can you refuse an assignment? - page 3

My previous DON stated to me that we could not refuse an assignment. Now....I'm confused. I thought the Nursing Practice Act stated that we had the "right' to practice safe nursing. Other staff... Read More

  1. by   mamason
    Mr. Huffman, thank you for clarifying right vs responsiblity. I found your post very empowering.
  2. by   pyegirlrn
    I worked until recently on a "critical care area" called Neuro-Stepdown. We routinely accepted ventilator dependent, hemodynamic altering drips, multiple tubes and frequent OTBS with a staffing matrix that states we should have a 1:4 ratio. Gradually the ratio increased to 1:5, but recently and more frequently was 1:6. On many occasions, my co-workers and I had talked about how taking more than 5 patients on our floor is dangerous. Now was the test time, 3 nurses scheduled with 6 patients a piece, one pct, and 1/2 shift unit clerk/monitor tech. Two of the three nurses refused to take that assignment, but we were looking for alternatives. The supervisor, NM, and Director of Critical Care told us "there is no help to send you and no beds to move any patients to. Either take report or consider yourselves voluntarily resigned." We left and in 2 hours 2 nurses were brought in to take our 6 patients, but "there is no help to send you" rang through my mind.

    I am planning on still attempting to receive unemployment since I believe I was left no choice, but to lose my job, a patient, or possibly my license. You must draw a line somewhere and stand by it. I will not put my patient's lives in jeopardy for a hospital or money. I have been in this situation once before and patients died, because of short staffing. Now there is
    research showing what safe staffing levels are and there is no more excuse for managers or nurses. That level is 2 in ICU, 4 in PCU/Stepdown, and 6 on the medical/surgical floor.
  3. by   Meriwhen
    You have the right to refuse an assignment, especially one that you think is unsafe...because if something happened on this assignment that resulted in you going in front of the BON, they're going to hold you accountable because you took that assignment on.

    However, the right of refusal doesn't protect you from being disciplined or even fired
  4. by   dishes
    Check the labour law for your area, there may be something stating that resignation must be voluntary, not threatened or coerced, since you were forced into resigning, you may have grounds for legal action. I think that nurses need more education on how to advocate for their right to provide safe patient care. Where I am, our union informs nurses of the steps they need to take correct excessive workloads and unsafe patient care environments. We have a professional responsibility decision tree that helps guide us and an electronic professional responsibility workload report form that we complete and submit to our employer if we have workload concerns Ontario Nurses' Association - Professional Responsibility Workload Report Forms

    I realize that the workload report forms won't help in your situation, at this point, but it may provide ideas for nurses who want to document and report to their employers excessive workloads and unsafe patient environments inthe future.

  5. by   imintrouble
    You can refuse a pt, but it could cost you your job. You already know that from previous posters.
    Oddly enough, the most pressure I've ever felt to take more pts than is safe, was from my fellow floor nurses.
    If I took a stand, refused the assignment, who do you think was going to have to pull that extra weight? Yep, the nurse working beside me. There would be anger. The silent treatment. Slamming, banging, raised voices.
    Tremendous pressure to buckle, and do what I felt unsafe to do.
    I don't know about the rest of you, but I find it much harder to say no to the nurse I sit next to all night, than the nurse I see a few minutes every hour.
  6. by   leslie :-D
    i've refused unsafe assignments, but when i knew that others would have to carry the extra load, i have accepted the assignment...
    noting on the assignment sheet "accepted under duress".
    i also made my own personal notes as well.

    it really isn't all that clear cut...
    knowing that when a nurse refuses, other nurses will only be further burdened, making it even more unsafe.

    i do believe that cn's, um's, should be made to take pts when staffing is so low, it's dangerous.
    everyone needs to step up to the plate, and it needs to be enforced.

  7. by   KelRN215
    I agree that the "higher ups" need to step up to the plate and do patient care when staffing is dangerous (they all have active nursing licenses, do they not?) but that never happens in my facility. My manager has been known to say that she "can't do patient care". I believe that is unacceptable.

    We have had several shifts recently where staffing is dangerously tight. We have patients on my floor that are so sick they're meant to be 2:1 and end up being 5:1 or sent to the ICU because of staffing. And then TPTB get mad that said patient got sent to the ICU/that we couldn't handle them on the floor. If they require 2:1 and we can't provide that, then they belong somewhere that can. The biggest problem is that staff on my floor- including charge nurses- are AFRAID to speak up to our manager when things like this happen.
  8. by   Quickbeam
    I have refused to take an assignment that was unsafe given my skills. This only happened when I was in a hospital setting and floated out of my specialty area. And the issue was cancelling travelers vs making me take patients I had no business taking care of (I'm a physical rehab RN, the floor was ICU).

    Once I said out loud :"I am refusing this assignment", everyone knew I was serious. I literally thought people would die because of my ineptitude. My decision to say those words out loud caused a cascade of changes which still go on today.

    I think you need to stand up for patient safety. I was willing to be fired, I felt so strongly. On the other hand, I have taken insane assignments within my skill set and just did a crazy amount of triage and priority setting.

    I do think we all have the obligation to say no for patient safety.
    Last edit by Quickbeam on Jan 3, '12 : Reason: typo
  9. by   caliotter3
    I work in extended care home health, where refusing a case or asking to be removed from a case is accepted policy. However, one 'employer' used that fact to see that my unemployment was stopped. Although the interviewing EDD employee told me that he understood that home health nurses can refuse cases, the EDD still took my unemployment away from me. And the one case that this particular employer had offered me was refused three months prior to me even applying for unemployment. Unintended consequences of doing your job according to business as usual.
  10. by   classicdame
    the BON has no control over your employer, so you can refuse an assigment but you might get disciplined by the employer for doing it. That is when you decide if your license is more important than your job. The DON might need to be educated on this to avoid complaints to the BON