Can nurses legally "refuse" to take a new admit?

[Kashia]

Can a nurse legally refuse to take a new admit when already have heavy patient load

and you know you will not be able to properly take care or even admit patient without

neglecting other patients?

I did this yesterday and had four managers having a fit!! One told me to leave if I did not take patient.

One called my agency and complained about me.

Would they rather I accept a patient and give sub standard care to existing patients in order to admit new one?

California, but there may be federal guidelines.

Concerning LTC ratios.

[steelydanfan]

Many replies to this thread have referrred to the idea that refusing an unsafe assignment is the right thing to do, however doing so might cost them thier jobs.

Have we ALL lost our minds?

Are nurse so scared for thier jobs that we will put pt's at risk to keep them?

I have been in nursing for 30+ years, and I have witnessed the slippery slope we have travelled, from patient ratios to what drugs can be given in tele vs. ICU, to who can draw blood from art lines. I am saying now, that if nurse don 't push back now, your degree won't be worth spit in 5 years. Your pt. techs WILL be doing assessments for $20.00/hr if you don't fight back.

[RNMLIS]

I was very vocal about many issues in the LTC facility.

I did get some of the nurses to stop punching out and returning to finish their jobs as ordered by the DON

Most of what I said fell on deaf ears

Each overworked and stressed nurse had their own issues

In a small LTC facility - where does one go to stand up for - To push back...

I am no longer nursing r/t disability (temp) but I will not return to LTC industry and yes I experienced insanity when I worked at that place and am still reeling from the

crazy making in that place - personal abuses nurses suffered abuses the residents suffered as a new nurse what went on in LTC went way beyond "first year in nursing vs what was learned in nursing school"

I think understaffing and poliicies of divide in conqueur threats and misinformation and others were useful tool for nursing management in increasing tensions and lack of trust with in the staff

the aides hasd a union the RNs did not

I always wonderd about that...

So where do I PUSH

[SFRN]

Yes, you have the legal right to refuse. It is also the professional and ethical thing to do. They shouldn't be threatening or bullying you to comply but I'm not surprised. Many times by bullying and threatening the nurse will accept because they become fearful of their job. If you can't handle another patient stand firm. They will either have to take the patient, get someone else to do so, call an agency or hopefully hire more staff when nurses learn to advocate better for themselves.

Also, taking the patient and signing a form doesn't excuse you from any liability. If anything happens to that patient under your care you are still liable, can still be sued, and your license is still at risk. First thing the opposing attorney will ask is, "Why did you accept the patient knowing you couldn't handle them?" It's a good question and your employer will not back you. Look out for yourself and your patients.

YES the ADO form DOES protect you!! If you have refused the assigment and OBJECTED then the supervisor and witnesses sign the form essentially you are saying this assignment is UNSAFE and this form protects you because you were given an assignment despite refusing the assignment. I am not sure if all places have the form. Here in California every hospital (all have been union) that I have worked in have had the form. And should you be called to court and the plantiff attorney asks why such and such happened, this form proves that you 1.) Refused the assignment and the supervising nurse/s knew of the objection and 2.) You had no choice in the matter and were assigned the patient. I HAVE NEVER seen or heard of a nurse that wanted to submit the ADO and still receive a patient--HINT, HINT. I once wanted to submit the ADO after refusing another patient due to the fact that I had a patient on multiple pressor gtts, CRRT, tubed, etc. and guess what? They found another nurse for that patient.

[makes needs known]

And most LTC have a certain amount of time (usually 24-72 hours) to do the assessment and other paperwork to admit a resident. You have to have your orders to the pharmacy, and do the MAR, but you usually have more time to complete the other stuff.

We are LTC and receive most of our admissions on 3-11 and we are expected to get most of the admission done ourselves on that 3-11 shift. That means in less than 8 hrs. Call DR. to clear med list, order meds from pharmacy, write MARS, send memos to different departments, order supplies, check skin and physical condition, and make them comfortable and reassure them. These are only some of the things that need to be done. We usually get 3 admissions, and we have 2 nurses and 35 other patients. We can not refuse patients.

[tencat]

The OP indicates they are in long term care. The forms mentioned above do not exist in our enviornment.

In LTC, I have never seen the floor nurse be able to refuse an admission. If the floor nurse is truly that overwhelmed that they can't handle it then someone needs to pitch in and help out (whether if from another unit or from nsg management).

The reality in LTC is the whole system revolves around money. Like any business in the world, money must come in or the lights can't stay on, payroll can't be met etc. The money comes in when we admit new residents. If we start telling local hospitals that we can't take "so and so today, we are just to busy" then they send the resident to another facility. If we do that one too many times, the hospital just quits calling with new admission referrals.

Um....really. Do you work on the floor? Somehow I doubt it. If you cannot safely and competently care for a patient, you have no business taking him/her just because you're afraid that referrals will dry up. If a company gives good, competent care, reputation works well for referrals, too......I surely wouldn't want my loved one in a facility that's more concerned about money than giving good care...and I've said as much to patients who want information about different facilities in my area. If you take too many patients, and they get substandard care, that is damaging to your new referrals as well.....

[highlandlass1592, BSN, RN]

Batman 25 is not correct. Yes, you have the right, and the legal responsibility to refuse an assignment that you know as a professional nurse to be unsafe. The ADO form is your legal recourse to state your objection. Once you have signed and submitted that form, it is up to your supervisor to address the situation. Your signature on that form, and possibly your co-workers (I hope you also involved them as well) is your legal protection against future lawsuits involving nursing malpractice committed by yourself. If you do NOT submit this form in the face of state mandated ratios the state board of nursing will come down on you severely.

That is NOT true in all states. You must be familiar with your state's practice act. In no way does a safe harbor form save you from lawsuits or liability. It is a tool to document your assignment with objection. Unfortunately, it is not a legal document in most states. Nurses have still been sued when utilizing.

[highlandlass1592, BSN, RN]

YES the ADO form DOES protect you!! If you have refused the assigment and OBJECTED then the supervisor and witnesses sign the form essentially you are saying this assignment is UNSAFE and this form protects you because you were given an assignment despite refusing the assignment. I am not sure if all places have the form. Here in California every hospital (all have been union) that I have worked in have had the form. And should you be called to court and the plantiff attorney asks why such and such happened, this form proves that you 1.) Refused the assignment and the supervising nurse/s knew of the objection and 2.) You had no choice in the matter and were assigned the patient. I HAVE NEVER seen or heard of a nurse that wanted to submit the ADO and still receive a patient--HINT, HINT. I once wanted to submit the ADO after refusing another patient due to the fact that I had a patient on multiple pressor gtts, CRRT, tubed, etc. and guess what? They found another nurse for that patient.

Really? this single solitary form offers so much protection? What piece of legislation guarantees that-> you should cite it. Also, I've worked in CA as a traveler, when I perused the State BON site, I recall no such guaranteed protection. Again, if you think this is "gospel" you need to cite the legislation to prove it.

[Batman25]

That form DOES NOT protect you from liability, lawsuits or from losing your license. This is a fallacy that many nurses believe. They feel that by signing the form the onus is completely off of them. It isn't. Can it help? Of course but it is not a freebie in any way, shape or form. This form leads many nurses into a false sense of security.

I urge all of you not to take my word it doesn't protect you or the word of others saying it will protect you. Call your own BON. Ask for something in writing about this situation. Ask if there is a guarantee that should you sign this form your license will be 100% safe, you won't be sued, you won't be found liable in a court of law, etc. They won't be able to guarantee that because no such guarantee exists. I beg all of you to protect yourselves and your license. Research this so you can make a better informed decision.

[Nascar nurse, ASN, RN]

Um....really. Do you work on the floor? Somehow I doubt it. If you cannot safely and competently care for a patient, you have no business taking him/her just because you're afraid that referrals will dry up. If a company gives good, competent care, reputation works well for referrals, too......I surely wouldn't want my loved one in a facility that's more concerned about money than giving good care...and I've said as much to patients who want information about different facilities in my area. If you take too many patients, and they get substandard care, that is damaging to your new referrals as well.....

I am in management, but I do work the floor as well. When we get slammed with admissions, I am right down there doing my share to help them.

Are you in management? Somehow I doubt it. I spent 10 years on the floor and I have spent 10 years in management (in which I regularly do patient care and am out on the floor!). I completely understand both sides of the fence. I also agree with you about substandard care & the damage to referrals from substandard care, but I also know money counts and counts a lot whether the floor nurses want to understand that or not. We will take the admissions as they come and there should be a reasonable plan in place to get the work done.

To some of the other posters... There is no state mandated ratios in LTC. There are no forms as you describe - at least in my state. Many states are an "at will" state & you will do the job as assigned or find another.

[monicanurse]

When Im in a situation like this, I always ask myself....what will happen to my license if I take this patient on and the rest of my patients? what is the chance of me doing something that will put my care at jeorpardy of losing my licence? Im not surprised they were mad at you. Its a shame that you get this kind of treatment when they are nurses themselves and should understand this. They should be commending you for wanting to be a safe nurse. Did they not think of that? In this case, it is what the masses do that can put you in trouble. I applaud you for standing up to your conviction. IT takes bravery to say no....funny thing is ....you have every right to! There is so much unsafe assignments that nurses accept these days...it boggles my mind. I have had better responses when Ive stood up for myself. That, plus alot more respect from fellow nurses. Some have been irritated....but so what??? They wont be defending you the day you lose your license.

[kcochrane]

Um....really. Do you work on the floor? Somehow I doubt it. If you cannot safely and competently care for a patient, you have no business taking him/her just because you're afraid that referrals will dry up. If a company gives good, competent care, reputation works well for referrals, too......I surely wouldn't want my loved one in a facility that's more concerned about money than giving good care...and I've said as much to patients who want information about different facilities in my area. If you take too many patients, and they get substandard care, that is damaging to your new referrals as well.....

I agree, around this area, there are more referrals then beds. Not only that, it is sometimes possible for the hospital to delay the transfer for a shift/day - as long as they aren't getting pushed to open a room.

[steelydanfan]

The Ca. BON will specifically look to see if an ADO was filed in any case involving unsafe staffing, and if the nurse involved did not adhere to state mandated ratios, or try to, (thus filing an ADO), she is out of luck. When you file a ADO in California, and do not have relief, you are SHIELDED by state law. No ifs, ands, or buts.

If you would like to enjoy such protections, contact CNA to find out how to organize the nurses in your state to advocate for safe patient care ratios.