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264 appendix 3 | Guidelines for the Registered Nurse in Giving, Accepting, or Rejecting a Work Assignment* CikguOnline
■ Does the care of these patients require you and the facility have a responsibility for safe
to have specialty knowledge and skills in patient care.
order to deliver safe nursing care?
■ Will there be qualified and experienced 4. POINT OF DECISION/IMPLICATIONS:
RNs on the unit? If none of the options are acceptable, you are at
■ What procedures and/or medications will your final decision point.
you be expected to administer? a) Accept the assignment, documenting carefully
■ What kind of orientation do you need to your concern for patient safety and the process
function safely in the unfamiliar setting? you used to inform the facility (manager) of
2. ASSESS yourself. Do you have the knowledge your concerns. Keep a personal copy of this
and skill to meet the expectations that have documentation and send a copy to the manag-
been outlined for you? Have you had experi- er(s) involved.Once you have reached this deci-
ence with similar patient populations? Have sion it is unwise to discuss the situation or your
you been oriented to this unit or a similar unit? feelings with other staff or patients. Now you
Would the perceived discrepancies between are legally accountable for these patients. From
your abilities and the expectations lead to an this point, withdrawal from the agreed upon
unsafe patient care situation? assignment may constitute abandonment.
3. IDENTIFY OPTIONS and implications of b) Refuse the assignment, being prepared for
your decision. disciplinary action. Document your concern
a) If you perceive that you can provide safe for patient safety and the process you used to
patient care, you should accept the assignment. inform the facility (manager) of your con-
You would now be ethically and legally respon- cerns. Keep a personal copy of this documen-
sible for the nursing care of these patients. tation and send a copy to the nurse executive.
b) If you perceive there is a discrepancy between Courtesy suggests that you also send a copy to
abilities and the expectations of the assign- the manager(s) involved.
ment, further dialogue with the nurse super- c) Document the steps taken in making your
visor is needed before you reach a decision. At decision. It may be necessary for you to use
this point it may be appropriate to consult the the facility’s grievance procedure.
next level of management, such as the house
supervisor or the chief nurse executive. Scenario—A Question of an Additional Shift
An example of another potential dilemma is when
In further dialogue, continue to assess whether
a nurse who recognizes his/her fatigue and its
you are qualified to accept either a portion or the
potential for patient harm is required to work an
whole of the requested assignment. Also point out
additional shift.
options which might be mutually beneficial. For
Suppose you are approached by your supervisor
example, obviously it would be unsafe for you to
and asked to work an additional shift. Your imme-
administer chemotherapy without prior training.
diate response is that you don’t want to work
However, if someone else administered the
another shift—what do you do?
chemotherapy, perhaps you could provide the
remainder of the required nursing care for that 1. CLARIFY what it is you are expected to do.
patient. If you feel unqualified for the assignment ■ For example, would the additional shift be
in its entirety, the dilemma becomes more complex. with the same patients you are currently car-
At this point the RN must be aware of the ing for, or would it involve a new patient
legal rights of the facility. Even though the RN assignment?
may have legitimate concern for patient safety ■ Is your reluctance to work another shift
and one’s own legal accountability in providing because of a new patient assignment you do
safe care, the facility has legal precedent to initi- not feel competent to accept? (If the answer
ate disciplinary action, including termination, if is yes, then refer to the previous example, “A
you refuse to accept an assignment. Therefore, it Question of Competence.”)
is important to continue to explore options in a ■ Is your reluctance due to work fatigue, or do
positive manner, recognizing that both the RN you have other plans?