RunningHead:LEGALITYOFREFUSINGANUNSAFENURSINGASSIGNMENT

Leadership Paper: Legality of Refusing an Unsafe Nursing Assignment

Christine Gannon
Northland Pioneer College

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Nursing can be a very rewarding job. A nurse gets to see people progress from their very
worst to their very best. Nurses help change lives and make an impact on the world every day
they go to work. Nursing, however, can also be a dangerous profession. Each day a nurse puts on
her scrubs and walks onto her floor, she willingly exposes herself to a wide variety of viruses and
bacteria, all of which are responsible for putting the patients into the hospital. In many cases,
these microbes are easily fought off by a person with a healthy immune system, and are thusly
not an issue for the nurse, but occasionally they can be highly contagious. In addition to exposure
to illnesses, nurses also must perform high-quality, skilled care that takes years of learning and
practice to master. Some skills are easily learned, while others require special training and
certification before a nurse can provide the care to a patient. Furthermore, nurses must be able to
keep track of multiple patients and ensure that each on receives the same high level of care that
they deserve. What happens when a nurse reports for work and finds that she has been assigned
to a patient that she feels presents a danger to herself or that she is uncomfortable caring for? Do
nurses have the right to decline an unsafe assignment, and if so, will there be repercussions?
According to the American Nursing Association (ANA), registered nurses 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. Registered nurses have the professional obligation to raise
concerns regarding any patient assignment that puts patients or themselves at risk for harm.
(ANA, " Patient Safety: Rights of Registered Nurses When Considering a Patient Assignment",
2009) Since the ANA does not oversee employment contracts between nurses and hospitals,
nurses must use critical thinking and clinical judgement when deciding what assignments they
feel are unsafe. Some situations are quite clear: an assignment that asks a nurse to perform care
that is outside her scope of practice or care beyond her skill are very good reasons for declining

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an assignment. (Brooke "When can you say no?") In these instances, refusal protects the patient,
the nurse, and potentially even the facility from a malpractice lawsuit. Other circumstances are
not so clear cut when it comes to choosing to decline the assignment. For instance, a heavy
caseload is often a cause for a nurse to want to refuse, however it may not be possible to walk
away from a high nurse to patient ratio without facing patient abandonment charges or
termination from the facility. (Brooke) Some states and hospitals have clear rules on how many
patients a nurse can be assigned to, but many others do not, leaving a nurse who refuses a high
number of patients open to legal action.
A nurses job depends on patients without people to care for nurses would not have a
profession. Therefore, nurses, and all healthcare workers, have a responsibility towards their
patients. In 1973, the American Hospital Association adopted a Patients Bill of Rights, which
outlined the expectations a patient should have regarding the quality of care they receive while in
a hospital setting. The first among these expectations is the right to considerate and respectful
care as well as right to expect reasonable continuity of care when appropriate. (American
Hospital Association, "The Patient Care Partnership", 2008). With these rights established for the
patients in a hospital, nurses have a professional duty to maintain care for the patients under her
charge. Doing otherwise can constitute a situation of patient abandonment. According to the
Arizona State Board of Nursing, patient abandonment requires two steps to have been met: a
nurse must first accept the patient assignment, creating a nurse-patient relationship, and then
disengage that relationship without giving reasonable notice and report to a qualified person.
(Arizona State Board of Nursing, "Advisory Opinion: Abandonment of Patients", 2012). When a
nurse is considering declining or refusing an assignment she considers to be unsafe, she must ask
whether or not this situation will meet the requirements of patient abandonment. If they do not,

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then she may move on in her decision-making process; if they do, however, she must seriously
reconsider her decision in order to protect the rights of her patient.
When a nurse is faced with an assignment that she feels is unsafe, there are two options
she can choose from: accepting the assignment despite objection and refusing the assignment.
(Tappen & Weiss, Essentials of Nursing Leadership and Management, 2015, pp. 251-256) With
assignment despite objection (ADO), the nurse takes responsibility for the patients care,
however she files appropriate facility paperwork noting her concerns and objections. The nurse
should make a copy for her own files in case something happens during the course of this
assignment. If the nurse continues to feel that refusing the assignment is the best course of
action, she still must document her objections and concerns for safety of the patient or herself,
and the process used to notify management of these concerns. Additionally, the nurse must be
prepared for disciplinary action from the facility. While the ANA supports a nurses right to
protect herself and her patient from unsafe assignments, the ANA has no control over an
employers response to a nurse refusing a given assignment. Even if declining the assignment is
in everyones best interest, a healthcare facility has the right to seek disciplinary action against a
nurse that chooses that course of action. The disciplinary actions available to the facility are
dependent upon the type of employment under which the nurse has been hired, but may include
verbal or written warnings, suspension, or termination. (Tappen & Weiss, 2015)
In conclusion, the area of refusing an unsafe nursing assignment is not black and white.
The decision to decline an assignment takes a great deal of critical thinking on the part of the
nurse to determine what the right course of action is. This decision is not one to be taken lightly.
First, and foremost, a nurses responsibility is to her patients; they deserve the highest quality of
care available. Second, the nurse has a duty to protect herself and her patients from situations

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that could be harmful. Finally, the nurse must recognize and accept that there may be
consequences to any action she chooses in this situation. All of these things must be considered
if a nurse is contemplating refusing an assignment. There is no set legal protection for a nurse to
declare an assignment hazardous, but there is also no definitive legal action that will be taken if
she does. A nurse must decide what an unsafe assignment means to her and acknowledge that the
validity of refusing an assignment depends on every nuance of the situation.

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References
ANA. (2009, March 12). Patient Safety: Rights of Registered Nurses When Considering a
Patient Assignment. Retrieved April 16, 2015, from
http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-andResolutions/ANAPositionStatements/Position-Statements-Alphabetically/Patient-SafetyRights-of-Registered-Nurses-When-Considering-a-Patient-Assignment.html
American Hospital Association. (2008). The Patient Care Partnership. Retrieved April 17, 2015,
from http://www.aha.org/aha/issues/Communicating-With-Patients/pt-carepartnership.html
Arizona State Board of Nursing. (2012). Advisory Opinion: Abandonment of Patients. Retrieved
April 17, 2015.
Brooke, MS, APRN, JD, P. (2011). When can you say no? Nursing 2011 Critical Care, 48-48.
Tappen, R., & Weiss, S. (2015). Appendix 3. In Essentials of Nursing Leadership and
Management (6th ed., pp. 251-256). Philadelphia, PA: F.A. Davis.