When an Assignment is Unsafe (2022)

Imagine that you are a new nurse, about six months out of school and working on a cardiac floor at a large teaching hospital. It is Christmas Eve and you report to your unit to work the night shift. The nursing supervisor calls and tells you to go to the oncology unit – you’ve been floated. You tell the supervisor you’ve never worked oncology. She says you are just going to help out, do general basic nursing care; the regular staff nurses will handle everything else. When you get to the unit, the charge nurse gives you a fast report on your assigned patients. Contrary to what the supervisor said, you have most of the sickest patients on the unit and it is a regular patient care assignment, including administration of chemotherapy for which you are not qualified. What do you do?

When an Assignment is Unsafe (1)Consider another situation: You are an experienced nurse. Your unit has a 6-bed intermediate care or step-down unit that is staffed at a “1 nurse to 3 patients” ratio. The unit also has 18 general medical beds. When you arrive for the day shift, you have a full house and you discover that one of the two step-down nurses is out sick. Then the nursing office pulls one of the two RN’s on the rest of the unit, leaving two LPNs and a tech for the 18 beds. You not only have all 6 step-down patients, you are now charge over the other 18 beds. By mid-morning, you have two disoriented step-down patients, including one who pulls out his IV and fights with his family, and your LPNs can’t give IV meds. The nursing office says it has no one to help you for at least another 4 hours, if that. The ICU wants to give you a new patient and things are going from bad to worse. What do you do?

Unfortunately, many nurses – and many leaders — will answer the question with some form of “suck it up and do the best you can.” And while I know that questioning an assignment, let alone refusing it, is hard, this is exactly what you must consider doing. Think about it this way: if you were a new airplane mechanic and were assigned to work solo on a new type of engine that you haven’t seen before, knowing that the plane was due to fly over 300 passengers and crew in 2 hours, would you do it without objection? If you were an internal medicine physician and told that you, as the only doctor available, had to perform a craniotomy, would you do it?

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The shortage of qualified practicing nurses is not new. Neither are nurses’ legal, professional, and ethical duties. The American Nurses Association has backed the nurse’s right to refuse an unsafe assignment since at least the 1980s. The current position statement, “Rights of Registered Nurses When Considering a Patient Assignment,” (ANA, 2009) expressly states that nurses have “the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm. Registered nurses have the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm.” (Emphasis added.)

In addition, the ANA’s Code of Ethics for Nurses (2001) spells out the RN’s accountability “for judgments made and actions taken in the course of nursing practice, irrespective of health care organizations’ policies or providers’ directives”, (Provision 4).

Nurse leaders should take note of Provision 6: “acquiescing and accepting unsafe or inappropriate practices, even if the individual does not participate in the specific practice, is equivalent to condoning unsafe practice.”

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Most state/territorial nursing associations and state boards of nursing echo these statements and many states have statutes that protect nurses who point out unsafe conditions. In Texas, it is called the “safe harbor” provision and other states, although they may not use that term, have similar policies or statutory wording. Nurses and leaders must speak up when circumstances put the nurse and the patient at risk of harm. Boards of nursing will discipline nurses and leaders who knowingly allow or foster unsafe practices.

Even if you have never been in questionable situation, you should know your organization’s policies and your state’s laws and regulations regarding refusing an assignment. Objections must be in writing so check to see if your facility or state has a form and keep several blank copies in your locker or backpack.

When a potential situation arises – either at the beginning of the shift or later on if conditions deteriorate – try to identify exactly what the problem is. Are you unqualified to care for the patients assigned? Is the assignment outside the scope of your practice or your experience and knowledge level? Has the assignment changed since you accepted it – have you received new patients or has a patient’s condition deteriorated?

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When an Assignment is Unsafe (2)Be polite and factual when you follow the chain of command through the charge nurse, unit leader, or nursing office. “I am not qualified to care for these patients because I don’t have the knowledge or the experience. I am concerned for the patients’ safety and I need your help to find a safer way to take care of these patients.” “I cannot accept this assignment because my lack of knowledge or experience will put these patients at risk of harm. What else can we do to ensure their care and their safety?”

Put your objections or refusal in writing. State facts, include the date and time, and why you are refusing or objecting. Don’t use subjective or accusatory terms such as “short-staffing.” Sign it. Give a copy to your leader and keep a copy for yourself. Understand that sometimes you must care or continue to care for the patients because not caring is the greater harm.

If you are a leader, do not punish the nurse objecting or refusing the assignment. This is retaliation and it is barred by law and professional practice rules. Listen carefully, consider all available options, and thank the nurse for having the courage to speak up. Document carefully and use the experience to identify potential staff or policy needs and ways to respond to future such situations. The ANA position statement is an excellent resource to start.

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As for the two examples at the beginning, they happened and I was the nurse. In the first situation, the supervisor told me to do the best I could, and none of my patients died that night. In the second situation, one of the attending physicians saw what was happening and went to the nursing office himself. I got some help. My head nurse, who was off that day, phoned and accused me of deliberately trying to make her look bad to senior management. This was the latest of many staffing incidents at this facility. I had the next two days off; I interviewed at another hospital where I was immediately hired. I worked my two weeks’ notice under the icy glare of my head nurse, knowing I’d done the best I could to keep my patients safe.

Remember that it could be you or a loved one in the patient room someday. Don’t hope that everything will be alright. Ask for help and help your colleagues when they are facing an unsafe assignment.

When an Assignment is Unsafe (3)

written by BJ Strickland

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FAQs

What is an unsafe assignment? ›

Some of the more common examples of unsafe assignments can involve (1) not receiving any type of orientation to the unit; (2) a discrepancy between the patient's needs and the nurse's skill set; (3) an inappropriate number of patients assigned to one nurse, with respect to patient acuity; and/or (4) a critical lack of ...

What is unsafe practice in nursing? ›

Poor or unsafe practice takes place whenever workers do not provide a good standard of care and support. It occurs when workers ignore the rights of individuals, do not give them the opportunity to make choices or participate in daily living activities or ignore agreed and safe ways of working.

Can a nurse refuse an assignment in California? ›

According to the American Nurses Association, Nurses have the "professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm.

Can a nurse refuse an assignment in Florida? ›

A nurse may refuse a work assignment. However, the refusal may be considered insubordination or abandonment. Therefore, a nurse should become familiar with the organization's policies and procedures regrading refusal to accept an unsafe assignment.

Can a nurse refuse an unsafe 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 for harm.

How do you refuse an assignment? ›

Ways to Respectfully Decline
  1. I'm sorry, but no. ...
  2. No, thank you. ...
  3. I have to say no. ...
  4. No, I don't have the right skills for this assignment. ...
  5. I'm not confident this will work out, but may I have a little time to think about it?
  6. Sorry, but I don't have the time for this right now.

What would you do if you notice a colleague using unsafe practice? ›

If your co-worker refuses to listen to you and the unsafe behavior continues, talk with your supervisor. Share details such as the offender, dates, times, and incidents. The supervisor can then follow-up and schedule more frequent walkabouts, increase safety discussions or take other appropriate actions.

How do you report unsafe practice in nursing? ›

Complaints may be filed online through DCA BreEZe Online Services. In filing your complaint, the information you provide will determine the action the Board will take. The most effective complaints are those that contain firsthand, verifiable information.

What is an example of poor practice? ›

Examples of poor practice:

They are having an inappropriate conversation. They do not focus on the task. There is no focus on the supported person (they even get her name wrong). The medicines safe has been left open - this should be closed.

Can a nurse be fired for refusing an assignment? ›

Refusing an unsafe assignment, demanding that someone else come in to assist you or take over an assignment may still get you fired. However, waiting until you just cannot take it anymore and storming out without giving report will definitely put your license at risk.

Is refusing an assignment patient abandonment? ›

Failure to notify the employing agency that the nurse will not appear to work an assigned shift is not considered patient abandonment by the BRN, nor is refusal to accept an assignment considered patient abandonment.

Can nurses refuse to float? ›

You should not provide any care or perform any procedures for which you have not demonstrated competency. 3. Refusal to float and accept an assignment for which you are competent may be interpreted by the hospital as insubordination and subject you to discipline.

Under what circumstances can a nurse refuse an assignment? ›

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 punative measures, including termination, but it is your license in the end.

Can a nurse say no or refuse treatment to a patient? ›

Every competent adult has the right to refuse unwanted medical treatment. This is part of the right of every individual to choose what will be done to their own body, and it applies even when refusing treatment means that the person may die.

Can a nurse quit in the middle of a shift? ›

Under no circumstances should a direct caregiver walk out of a job during the middle of a shift. Quitting in the heat of a bad moment could jeopardize both your patients' health and your professional license.

What other action is required by the nurse when refusing an assignment? ›

nurse when refusing an assignment? The nurse must collaborate with the supervisor in an attempt. to determine an alternate assignment that will not violate the nurse's duty to the patient(s).

Can a nurse refuse to work with a doctor? ›

In short, no a nurse does not always have to follow a doctor's order. However, nurses cannot just randomly decide which order to follow and which not to follow.

Can a nurse refuse to give a medication? ›

However, the patient should always receive the primary commitment of the nurse. Additionally, the patient has the right to accept, refuse, or terminate any treatment, including medications.

How do you say no to an assignment at work? ›

Examples of ways to say “no”
  1. “Unfortunately, I have too much to do today. ...
  2. “That sounds fun, but I have a lot going on at home.”
  3. “I'm not comfortable doing that task. ...
  4. “Now isn't a good time for me. ...
  5. “Sorry, I have already committed to something else.
17 Aug 2021

Can a nurse ask another nurse for help? ›

Answer: Yes. If a nurse is discussing a patient with another nurse who needs to know the information because he or she will cover the patient while the other nurse goes to a meeting, then, as long as the discussion is audible only between the two of them, they are complying with HIPAA.

How do you handle job assignment? ›

Here are a few tips to help you handle the difficult assignment—and conquer it:
  1. Develop an action plan. Start by outlining how you will approach the assignment and do small chunks of the work at a time. ...
  2. Get a group together. ...
  3. Ask for help. ...
  4. Step back from the assignment.
9 Apr 2014

How do you deal with an unsafe situation? ›

Advice in dangerous situations
  1. Keep calm and get to safety.
  2. Help others in any way you can, without putting yourself at risk.
  3. Notify the emergency services if they are not already on the scene.
  4. Keep yourself informed and follow any advice from the police or other authorities.

What is the first thing you should do if you think your workplace is unsafe? ›

If you believe working conditions are unsafe or unhealthful, we recommend that you bring the conditions to your employer's attention, if possible. You may file a complaint with OSHA concerning a hazardous working condition at any time.

What must employees do if they identify an unsafe work practice in the workplace? ›

Advise your supervisor immediately if you see a safety problem at work. If you have concerns about safety practices in the workplace you can contact: Training Services NSW - your regional office. The workplace Health and Safety Representative (HSR)

What can get you fired as a nurse? ›

Top 5 Reasons Nurses Get Fired
  • Too Many Absences. Absences are a common reason nurses get fired. ...
  • Habitually Late to Work. ...
  • Failure to Update Licenses and Certifications. ...
  • Drug Abuse. ...
  • Patient Abuse.
11 Sept 2020

What happens when a nurse is reported to the board? ›

Once a complaint hits their desk, the board has to determine if the facts as stated in the complaint are a violation of the laws that govern a nurse's practice. If so, an investigation is initiated, and the nurse may respond to the allegations. The board then resolves the complaint. It may or may not require a hearing.

When should a nurse be reported? ›

When there is a legal requirement to report under the Regulated Health Professions Act, you must do so within 30 days of the incident. In any event, we encourage you to submit the report as quickly as possible.

What are 6 principles of safeguarding? ›

What are the six principles of safeguarding?
  • Empowerment. People being supported and encouraged to make their own decisions and informed consent.
  • Prevention. It is better to take action before harm occurs.
  • Proportionality. The least intrusive response appropriate to the risk presented.
  • Protection. ...
  • Partnership. ...
  • Accountability.

What are poor working practices? ›

Poor standards of work, e.g. frequent mistakes, not following a job through, unable to cope with instructions given. Inability to cope with a reasonable volume of work to a satisfactory standard. Attitude to work, e.g. poor interpersonal skills, lack of commitment and drive.

Why do I need to report unsafe or abusive practices? ›

I must report unsafe or abusive practices because... There will be times when your duty to safeguard the wellbeing of the individual is in conflict with your duty to promote the individual's right to take risks.

Under what circumstances can a nurse refuse an assignment? ›

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 punative measures, including termination, but it is your license in the end.

What other action is required by the nurse when refusing an assignment? ›

nurse when refusing an assignment? The nurse must collaborate with the supervisor in an attempt. to determine an alternate assignment that will not violate the nurse's duty to the patient(s).

Can a nurse say no or refuse treatment to a patient? ›

Every competent adult has the right to refuse unwanted medical treatment. This is part of the right of every individual to choose what will be done to their own body, and it applies even when refusing treatment means that the person may die.

Can a nurse quit in the middle of a shift? ›

Under no circumstances should a direct caregiver walk out of a job during the middle of a shift. Quitting in the heat of a bad moment could jeopardize both your patients' health and your professional license.

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