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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