The hospital is never going to stand behind your error in judgment or mistake, but it will do everything it can to make you take the assignment.

A recent scenario in one of our ICUs left a charge nurse with two patients. One patient was an asystolic donor. The level of nursing care required to support the donation process kept the NIC off the floor with the donor for a couple hours. His other patient also needed to travel. Thus, the NIC with two patients, was unable to perform his charge role of staff support including physical as well as clinical care of his own patient assignment. So where is the unsafe staffing report? What? Too frazzled to fill it out? Too tired to go “find” it? Too demoralized to even care? Ca-ching, caching they win! And patients and nurses lose!

Do you feel that you actually are giving excellent and safe care when you float to a unit where you have never been oriented, or are given an assignment for which you are not clinically prepared to deliver care? Recently, several nurses in the bargaining unit have been floated to units where they have not had an orientation and have been given patient assignments that are out of their competency range. Are you one of those nurses who doesn’t speak up about this? Who would rather take the assignment, cross their fingers and let the gods take care of them because they are too afraid to refuse the patient and, even worse, too afraid to speak to their Nurse Manager about it? If you accept a patient who is beyond your level of competence, (meaning you have never had a full orientation to that type of patient) you are putting not only your license but your patient at risk. Your first action in this kind of scenario is to inform the NIC that you are not competent to provide the specialty care required for this patient. We are very aware that this can present a stressful moment for many nurses, but you are the only one who knows specifically with which patients you are competent. Any nurse acting as a NIC who makes out an assignment is responsible and accountable for his/her actions. We will say it again for those of you who have not heard this in a while: You are responsible and accountable for your decision to accept a patient you cannot care for. So speak up, follow up and refer to your contract. There is specific language pertaining to inappropriate assignments.

			You are responsible and accountable for your decision to accept a patient you cannot care for.

When bad assignments are made and good nurses accept those bad assignments, beware! The hospital is never going to stand behind your error in judgment or mistake, but they are going to do everything they can to make you take the assignment. After all, they have a business to run. If this is happening to you and your colleagues, go to your nurse manager and explain the specifics of the situation. She/he should speak to the manager of the unit in which this is occurring. And please be sure to use the unsafe staffing forms as well as another way of communicating your concerns.