trouble and was really trying to the pt help.
I had no trouble with the pt but the whole idea of the what could have and still can happen from such threats. Like I said before to many details to type but I want to know for future knowledge my rights under the nurse practice act and what legal ramifcation if any could have happened if staff or pts were injured because of his actions etc

I am curious what your supervisor has to say. What was his/her response at the time? What is his/her expection for the next them?

First, I will address duty by giving you a real case facts and ruling. A patient in a rural area presented to the local ER with chest tightness. The nurse triaged/assessed including vital signs. She informed the ER physician about the patient, his complaint and her assessment. He told her to send the patient to the other hospital 20 minutes away because they can better handle cardiac problems. The nurse emphasized she felt the patient should be seen. The physician refused to see the patient. The nurse informed the patient and family member and helped him back into their car for the drive to the next hospital. The patient died in route.

The court ruled:
1) The hospital is there for the community and thus has a duty to the people who go there for medical help.
2) Employees (e.g.; the nurse) have a duty to people who present for help in the emergency room by virtue of employment in the hospital.
3) The doctor was not an employee of the hospital.
4) Doctors do not have a duty to patients. They have the choice to decide which patients they will or will not accept.
5) The hospital and nurse were neglient in their duty to this patient.

In addition, to losing the civil law suit the Board of Nurse Examiners found the nurse neglient in her duties and revoked her nursing license.

Now I will address what you may not know related to patients expressing homocidal threats. A mental health warrant can be sought for such individuals. Whoever is in charge in the emergency room should know how this is done in your area. If they don't then he/she should find out. If they are too lazy to do it, then maybe you should to protect yourself.

Where I am this is done by the police department. Anyone can call the police and say Joe Doe is threatening to kill me. Most often it is a family member who calls the police and sayes: My son, Joe, is threatening to kill me. He is manic-depressive and takes street drugs. I think he needs to be evaluated because he is treatening to kill me. When the police come there is paperwork the caller has to complete to facilitate the mental health warrant with evaluation. The individual is kept in jail until placed in a psychiatric facility.

I have worked in PICU, psychiatric intensive care. We got patients from over 200 miles away because they did not have beds in the area they were picked up so no beds available makes me wonder. I have even moved lons of people a day earlier than plan to get such patients.

Good Luck!
Joy