Can I Refuse An Unsafe Patient Assignment?
There seems to be an old wife’s tale in nursing that if you do not accept a report of a difficult assignment then, you are free to leave. I don’t understand why nurses think that this is OK, because if you do leave, who is going to take care of the patients
assigned to you? How are they going to be able to get another nurse in to fulfill your patient assignment and if you are concerned about the difficult assignment that you received and want to leave, then what are you doing to the other people who will have to absorb your assignment that you already feel is not safe?
Unfortunately, many nurses have this belief that if they don’t accept report that they can refuse to take an assignment. The American Nurses Association (“ANA”) upholds that, “Registered nurses- based on their professional and ethical responsibilities — have the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk of harm. Registered nurses have the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk of harm.”
Unfortunately, in reality, you can’t walk off the job and think it’s OK. Know your state’s Nurse Practice Act and know what your rights and responsibilities are to determine whether you can refuse to accept an assignment.
Should you refuse to accept an assignment, the ANA says you must refuse in writing. That still may not be enough for the Board of Nursing. I do know that Texas has a safe harbor law where if you get an assignment that you don’t feel is safe then you can fill out some kind of safe harbor form.
In California, you can refuse an assignment if you are floated to an area in which you were not professionally trained. Each state is unique in their own nurse practice act and their own requirements, but refusing to accept a patient assignment not only impacts patients but also the rest of the healthcare team and the entire hospital.
It is important that if you choose to refuse an assignment, that you do so properly. If you are in a state that does not allow you to refuse an assignment, I
suggest enumerating your concerns in writing and giving copies to your manager and supervisor on duty. That way if anything happens and you are reported to the Board or if there is a malpractice claim, you have done your part by saying, “I’ve done everything I can to get the assignment changed, but no help was forthcoming.”
Should you refuse to accept an assignment, do not view the patient’s medical records, do not say “hi” to the patient, do not take doctor’s orders regarding the patient, and do not administer any type of care. This is only for a state in which you are allowed to refuse an assignment.
Do your research and be prepared ahead of time by knowing your state’s Nurse Practice Act and whether you can refuse a patient. Also know your facilities, policies and procedures and your nursing rights. The more prepared you are in case this happens, the better.
Lastly, ask yourself why do I continue to work at a facility that gives me an unsafe assignment? My warning is simple: you can always get another job, but you can’t get another license.
If you are given an assignment that you feel is unsafe, call a resource RN to help with your patient care tasks, ask that the assignment be redistributed, ask if the assignment can be changed and the patient acuity be better redistributed among all the nurses. Ask for a one-on-one sitter for a confused patient. This will allow you to be freed up to take care of your other patients.
Ultimately, nursing is team practice, and the goal is for patient safety. You need to speak up. If you received an inappropriate assignment putting your patients’ well-being and your nursing license on the line, you need to speak up. If you are required to
continue to accept the assignment, make sure that you note your objections properly by putting it in writing.
But if you’re in a state where you’re not allowed to refuse an assignment, go ahead and take it, but do your CYA letter.
