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:
The response to your question is beyond the scope of this column. Some general comments can be made, however.
The refusal of an unsafe assignment has been the concern of nurses for many, many years. How such a refusal can be handled is based on many factors, including state nurse practice acts/rules and employer policies, as examples. Professional association guidelines also impact upon this situation. The American Nurses Association Web site, nursingworld.org, is one resource for you to review.
Another resource is to place nurse refusing an assignment or something similar in your search bar. The results yield how different states handle this issue. Also included in the results are articles, board of nursing opinions, and other information. These results are not specific to your situation, so a consultation with a nurse attorney or attorney in your state would be essential in order to obtain specific advice on how best to handle the refusal of an unsafe assignment.
Several general principles continue to be identified, however. A nurse who is faced with an unsafe assignment must communicate his or her concerns to the person designated to be contacted in the facility (e.g., DON, supervisor). The nurse needs to be factual and clear in communicating what the identified risks for the nurse are with the assignment. Documenting the discussion and the concerns about the assignment pursuant to facility policy is also important. Last, and by no means least, the nurse cannot leave the patient without nursing care until a replacement is obtained.