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Are there laws in place that indicate a nurse’s right to refuse a patient assignment if accepting the assignment would be unsafe for the patients or nurse?

Friday November 19, 2010
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Dear Nancy,

Are there federal or state laws in place that indicate a nurse’s right to refuse a patient assignment if, in her professional judgment, accepting the assignment would be unsafe for the patients or nurse?

In my workplace, it is common practice for nurses, RNs and LPNs, to be assigned six patients. On a cardiac telemetry floor, many patients are on cardiac drips and need to be monitored much more frequently and closely than other patients. Other patients can be confused, restrained and extremely unstable. Recently, I had a pre-code situation, and I spent about three hours stabilizing this patient. Therefore, my other five patients were neglected during that time. What if something had happened?

Most of the staff nurses share these feelings of being overwhelmed and that patients' safety and our licenses are in jeopardy. We feel alone in this matter and that our supervisors aren't listening to our concerns. Do you have information on this subject matter?


Nancy Brent replies:

Dear Ned,

The right to refuse an unsafe patient assignment is based on the ANA Code of Ethics (and other applicable nursing ethics codes) and a state nurse practice act and/or rules. A state nurse practice act may have specific language concerning the nurse's right to refuse an unsafe assignment, or the act may allude to such a right.

The problem that often comes up when a nurse refuses an unsafe patient assignment is that the employer treats it as patient abandonment and therefore a violation of an adopted policy. As you probably know, for patient abandonment to arguably occur, there must be a nurse-patient relationship and a duty to provide care to the patient or patients.

If an unsafe assignment is, in a nurse's critical assessment, unsafe, the nurse must immediately make his or her concerns clear to the nurse supervisor, in writing if possible. If the employer takes adverse action against the nurse for refusing the assignment after such notification, the nurse can contest the discipline, including possibly termination, through the employer's grievance procedures. If the nurse is reported to the board of nursing for his or her refusal, retaining legal counsel is essential in any proceeding in relation to the refusal.

Some boards of nursing have published statements concerning the right of the nurse to refuse an unsafe assignment. One such board is the Nevada Board of Nursing, whose statement is supportive of the nurse when making such a decision. The statement is based on the Nevada Nurse Practice Act. You can review the publication at: http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263/?tag=content.

Also, it might be helpful for you to see if your state board of nursing has issued any statements on this issue as well.


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.