What is the procedure for refusing an unsafe assignment? Do you have to refuse right after report or when you do assessments and see that report was not adequate? How do I document that I notified the charge nurse that it was unsafe?
Nancy Brent replies:
A nurse has the legal and ethical obligation to refuse an unsafe assignment that compromises patient safety. Authority for this type of refusal can be found in many professional ethical publications, including the American Nurses Associations Guide to the Code of Ethics for Nurses: Interpretation and Applications and its Standards and Scope of Nursing Practice.
Additionally, many state nurse practice acts and rules include guidance for the nurse licensee when confronted with an unsafe assignment and how it should be handled. It would be a good idea for you to check your state practice act and rules, as well as any opinions on the subject your state board of nursing has issued.
When confronted with an unsafe assignment, it is important for the nurse to also follow any policies and/or procedures the facility has in place to govern this type of situation. At a minimum, the policy may include to whom you must voice your concern about the assignment, when that concern needs to take place, and the caveat that the nurse cannot withdraw from the assignment by simply leaving the facility. The nurse employee must remain in the facility and perhaps even care for the patient or patients until another nurse takes his or her place so that the patient(s) is/are not placed at risk.
In addition, the policy may indicate that the nurse can file an incident report concerning the assignment and what happened in a factual and accurate manner. Even if the policy does not provide for the filing of an incident report, the incident report policy is probably broad enough to include an unsafe assignment issue, particularly if the nurse is not relieved by another staff member and the nurse employee must provide care. The report can alert risk management to the difficulties on the unit with this, and perhaps other, unsafe assignments, especially when they are due to inadequate staffing or inexperienced nursing staff, as examples.
A consultation with a nurse attorney or attorney in your state might help in obtaining specific advice based on your place of work and the applicable state laws.