Our most recent PEDS patient, one year old, had back to back seizures and because we are a small facility, he was transferred to a children's hospital once he was stabilized. I'm trying to find out the legal way to handle this situation and whether we have the right to refuse to care for these PEDS patients, at least until we are sufficiently trained. I am not only concerned from a liability standpoint for myself, but extremely concerned for these patients who have nurses with little experience caring for them and even new grad nurses with NO experience with children beyond their college training.

Dear Can I Refuse an Assignment, This is serious. Pediatric patients are not little adults and require specialized skills and knowledge. The bottom line is that you can refuse an unsafe assignment and you can also lose your job by doing so. Here are a couple of things to consider. Your Responsibility You have a professional right and obligation to refuse any patient assignment that harms the patient or yourself. Lack of training is a legitimate reason to refuse a patient assignment. The Patient Safety: Rights of Registered Nurses When Considering a Patient Assignment is clear. However, neither the ANA, Georgia BON, nor the Georgia Nurse Practice Act has jurisdiction over your employer and cannot protect your job. While the Georgia BON cannot intervene between you and your employer, it could remove your license if you are negligent and cause harm. The Hospital's Responsibility Providing adequate staffing is the responsibility of the employer, not the staff. However, there may be situations where a facility is unable to provide the necessary level of care due to staffing or resource limitations. In such cases, it's crucial to follow established protocols and procedures to ensure patient safety and facilitate appropriate transfers to more specialized facilities. Ask to see the protocol in such situations. Regulatory Bodies The Georgia Department of Community Health Division licenses hospitals that receive Medicare/Medicaid reimbursement. The Joint Commission accredits hospitals. A facility could get in trouble during an accreditation survey with either regulatory body if an astute surveyor asked to see how patient care assignments are made (should be competency-based). Unfortunately, sometimes it takes an adverse event or complaint to prompt a state investigation. If the facility were at fault, it would have to submit a corrective plan of action to include sufficient orientation/training. Your Strategy Georgia is an at-will employer, meaning you can be terminated without cause. You can lose your job by doing the right thing (not taking an unsafe assignment). Here are some considerations: Preemptive: Make an appointment with your supervisor. What are the requirements for caring for peds patients? Is there a policy or a competency checklist? Are PALS required? An orientation? This puts her on alert and may prompt needed training. Once you accept an assignment, the patient is your responsibility until you are relieved of duty. Never refuse an assignment after you have accepted it (received report). If you refuse an assignment, do it before taking report (otherwise, it's considered abandonment). Refusal. At the point of being sent to Peds or given a Peds patient, "I am sorry, I am not safe caring for this patient as I do not have the competencies. I do not want to put my license, this facility, or this patient at risk. Is there another assignment I can take for which I've been trained?" Before refusing, consider if there are any ethical concerns. As a simplified example, if there were only 2 nurses available to take the patient- you and a brand-new grad-then you are the best alternative until the patient can be transferred. The important thing is that you think through the decision critically and that you're able to articulate your rationale, with patient safety as the driving concern. Sometimes the Staffing Coordinator or House Sup will not put forth the effort to find a qualified RN if a float readily agrees. Personally, I would expect the RN manager of a Peds unit to take patients before assigning an unstable patient to a float. Note: If yours is a critical access hospital, different rules apply. Good luck; please let us know how it goes.

Can I Refuse an Assignment?

Dear Nurse Beth Advice Column - The following letter submitted anonymously in search for answers. Join the conversation! Nurses Nurse Beth Nursing Q/A

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