When to Refuse a Nursing Assignment

Being assigned to an unfamiliar clinical area is one thing, but what if you are ordered to perform an unfamiliar procedure or a task that’s outside the scope of nursing practice? When should you refuse an assignment?

Too many patients, too little staff. That’s a standard scenario at most hospitals these days. It’s also a setting in which floating and faulty assignments, issued with little regard to nurses’ (in)experience or (lack of) training, proliferate. 
Being assigned to charge duty in the ICU, for instance, is a frightening proposition if you haven’t cared for ventilator patients for years. Being ordered to perform an unfamiliar procedure or a task that’s outside the scope of nursing practice can be even more threatening to patient and clinician alike. 
The proper response depends on the circumstances. If you are absolutely certain that your hospital policy or state Nurse Practice Act prohibits RNs from doing the work at hand—wound debridement, for example, which some state laws permit but yours does not allow even certified enterostomal nurses to do—refuse the assignment. But what if you’re not sure? 
Call your state Board of Nursing or consult your facility’s policy manual if time permits. If the procedure cannot be delayed and there’s no one else available to handle it, however, consider accepting the assignment. Refusing the assignment under these circumstances could lead to charges of patient abandonment and is not recommended, unless you’re convinced that your lack of knowledge or training would compromise the safety of the patient. 
Whenever you say “Yes” in such an instance, inform your supervisor of your inexperience and your suspicion. Let her know that you’ll check hospital and state policies as soon as the work has been done. 
When the assignment is within a nurse’s scope of practice but not within your realm of experience or training, you’re on even shakier ground. It’s crucial to speak up here, too, but saying No could lead to dismissal. Try to negotiate instead. Tell your supervisor you’re perfectly willing to help provide care for patients in the ICU, for instance, but that you have never worked with the new ventilator and monitoring equipment and have very limited experience caring for critically ill patients and should not be left in charge. 
If that tactic fails and you have little recourse other than to take on the assignment, submit an “assignment under protest” form. Describe the task or assignment you don’t feel equipped to handle, the reason for your feelings, and the training you would need to be more confident and better prepared. 
Give copies to your supervisor and to her administrator, and keep one for your records. If the problem continues, take your complaint up the chain of command.
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Frequently Asked Questions

You have questions. We have answers. (It's why we're here.)

What kinds of activities might trigger a disciplinary action by a licensing board or regulatory agency? 

The fact is anyone can file a complaint against you with the state board for any reason—even your own employer—and it doesn’t have to be solely connected to your professional duties. All complaints need to be taken seriously, no matter how trivial or unfounded they may appear. 

How does a shared limit policy work?

A shared limit policy is issued in the name of your professional business or company. The policy provides professional liability insurance coverage for the business entity named on the certificate of insurance and any of the employees of the business entity, provided they are a ratable profession within our program. Coverage is also provided for locum tenens professionals with whom the business entity has contracted for services the locum tenens performs for the business entity.

The business, and all eligible employees and sub-contractors you regularly employ, will be considered when determining your practice’s premium calculation and share the same coverage limits you select for the business.

We have a shared limit policy. Are employees covered if they practice outside our office?

The policy covers your employees outside the office as long as they are performing covered professional services on behalf of your business.

If your employees are moonlighting, either for pay or as a volunteer, they should carry an individual professional liability insurance policy to cover those services. Otherwise, they might not be covered for claims that arise out of these activities.

There are plenty more where those came from.

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