Refusing a Clinical assignment

caliotter3 · Jun 27, 2012

This would be a question for your clinical instructor as different schools have different policies, and for that matter, it may be at the discretion of the individual instructor.

ImKosher · Jun 27, 2012

Lol if we had a right to refuse, I think it will be abused. Oh that pt is bad, I refuse. Oh that pt smells to bad, I refuse. Oh I don't feel like doing it, I refuse. I believe you learn the most when your in the most uncomfortable state.

Trauma Columnist · Jun 27, 2012

A good response is "I'm not familiar with that care or procedure or equipment, can I watch you do it and then I'll do it next time?" Or...."I'm not sure how to do that - can you go with me and make sure I'm doing it right."

elkpark · Jun 27, 2012

I agree that the most appropriate course of action would be to discuss your concerns with your clinical instructor. Students are put in lots of situations that they may feel they aren't ready/prepared for, but that's part of the learning process. The only situation in which I can imagine a student having a "right" to refuse would be situations in which the student has a religious/moral objection to a particular procedure.

Double-Helix, BSN, RN · Jun 27, 2012

What sort of situation would you feel you need to refuse as a student? If you feel that you're being pushed to perform a skill on a patient that you're not comfortable doing, then by all means you can state that you're not comfortable and ask to observe the skill rather than performing it yourself. But to refuse to care for the patient at all? I'm having trouble thinking of a situation that would require that, as a student nurse. What is it that you're concerned about?

ixchel · Jun 27, 2012

"I don't feel ready to do this. Can you help me?"

Trust me--they'll appreciate your honesty, and it's not a refusal, which means you're up for the challenge. Go outside your comfort zone. Do it now while you still have the safety net of instructors.

sunflowerlamb · Jun 27, 2012

I did refuse an order while in clinicals my very first semester. The patient was a sweet 90+ lady who was getting extended release morphine. Crushed. I refused to crush the med. The nurse was annoyed when I explained to her that I would not crush this medication and why I would not do it. My instructor stood behind me and told the nurse if she thought it was safe to give the med that way then she should do it herself. The nurse did give the med, but by noon speech therapy was there to do a swallow study to see if it was safe to give the patient pills or if she needed to be changed to liquids. It felt great to advocate for my patient and even better that my instructor stood up for me!

Yoinks · Jun 27, 2012

I agree with elkpark - I don't feel like there is a valid reason other than a religious reason (ex: a jehovah's witness refusing to participate in a blood transfusion procedure, unlikely in a clinical situation but a reasonable example) but, I feel like that is something you should discuss with the teacher at the very beginning of the semester/quarter before clinicals even start. you can't refuse to treat a patient in the real world - so you shouldn't be able to in clinicals - of course in the real world you can work around those issues or switch out with someone willing to if allowed or work in a place that avoids things you dislike, but I think short of a specific religious issue you shouldn't refuse a patient in clinicals. honestly, it would probably make you look bad and your instructors might question your ability to be a nurse.

neverbethesame · Jun 27, 2012

If it is valid then your request should be honored. If it is minor or not willing to be (mostly) disclosed, the instructor can't keep changing assigments.

I can think of two situations recently where I nurse's aide felt that a pt was making sexually inappropriate remarks to her and refused to care for him again. He didn't make any to others so they were ok with him. Another case recently was an ex-boyfriend of an aide was a patient on the floor and she declined work OT so as not to cause discomfort for herself, him (and his girlfriend.)

Abigail612 · Jun 27, 2012

As a student nurse and as a nurse you do retain the right to refuse fulfilling an order or procedure that you feel may cause harm to your patient. Also if you have a patient that is becoming agitated or if you are becoming frustrated with a patient's behaviors most facilities do allow you the right to leave the situation (as long as the patient is safe) until both you and the patient have had a chance to calm down.

If it is matter of inexperience refusing to perform the procedure or order will make you look as though you are not ready to take on the responsibilities that come with being a nurse. However it is important to ask question when performing a new procedure and to get the proper supervision. If you perform an unfamiliar procedure alone and something goes wrong you can cause the patient injury or a setback in their healing; this can also make you look as though you are unprepared for the responsibilities that come with being a nurse. Also ask you instructors especially if you don't have a lot confidence in a particular skill, they may be able to help through your discomforting or allow you some more practice doing the skill. Just make sure that what ever you do that it is what is best and is to the benefit of the patient. :)

pecanpies · Jun 27, 2012

You should never do anything outside your scope of practice or anything you do not feel safe doing. If that's what you mean by "refuse," then yes - you can refuse. If you're asked to do something that you don't feel safe or comfortable doing, what I would do rather than just refuse is to explain you don't feel comfortable and ask for help. You could ask for a demonstration, or ask them to walk you through the procedure as you do it. The downside to this is that many nurses, when asked for help, will just do the task themselves rather than assisting you to do it. Keep that in mind and be an advocate for yourself - explain that you really want to perform the skill or task, but would like them to watch you/walk you through it/guide you/etc.

If you're asked to do something outside your scope of practice, you should always politely refuse regardless of whether or not you feel competent. For example, as a second semester nursing student, I was asked to call a doctor. That's not an appropriate request to make of a nursing student. Even though I consider myself capable of making a phone call and was familiar with SBAR, I politely explained that I was not allowed to speak with the doctor over the phone and apologized for being unable to help them. They were annoyed, but I did what I had to do to protect myself.