How to refuse an unsafe assignment

Nevada RNformation, Nov 2003 by Scott, Debra

Question and Answer with Debra Scott, MS, RN Executive Director, Nevada State Board of Nursing

Q. How can I refuse an assignment that is unsafe without losing my license and my job?

A. The Board of nursing receives many calls from nurses who feel they are being asked to place their patients at risk or their licenses in jeopardy. Many think they have no choice but to accept assignments they are unable to safely manage, to perform acts they aren't qualified to do, or to work longer hours than they believe they can physically or mentally endure and still provide safe patient care.

Often, refusing an assignment does not seem an option for these nurses who believe either the patients would be endangered or they would lose their jobs if they simply said "No." Some blame poor staffing due to economic motivations, others point to nursing administration's failure to advocate for staff nurses, and sometimes the situation seems a factor of the nursing shortage or the rural nature of our state.

Yet, all licensed nurses in Nevada are subject to the Nurse Practice Act that holds nurses responsible and accountable for nursing judgments, actions and competence and requires the nurse to safeguard the patient. Accepting an assignment that the nurse knows she is not qualified for, and/or accepting an assignment that places a patient in jeopardy, are violations of the Nurse Practice Act and may result in disciplinary action.

Q: How can nurses protect their patients, protect their licenses, and still maintain their jobs in the "real world"?

A: Prevention and early intervention are always a place to start. Nurses should know the laws and regulations that govern their practice and clearly understand what constitutes a violation of the Nurse Practice Act. For example, nurses may be told that refusing to accept an assignment is "wrongful abandonment," but in fact, the Nurse Practice Act cites three conditions that must exist before such an action would be considered abandonment by the Board. Specifically, according to NAC 632.895(6):

"An act of patient abandonment occurs if:

(a) A licensee or holder of a certificate has been assigned and accepted a duty of care to a patient;

(b) The licensee or holder of a certificate departed from the site of the assignment without ensuring that the patient was adequately cared for; and

(c) As a result of the departure, the patient was in potential harm or actually harmed."

Evidence of all three conditions must be shown before the Board may consider disciplinary action against a nurse for patient abandonment.

However, it should be noted that the Board has no jurisdiction over employment or contract issues.

Until unsafe conditions are corrected, well-intentioned nurses may feel like they're in a "Catch 22," where if they practice in accordance with the law, they will keep their licenses but lose their jobs. Unfortunately, sometimes leaving a position is the only option. Here are some things to consider

* Place patient safety and well-being first. Act in good faith.

* Know the laws and regulations that govern your practice.

* Build a defense for why an action (or act of omission) was unavoidable.

* Document carefully. Be able to demonstrate that the course of action was what would have been provided in a similar situation by a reasonable and prudent nurse with similar education and experience.

* Continue to advocate for safe nursing care for patients.

If you believe that a situation is truly a risk for the public, please do not hesitate to call the Board and discuss your concerns.

Debra Scott, MS, RN Executive Director, Nevada State Board of Nursing