appendix 3
Guidelines for the Registered
Nurse in Giving, Accepting,
or Rejecting a Work Assignment*
Registered Nurses, as licensed professionals, share
the responsibility and accountability along with
their employer to ensure that safe, quality nursing
care is provided. The scope of professional nurses’
accountability involves legal, ethical, and profes-
sional guidelines for assuring safe, quality patient
care. Legal responsibility for the provisions, dele-
gation and supervision of patient care is specified
in the Nurse Practice Act 464.001, and the
Administrative Rules Chapter 59S. The American
Nurses Association (ANA) Code for Nurses with
Interpretive Statements (1985) guides ethical
conduct and decision making of professional
nurses. The ANA Standards and Scope of
Practice (1997) provides a systematic application
of nursing process for patient care management
across patient care settings. In addition, the ANA
Restructuring Survival Kit (1996) suggests com-
mon strategies to assist the professional nurse
facing assignment and delegation issues during
reassignment and reorganization, temporary or
permanent. Lastly, the employer requirements for
safe, competent staffing are outlined in facility
policies and guidelines.
Within ethical and legal parameters the nurse
exercises informed judgment and uses individual
competence and qualifications as criteria in seek-
ing consultation, accepting responsibilities and
delegating nursing activities to others. The nurse’s
decision regarding accepting or making work
assignments is based on the legal, ethical and pro-
fessional obligation to assume responsibility for
nursing judgment and action.
The document offers strategies for problem
solving as the staff nurse, nurse manager, chief
nurse executive and administrator practice within
the complex environment of the health care
system.Nursing Care Delivery
Only a Registered Nurse (RN) will assess, plan
and evaluate a patient’s or client’s nursing care
needs. No nurse shall be required or directed to
delegate nursing activities to other personnel in
a manner inconsistent with the Nurse Practice
Act, the standards of the Joint Commission on
Accreditation of Health Organizations, the
ANA Standards of Practice or Hospital Policy.
Consistent with the preceding sentence, the
individual RN has the autonomy to delegate (or
not delegate) those aspects of nursing care the
nurse determines appropriate based on the
patient assessment.
When a nurse is floated to a unit or area where
the nurse receives an assignment that is consid-
ered unsafe to perform independently, the RN has
the right and obligation to request and receive a
modified assignment, which reflects the RN’s
level of competence.
The Florida Nurses Association (FNA), the
Florida Organization of Nurse Executives
(FONE), and the FNA Labor Employee
Relations Commission (LERC) recognize that
changes in the health care delivery system have
occurred and will continue to occur, while empha-
sizing the common goal to provide safe quality
patient care. The parties also recognize that RNs
have a right and responsibility to participate in
decisions affecting delivery of nursing care and
related terms and conditions of employment. All
parties have a mutual interest in developing sys-
tems, which will provide quality care on a cost
efficient basis without jeopardizing patient out-
comes. Thus, commitment to measuring the
impact of staffing and assignments to patient out-
comes is a shared commitment of all professional
nurses irrespective of organizational structure.
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