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.
FAQs
This is where making assignments gets difficult. You'll need to consider continuity of care, new nurse orientation, patient requests and sat- isfaction, staff well-being, fairness, equal distribution of the workload, nurse development, and workload completion.
What factors do you need to consider when making assignments nursing? ›
This is where making assignments gets difficult. You'll need to consider continuity of care, new nurse orientation, patient requests and sat- isfaction, staff well-being, fairness, equal distribution of the workload, nurse development, and workload completion.
What methods are used to determine nurse staffing needs? ›
budget based, in which nursing staff is allocated according to nursing hours per patient day. nurse-patient ratio, in which the number of nurses per number of patients or patient days determines staffing levels. patient acuity, in which patient characteristics are used to determine a shift's staffing needs.
What are some good questions to ask a nurse? ›
How do you set priorities in your work? Do you have any time-management tricks other nurses could benefit from? What are the most important lessons you've learned in your career? How much supervision do you want or need?
What are every RN's choices when given an assignment? ›
Final answer: Registered nurses have four choices when given an assignment: accept, delegate, decline, or negotiate.
What should a nurse ask before accepting an assignment? ›
This set of questions can help guide you through decisions about nurse staffing assignments.
- What is the assignment? ...
- What are the characteristics of the patients being assigned? ...
- Do you have the expertise to care for the patients?
The nursing process functions as a systematic guide to client-centered care with 5 sequential steps. These are assessment, diagnosis, planning, implementation, and evaluation. Assessment is the first step and involves critical thinking skills and data collection; subjective and objective.
How do you evaluate staffing requirements? ›
This blog discusses some valuable tips that can help you determine your staffing needs effectively.
- Evaluate Current Workload.
- Forecast Future Needs.
- Analyze Key Performance Indicators (KPIs)
- Consider Seasonal and Cyclical Patterns.
- Conduct Skills Gap Analysis.
- Seek Employee Feedback.
- Leverage Technology and Automation.
A staffing plan involves three main steps:
- Determining current staffing levels.
- Forecasting future staffing needs.
- Identifying the gaps between the two.
It describes 5 main methods: 1) case method where one nurse assumes total responsibility for a patient's care, 2) functional method which divides care into tasks assigned to different roles, 3) team nursing uses groups directed by a leader to provide total care, 4) primary nursing assigns one nurse total responsibility ...
The 6 Cs – care, compassion, courage, communication, commitment, competence - are a central part of 'Compassion in Practice', which was first established by NHS England Chief Nursing Officer, Jane Cummings, in December 2017.
What are open ended questions for nurses? ›
Example questions
| Opening questions | What are your concerns? Tell me how you are feeling right now. |
|---|
| Pain management | Do you feel like your pain level is ok? Manageable? Are you being kept comfortable? |
| Care plan | Do you understand your plan of care? Talk to me about the procedure/test you had. Are you waiting for anything? |
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Interviewee: Before your interview, you must ensure you understand the six Cs of nursing, which are: care, compassion, competence, communication, courage and commitment. It's not enough to say what they are – you need to share examples of when you've successfully exhibited all these traits.
What are the 4 A's in nursing? ›
A Model for Nurse Health: The 4A Model. Creating an environment of health and wellness requires attention, accountability, action, and accessibility to be effective (Table 1).
What are the RN's rights when considering a patient assignment? ›
Practice & Advocacy
The American Nurses Association (ANA) upholds that registered nurses – based on their professional and ethical responsibilities – have the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm.
What should the RN do when asked to accept a patient assignment that he or she may feel unqualified to manage? ›
What should the RN do when asked to accept a patient assignment that he or she may feel unqualified to manage? Accept the assignment as appropriate if assigned by a legitimate power. Be primarily concerned with the number of patients being assigned. Ask how other nurses have handled the assignment in the past.
What factors should the nurse consider when prioritizing a patient assignment? ›
Priority-Setting Frameworks
- airway, breathing, and circulation (ABCs),
- Maslow's hierarchy of needs,
- nursing process.
- safety and risk reduction.
- least restrictive/least invasive.
- survival potential.
- acute/urgent/unstable versus chronic/nonurgent/stable (ATI, n.d.; Jessee, 2019)
Assessment findings that include current vital signs, lab values, changes in condition such as decreased urine output, cardiac rhythm, pain level, and mental status, as well as pertinent medical history with recommendations for care, are communicated to the provider by the nurse.
What are the 5 task factors the nurse should consider prior to delegating care? ›
Five Rights of Delegation
- Right task.
- Right circ*mstance.
- Right person.
- Right supervision.
- Right direction and communication[1]
Nurses must be detailed and accurate, and it's important to take emotion and subjectivity out of this type of writing.
