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What is the procedure for refusing an unsafe assignment?


Dear Nancy,

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:

Dear Heather,

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 Association’s 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.


By | 2009-04-01T00:00:00-04:00 April 1st, 2009|Categories: Blogs, Nursing careers and jobs|6 Comments

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  1. Avatar
    Dawn Marie September 26, 2017 at 9:18 am - Reply

    I refused an assignment as unsafe and was told as It was taken to the manager on duty that if I did not, to leave the building. I requested a nurse on duty doing paperwork to help offload for safety and was refused. Furthermore, I had never taken report. I was then cornered by the same manager who informed me that If I left, it was going to be reported to my nursing board as abandonment. With another nurse available at the time of refusal, was I within my rights to leave? The manager had told me to leave and then confiscated my badge on the way out after I protested that the extra nursr onbthe fliir could assist.

  2. Avatar
    Jolee January 12, 2018 at 5:42 pm - Reply

    I work a skilled longterm unit with 40 residents and was the only Cna to work the whole unit on night shift by myself. I walked out and clocked off my shift because I couldn’t take Care of 40 residents by myself.The D.O.N. gave me a write up. Is that OK to have one CNA do patient care for 40 residents alone?

  3. Avatar
    Sherlynn McKenzie May 25, 2019 at 3:28 pm - Reply

    I work for long term care. Staff call offs, and shortage is ramped, but the administration does not seem to hold people accountable, prevent it, or assist with the problem. Nurses are having to work more than their 12 hrs because there is absolutely no one to relieve them. I have worked many 16-18 hr shifts because there was no one available or no other licensed nurse in administration/management, would take over. I have been threatened with abandonment if I leave without having a replacement. At what point can we safely leave without coverage and risk abandonment resulting loss of licensure? I’ve been a nurse over 35 yrs. This has become a norm with many LTC facilities I have worked. I would quit that job and move on, only to be faced with it again. I’m LPN, and most other facilities that are non-LTC, will not hire LPNs. What are my resources for help?

  4. Avatar
    Jim Krossa, R.N. June 2, 2019 at 5:20 am - Reply

    First, look to your State Nurse Practice Act. There are usually regulations on how many hours you can be scheduled to work, and how many hours you are allowed to be held over doing patient care.
    Second, look to the regulations for LTC, and your facility’s policy on hours work.

  5. Avatar
    Jimmy August 18, 2019 at 11:14 pm - Reply

    Is it ok to refused patient if you feel unsafe with the relative’s attitude towards nurse.The provoked all the nurse who cares for their mom.

  6. Avatar
    Justin p Acklin December 2, 2019 at 6:55 am - Reply

    Simple question not answered by article: can a nurse be fired for refusing a dangerous patient load?

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