262 appendix 3 | Guidelines for the Registered Nurse in Giving, Accepting, or Rejecting a Work Assignment*Assignment Despite Objection
(ADO)/Documentation of Practice
Situation (DOPS)
Staff nurses today face often untenable assignments
that need to be documented as such. Critical, clin-
ical judgment should be utilized when evaluating
the appropriateness of an assignment. Refusal to
accept an assignment without appropriate discus-
sion within the chain of command can be defined
as insubordinate behavior. Each Registered Nurse
should become familiar with organizational poli-
cies, procedures and documentation regarding
refusal to accept an unsafe assignment. ANA has
recently adopted a position statement and model
ADO form available for use by SNA members.
(Please contact Florida Nurses Association for
further information.)Staffng
In the event a Registered Nurse determines in
his/her professional opinion that he/she has been
given an assignment that does not allow for appro-
priate patient care, he/she shall notify the
Supervisor or designee who shall review the con-
cerns of the nurse. If the nurse’s concerns cannot be
resolved by telephone, the Supervisor or designee,
except in instances of compelling business reasons
that preclude him/her from doing so, will then
come to the unit within four (4) hours of being
contacted by the nurse to assess the staffing. Such
assessment shall be documented with a copy given
to the nurse. Nothing herein shall prohibit a
Registered Nurse from completing and submitting
a protest of assignment form.Nurse Practice Act, 1994,
Administrative Rules Chapt. 59S,
14.001 Definitions (4/29/96)
“Assignments” - are the normal daily functions of
the UAPs based on institutional or agency job
duties which do not involve delegation of nursing
functions or nursing judgment.
“Competency” - is the demonstrated ability to
carry out specified tasks or activities with reason-
able skill and safety that adheres to the prevailing
standard of practice in the nursing community.
“Delegation” - is the transference to a competent
individual the authority to perform a selected nurs-
ing task or activity in a selected situation by a nurse
qualified by licensure and experience to perform
the task or activity.“Supervision” - is the provision of guidance by a
qualified nurse and periodic inspection by the nurse
for the accomplishment of a nursing task or activi-
ty, provided the nurse is qualified and legally enti-
tled to perform such task or activity. The supervisor
may be the delegator or a person of equal or greater
licensure to the delegator.Scenario
■Suppose you are asked to care for an unfamil-
iar patient population or to go to a unit for
which you feel unqualified—what do you do?
■Suppose you are approached by your supervisor
and asked to work an additional shift. Your
immediate response is that you don’t want to
work another shift—what do you do?
Such situations are familiar and emphasize the rights
and responsibilities of the RN to make informed
decisions. Yet all members of the health care team,
from staff nurses to administrator, share a joint
responsibility to ensure that quality patient care is
provided. At times, though, difference in interpreta-
tion of legal or ethical principles may lead to conflict.
Guidelines for decision making are offered to
assist RNs problem-solve work assignment issues.
Applications of these guidelines are presented in
the form of scenarios, examples of unsafe assign-
ments experienced by RNs.Guidelines for Decision Making
The complexity of the delivery of nursing care is
such that only professional nurses with appropriate
education and experience can provide nursing care.
Upon employment with a health care facility, the
nurse contracts or enters into an agreement with
that facility to provide nursing services in a collab-
orative practice environment.
It is the Registered Nurse’s Responsibility to:
■provide competent nursing care to the patient
■exercise informed judgment and use individual
competence and qualifications as criteria in
seeking consultation, accepting responsibilities
and delegating nursing activities to others
■clarify assignments, assess personal capabilities,
jointly identify options for patient care assign-
ments when he/she does not feel personally
competent or adequately prepared to carry out
a specific function
■refuse an assignment that he/she does not feel
prepared to assume after appropriate consulta-
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