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Am I doing the right thing in refusing an assignment I don't feel I am properly trained for?

Friday June 15, 2012
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Dear Nancy,

I am a 20-year-old RN with experience in ICU/CCU, oncology, telemetry, med/surg, long-term care and telephonic disease management. I started working in an ambulatory surgery center as a pre-op nurse, with rotations to PACU. On non-surgery days, I perform administrative duties, assist with scheduling and assist the director of nursing. Without any OR nursing experience or formal training, I have been invited into the OR by the surgeon and owner of the ASC less than 10 times over the past year to observe surgeries and assist the circulating first assistant who is a per-diem employee. Twice I filled the role of circulator during light anesthesia cases, which is permitted in my state. Recently, my boss has been requesting that I be the circulator in the OR during general anesthesia cases. He wants to keep staffing at a minimum. The law states that only a licensed RN, who is qualified by training and experience in operating room nursing, shall function as a circulating nurse during procedures performed under general anesthesia or deep sedation. I do not consider myself trained or experienced and highly respect the specialized level of training required of OR nurses. Am I doing the right thing in refusing the assignment?


Nancy Brent replies:

Dear Becky,

Your best approach in this situation is to obtain a legal opinion from a nurse attorney or attorney in your state who works in regulatory law and knows nursing practice and can discuss his or her opinion about the language in the nurse practice act with your surgeon or employer. As you know, your compliance with your state nurse practice act and rules is essential. If there is a violation, it will be you and you alone who will bear accountability and responsibility for your practice.

It is interesting that some employers in many types of healthcare settings believe that the nurse practice act and rules can be rewritten or they can decide that these laws are not applicable to them in their healthcare setting. They are applicable and are not able to be adjusted by an employer.

Seeking an opinion as soon as possible would be in your best interest.


Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.