It’s happened to many of us. We show up for work, get our reports, and realize that we cannot safely perform our job under the current conditions. What can we do?

A jury awarded Linda Boly, RN, $3 million for wrongful termination by Portland Oregon’s Legacy Good Samaritan Hospital last fall. A Legacy employee for 34 years, Boly lost her job after blowing the whistle on her employer’s unsafe staffing. While the hospital argued the firing was performance based, her lawyer argued that she was targeted because of her seniority, and because she had complained about recent hospital policies that rushed Patient care. In addition, Boly had even testified before the state legislature on her hospital’s policies.

Her hospital had made staffing changes that required Boly to meet productivity quotas and forced nurses to see a certain number of patients a day, regardless of the amount of time each patient needed for assessment and nursing care. Boly refused, instead offering the level of nursing care she felt was required. She complained to management, and in response, she was written up multiple times, leading eventually to her firing.

Speaking Up

Cases like Boly’s remind us that while our primary focus is taking care of our patients, doing so in a safe environment sometimes requires taking a risk and speaking up. Speaking up about safety concerns can protect you in the case of adverse outcomes. If you show up for a shift, for example, and you are given an Assignment that you feel is unsafe, then it is your responsibility to immediately contact your supervisor. 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.

Different state nursing boards have different rules regarding specific action steps, so know what your board says in this situation. Some states offer patient assignment objection forms, such as Assignment Despite Objections (ADO), Objection to Assignment, or Protest of Assignment, which offer a way for nurses to accept a patient assignment while expressing an objection and concern in writing about the safety of that assignment.

Depending on the state, nurses may file such a complaint during the shift for a myriad of reasons, including lack of sufficient orientation, inadequate staffing for patient acuity, inappropriate skill mix, mandatory overtime, or if the assignment poses a serious threat to the health and safety of the staff. In Texas, for example, a nurse may request Safe Harbor before accepting an assignment, and it must be made in writing.

Patient Abandonment

You have been given an assignment, the previous shift nurse has given you a report, and you realize you have been given a hot mess that is waiting to implode. You know you can’t care for these patients safely. Now what? Once you have accepted an assignment, typically understood to be once you have received report, you cannot refuse the assignment without running the risk of patient abandonment charges, which can sometimes carry criminal charges. At the very least, you can face nearly certain job termination and potential action against your nurse’s license by the state board of nursing.  What’s a nurse to do?

• Always, always notify a supervisor about your concerns. It may be relatively easy to address.
• Document your concerns quickly.
• Do not leave. Stay through your shift or until another acceptable alternative has been created (additional staff are added, you are floated to another area, etc)
• Keep in mind that your state board of nursing guidelines regarding abandonment may be different from your hospital or nursing home guidelines. Become familiar with both.