Have You Ever Refused To Accept Report on a Patient?

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What are the laws in your area of refusing to accept a patient into your care?

I refused to accept a patient who had assaulted me sexually earlier in the year. I'm trying to find the Florida Nuse Practice Act to see if that was OK.

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Specializes in Education, Acute, Med/Surg, Tele, etc.

I have never not accepted a patient as of yet, but when I was hired on there were certain tasks I said I would not do and wanted that in writing as part of my contract. Usually if those tasks had to be done, then wouldn't get that patient.

The thing is to have that in writing upon hiring! And if you are smart you will resign that yearly! That makes it a lot easier to explain if it is already in writing then to have it all happen on the spot on top of your head...

For instance, I will not personally administer pain meds to someone that has a respiratory rate of less than 6 breaths per minute (some nurses say 8 or even 12). I feel if this needs to be done, then hospice (if that was arranged) or an MD should be present to protect the patient and myself from any accusations of false death. That was written into my contract at hire, and lucky for me only needed to be done once, and the hospice nurse was there and watched the patient carefully. I had too many other patients to stand by, so it wasn't possible for me to administer and watch for lengths of time and deal with family members as well. (this was an ALF, I had watch over 140 pts as their only floor nurse).

I also will not give chemo drugs to pregant women, or TPA.

So since I have that as part of my contract I don't have to and can decline as that pts nurse.

Think about it carefully and really add what you won't do and why. If it is a case of sexual assult or harrassment that is perfectly legitimate to me...and would be in the best interest of the patient and yourself!!!

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What are the laws in your area of refusing to accept a patient into your care?

I refused to accept a patient who had assaulted me sexually earlier in the year. I'm trying to find the Florida Nuse Practice Act to see if that was OK.

I'm not sure what the laws are concerning this-but you did the right thing. I would think that the hospital would not want to give you this patient for one to protect you, the Nurse. And two, to protect themselves against a potential law suit. What if the patient said you did not care for him/her and caused them harm because of the earlier assault?

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I can't imagine the BON having a problem with that Meerkat. Nurses need to remain professional with their patients and I don't think that would be really possible with someone who had assaulted you.

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Specializes in many.

Good God!!!

Did someone actually try to make you take this patient?

When I worked M/S in a low income area I saw several patients that I had seen previously when working in the county jail. While I did my best to practice competent compassionate care in the jail and tried not to find out what some of the prisoners were in for, it still happened.

My assistant nurse manager knew that I worked in the jail and had no problem keeping the former prisoners away from me, all I had to do was ask for a switch. If anyone asked me what the problem was, I just told them that the asst nurse mgr and I had an understanding about such patients.

I am sure that if you took this up the line, charge nurse, ANM, NM etc, it would not be an issue. And while working in a jail is not something that I mind mentioning in public I can understand you not wanting to talk about your assault to the general public. If you had to jump directly to your NM, I am sure that she/he would understand.

I am sorry this happened to you, both the assault and the difficulty in having to face this person again.

Best Wishes

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Specializes in Critical Care.
What are the laws in your area of refusing to accept a patient into your care?

I refused to accept a patient who had assaulted me sexually earlier in the year. I'm trying to find the Florida Nuse Practice Act to see if that was OK.

Pt abandonment has to do with neglecting the needs of a pt already UNDER your care. Most BONs, I believe, have established that refusing an assignment is NOT patient abandonment. You are, in fact, refusing to accept the nurse-pt relationship that would obligate you. You can't be found to be obligated for refusing to be obligated. You know?

Also, the BON in MOST states require you not to accept an assignment that would put your pt at risk. The potential for you not acting in that pt's best interest, intentionally or not, is great enough that you have an OBLIGATION NOT to become involved in that care.

I would think this would be self-evident. It's the same reason we don't take care of family members: too much emotional investment. In this case, emotions of another sort, but nevertheless.

I would think you would be in more trouble from the board if you DIDN'T refuse this assignment and something happened.

Now, on another note: being in trouble with the BON (which I can't IMAGINE), and being in trouble with your employer are two different things. But, I also can't imagine how your employer couldn't understand this: and if they can't, I can't imagine how your employer's risk manager couldn't explain it to them.

And IF THEY DO give you grief about it: I can't imagine this would be a place I would continue to work at.

~~~~~

From National Council of State Board's of Nursing: State positions on patient abandonment:

http://www.ncsbn.org/news/stateupdates_state_abandonment.asp

6. Florida:

"The Florida Board views abandonment as leaving an assignment after the nurse has accepted responsibility for patient care. It does not view abandonment as refusing to take an assignment for which the nurse is not capable of handling."

~faith,

Timothy.

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Pt abandonment has to do with neglecting the needs of a pt already UNDER your care. Most BONs, I believe, have established that refusing an assignment is NOT patient abandonment. You are, in fact, refusing to accept the nurse-pt relationship that would obligate you. You can't be found to be obligated for refusing to be obligated. You know?

Also, the BON in MOST states require you not to accept an assignment that would put your pt at risk. The potential for you not acting in that pt's best interest, intentionally or not, is great enough that you have an OBLIGATION NOT to become involved in that care.

I would think this would be self-evident. It's the same reason we don't take care of family members: too much emotional investment. In this case, emotions of another sort, but nevertheless.

I would think you would be in more trouble from the board if you DIDN'T refuse this assignment and something happened.

Now, on another note: being in trouble with the BON (which I can't IMAGINE), and being in trouble with your employer are two different things. But, I also can't imagine how your employer couldn't understand this: and if they can't, I can't imagine how your employer's risk manager couldn't explain it to them.

And IF THEY DO give you grief about it: I can't imagine this would be a place I would continue to work at.

~~~~~

From National Council of State Board's of Nursing: State positions on patient abandonment:

http://www.ncsbn.org/news/stateupdates_state_abandonment.asp

6. Florida:

"The Florida Board views abandonment as leaving an assignment after the nurse has accepted responsibility for patient care. It does not view abandonment as refusing to take an assignment for which the nurse is not capable of handling."

~faith,

Timothy.

Thank you for the great info!

Yes, my manager was not happy at all that I refused the assignment, even in light of the circumstances. The reasoning was that 'everyone' has been assaulted at some time on our floor because it's a psych unit and that I am just another nurse who has been assaulted. (Not EVERYONE has been assaulted, that's an exaggeration--and certainly even less have been sexually assaulted by their pt)

But moreover, I already had a pt under my care during the shift who was sexually inappropriate, and I truly did not feel I could handle both, on top of the rest of my patients.

Frankly, I was afraid of him. I think the problem came when other nurses wanted to refuse him as well. And I can understand the manager's problem with that---what do you do when nurses refuse report on someone? But I thought, considering the patient's history with me in particular, that I would be excused.The nurse manager later said I should be fired.

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Specializes in Critical Care.
Thank you for the great info!

Yes, my manager was not happy at all that I refused the assignment, even in light of the circumstances. The reasoning was that 'everyone' has been assaulted at some time on our floor because it's a psych unit and that I am just another nurse who has been assaulted. (Not EVERYONE has been assaulted, that's an exaggeration--and certainly even less have been sexually assaulted by their pt)

But moreover, I already had a pt under my care during the shift who was sexually inappropriate, and I truly did not feel I could handle both, on top of the rest of my patients.

Frankly, I was afraid of him. I think the problem came when other nurses wanted to refuse him as well. And I can understand the manager's problem with that---what do you do when nurses refuse report on someone? But I thought, considering the patient's history with me in particular, that I would be excused.The nurse manager later said I should be fired.

I can only say that your nurse manager should be fired for even suggesting that your refusal was inappropriate.

And, you can quote me to her on that.

It reminds me of the story about the person who had been planning their wedding for 6 months and the manager "forgot" to give them the days off. When confronted, the manager suggested that it was completely selfish not to reschedule the wedding.

~faith,

Timothy.

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I refused to be assigned to a patient in postpartum recovery. She needed a PCA pump for severe pain but an epidural had been given with no effect. With the supervisor and L&D RN we decided I would stay with the patient, start the PCA, monitor her as if it were conscious sedation (pulse ox, monitor, automatic BP) and the competent L&D nurse would be assigned to her.

She did fine. With the PCA her pain was relieved.

When a family member asked why the baby had milia(see I remember nursing school) I told her, "***** is the nurse assigned. I'm from critical care to make sure she is OK with this pain medication."

I think it was much better than having them think the nurse was ignorant. Of course I was because it was NOT my specialty. A competent nurse checked the fundus and did teaching while I monitored vital signs and admired her beautiful baby.

Our BRN agrees:

http://www.rn.ca.gov/practice/pdf/npr-b-21.pdf

I asked not to care for a neighbor. The assignment was changed. No problem.

I agree that asking you to care for someone who assaulted you is over the top.

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Specializes in LDRP.

I once had the man who molested me as a child as a patient on our unit. I made it very clear that I would not take care of this man. After that, he was not put on my assignment. If he had been, you are darn tootin I would have refused report, no matter the consequences.

you are totally in the right, meerkat. I can't beleive your boss thinks its acceptable, just b/c "it happens to everyone".

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Specializes in LDRP.
She needed a PCA pump for severe pain but an epidural had been given with no effect. With the supervisor and L&D RN we decided I would stay with the patient, start the PCA, monitor her as if it were conscious sedation (pulse ox, monitor, automatic BP) and the competent L&D nurse would be assigned to her.

She did fine. With the PCA her pain was relieved.

WHY did she need special one on one monitoring for a pca pump? I don't understand.

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Specializes in Medical/Surgical/Maternal and Child.

Question, HappyNurse. If this person molested you as a child, why is he not in jail?

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