appendix 3 | Guidelines for the Registered Nurse in Giving, Accepting, or Rejecting a Work Assignment* 265■Is this a chronic request due to poor sched-
uling, inadequate staffing, or chronic absen-
teeism?
■Are you being asked to work because there
is no relief nurse coming for your present
patient assignment? Because your unit will
be short of professional staff on the next
shift? Because another unit will be short of
professional staff on the next shift?
■How long are you being asked to work—the
entire shift or a portion of the shift?
2.ASSESS yourself.
■Are you really tired, or do you just not feel
like working? Is your fatigue level such that
your care may be unsafe? Remember, you
are legally responsible for the care of your
current patient assignment if relief is not
available.3 IDENTIFY OPTIONS and implications of
your decision.
a) If you perceive that you can provide safe
patient care and are willing to work the addi-
tional shift, accept the assignment.
b) If you perceive that you can provide safe
patient care but are unwilling to stay due to
other plans or the chronic nature of the
request, inform the manager of your reasons
for not wishing to accept the assignment.
c) If you perceive that your fatigue will interfere
with your ability to safely care for patients,
indicate this fact to the manager.
If you do not accept the assignment and the man-
ager continues to attempt to persuade you it may be
appropriate to consult the next level of manage-
ment, such as the house supervisor or the nurse
executive.
In further dialogue, continue to weigh your rea-
sons for refusal versus the facility’s need for an RN.
If you have a strong alternate commitment, such as
no child care, or if you seriously feel your fatigue
will interfere with safe patient care, restate your
reasons for refusal.
At this point, it is important for you to be aware
of the legal rights of the facility. Even though you
may have legitimate concern for patient safety and
your own legal accountability in providing safe
care, or legitimate concern for the safety of your
children or other commitments, the facility has
legal precedent to initiate 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
both you and the facility have a responsibility for
safe patient care.4.POINT OF DECISION/IMPLICATIONS
a) Accept the assignment, documenting your
professional concern for patient safety and the
process you used to inform the facility (man-
ager) of your concerns. Keep a personal copy
of this documentation and send a copy to the
nurse executive. Courtesy suggests that you
also send a copy to the manager(s) involved.
Once you have reached this decision it is
unwise to discuss the situation of your feel-
ings with other staff and/or patients.
b) Accept the assignment, documenting your
professional concerns for the chronic nature
of the request and possible long-term conse-
quences in reducing the quality of care.
Documentation should follow the procedures
outlined in (a).
c) Accept the assignment, documenting your
personal concerns regarding working condi-
tions in which management decides the legit-
imacy of employee personal commitments.
This documentation should go to your man-
ager. You may wish to request a meeting with
your manager to discuss the incident and your
concerns regarding future requests.
d) Refuse the assignment, being prepared for
disciplinary action. If your reasons for refusal
were patient safety or an imperative personal
commitment, document this carefully, includ-
ing the process you used to inform the facili-
ty (nurse manager) of your concerns. Keep a
personal copy of this documentation and send
a copy to the chief nurse executive. Courtesy
suggests that you also send a copy to the
manager(s) involved.
e) Document the rationale for your decision. It
may be necessary to use the facility’s grievance
procedure.Summary
Two scenarios of how an RN may apply the guide-
lines for decision making in the actual work situa-
tion have been presented. Staffing dilemmas will
always be present and mandate that active commu-
nication between staff nurses and all levels of2208_APP-3_261-266.qxd 11/6/09 6:05 PM Page 265