Nurses run into all kinds of problems on the job that can jeopardize patient care, especially when there aren’t enough staff members to go around. It’s not uncommon for nurses to receive assignments that go beyond their capabilities either due to a lack of experience or support.
For example, a nurse may be assigned to charge duty in the ICU even though they haven’t worked with patients on ventilators for years. When your facility is short-staffed, you may be ordered to perform a task that goes beyond your scope of nursing practice, which can threaten patient and clinician safety alike.
So, what should you do in this situation?
The answer depends on the circumstances. You’ll need to be familiar with your hospital’s care policy as well as your state’s Nurse Practice Act, which outlines the scope of nursing practice in your state. These laws differ from state to state, so don’t assume they are the same if you’ve recently moved.
If you are absolutely sure your hospital or state prohibits you from taking on the task, you should refuse the assignment.
But what if you’re not sure?
You can contact your state’s Board of Nursing or consult your facility’s policy manual for more information. But you may not have the time to research the issue when someone’s life is on the line. If the procedure can’t be delayed and there’s no one else around to do it, consider taking the assignment.
Refusing the assignment could lead to charges of patient abandonment and should be avoided at all costs – unless your lack of knowledge or experience threatens the safety of the patient.
If you decide to take on the patient despite these concerns, make sure your nursing supervisor is aware of your lack of experience or training and that you plan on checking the facility and state nursing policies as soon as the work is done.
If the assignment is within a nurse’s scope of practice but outside your training and experience, refusing can be even more complicated. Saying no could lead to dismissal, so consider taking on the assignment while sharing your concerns with your manager. Consider negotiating instead. For example, you could say that you’re willing to care for patients in the ICU but mention that you don’t have a lot of experience working with ventilator patients and shouldn’t be left in charge. Ask for an impromptu training session to learn how to use new equipment or ask a more experienced nurse to shadow your work.
If these tactics fail and you have no option but to take on the assignment, you can fill out an “assignment under protest” form with a description of the task you are completing, your reasons for protesting the assignment, and what you would need to be better prepared.
Make copies of the report and share them with your supervisor and administrator. If the problem continues, take your complaint up the chain of command.
According to the American Nurses Association (ANA), registered nurses – based on their professional and ethical responsibilities – have the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm.
Knowing when to accept an assignment can be even harder for travel nurses, who frequently move from state to state and hospital to hospital. While travel nurses tend to be highly trained, they mostly work at hospitals with staffing shortages that can jeopardize patient safety.
It’s important to be aware of your rights as a nurse while providing the best possible care for your patients. You shouldn’t be asked to complete tasks that go outside your scope of practice or experience. Your hospital has a responsibility to provide a safe work environment and that includes proper training for nurses.