Under what circumstances can a nurse LEGALLY refuse an assignment?

[Hellllllo Nurse]

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.

[Hellllllo Nurse, BSN, RN]

When I worked medical-surgical in South Texas (Rio Grande Valley), nurses were routinely assigned 13-15 pts each, with no CNA and no unit clerk.

This is also where the unsafe assignments occurred. Of course, every assignment every day was unsafe. I spoke up only about exceptionally unsafe situations and was still regarded as crazy for having done so.

That's one reason why DH and I left the area.

[Havin' A Party!, ASN, RN]

Hellllllo Nurse said:

Medical-surgical nurses were routinely assigned 13-15 pts each, no CNA, no unit clerk.

Wow!

Who's attracted to that place??? What's the hourly rate??? $100 / hr???

[CSLee3, ASN, BSN, LVN, EMT-P]

You mentioned Texas; well, in this fine state, we have "Safe Harbor" laws. If you claim "Safe Harbor," all wheels stop turning, and administration needs to be called, and THEY are the only ones who can resolve it, not the charge nurse. (house supervisor would be considered admin)

Under this law, you can refuse treatment or assignment if you feel you cannot safely complete the task or a danger exists, etc. There is reporting to the board involved here, so be careful. As much as we all hate Jhaco and their policies, they set the standards in courts of law. There is no way they can say you can care for 13-15 patients and do it safely with no help from other staff.

"Keep up the fight."

[CherryRN]

Never protect your JOB.

Always protect your LICENSE.

You can get another job. You can't get another license.

[mattsmom81]

Nurses shouldn't guess or speculate about such things. Get a copy of your very own Nurse Practice Act and be sure. If it's not clear, write your BON and specifically ask.

Personally, I feel it's my duty to refuse new admissions if my unit is not staffed to handle them; and I HAVE refused to accept a grossly unsafe assignment. As mentioned, we may lose our job but will keep a license. (It's happened to me twice, and I quit both times. Who wants to work for someone who doesn't care about staffing safely?)

Hospitals prefer 'yes men' on their staff, but we send a strong message when we say 'no', and we all must find our limit regarding what we will take responsibility for and what we won't. I know some nurses who cower and think they have no right to protest or refuse unsafe assignments, but this may backfire on them someday, and blind acceptance encourages the facility to do it again and again...since the nurses will 'take it.'

My nurse attorney tells me in Texas if we file specific assignments under protest letters with our management team, the hospital assumes some responsibility if the nurse wishes to 'do her best' in an unsafe situation. But the way today's hospitals operate, the NURSE may well end up under the microscope here and end up a scapegoat.

Cynic that I am, I don't expect a facility to back me up if push comes to shove. They will happily sacrifice a nurse to cover their orifice; I've seen it happen.

It's an individual decision. I don't judge a nurse who says no; in fact, I don't think nurses say 'no' nearly enough. We have walked the safety line so long that varying degrees of inadequate staffing are business as usual in many places.

[Euskadi1946]

LarryG said:

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.

About a year after I had graduated from nursing school, I was working the 3-11 shift at a long-term care facility. On my shift, I had 1 LPN and 1 CNA for 28 residents. Luckily I finished my assignment on time and was waiting for an LPN, who was working at the Jail, to come and relieve me. 11:30 PM, no LPN; 12:30 AM, no LPN, so I called the Nurse Manager about the situation and was very upset that I had called her. I told her that I had been very busy, my shift was over, and I wanted to go home but could not leave until I got some relief, and the LPN who was scheduled to come in at 11:00 PM hadn't shown up yet. We called her at the Jail, and they stated she had left at 10:30 PM; we called her at home, no answer. The manager wanted me to start calling around to find relief, so I did. Still, no sign of the LPN, and nobody else wanted to come in. I called the Manager at 1:00 AM and told her what the situation was. Still, she refused to come in. Finally, at 3:00 AM, the LPN came waltzing in, stating that she had gone out with friends after work and had lost track of time. Told how very thoughtful of her not to call and let us know! (This was in Reno, Nevada, a 24-hour town). I gave her a report, put down 4 hours of overtime, filled out an incident report, took copies of it, and put the original in Manager's office. The next morning I get a call from the Manager to come into her office; she wants to talk to me. This was my day off, of course, so I went in. She told me that there was no way in the world she would pay me the overtime because I was a salaried employee and to please never call her in the middle of the night again. I proceeded to tell her that I would take a copy of the incident report, a copy of the staffing grid, with a copy of my time card to the Labor Board and the BON and would notify every TV Station within 100 miles regarding the horrible working conditions and how she treated her nursing staff. She did cut me my check with the time and a half and two weeks severance pay and told me never to come back again. I said my pleasure. I still sent a copy of the incident and the staffing grid to the BON. The last I heard, the LPN who was supposed to relieve me was still working there. I lost a lousy job but kept my license and my integrity intact because I refused to abandon my pts.

[wjf00]

CeCiRN said:

About a year after I had graduated from nursing school, I was working the 3-11 shift at a long-term care facility. On my shift, I had 1 LPN and 1 CNA for 28 residents. Luckily I finished my assignment on time and was waiting for an LPN, who was working at the Jail, to come and relieve me. 11:30 PM, no LPN; 12:30 AM, no LPN, so I called the Nurse Manager about the situation and was very upset that I had called her. I told her that I had been very busy, my shift was over, and I wanted to go home but could not leave until I got some relief, and the LPN who was scheduled to come in at 11:00 PM hadn't shown up yet. We called her at the Jail, and they stated she had left at 10:30 PM; we called her at home, no answer. The manager wanted me to start calling around to find relief, so I did. Still, no sign of the LPN, and nobody else wanted to come in. I called the Manager at 1:00 AM and told her what the situation was. Still, she refused to come in. Finally, at 3:00 AM, the LPN came waltzing in, stating that she had gone out with friends after work and had lost track of time. Told how very thoughtful of her not to call and let us know! (This was in Reno, Nevada, a 24-hour town). I gave her a report, put down 4 hours of overtime, filled out an incident report, took copies of it, and put the original in Manager's office. The next morning I get a call from the Manager to come into her office; she wants to talk to me. This was my day off, of course, so I went in. She told me that there was no way in the world she would pay me the overtime because I was a salaried employee and to please never call her in the middle of the night again. I proceeded to tell her that I would take a copy of the incident report, a copy of the staffing grid, with a copy of my time card to the Labor Board and the BON and would notify every TV Station within 100 miles regarding the horrible working conditions and how she treated her nursing staff. She did cut me my check with the time and a half and two weeks severance pay and told me never to come back again. I said my pleasure. I still sent a copy of the incident and the staffing grid to the BON. The last I heard, the LPN who was supposed to relieve me was still working there. I lost a lousy job but kept my license and my integrity intact because I refused to abandon my pts.

Outstanding! If more nurses act as you have, working conditions will improve for all of us.

[Hellllllo Nurse, BSN, RN]

CeCiRN,

You did the right thing.

Great post and advice.

[Hellllllo Nurse, BSN, RN]

LarryG said:

Wow!

Who's attracted to that place??? What's the hourly rate??? $100 / hr???

My pay was $19.00/hr.

Of course, I was told when I was hired that staffing was one nurse to six pts. The place even runs ads on TV trying to recruit nurses, in which they claim their ratio is 1:6.

When I was trying to leave the place, I called another local hospital that was running an ad for nurses in the paper. This hospital came right out and told me on the phone that their nurse-to-pt ratio on medical/surgical was 1:13.

There was a unit clerk and CNA on the unit where I worked, but the charge nurse instructed them not to assist me or my pts in any way. A co-worker overheard this conversation and informed me. Of course, she said she would deny having heard anything if I filed a complaint or went to mgmt in any way.

This charge nurse actually functioned more as an asst. to the NM. He had been recruited from The Philippines by the hospital in the 1980s.

One NOC, the evil charge nurse, berated me for assessing my pts, saying, "You don't have time for that." He advised me to "copy last shift's assessments."

This nurse had a thing against Caucasians and women.

He refused to help me with my first-ever transfusion. I was given 3 to do on 3 pts simultaneously. When I asked other staff to assist me (Remember I'd never given a transfusion before), they sheepishly told me that the charge nurse had told them that I needed to prove myself to him and that they were not to help me.

When I went to my NM, I was told I was the first person who'd ever complained about him. She didn't believe me.

However, I learned that almost every white nurse who'd been hired in the last few years had left. Some Canadian nurses had broken their contracts and forfeited bonuses to leave. Another "white" nurse who quit just before I did, was recruited from Minnesota and paid a $35./hr per diem rate for full-time. She was so desperate to leave she quit without another job and as the sole breadwinner for her family. She now works for a medical malpractice attorney helping pts to sue docs and hospitals.

I was the only "white" nurse left on the unit on my shift. The unit was mostly male, as well, as this charge nurse preferred working with males.

Any women working on the unit were usually very young, very passive, and very pretty, as this nurse preferred those traits in female nurses. He basically had the NM totally fooled. She relied heavily on him. She made many of her decisions as boss based on this guy's words.

I had never witnessed such screwed-up dynamics in my life.

I was a new grad RN when I worked at this place. This was my first hospital job as a nurse.

Mgmt assigned a special "staff theme" every month. The month I left, the theme was "respect for co-workers."

When I've talked to other nurses about the things I saw and experienced at this hospital, they generally have a hard time believing me. A couple have even replied with statements such as "Come on. You're exaggerating. That can't be true."

I quit three years ago, but I'm still bothered by how awful my experience was. I guess you could say I'm haunted by it.

[kayleighac]

Okay, I have a situation that I would like everyone's opinion on.

I am an LVN in the state of CA. Today I had a patient refuse care from a CNA. We tried talking to her, and she would not change her mind; she requested to have a different CNA. So I used my best judgment, and I decided to give this patient to a different CNA. The reason I chose the CNA that I chose was because she had the closest round to this particular patient. She works down the same hallway while all the rest of the CNAs are in different hallways in different parts of the facility. She has also worked with her in the past and knows this patient well, and the patient likes her. The CNA that I tried assigning to her refused to accept the change. I was going to switch patients so that the two CNAs still have the same amount of patients. She still refused to accept the assignment change. Now, me being the charge nurse, I ultimately have the decision in the end on who gets what assignment. I did not appreciate the CNA arguing with me in the hallway, refusing to take a patient. My supervisor and I decided to write her up because this is the second time this has happened with this CNA in a completely different situation.

I think about it this way: She gets paid to be here and do this job. Patients can refuse care from a nurse, but we cannot refuse care to a patient unless it's a special circumstance, such as the patient threatening the staff, which doesn't happen to be the case here. She doesn't want to take care of this patient because it's not a part of her normal round, and she doesn't like it when a change is required, basically because it's an inconvenience to her. Nothing is ever perfect, and when we do get special requests from patients, we have to try to work around them. If my supervisor gave me an assignment to do, I would not dream of refusing it unless I had very good reason to. I would never think of arguing with my boss or supervisor about the work that they give me. This is what we get paid for. Does anyone agree with me?

[Mr Ian]

kayleighac said:

kayleighac said:

Okay, I have a situation that I would like everyone's opinion on

I am an LVN in the state of CA. Today I had a patient refuse care from a CNA. We tried talking to her, and she would not change her mind; she requested to have a different CNA. So I used my best judgment, and I decided to give this patient to a different CNA. The CNA that I tried assigning to her refused to accept the change.

Totally agree the CNA is out of line.

However, it's worth checking in with the CNA to find her/his reasons for refusing - rather than assuming it's cos it's an unscheduled change.

I think that perhaps she has a problem with the other CNA and, even tho it was the pt that requested a different CNA - why was that?

One thing I know is good CNAs do not like to pick up other bad CNAs because that's like punishment for being a good CNA.

[Mr Ian]

Hellllllo Nurse said:

When I've talked to other nurses about the things I saw and experienced at this hospital, they generally have a hard time believing me. A couple have even replied with statements such as "Come on. You're exaggerating. That can't be true."

It sounds more like the CN is a sociopath and rules by the rod.

I'll cautiously comment on the cultural aspect - as there are still a lot of ethnic cultures where male domination exists. But I think from your description, this guy is going beyond what is culturally explicable.

Asking you to prove yourself on blood transfusions is beyond belief.

If you were still there, I'd offer you tips on how to get rid of him. As you're not - I'll say, you are out of that place now, and nothing in your thinking seems odd to me at all. It was the wrong place.