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