To Comment:
It's not often where I question whether or not to accept my patient assignment due to either acuity of the patients, inappropriate staffing levels, the assignment poses a serious threat to the health and safety of the patient or staff, or the unit is lacking the appropriate type of resources such as patient care equipment or supplies (American Nurses Association Nursing World, 2009).
When instances like these occur though, it's important that nurses understand that they 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 (American Nurses Association Nursing World, 2009).
Since situations like this are not unheard of, it's important to know that if an assignment is refused, there can be ethical and legal consequences that can be personally devastating for the nurse.
Legally, when nurses accept an assignment, they are accepting responsibility for the patients that are under their care for the duration of their shift/assignment.
They are bound to provide safe and competent care to their patients. A nurse cannot refuse an assignment due to the patient's race, ethnicity, or due to their economic status. Once a patient care assignment is accepted, refusal to care for a patient may lead to charges of abandonment (Graner, 2015).
Abandonment can be claimed if a nurse refuses an assignment due to moral or religious reasons and when no one else is available to care for the patient (Westrick, 2014). This would result in negligence on the nurse.
Ethically speaking, the Code of Ethics for Nurses requires nurses to use informed judgment when deciding to accept a patient assignment or when making assignments for other nurses.
They are to be accepted or rejected based on the nurses level of education, knowledge, competence, an experience (Westrick, 2014).
For example, ethically speaking, if a nurse from a medical-surgical unit were to be floated to the intensive care unit, it would be unethical for a nurse to accept a patient assignment which included a patient who was recently identified as being critical and required services and care that was out of the nurses current competence level and acquired knowledge.
When delegating tasks to unlicensed personnel, the nurse must consider certain factors such as if the task is capable of being delegated, the competency of the unlicensed personnel, what level of supervision/surveillance needs to occur, and if the delegated directions are clear and accurate (Westrick, 2014).
If a nurse delegates a task that is inappropriate to be performed by an unlicensed personnel, it can cause them to be liable for improper delegation and at risk for legal consequences. Insurance issues can come into play because if the unlicensed personnel performs a task they are incapable of performing and something goes wrong or is outside their competency level, the liability is generally shifted to the employer, therefore their insurance would be involved in issues.
Respondeat superior embodies the general rule that an employer is responsible for the negligent acts or omissions of its employees. Under respondeat superior, an employer is liable for the negligent act or omission of any employee acting within the course and scope of his employment (Thornton, 2010).
Although the employer may have put their employee through adequate and sufficient training this doesn't mean that the employer is free from liability if the employee acts in a negligent way.