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Ethical or legal?

Posted

Specializes in Gero Psych, Ortho Rebab, LTC, Psych. Has 20 years experience.

I'm researching an ethical dilemma. I would like to know if it's a legal or ethical stand to accept or decline a patient assignment that the rn feels is unsafe. Ie: Too many patients or patients assigned that rn is not comfortable with (skill wise) or just an unsafe pt load (too many critical pts or pts going south so to speak).

Its an important topic which I'm just not sure if its really ethical or more legal. Thanks for any input and opinions. :bowingpur

I know you are specifically asking for RN's but it has been my experience from talking to BONs that it IS legal to refuse an assignment for ANY reason. Until the RN actually accepts the assignment many BONs consider it an employment issue and not under their purview.

I think the ethics of the refusal depend on the reason why the nurse is refusing.

loricatus

Specializes in ED, ICU, PACU.

I'm researching an ethical dilemma. I would like to know if it's a legal or ethical stand to accept or decline a patient assignment that the rn feels is unsafe. Ie: Too many patients or patients assigned that rn is not comfortable with (skill wise) or just an unsafe pt load (too many critical pts or pts going south so to speak).

Its an important topic which I'm just not sure if its really ethical or more legal. Thanks for any input and opinions. :bowingpur

In the state's that I am licensed in, it is an RN's duty to decline an assignment they do no have the skill or training for.

As for patient load, that's another thing. Wish there was a way to legally decline that.

In the state's that I am licensed in, it is an RN's duty to decline an assignment they do no have the skill or training for.

As for patient load, that's another thing. Wish there was a way to legally decline that.

Check with your BON but I believe that comes under safety, too. Decline away.

elizabells, BSN, RN

Specializes in NICU.

Check with your BON but I believe that comes under safety, too. Decline away.

That's right. I don't have the SKILLS or the TRAINING to take care of 4 ICU patients (or 15 med/surg, or whatever). So there you go.

Check with your BON but I believe that comes under safety, too. Decline away.

Correct. It is legal and within your rights to decline an assignment where you feel the patient load is unsafe.

loricatus

Specializes in ED, ICU, PACU.

That's right. I don't have the SKILLS or the TRAINING to take care of 4 ICU patients (or 15 med/surg, or whatever). So there you go.

Good way to look at that. I wish in the ER that could be done. The patient's just show up in your district and you have to deal with it. There is no option to get report and no one to decline the patient to. If one of the patient's code, the other's can be left unattended; yet, are technically still your responsibility, no excuses (I have been told).

In Texas, there is an option called 'safe harbor' that can be used when the patient load is unsafe. It only allows you to keep your license if a patient comes to harm from the particular unsafe assignment; but, it does nothing to eliminate the unsafe assignment. In fact, if you file the safe harbor form with the BON, you will lose your job (common knowledge).

The only way to keep staffing at a safe level is to have cooperative managment who understands patient safety issues. I would love to find such a place. PS: I am not talking about California, as the only state to have staffing guidelines.

this lpn had worked ob/gyn as an cna and on her first job they thought that she was an experienced nuse and assigned her 6 labor patients two were pre eclampic [sp] she refused the assignment d/t lack of experience and they fired her on the spot

really a rough start to a career but she bounced back and got another job within a few days

It is also entirely possible that one's ability to handle loads and acuity can fluctuate based on one's personal going-ons from day to day. Even though I am a nursing student, I would much rather be unjustly terminated from employment than unnecessarily risk my license or a patient's well-being.

chevyv, BSN, RN

Specializes in Gero Psych, Ortho Rebab, LTC, Psych. Has 20 years experience.

Thank you everyone for your input. I'm attempting to find and research an ethical dilemma that is different from the ones that most of my classmates will be reporting on. I so wanted to do something different than euthanasia or taking a stand on letting infants born before 23 weeks die or going all out to save them knowing they may need permanent care......that sort of the more common well known topics that the other 20 people in my class are going for. I'll keep working on it! Thanks again all :D

RNAnnjeh, MSN, CNS

Specializes in Pedatrics, Child Protection. Has 18 years experience.

An ethical dilemma is one that challenges your personal values and beliefs. For example fairness, justice, not doing harm---basically something that makes you feel uncomfortable about a situation.

Does this help?

chevyv, BSN, RN

Specializes in Gero Psych, Ortho Rebab, LTC, Psych. Has 20 years experience.

Thanks, yes it helps a lot! I think I'll just end up doing more of a hot topic like abortion for pregnancies that are 16 weeks along or physician assisted suicide.....many of my classmates are doing these types. I was going for something a bit more obscure, that would reach out and grab me. Oh, where is the passion! (ha ha). :typing

southernbeegirl, BSN, RN

Specializes in Rehab, Infection, LTC. Has 16 years experience.

at my facility, if you refuse an assignment, it's the DON's policy that you be walked to the timeclock and clocked out. she will then fire you and turn you into the BON for abandonment.

wonder if thats legal?

chevyv, BSN, RN

Specializes in Gero Psych, Ortho Rebab, LTC, Psych. Has 20 years experience.

I understand that if you clock in and then refuse that could be abandonment. If you refuse before you clock in, then its not. Either way, I could see a facility firing that person. Not sure if thats legal, but I bet they would 'find' enough to get rid of them sooner rather than later. I was thinking there might be an ethical angle to that, but I guess that would be more of a pt safety issue. According to the ANA (if I'm reading it correctly), the nurse can write it up, but it doesn't offer a safe haven as far as refusing and keeping your job.

RNAnnjeh, MSN, CNS

Specializes in Pedatrics, Child Protection. Has 18 years experience.

I thought of this situation after being in a meeting this afternoon.

There have been some babies born with multiple life-limiting conditions who have eventually had a tracheostomy tube inserted as they kept extubating themselves while on the ventilator. Does adding an artificial airway, and all of the associated complications improve their quality of life and give families false hope when they already have a poor prognosis?

Feel free to PM me if you would like clarification/more information.

at my facility, if you refuse an assignment, it's the DON's policy that you be walked to the timeclock and clocked out. she will then fire you and turn you into the BON for abandonment.

wonder if thats legal?

It is not illegal.

However, there IS a difference between JOB abandonment and PATIENT abandonment.

Clocking in and leaving is JOB abandonment. Not one BON that I have seen will touch that. It is an employment issue.

Patient abandonment requires accepting responsibility for that patient. Basically, if you get report OR take responsibility for the assignment you are stuck.

The DON can report all she wants. The BON won't touch it. She is either ignorant of the law or trying to intimidate nursing staff, who also tend to be ignorant of the law.

chevyv, BSN, RN

Specializes in Gero Psych, Ortho Rebab, LTC, Psych. Has 20 years experience.

That is a very good one. I've heard nurses discuss if its really in the babies best interest to keep on attempting to save them. I'm going to look into this. I've done some research on preemies and the controversy surrounding how young is too young, but I'm more interested in checking into this topic.

Thanks!

Antikigirl, ASN, RN

Specializes in Education, Acute, Med/Surg, Tele, etc. Has 13 years experience.

I don't know if this will help, but in my hospital we have a nurses union and they have forms to fill out when we have unsafe patient ratios. They don't take long to fill out, and go directly to the Union that goes over them and sends them back to the hospital to fix and get a plan of action...

I find, however, this only works well if all the nurses on that shift complete one! We have done this several times and it is laxing a bit..then goes up...we do it again...and so on and so on...but it does help a bit!

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