Accepting/Rejecting an Assignment
Each nurse is directly accountable for the safety of nursing care
he/she provides [MGL 112 § 80B.]. Decision making utilized
by the nurse when accepting /rejecting an assignment should follow
a logical progression (see
Algorithm 1)
Rejecting an Assignment
If the nurse is given a work assignment and then believes he/she
may not have the knowledge, skills, or experience to perform the
assignment, he/she must consult with the supervisor and state
that he/she cannot accept the assignment. In doing so, because
of the disciplinary consequences of refusal, the nurse is responsible
for three additional steps.
Step
1: The nurse needs to verbally and, in writing,
inform the agency’s manger/supervisor of the perceived
discrepancies between the required competence and his/her own
knowledge, skills,
and abilities. The nurse should keep a personal copy of this
documentation and the steps taken to remedy the situation. Documentation
provides
a record of the situation for future reference. Documentation
done at the time of the incident is more accurate and complete
than documentation done at a later date.
Step 2: The
nurse should complete and file a “MNA Objection and Documentation
of Unsafe Staffing/Unsatisfactory Patient Care Form” if
available or otherwise document the situation. A nurse may conclude
that it is necessary to refuse to accept a work assignment. It
is important for the nurse to be aware of the consequences of
his/her decision to accept or refuse the work assignment. You
have the right to report this practice to a public body(outside
agency). (See MGL, Chapter 149, Section 186 (c) (1), An Act to
Protect Conscientious Health Care Employees (The Health Care
Workers
Whistleblowers Protection Law).
Step 3: The
nurse needs to be prepared for disciplinary actions, which may
follow as a result of the decision to reject an assignment. This
action may include sanctions by the employer. The nurse should
be aware of options to contest the disciplinary action. These
options are found in employer policies or contractual grievance
procedures. The nurse has the responsibility to request that the
employer provide additional training/orientation for the nurse
to practice safely.
Delegation to Licensed/Unlicensed
Personnel. Delegation of nursing activities to
licensed or unlicensed assistive personnel (UAP) follows a pattern
similar to that of evaluating the appropriateness of a work assignment
(see
Algorithm 2). [244 CMR: 3.05(2)].
Step 1. Assess
patient first, then state clearly the tasks to be delegated.
What
aspects of care will be delegated? What specific tasks are to
be done? What is the condition of the patient? Is the patient’s
condition stable or unstable?
Step 2. Assess
the competency of the licensed/unlicensed individual. Does the
unlicensed person have the documented competencies need to do
the task? Can the task be performed without requiring nursing
judgment? [CMR: 3.05:(2)(c)].
Step 3. Confirm
or reject delegation. If competencies are documented delegation
may occur. If delegation is rejected, the nurse has the responsibility
to personally perform the care or seek alternate ways to provide
the care. Notify the supervisor of this decision.
(See
algorithm 2 for delegating an assignment to licensed or unlicensed
personnel.)
It is within the scope of the individual
licensed nurse’s professional judgment to make the final
decision, in any given situation, as to what nursing activity
can safely
be delegated to a UAP.
