Questions to Ask in Making the Decision to Accept a Staffing Assignment for Nurses

Registered nurses need to know their rights and responsibilities when considering a patient assignment. If you feel that you lack expertise on a unit and patient population, you don’t just have the right to refuse an assignment there, you have an obligation to do so. Your case managers should never ask you to work with patients you aren’t qualified to have in your care. There are many factors to consider before accepting a new patient assignment.

This set of questions can help guide you through decisions about nurse staffing assignments.

• What is the assignment?
  Clarify what is expected. Do not assume. Be certain in the details.
• What are the characteristics of the patients being assigned?
  Don’t just respond to the number of patients; make a critical assessment of the needs of each patient, complexity, stability, and acuity and the resources available to meet those needs.
• Do you have the expertise to care for the patients?
  Are you familiar with caring for the types of patients assigned? If this is a “float assignment,” are you crossed-trained to care for these patients? Is there a “buddy system” in place with staff who are familiar with the unit? If there is no cross-training or “buddy system,” has the patient load been modified accordingly?
• Do you have the experience and knowledge to manage the patients for whom you are being assigned care?
  If the answer to the question is “no,” you have an obligation to articulate your limitations. Limitations in experience and knowledge may not require refusal of the assignment, but rather an agreement regarding supervision or a modification of the assignment to ensure patient safety. If no accommodation for limitations is considered, the nurse has an obligation to refuse an assignment for which she or he lacks education or experience.
• What is the geography of the assignment?
  Are you being asked to care for patients who are in close proximity for efficient management, or are the patients at opposite ends of the hall or in different units? If there are geographic difficulties, what resources are available to manage the situation? If the patients are in more than one unit and you must go to another unit to provide care, who will monitor patients out of your immediate attention?
• Is this a temporary assignment?
  When other staff are located to assist, will you be relieved? If the assignment is temporary, it may be possible to accept a difficult assignment, knowing that there will soon be reinforcements. Is there a pattern of short staffing, or is this truly an emergency?
• Is this a crisis or an ongoing staffing pattern?
  If the assignment is being made because of an immediate need or crisis on the unit, the decision to accept the assignment may be based on that immediate need. However, if the staffing pattern is an ongoing problem, you have the obligation to identify unmet standards of care that are occurring as a result of ongoing staffing inadequacies. This may result in a request for “safe harbor” and/or peer review.
• Can you take the assignment in good faith?
  If not, you will need to get the assignment modified — or refuse the assignment. Consult your state’s nursing practice act regarding clarification of accepting an assignment in good faith.

  In understanding “good faith,” it’s sometimes easier to identify what would constitute bad faith. For example, if you have not taken care of pediatric patients since nursing school and you are asked to take charge of a pediatric unit, unless this is an extreme emergency, such as a disaster (in which case you would need to let people know your limitations, but you might still be the best person, given all factors for the assignment), it would be bad faith to take the assignment.

  It’s always your responsibility to articulate your limitations and to get an adjustment to the assignment that acknowledges the limitations you have articulated. Good-faith acceptance of an assignment means that you are concerned about the situation and believe that a different pattern of care or policy should be considered. However, you acknowledge the difference of opinion on the subject between you and your supervisor and are willing to take the assignment, and await the judgment of other peers and supervisors.