Refused assignment due to patient safety, was I wrong?

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I work in LTC that has a census of approx 45. Our usual staffing on 3-11 shift is 1RN Supervisor and 2 LPN's on the medication carts. My question has to do with safety of patients and my license. I was told one shift that I had to take a med cart due to call off. I hadn't even clocked in yet, I said I wouldn't do it because of liability. Being in charge of 45 people, passing meds, doing blood sugars, handling any problems that arise ie, falls, medical emergencies, admissions is too much. I have been a nurse for 40 years and I know how easy it is to make a med error and cause harm. Because I hadn't clocked in and accepted charge I told them I would leave if there was no alternative. I just wanted your opinions to see how others feel about this issue. I felt bad by not agreeing to do it, but it's my license and my patients lives. Thank you

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8 Answers

Specializes in Tele, ICU, Staff Development.

In a nutshell, I agree with your decision. Your concerns about patient safety and protecting your nursing license are valid, especially given the challenging circumstances you described.

Taking on the dual role of RN Supervisor and medication pass nurse for 45 residents is an overwhelming responsibility. As charge nurse, you would have been continually interrupted while passing meds. You couldn't have focused on either role safely. The potential for errors, especially under pressure, increases significantly.

Your decision not to take on the medication cart role, especially when you hadn't yet clocked in or accepted the charge, shows a commitment to patient safety and professional responsibility. 

The owners/administration have an ethical responsibility to provide safe and adequate staffing, including having a backup plan when needed that ensures patient safety. Assigning the charge nurse to manage a medication cart is not a suitable solution and reflects poor judgment.

Here are a few key points to consider:

  • Patient safety. When the workload becomes unmanageable, the risk of medication errors, delays in care, and missed assessments increases. Your refusal to take on the additional duties reflects a strong prioritization of patient safety, which is at the core of nursing practice.
  • Professional responsibility. As a nurse with 40 years of experience, you understand the importance of protecting your license. Accepting an assignment that you believe to be unsafe could put your license at risk if something were to go wrong.
  • Staffing policies. Discuss these concerns with your facility's administration. Advocate for better staffing policies that ensure patient care isn't compromised due to call-offs or other staffing issues.

Peer support. Many nurses share your concerns. It's not uncommon for nurses to face similar situations, and your feelings of guilt are understandable. However, your decision was made with your patients' best interests and professional integrity in mind.

In summary, your decision to prioritize safety over the immediate demands of the shift was the right one. Nursing is not just about doing the job; it's about doing it safely and ethically. It's essential to stand firm in your decision, knowing that you acted in your patient's best interest and professional responsibilities.

Best wishes,

Nurse Beth

Specializes in Med nurse in med-surg., float, HH, and PDN.

Wish I could have copied Beth's answer and placed it in front of the supervisor and administrators at my last facility job (years ago). I did the meds, manned the phone, had to go get 02 tanks for the aides (and not just a few, and none at the same time) whenever their patients were low or out of 02 in the smaller tanks they traveled with. I was constantly interrupted. Had to keep track of faxes and calls to the doctors, new orders, and deal with relatives ... It was hellish in a 12 hour shift and I never got charting done in a timely manner, having to stay up to 2 hours over to get it all covered.

I should have quit, but I kept trying harder, which didn't work at all, because I was canned after 6 months. Never in my entire career (40+ years) have I ever had to deal with such a ridiculous assignment, nor had I ever encountered such chaos and confusion. 

What were the shortcuts ( and I swear there HAD to be some they employed) taken by the other hall's nurses that allowed them to be done in time enough to sit down and chatter at the nurse's station while waiting for the shift to end? 

It was entirely like working an assembly line in a factory with no personal touches allowed. Yes! That's true. I was told my job did not entail talking with the patients, but just 'doing my job' (that was actually 5 or 6 jobs.) I am not a robot and can not be impersonal and business-like all the time when it involves PEOPLE who have needs other than swallowing pills. 

I totally agree with your actions.  I worked for LTC facility with 37 patients.  My DON was supposed to be my second nurse one day and she called out leaving me alone to be charge, medication and wound care nurse,  I quit that day - it happened all the time and I was not going to lose my license either.  

Specializes in Geriatrics, Dialysis.

This might have been doable if the other floor nurse had been an RN. Not ideal by any means but manageable if all residents in the building are stable. Which is pretty unlikely. But as the only RN in the building you would have no choice but to respond to every situation that requires an RN assessment, so who's covering your hall when you have to go across the building to assess a resident who fell?  Nobody, that's who. Because there is nobody else there. Been there, done that when I worked LTC for 25 years. The impossible workload and ever-increasing expectations for charting. Then add on the need to do your job plus help with everyone else's jobs and it's no wonder nurses leave. That's a big part of the reason I finally left.

I don't blame you at all for saying no, that's not safe for the residents or the staff.

I think everyone who has done hands on nursing recently will understand your decision. As you said it is your license and if something were to happen the facility will throw you under the bus first. 

For a 3-11 shift I got to say I'm jelly. Never worked in a LTC that didn't have awful ratios on a regular basic of 1 nurse for 45 residents. And they were in charge of charting, medication, treatments and feedings. And we would be lucky if we had 2cnas. These weren't assisted living either.

I'm not saying it's right. Just it's a shame. Unless something changes I can see Nursing getting worse every year for about the next 15-20 years in the us.

I've had this happen to me quite a bit. I always said no. They need to either hold over the nurse currently on, get someone to come in, or the RN supervisor should take the cart. In assisted living, with 45 people, and one cart, this is doable. In skilled nursing, with 2 carts, you need 2 nurses.

Specializes in Med/Surge, Psych, LTC, Home Health.

I once worked in a LTC facility as a Shift Supervisor.   There were nights when I was expected to perform my supervisor role AND take a medication cart.  I lasted two months in that job.

Any admin that would ask you to do this, would just as readily throw u under the bus for any error. They do not value nurses. They never should have asked you to do this. Good for you. You need to protect your license. Also one you say yes, it will be repeated and expect you to always say yes. 

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