Questions r/t sub-acute/ltc agency msg

So, as I mentioned in an earlier post I've started with an agency. I actually really love it so far, although it's a second job for me and not something I'm doing full time yet.

What I did was look up the facilities and decline the ones that I felt were too risky. There isn't ANY orientation what-so-ever, I literally function as a fully trained staff nurse. (Fake it till ya make it, i guess).

I've been thinking about possible situations where I would feel unsafe, and I"m wondering if anyone has any input.

If I were to arrive at a facility and the patient load was ridiculous, for example - could I refuse the assignment? I'm talking over 30 patients or something along those lines, it would have to be truly unsafe for me to not want to work, but how does that work?

Would I need to decline/refuse before or after taking report? I'm thinking it would be during report that I would probably find out that the assignment was too much, etc. Would I call the facility DON? I'm truly worried this could eventually happen to me and the last thing I would want to do is accept an assignment I can't handle - this is why I do my research and decline the terrible facilities, but I know it could still happen.

Also - I'm wondering under what circumstances other nurses ignore so called facility policy and do what is best for the patient, things like calling the MD for something another nurse says would normally wait until the morning or holding a med without parameters, etc.

Or things like wound care, implementing a dressing (something many facilities have standing orders for).

I had a facility tonight that doesn't allow nurses (or anyone non-dietary) to make patients a cup of tea. What could actually happen to me if I just did it anyways or did it before I knew it wasn't allowed?

Argh, so many things to know!