can you refuse an assignment?

Jolie, BSN · Sep 26, 2006

I know of no state BON that would discipline an RN for refusing to accept what s/he believed to be an unsafe assignment.

An EMPLOYER may fire or discipline you for refusing to accept an assignment, but at least your license would be intact. I have known of administrators who threatened to report nurses to the BON for "abandonment" if they refused an assignment, which is an unscrupulous tactic. In my understanding, it is NOT abandonment to refuse to accept an assignment. To "abandon" a patient or assignment, you must have already accepted responsibility for their care, which would not be the case if you refused the assignment in the first place.

bargainhound, RN · Sep 26, 2006

Yes, you can refuse an assignment.

JB CC-RN · Sep 26, 2006

You can refuse an assignment if you feel it to be unsafe, such as taking care of a pt with infectious disease when you are pregnant or immunosuppressed.

mamason · Sep 26, 2006

I know of no state BON that would discipline an RN for refusing to accept what s/he believed to be an unsafe assignment.
An EMPLOYER may fire or discipline you for refusing to accept an assignment, but at least your license would be intact. I have known of administrators who threatened to report nurses to the BON for "abandonment" if they refused an assignment, which is an unscrupulous tactic. In my understanding, it is NOT abandonment to refuse to accept an assignment. To "abandon" a patient or assignment, you must have already accepted responsibility for their care, which would not be the case if you refused the assignment in the first place.

I had already been assigned 6 Pt's on a tele/stepdown unit. 4 of the Pt's were extremely sick and required a lot of one on one. I was told that I would be recieving a new admit by the charge nurse. I explained to her that I was already overwhelmed with what was going on with my current pts. And that I didn't think I could handle another pt at that time. I was pretty much told to "suck it up." Then the NM came down and informed me that I couldn't refuse a pt. To make a long story short, I requested a meeting with the DON and I explained the circumstances. That's when she made the statement. So, just to clarify, would this have been considered abandonment in this particular situation?

mamason · Sep 26, 2006

You can refuse an assignment if you feel it to be unsafe, such as taking care of a pt with infectious disease when you are pregnant or immunosuppressed.

Yes...that happened too. I was pregnant, assigned 2 pt's that were on isolation for c-diff. Yeah.. on a floor that we recovered open hearts. That's another story. I said I would prefer not to have those two Pt's in my assignment. And one of the nurses stated, " Don't say that too loud. You'll get yourself in trouble." Needless to say the charge that day was cooperative and reassigned my pts for me.

MultipurposeRN · Sep 26, 2006

You should be all right if you don't accept the additional patient. It would be if you abandoned a patient you had already accepted for care. At least that's how I interpret it. You might write or call your BON and clarify it with them, then if it happens again at least you'd have the correct info. MIght not hurt to have it with you to show your DON or manager, too.

hopecandles, RN · Sep 26, 2006

One of the nurses I work with dealt with that issue. She was overloaded on an assignment, and there was some kind of "bad result". She didn't say what it was, but she said that the legal dept talked to her, and she told the legal dept about how many patients she had, and she wasn't supposed to according to floor guidelines. The legal department told her that in that case... she should have contacted the supervisor, and told them that she felt the assignment was unsafe prior to accepting it, and then maybe even go a step higher. Also, that she needed to document who she called and spoke with and what they said... not in the patient's notes, just for her own record...so that if she was ever taken to court, she could defend herself, and say I contacted this supervisor, and that supervisor, and told them I felt staffing was unsafe and that I didn't feel the assignment was within safe nursing standards, etc.

As staff nurses we can't stop call up other nurse's and get them on the floor. We can't adjust staffing guidelines, etc., but we do need to speak up for ourselves.

I don't have a legal background, and I don't know how that would all play out. I'm just relating what a coworker told me. I don't think anything ever came of her instance, but I know it encouraged people to speak up, and call the supervisor in those issues, and sometimes they did give us more staff, or stop an admission. Although staffing really hasn't improved overall.

We are our patient's advocate!!! Ask yourself, if you would want a family member being taken care of by a nurse with the same assignment you have?

Jolie, BSN · Sep 26, 2006

I had already been assigned 6 Pt's on a tele/stepdown unit. 4 of the Pt's were extremely sick and required a lot of one on one. I was told that I would be recieving a new admit by the charge nurse. I explained to her that I was already overwhelmed with what was going on with my current pts. And that I didn't think I could handle another pt at that time. I was pretty much told to "suck it up." Then the NM came down and informed me that I couldn't refuse a pt. To make a long story short, I requested a meeting with the DON and I explained the circumstances. That's when she made the statement. So, just to clarify, would this have been considered abandonment in this particular situation?

I would have refused the additional patient. It is true that by institution policy, you may have been fired or disciplined for your refusal, but there would have been no danger to your license.

In my understanding, it would NOT be considered abandonment to refuse an additional patient. Abandonment would mean walking away from the care of patients on whom you have already accepted report and for whom you have accepted responsibility.

By and large, refusing an assignment is an employee-employer issue. Abandonment is a BON issue.

Jolie, BSN · Sep 26, 2006

As a former nurse manager, I would like to know what assistance your NM offered to the unit during this busy time.

Did she make any effort to obtain additional staff, or (God forbid) help out herself?

I have no respect for managers who don't pitch in when needed. I know how difficult that can be, but it is the manager's responsibility to do so.

kalayaan · Sep 26, 2006

nurses should remember to take care of themselves too. meaning, if your can make everything in writing, do it. if you already have 6 patients and feel its getting difficult to care for all six, write a report that its too taxing. if theyre giving you an additional assignment, refuse. then write a report that despite 6 patients, management insists on giving you another one and you refused bec you cannot give adequate care to the additional patient.

nurses have to learn to protect themselves.

mamason · Sep 26, 2006

As a former nurse manager, I would like to know what assistance your NM offered to the unit during this busy time.
Did she make any effort to obtain additional staff, or (God forbid) help out herself?
I have no respect for managers who don't pitch in when needed. I know how difficult that can be, but it is the manager's responsibility to do so.

Ugh...NM....help out?Not on this floor. Her statement to staff was that she does not "do" pt assignments. Meaning would not take a team.

This was brought up to her boss, the director of cardic/ICU. Diector stated that,"She won't take a team because she doesn't know how." This true, heard it with my own ears at astaff meeting with the director. Sorry about thegrammer. Typing with one hand.

No additional staff was available to send to us. The charge on this shift, did not take a team either. This was not an isolated incident. This type of staffing was utilized on a daily basis. Charge nurse went to NM and said I was being uncooperative when I mentioned that I was overwhelmed with assignment. NM came barging out of her office with anasty attitude and said I could not refuse the pt. It was a no win situation.Had not taken report on new pt yet, at this point. I was very frustrated and wasn't sure what I should or could doI ended up taking the pt after feeling like I was being pressured to do so. Needless to say, I worked a fourteen hour shift that day.