Accept or refuse an assignment

Nurses General Nursing

Published

I

Specializes in Community Health Nurse.

You've got it Squirrel! ;) That's exactly right! :)

Squirrel, you are a professional registered nurse no matter where in the hospital you are floated to, no matter what the supervisors "call you". Legally, an RN is an RN is an RN, and in a court of law, that is how you will be viewed and judged. Have a great upcoming week, Squirrel! Be strong and be encouraged! :)

Just because someone is in a position of authority over you does NOT make everything they say "sound judgement" for you to follow.

Up Vote Up Vote ×
Specializes in ICU's,TELE,MED- SURG.

Ok, I am reading everyone's post and I have a better idea.

I would speak to the Administrator and th CNO, immediately. I woul tell them that I feel uncomfortable with this and that I spoke to my Nurse Manager at length, first. I would also talk with the Risk Manager and tell her what is happening here.

If there is no staff coming in to relieve you, you must chart something defensive that will state that staffing is short and that you had for example asked for a sitter for this patient because he needs to be a 1:1 for his own safety. I would then state in my notes who refused you.

In another situion, I would state that Nurse Manager and perhaps CNO not able to supply sufficient staffing and I would state what the patient's witnessed behavior is upon as frequent rounds as can be made and state that x-amount patients assigned to you for the day.

What I am saying is to defend yourself with something that will stand up for you in court. To state this is a legally binding patient record. It IS the hospital's fault if something occurs since you can not be in 10 rooms simultaneously.

I would very much like to ask the responders what they could say that would help you out further and also, I am so disturbed that Nurses are so over the barrel! Go start to protect your back some. State what the conditions are and if something should arise, it is well documented. This will all stop in time when they can not defend their unsafe staffing practices and drive good Nurses out of the profession because of fear of license.

Up Vote Up Vote ×
Specializes in Community Health Nurse.

As long as nurses gripe, but continue to work in the conditions they are griping about, management only "sees" that nurses are willing to continue in those conditions "in spite of" their griping about it, and so the unsafe practices continue.

The ONLY way the message regarding nurses practicing in unsafe conditions is going to have a massive impact on management is when nurses STOP griping, and START acting by NOT accepting those unsafe assignments. ACTIONS ALWAYS SPEAK LOUDER THAN ANY WORDS ONE CAN SPEAK! ;)

Up Vote Up Vote ×
Specializes in CV-ICU.

Squirrel, be REAL careful here! You need to follow YOUR states' Nurse Practice Act; and New Mexico is quite firm in that abandoning a patient is unprofessional conduct and violates your Nurse Practice Act (NPA). According to your New Mexico NPA, each case will be examined individually.

Here is a site for those of you who want to review what your states may say about patient abandonment, accepting assignments, etc. This is at the National Council of State Boards of Nursing site.

http://www.ncsbn.org/public/news/state_abandonment.htm

North Carolina is very specific about short staffing and accepting assignments:

When a licensed nurse comes on duty to find that the mix or number of staff is not adequate to meet the nursing care needs of the patients, what should he/she do? Before accepting the assignment, the nurse should contact the immediate supervisor to report the unsafe situation and ask for assistance in care planning based on the available resources within the agency. Such assistance may include:

> acquiring more staff

> negotiating "periodic" assistance from the immediate supervisor for delivery of specific care activities

> prioritizing the care activities that will be delivered during that shift or tour of duty; and

> notifying other health care providers regarding the limitations in providing optimal care during periods of understaffing.

Although it may be impossible to deliver the type of nursing care that would be delivered with a full complement of staff, there are certain activities that must be carried out regardless of staffing. These activities include:

> accurately administering medications and implementing critical medical treatment regimens;

> protecting clients at risk from harming themselves;

> monitoring client's response to medical and nursing interventions consistent with each client's health care problem;

> notifying the physician of deteriorating or unexpected change in a client's status;

and

> accurately documenting the care delivered to the clients.

Renee, if you practice in North Carolina and a number of other states, you have accepted the assignment WHEN YOU GOT REPORT! Be VERY careful giving advice unless you have checked the Nurse Practice Acts in various states. I am a firm believer that each nurse should have her own copy of their Nuurse Practice Act and should KNOW what is in it! You can notify the supervisor, etc, BUT the assignment you have IS YOUR RESPONSIBILITY until someone relieves you of either part or all of it.

Up Vote Up Vote ×
Specializes in CV-ICU.

Okay, I goofed! This advice is what I was giving to Renee and Squirrel after only reading the first page of this thread. (I'm watching the Olympics instead of concentrating on the BB here) ;)

LadyNASDAQ, some legagl advice is that even though you chart that the hospital is short staffed, that will NOT protect you if something happens to your patient!

Up Vote Up Vote ×
Specializes in CV-ICU.

BTW, I agree with Renee when she says DO NOT ACCEPT UNSAFE ASSIGNMENTS!!!!

Up Vote Up Vote ×

Very interesting comments from everyone in this forum!

Sometimes it seems liked we're 'danged if we do and danged if we don't' in regards to the marginally unsafe practice environments of today. Acuity staffing is out the window. Used to be we had a free floating charge and/or extra nurse in ICU to help out, admit, teach/mentor, go to codes, bed control, etc. Not any more! We're extremely fortunate if we even have an 'on call' nurse now (everyone is exhausted..who wants to take call?) and we usually start our shift already stretched to or past capacity census-wise and staff-wise. . I get so tired of supervisors saying "I can't staff you for what might happen" as an excuse to never give us any breathing room. It's all about money now...I get so discouraged sometimes. And so tired from the endless fight for proper staffing.

The floating issue is a big one as well. We allow ourselves to be manipulated into floating without considering the risk we take. I recall a night as an agency nurse I showed up for an ICU shift. Here's what transpired; The supervisor says " Oh, ICU doesn't need you, would you mind working newborn nursery with another RN?"

Me: "Healthy newborns? Is the other RN a nursery nurse and is this OK with her?"

Supe: "You are working in place of an aide that didn't show. We would really appreciate it. Easy job, rocking and feeding well babies"

Me "Well, OK I guess...."

I went to the unit to find a frazzled RN who needed a NICU nurse, not a well baby nurse aide.! (It was a combined unit). I called the supe down and we discussed this---I was not qualified in any way to work NICU, I would have to refuse. Both nurses cried, they got the NM on the phone to plead with me to stay, no other help, yada yada. I got suckered in plain and simple!. It turned out OK, I did my best to help out, enjoyed the premies, learned a lot... but now that I'm older and wiser I think of how I could have been hung out to dry if anything went wrong that night...(another 'nightmare in nurseland'...LOL!)

Keep upall the good talkin'--we learn so much from each other! And Happy Valentine's Day--hope your sweeties do something extra special for all of you!

Up Vote Up Vote ×

I

Up Vote Up Vote ×

Renee:

Thank you for all your help!

Jenny P:

Thank you for that reference! That is a very informative website regarding how different states view abandonment. Some states are very specific and have much to say while others do not even define patient abandonment. For my state of New Mexico, it states: "Each abandonment complaint against a licensee has its own unique situation and the Board determines each accordingly." So I guess this means there is no specific definition of abandonment in my state, and will be evaluated on a case by case basis.

Mattsmom81:

What a horrible experience! Your example reaffirms the warning Renee gave to me regarding being an RN and working as a nursing assistant. I can see the floor saying to me "Oh, we need you to pass meds or do treatments ect." Like I said before, you give an inch and they take a mile.

Up Vote Up Vote ×

I know different states have different laws but unsafe is just that. I agree nurses need to stop accepting these unsafe assignments, really it undermines what we are trying to do. When I come to work I understand we get get slammed just as long as we get some help even if that means the manager comes in and take an assignment is fine. But it is getting ridiculous. True each case of abandoment is different and there are circumstances. I had an administrator threaten to report me because I quit the next following day when I was left with 1 CNA with 50 patients. I laughed! No one can tell me to jepordize nothing. I even had a nurse tell me ooh you must float or lose your job! Again, I lauged no one can make you do anything you don't want to do. So why as a whole we can't come together and realize our license is very important we sacrifice a lot to have why lose it over some bull sh** like working for unsafe facilities!

Up Vote Up Vote ×
Specializes in CV-ICU.

Teshiee, you are so right when you said "why as a whole we can't come together and realize our license is very important we sacrifice a lot to have why lose it over some bull sh** like working for unsafe facilities"

I don't know about you, but my license is the only way I can make a living. I refuse to risk it over some cheap cost and staff cutting hospital!

Up Vote Up Vote ×

I just got fired for refusing an assignment. According to the nurse manager is automatic termination if you refuse an assignment. Check your policies but protect your license first.

Up Vote Up Vote ×
+ Add a Comment