Essentials of Nursing Leadership and Management, 5th Edition

264 appendix 3 | Guidelines for the Registered Nurse in Giving, Accepting, or Rejecting a Work Assignment*

■Does the care of these patients require you

to have specialty knowledge and skills in

order to deliver safe nursing care?

■Will there be qualified and experienced

RNs on the unit?

■What procedures and/or medications will

you be expected to administer?

■What kind of orientation do you need to

function safely in the unfamiliar setting?

2.ASSESS yourself. Do you have the knowledge

and skill to meet the expectations that have

been outlined for you? Have you had experi-

ence with similar patient populations? Have

you been oriented to this unit or a similar unit?

Would the perceived discrepancies between

your abilities and the expectations lead to an

unsafe patient care situation?

3. IDENTIFY OPTIONS and implications of
   your decision.
   a) If you perceive that you can provide safe
   patient care, you should accept the assignment.
   You would now be ethically and legally respon-
   sible for the nursing care of these patients.
   b) If you perceive there is a discrepancy between
   abilities and the expectations of the assign-
   ment, further dialogue with the nurse super-
   visor is needed before you reach a decision. At
   this point it may be appropriate to consult the
   next level of management, such as the house
   supervisor or the chief nurse executive.

In further dialogue, continue to assess whether

you are qualified to accept either a portion or the

whole of the requested assignment. Also point out

options which might be mutually beneficial. For

example, obviously it would be unsafe for you to

administer chemotherapy without prior training.

However, if someone else administered the

chemotherapy, perhaps you could provide the

remainder of the required nursing care for that

patient. If you feel unqualified for the assignment

in its entirety, the dilemma becomes more complex.

At this point the RN must be aware of the

legal rights of the facility. Even though the RN

may have legitimate concern for patient safety

and one’s own legal accountability in providing

safe care, the facility has legal precedent to initi-

ate disciplinary action, including termination, if

you refuse to accept an assignment. Therefore, it

is important to continue to explore options in a

positive manner, recognizing that both the RN

and the facility have a responsibility for safe

patient care.

4.POINT OF DECISION/IMPLICATIONS:

If none of the options are acceptable, you are at

your final decision point.

a) Accept the assignment, documenting carefully

your concern for patient safety and the process

you used to inform the facility (manager) of

your concerns. Keep a personal copy of this

documentation and send a copy to the manag-

er(s) involved. Once you have reached this deci-

sion it is unwise to discuss the situation or your

feelings with other staff or patients. Now you

are legally accountable for these patients. From

this point, withdrawal from the agreed upon

assignment may constitute abandonment.

b) Refuse the assignment, being prepared for

disciplinary action. Document your concern

for patient safety and the process you used to

inform the facility (manager) of your con-

cerns. Keep a personal copy of this documen-

tation and send a copy to the nurse executive.

Courtesy suggests that you also send a copy to

the manager(s) involved.

c) Document the steps taken in making your

decision. It may be necessary for you to use

the facility’s grievance procedure.

Scenario—A Question of an Additional Shift

An example of another potential dilemma is when

a nurse who recognizes his/her fatigue and its

potential for patient harm is required to work an

additional shift.

Suppose you are approached by your supervisor

and asked to work an additional shift. Your imme-

diate response is that you don’t want to work

another shift—what do you do?

1.CLARIFY what it is you are expected to do.

■For example, would the additional shift be

with the same patients you are currently car-

ing for, or would it involve a new patient

assignment?

■Is your reluctance to work another shift

because of a new patient assignment you do

not feel competent to accept? (If the answer

is yes, then refer to the previous example, “A

Question of Competence.”)

■Is your reluctance due to work fatigue, or do

you have other plans?

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