Refusing a patient: Is it acceptable?

I work on a telemtry unit and just worked this past weekend and as luck would have it I was charge nurse. (we have one charge nurse Mon. through Fri. but take turns being in charge on the weekend). My dilemma was this... I had a nurse who btw has been a nurse for over 30 years, who refused to take care of a patient because she said he was the heaviest patient on the floor and that she felt like she was always assigned to him and that she was getting "dumped on" in her words. The assignment is already made out when I come on at 7a so it wasnt even my decision to give her this patient. What we usually do is see who has had the patients on previous shifts and try to give that nurse the same patiernts that he or she knows also for continuity of care for the patient as well.

I am all for giving a nurse a break from a very heavy assignment but this nurse hadnt had this particular patient in 2 days... and the pt was given to her probably because no one else had taken care of him. On our floor especially the weekend that I work we all help each other and we never let anyone "drown" so to speak so its not like she would be left on her own. I was really offended that this nurse would put me in this situation , but being the sucker that I am and trying to please everyone I told her I would take the patient myself even thought the charge nurse shouldnt have to take the heaviest patient on the floor. (btw he wasnt even that bad). Luckily I had an excellent nurse (and friend) who offered to take the patient herself and we worked together and was out on time even . Needless to say I was a little annoyed by the whole incident and just wondered if I did the right thing...and is it really ok for a nurse to refuse to take a particular patient for this reason?

My understanding is that you can refuse a patient as a staff nurse. Now, if it becomes a daily thing, then surely there would be a counseling by the higher level manager. Actually, I would think that if it happened twice in a short period of time, the manager would step in to counsel the person. The simple answer is "YES", you CAN refuse, as far as I know.

I have a question Heavy means a lot of work not literally Heavy like a 400lb Pt?

If this is this case I would say I would not have personally changed the assignments, I would have explained that for continuity of care and and the fact that assignments are already made for today I would appreciate it if you take the assignment, I will invistigate and see if it seems you are seriously overburdened by your assignment and we will make changes if needed, meanwhile I am here and will assist you as much as I can and the rest of the staff will help if need it. You understanmd that if we start changing assignments now it is going to throw everything behind. Also you haven't had him in a couple of days maybe things are smoothed out now, lets just see how it goes and if it is too unbearable I will figure something else out.

I guess technically a nurse can refuse an assignmentbut If I was charging I would attempt to dissuade this because once you let it happen then every other day someone will have a problem with something.

Now we do occasionally have the 400/500 pounders like I asked about and it is really hard for the nurse to continue to have these Pts daily just related to the actual strain involved with turning and cleaning etc. I do not think a Pt that is this large should necessarily get the sme nurse everyday because of liklihood of back damage. Ii think these Pts should be rotated by staff frequently.

A heavy Pt as far as many interventions and meds or drsg changes etc. is just part of the job and if you had them and are a good nurse you should have developed a sort of rhythm and have a pattern and everyday should be easier as long as continuity of care is maintained.

The only time I have ever seen a pt refusal that was acceptable was:

1.) The nurse knows or is related to the pt & it would be uncomfortable for either one or both to accomodate the assignment.

2.) As previously stated, a multiple request/needy pt assigned over a period of time that for mental health reasons ( STRESSED ) nurse needs a reprieve.

I have worked areas where there was a list, documented on daily/shiftly of who has had the heaviest/most demanding patient. Then there is easy track of who has had who & it is rotated fairly. My impression of refusal of patient assignment had to do with family/friends &/or religious/cultural differences, ie. nurse doesn't believe in abortions but has been assigned a patient who is having one...kind of thing. The problem that arises is when nurses consistently "refuse" assignments & continue to get away with it...they end up with what they want each shift while their co-workers consistently have to accommodate...could make for a bitter shift.

sometimes it is better to break up continuity. If a nurse is headed toward burn out on a particular patient I don't believe you are doing the patient a favor by assigning that nurse to him, even if she knows him best. Sometime that familarity is a negative.

If a nurse habitually refuses patients then you have a different issue. But It is not good for anyone, the nurse the patient nor her other patients if she is stressed by this. It is unfortunately an individual nurse's perception. He may have been just a peach of a patient. But if she is burned out on him no matter how the day went she would not have seen him as a peach.

You don't know what other stressors are going on for this nurse at this time.

Again if this is a habitual thing then you should not be changing assignments. Instead you have a different issue insubordination, or something else with this nurse.

I usually refer them to the nurse who makes the assignment, hinting I'm not going to change it so see if there's a good reason why the assignment was made that way, but while trying to validate their concerns.

Sometimes people do get burned out with a particular patient and need a break. But I don't like the "victum" nurses and the "why do I have to take......" nurses. I work with one of those. The last time she pitched a fit about "having the heaviest assignment on the floor", I refused to change her assignment. She literally went into the nurses lounge and yelled that she went into every room and she had all the totals, etc. I had to inform her that she was echoing down the halls and had to be quiet and address her concerns with the manger the next day. It was ugly, but she got over it and it wasn't as bad as she thought. But to show I heard her concerns she didn't get any admissions.

Basically if she allowed you to take the patient she's being selfish and manipulative and she got away with it.

The only time I refused to take care of a patient is when the patient was really wacky, anxiety or to the point of being abusive or the patient would make disgusting remarks to female nurses/staff.

Otherwise most patients don't bother me. The only time I said "no way" was when a patient make sexually inappropriate comments and would not stop, or I knew the family of a palliative care patient.

You know I thought of something else. It is not right but on rare occasion there is the nurse who object to taking care of certain types of patients based on the nurse's disaproval of life style etc. Gays, abortion (yes I know this one is a bit different), Aids etc.

As I said it may or may not be right depending on your personal view point. We can debate the morality or inmorality of it that is another issue.

Right or wrong depending on how you view it I would not want such a nurse careing for that patient. I would not want her careing for me if I was that patient.

I do not think your disaproval of me is a good reason to refuse to care for me, but if you feel that way, I don't want you to care for me, as the relationship can only be toxic.

This is one of those cases where the issue needs to be addressed on an administrative level with the nurse.

I understand the nurse has a right to participate in abourtion. I respect that right. But to refuse to care for me because of your disaproval is another thing.

The only reason I ever refused a Pt. was because I was floating to Peds ( I work NICU ) and they wanted me to D/C a pt. who's family needed a lot of discharge teaching. It was a safety and competency problem as I had never had a Pt. with that Dx. But I would never refuse an assignment on my own unit. It seems to me that a "busy" assignment is not an exceptable reason to refuse a patient. As long as the I can care for my Pt. safely, I take the OT and go with it.

This is why I love the way we do assignments in my unit....we all take report on all the patients and then we make out our assignments together. We have a team leader who is responsible for pairing the patients and writing out the assignments but we always decide as a team. If a particular nurse feels like taking a certain type of assignment (like yesterday, I wanted to be really busy so I took a very sick, one-on-one patient) then it is no problem. Sometimes, we draw to see who gets what if no one has preferences. I don't think I would like having my assignment made out for me! However, I realize this system is not possible on all units because there are too many patients, etc...We are a 20 bed ICU and we divide the patients into two teams of 10 so we only get report on 10 patients.

When I first came off orientation where I work now, I was given an assignment of 6 patients (this is a telemetry unit), 2 who were in DT's, 4 were in isolation, and one was on an insulin drip I worked that day, left 3 hours after clock out time, but not before I wrote the manager and said never again. There are often times when an assignment should be "discussed" (the reply when I pointed it out that day was "tough - I have already made out the assignments). If there is no understanding reached, go up the ladder. No one should have to work with someone they are burned out about - the attitude shows, and makes a hard situation worse. When I returned to work, there was a general e-mail that no one should have more than one patient in isolation at a time, and that's how it has been ever since!