Refusing a patient: Is it acceptable?

[~Anne~]

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?

[Repat]

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!

[NursesRmofun, ASN, RN]

I don't know. I think there are a few legitimate reasons to want to request a change. I was on as a floater and was dumped-on frequently on some units. I never refused an assignment but I sure did voice my displeasure. I did refuse an admission once because some other nurses were standing around the nurses' station drinking coffee and made personal phone calls all morning while I worked my butt off. One time, on my regular unit, I did "give a patient up" (only once!) because when I took the patient, she was getting me so annoyed that I felt my professionalism was on the edge. It was scary to feel that way. I was right to hand her over mid-shift, and the charge nurse understood and did not mind.

[MandyInMS]

We rotate pts so nobody is 'stuck' with any particular pt..really helps when you have the pt from HELL....the only time I have refused a pt was for personal reasons..I refused to take a woman my Dad had an affair with while married to my Mom..no wayyyy I could be objective with that woman...wasn't a problem..everyone else said they would refuse her too.

[susanmary]

I'm a believer in primary care nursing & continuity of care. That being said, some staff may feel they need a "break" from a patient and/or their family. Even if a patient is a very heavy patient, I feel that by following that patient closely by being a primary nurse -- it makes for an "easier" assignment: I know the patient, may know the family, know the dressings/meds/etc. -- the care plan is up-to-date -- kardex up-to-date, etc.

Let the charge nurse know if you have an extremely challenging patient with complex needs -- specify if this is a patient is heavy regarding nursing care, tech care, or both. If a patient's condition deteriorates during the shift -- let the charge know so that he/she can plan the assignments accordingly. Being charge is not easy -- there is virtually no shift where everyone is going to be happy with their assignment. I've done charge (as many others will shake their heads up-and-down in agreement) where I've taken ALL the heavy patients ... boy did I learn fast. Advocate for yourself, for patient safety, and try to look at the whole unit's picture. Sometimes, we may think we have the most difficult patient ... the most difficult assignment, etc. without truly knowing that the other nurses feel this way about their assignments, too.

What I think we all can do is when we know a fellow staffer has a very difficult patient, pitch in to help -- with turns, assist with dressing changes, give a med for them, etc. TEAMWORK only works when team members are team players. Oh gosh, what was this thread originally about?

Have I refused a patient because he or she was heavy? No. But I've asked for help when I've needed it and learned to reprioritize. If the same nurse keeps refusing "heavy" patients, perhaps he/she needs to sit down with the charge nurse and nurse manager to understand what her expectations are of the position. Overwhelmed? Lazy? Unsure of what to do for certain, complex patients? Burnt out?

This is a very interesting thread.