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Discussion

Assignment Refusal

Hi, I work in a 4 bed ICU. Some days I can have 2 pt's. with a CNA. They can be unstable with vasoactive gtts. and/or be intubated as well. I have just sucked it up for this assignment. Today I was with another nurse no CNA and two pt's. No problem with that. The other nurse said the supervisor told her we would be getting a 3 week (preemie, no less) old to rule out for sepsis. I have had no experience, competencies or orientation to take care of a pt. like this. I told the other nurse and she said neither did she. I decided to finish what I was doing (deciphering a page of orders while the doctor who wrote them was still available) and then speak to the supervisor. Well, within about 15 minutes (quicker than I've ever seen at this hospital) the ED was calling to give report. I told them I was refusing that pt. for the reasons stated above. Within 2 minutes the Nurse Manager comes in the ICU and says that the ER said I called THEM and told them that I was refusing and that I am not allowed to refuse an assignment without speaking to her or the supervisor. And besides the baby was just a med-surg pt. and they didn't have enough beds. I tried to explain to her that everything happened so fast I was trying to complete another task and we didn't expect the call for report so quickly. She wasn't listening. The other nurse took the pt. She was scared the whole time because this baby wasn't holding his sat's. When we looked at the orders the admit was for ICU. There were no corrections from med-surg status just the order for ICU. Anyway they transferred the pt. to a PICU at another hospital 5 hrs later. The other nurse later told me that our Unit Manager told her she is not allowed to refuse an assignment. There are no policies in place at this hospital to accept an assignment with reservations. What are your thoughts on this everyone?

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my thoughts are that if your facility does not have the capabilities to care for a patient, then the ed needs to transfer the patient to a facility that does have the capabilities to care for the patient.

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[color=#483d8b]do you have pals? did the other nurse? i bet the nurses in the ed do.

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[color=#483d8b]was there a problem in getting the receiving facility to accept the patient? was the patient deemed too unstable to transfer? did you have to do something to stabelize the infant before it could be transferred?

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[color=#483d8b]it is tough to pass judgement on the info you've given, but ......

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[color=#483d8b]i work prn in a small er. we have a 12 bed icu. we don't have a peds unit, either med-surg or picu. (we do, however, have a small nicu -- at least we used to).

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[color=#483d8b]if we get an infant through the er that needs to be admitted, it goes to one of the facilities in the area that does have pedi units. the infant stays in the ed until stabelized for transfer, an accepting facility is found, and transport comes to get the patient. all of the ed rns are required to have pals.

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[color=#483d8b]all of this doesn't usually take all that long, and the closest facility is minutes away. was the hospital that ended up taking the patient in the area, or was this a long-distance transfer?

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[color=#483d8b]my gut feeling, as both an er nurse and an (adult) icu nurse is that the baby should have stayed in the er, unless your icu is a designated pediatric unit (in which case you would probably be requred to have pals.)

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[color=#483d8b]i'm interested in hearing what their rationale was.

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