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Can a nurse refuse to work in any other capacity than what he or she was hired for?

Friday August 3, 2012
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Dear Nancy,

I work in a psychiatric ward where the census fluctuates constantly. Whenever the census is low, instead of cancelling the nurses, the administration assigns us to work as mental health technicians or 1:1 sitters. Can a nurse refuse to work in any other capacity than what he or she was hired for?


Nancy Brent replies:

Dear Drew,

Unfortunately, when a nurse is hired in a particular role or on a particular unit, there is no guarantee that the hired role or unit will involve consistent employment conditions, unless one has a written contract of employment or is a member of a union. So, one can refuse to work in a new or different role or area, but there are no guarantees that continued employment would exist after the refusal.

In a psychiatric unit, being assigned to be a 1:1 sitter is probably using your RN skills, albeit in a different way. As you know, 1:1 observation is absolutely necessary with some patients and may save their lives if it is done correctly.

Being assigned to function as a mental health technician is a bit more of a stretch. How do you take off your RN hat and put on your mental health tech hat? Another question is your pay rate when you are functioning as a mental health technician. Do you make less? Or is your rate of pay the same?

There is an argument to be made for at least being able to work and be paid rather than being sent home with no or fewer hours worked. Even so, other options might be available to employers whose staffing numbers are in excess when the census is low. Having nurses take a CE course on restraints or informed consent for the mentally ill, review patient records for missing documentation (as part of the facility's chart auditing committee), or take a required CPR course for continued certification might be suggested to the employer. Certainly, raising your concerns with the employer would be an important first step.


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.