Under what circumstances can a nurse LEGALLY refuse an assignment?

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For instance- a nurse is reporting to work in a hospital. She feels her pt load is too large for her to be able to provide safe care- OR- a nurse is assigned to an area where she does not feel competent, I.e., a medical surgical nurse w/ no L&D experience is assigned to L&D.

Please only answer these questions if you have the FACTS.

"I think" and "I heard" type of answers won't help.

Thank you so much.

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You may legally refuse to care for family members. You may legally refuse to care for a patient who has threatened to harm you physically/legally. You may refuse an assignment on a floor or in an area that you are not cross-trained to work in, this may lead to punitive measures, including termination, but it is your license in the end. You may not refuse to give standard nursing care in an emergency situation, even if the situation is not familiar to you. I hope this helps.

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Hellllllo Nurse said:

For instance- a nurse is reporting to work in a hospital. She feels her pt load is too large for her to be able to provide safe care- OR- a nurse is assigned to an area where she does not feel competent, I.e., a medical surgical nurse w/ no L&D experience is assigned to L&D.

Please only answer these questions if you have the FACTS.

"I think" and "I heard" type of answers won't help.

Thank you so much.

This was told to me by a nurse's attorney at a legal nursing conference. I took it to be fact. You take it as you like.

The nurse can refuse the assignment for any of the above reasons LEGALLY in order to protect the patient and his/her license. However, the hospital can still fire the nurse for insubordination - LEGALLY in a right-to-work state. The nurse can sue the hospital and demand to be reinstated. Those cases are decided on a case-by-case basis. Sometimes they are won, sometimes not. The point of the situation is - jobs come and go, and you do what you have to do to protect your license.

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barefootlady said:
You may legally refuse to care for family members. You may legally refuse to care for a patient who has threatened to harm you physically/legally. You may refuse an assignment on a floor or in an area that you are not cross-trained to work in, this may lead to punitive measures, including termination, but it is your license in the end. You may not refuse to give standard nursing care in an emergency situation, even if the situation is not familiar to you. I hope this helps.

That is a state-by-state thing. In my state (and many others), if you are not ASSIGNED to the patient, you do not have the duty to care. This is per a nurse attorney who specializes in negligence and malpractice cases.

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At what point has a nurse been "assigned" to a pt?

I have been told that it is legal for a nurse to refuse an assignment if she has not yet taken a report on an assignment. I want to know if this is true.

How will a nurse know what her assignment entails if she has not yet taken a report?

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Specializes in Maternal - Child Health.
Hellllllo Nurse said:

At what point has a nurse been "assigned" to a pt?

I have been told that it is legal for a nurse to refuse an assignment if she has not yet taken a report on an assignment. I want to know if this is true.

How will a nurse know what her assignment entails if she has not yet taken a report?

It is correct that a nurse may "legally" refuse an assignment at the beginning of the shift if she has not yet "assumed" care of the patients.

It is also correct that the facility may discipline or fire the nurse for doing so. But the State BON will not take action for patient abandonment because a nurse can not abandon patients for whom s/he has not assumed care.

So, if you report to work and are told to take an assignment of 10 patients, which you believe to be unsafe, you may refuse the assignment and protect your license but still lose your job.

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So it's almost like a Catch-22 thing, huh? So you mean to say that if (for example) a nurse manager wants to "get rid of" a particular nurse, all they have to do is to create a situation (like giving the nurse 15 cases) in which the nurse MUST refuse to protect her license, but she will DEFINITELY be fired and out the nurse manager's hair who wanted her to leave in the beginning?

Also, you say that jobs come and go, but being fired has GOT to look bad on a resume when you're searching for a new job!

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Nurses-

Thanks for your responses. I am not currently in a situation where I need to know this, but I have been in the past. I accepted an assignment that I felt was unsafe more than once. Both times I voiced my objections to my charge nurse. I explained why I felt the assignment was unsafe and why I did not think I should take it. Both times the charge nurse said nothing and walked away, leaving me alone with the pt. Nothing untoward happened, thank God, but I still look back on the situations with uneasiness and unanswered questions.

I gave my notice the day after the first situation, and the second situation happened when I was completing my notice.

Also, a friend of mine believes that she does not have the right to refuse any assignment without risking charges of pt abandonment. I do not believe this to be true and want some information to take back to her.

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At the hospital where I worked several years ago, some of the nurses would come up to the floor prior to clocking in to see the assignment. The hospital was known for giving us 8 to 10 total care patients with 1 CNA for 20 + patients. This was not a LTC facility. I was a new nurse and didn't understand the way things worked. But the other nurses told me that they did this prior to clocking in so that if they didn't want the assignment, they would call off. Thinking back, I'm sure they could have been terminated if they had actually "called off" at the last minute, but they wouldn't have been reported for abandonment.

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Specializes in ICU, CM, Geriatrics, Management.
Jolie said:
It is correct that a nurse may "legally" refuse an assignment at the beginning of the shift if she has not yet "assumed" care of the patients.

It is also correct that the facility may discipline or fire the nurse for doing so. But the State BON will not take action for patient abandonment because a nurse can not abandon patients for whom s/he has not assumed care.

So, if you report to work and are told to take an assignment of 10 patients, which you believe to be unsafe, you may refuse the assignment and protect your license but still lose your job.

This sounds correct to me.

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Specializes in ICU, CM, Geriatrics, Management.
pnurseuwm said:
Like giving the nurse 15 cases.

It seems a bit exaggerated.

If the assignment is totally unrealistic, the facility will certainly encounter several prob's they'd rather not have to deal with.

As stated above, a lot of this is situational -- all depends on the specific particulars.

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And unless you have a contract, an employee-at-will can be fired for any darn reason at all.

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