I finally had the guts to say no!!!

[stella123 rn]

I do not know if anyone remembers my posts about being more assertive and such. I never want to say anything to the charge nurse because I do not want her to think that I can not handle things. Well, last night I was VERY busy will a fresh knee, fresh hip, and three other patients. The CN wanted to give me another admission. I was keeping my head above water but just barely. I said I can not take an admission right now. Maybe in a few hours once these two are settled but not now. She gave me a disgusted look but I felt so good. Maybe I am actually getting a spine. You know what is weird....she asked the three nurses that were maxed out to take the admission. Not the two who had an aid with them and room for one. We all said no. Sometimes I just do not know what she is thinking. The patient did not end up staying (it was an outpatient who was on the borderline of needing to spend the night). Yah me!!! Small victorys. (it would have been a different story if they was not room for this patient anywhere and he absolutely had to stay, but in this case, I could say no).

[CseMgr1, ASN, RN]

Originally posted by stella123 rn

Like I said there were other people that could have taken it. In situations where we are all maxed out but the admissions keep coming, I never say no. This just was not the case. This CN is famous for lopsided assignments. The CN leaves at 9pm, after that we do very well deciding as a unit who should take any admissions. We also team up and do them together to get them done. Sometimes I think we do better when the CN is not there.

Excuse me for asking a stupid question, but is there something in your CN's job description, that makes her EXEMPT from doing admissions?? As a former supervisor, I was NEVER exempt from doing admissions, if my staff was overwhelmed. I don't get it!

[sjoe]

Right on, Stella.

jnette wonders: "MAY we as nurses "refuse" to take a patient if your CN or whoever says you have to take one? "

You are asking, in effect, "Does a nurse have a right to refuse an unsafe assignment?" The answer is 'Yes," and not only a right, but a duty (to her/himself and to all his/her other patients).

jnette again: "We do not have this option where I work now as it is an entirely different setting."

WRONG!

So far as being fired for setting limits is concerned, this is one more reason for a strong union.

[Scis]

jnette:

Not only CAN you say no, but your license REQUIRES that you say no and inform your management if you feel you are not able to give the safe amount of adequate care with the patient load you are being asked to assume. Yes, we're all overwhelmed with shortage of staff, but if you knowlingly feel overwhelmed with the patients you already have and you accept another and something happens to any of the patients, your CN will be the first to retort with "well, she/he should have told me that they could not take the patient". If you try to appear to shoulder care for patients without it being humanly, safely possible, you are accountable for any adverse situations that are sure to arise. The reason the CN keeps approaching the staff to take extra patients on is that he/she knows if they ask enough, or the right person, they will get someone that will say yes, knowing full well that they should not. Don't try to be a hero, we're only human, and to adequately care for your patients, it is your duty and responsibility to inform the charge nurse if you absolutely cannot assume care of another patient. Think cognitively, not emotionally, don't care what they think of you, it's your license and your patients that you need to be protective of!

Patty

[ceecel.dee, MSN, RN]

If you will not be able to give quality care to each patient on your assignment, you will not have trouble proving (if you should need to) why you had to decline taking another.

If it is about "fair assignments", and you could have done it, I think you could have a problem.

As long as the patients are your priority, no one will fault you.

[tonchitoRN]

i hear everyone advocating for the patients on the floor. but who is advocating for the patient who needs to be admitted. that patient probaby has been waiting for hours in a busy er or is waiting in the recovery room for hours. who is advocating for their care? no one seems to be concerned for their well being.

[jadednurse]

Originally posted by tonchitoRN

i hear everyone advocating for the patients on the floor. but who is advocating for the patient who needs to be admitted. that patient probaby has been waiting for hours in a busy er or is waiting in the recovery room for hours. who is advocating for their care? no one seems to be concerned for their well being.

I hear what you're saying. But admitting that patient to a floor/nurse that is already over-extended is hardly in that patient's best interest either. In my experience, a good admissions coordinator should take care of this.