Have you ever refused to accept a patient D/T too many already?

I was wondering if anyone has ever refused to accept a patient because you already were overwhelmed? I colleague of mine recently refused to accept an admission one night because she already had 9 or 10 patients. Our floor is a general med/surg floor, but we usually have a lot of geriatric patients who are confused, unable to control their bodily functions etc. This nurse felt like she already had more than she could safely handle. So, another nurse ended up taking the patient. My friend has her eval done the other day by our manager and this was put on her eval. No one in mgmt had ever talked to her before it was placed on her evaluation. So now it is on her permanent record that she refused to take a patient. How do you handle a situation like this? Can a nurse refuse to accept another patient if she believes that she cannot truly provide good, safe, nursing care? I was just wondering how other nurses handle this situation and how does mgmt handle it when a nurse refuses a patient. Do we have any solid ground to stand on when this situation arises?

[Jenny P]

Yes, there is something she can do about it. The nurse can go into her permanent record and write a rebuttal to this there. While in her record, she should read through it all and NUMBER the pages IN INK in either the upper right or left corners so she can tell if pages were added or removed in the future. She should also have a copy of her states Nurse Practice Act with her and quote from it (citing page and leg. #) anything that may pertain to this in the record (in other words, she should read the Nurse Practice Act before she goes to Records and Benefits Dept.). Remember, it is OUR license we are working under, NOT the hospitals. And if something should happen while she was caring for too many pts., do you suppose the hospital would support the nurse? I doubt it. That's why we should all be carrying our own Liability Insurance.

[NRSKarenRN, BSN, RN]

Yes, I have refused patients, both in the hospital and in homecare. Gotten written up once in the hospital (not on an evaluation) and documented my side of the situation on the form.

Jenny P's advice accurate. EVERY evaluation form I've ever seen has space for the nurse's response. Make sure you tell your friend to document her side on that form including name of other nurse who accepted the patient AND ask for a copy as it's your right to have one.

Review and Copy for your files:

The Right to Accept or Reject an Assignment

http://www.nursingworld.org/readroom/position/workplac/wkassign.htm

Link to state boards of nursing for practice acts on-line:

http://www.ncsbn.org/public/regulation/boards_of_nursing_board.htm

Also see response to essarge posted on this forumn.

[nur20]

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