How to turn down an assignment

[CrystalSSA]

First let me say that nothing bad happened, but I feel I took a risk at work that I am not willing to take again.

I was given my usual assigment at the start of the day. It is a heavy load, but I can deal with it. I was then told that some people "didnt show up" and that I would have to provide total care on some of my patients for a few hours. Again, it's a heavy load, but I can do it "for a few hours" until they get someone in. "someone" never came.

Then 4 hours into my shift, I was told that a nurse was leaving sick and that I needed to take two additional patients. "Just until they can get someone in".

Again.."someone" never came.

Looking back, even though nothing happened, I felt I took a risk. My state nursing law states that I do not have to accept an assignment that I am uncomfortable with, but it does not say what happens if I refuse (like I've seen TX has a clause for what to do).

How would you have handled the situation? I do not want to get fired, but I will not accept an assignment like that again..EVER.

Should I go to my manager now and express my concerns or wait for it to happen again?

[CrystalSSA]

ps: no union here...as you can guess

[Tait, MSN, RN]

I would definitely discuss it with my manager. At least give them a heads up that it happened and that you didn't feel safe.

[RNperdiem, RN]

If you do go to your manager, make sure to phrase this in terms of a patient safety issue. Pay attention to the response; the manager sets the tone for the unit.

If something like this does happen again, ask the charge nurse if the staffing office has been called, have any nurses been called, ask exactly what is the plan- you must try to get something firmer than "until they get someone in" before taking an assignment.

[HouTx, BSN, MSN, EdD]

Actually, the Texas Safe Harbor process does not mean that you can just 'refuse' the assignment - but it does provide the nurse with a formal means of documenting the fact that the nurse is protesting an assignment based on the fact that it poses a risk for the patients involved due to ______ (specific reasons). It provides not only a formal record of the dispute/discussion that will be used to protect the nurse from any adverse outcomes associated with the reasons that were specified.

Safe Harbor does not indemnify the nurse from problems resulting from personal malpractice or mal/misfeasance. The organization must also review all Safe Harbor claims - and aggregate/analyze all claims as part of their Quality & Patient Safety processes. In most organizations, Safe Harbor claims are an indicator of poor performance for the supervisors involved.

Of course, if a nurse is simply not competent to carry out a task that s/he has been assigned, we have a responsibility to refuse it. But it would be rare for the entire assignment to be outside the bounds of a nurse's incompetence. The problems are usually due to workload or environmental/system factors - and these are covered by Safe Harbor.

[SaoirseRN]

At the very least, it sounds like they should have divided your extra workload amongst a couple of nurses, or when the other nurse went home, given his/her assignment to the staff whose load wasn't already larger than normal.

When there's no one to come in, the staff who are there have to take on the extra work. It isn't ideal but we all agree the patients need care. It just sounds to me like the division of the extra workload wasn't done in the best possible way.

[BSNbeauty, BSN, RN]

I've been there and done that. Instead of "refusing" I try to negotiate. I have refused assignments twice and it was not pretty. I think I was able to keep my job simply because I attempted to negotiate. For example: I refused an another ICU patient when I already had three ( one was a transfer), I helped with the admission and that was it.

[SuzieVN]

Sounds like yet another catch22/lose-lose situation.

[TakeTwoAspirin, MSN, RN, APRN]

Let's all practice together...... "NO".

Not, "no, I'm sorry...".

Not, "maybe for a little while".

Not, "well if someone else can help me".

Not, "I'd like to but..."

Just, "No" and then walk away.

[Daliadreamer]

This has happened at the facility I work at several times. I was surprised to hear, though, that your manager was not aware of the situation right away. Was the charge nurse taking on a full load as well? As a charge RN, it is my responsibility to take care of my staff RNs in any way possible, either by running my butt off helping everyone else, or taking a full load of patients (or both). My first duty would be to let the manager know what is going on in the floor, and then call the staffing office, and then take out the unit phone book and call everyone (nurses and aides) on the list!

[noyesno, MSN, APRN, NP]

Let's all practice together...... "NO".

Not, "no, I'm sorry...".

Not, "maybe for a little while".

Not, "well if someone else can help me".

Not, "I'd like to but..."

Just, "No" and then walk away.

NO.

(That was me practicing. Not saying "no" to your post.)

[jadelpn, LPN, EMT-B]

Amazes me in situations such as this, your manager wouldn't put on a pair of scrubs and jump right in. I am quite positive THEN "someone else" would have appeared pretty quickly.....