Legally speaking… When can you say no? By Penny S. Brooke, APRN, MS, JD Nursing2009, July 2009 1.8...
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Transcript of Legally speaking… When can you say no? By Penny S. Brooke, APRN, MS, JD Nursing2009, July 2009 1.8...
Legally speaking…When can you say no?
By Penny S. Brooke, APRN, MS, JD
Nursing2009, July 20091.8 ANCC contact hours
Online: www.nursingcenter.com
© 2009 by Lippincott Williams & Wilkins. All world rights reserved.
Reasons for saying no
Manage your time efficiently
Keep patients safe
Protect yourself from burnout and legal repercussions
Saying no to overtime
Depends on state law and facility policy
A growing number of states are enacting laws prohibiting mandatory overtime
Contact your state board
More on state laws regarding overtime
Laws typically include provisions for protection from disciplinary action, retaliation, or discrimination for refusing mandatory overtime
Under these laws, mandatory overtime is permissible in an emergency when you’ve signed a contract to accept or volunteer for it
Facility policy and procedure regarding mandatory overtime
Should reflect requirements of state law
If overtime is permitted by state law and facility policy, you’re agreeing to it when you accept employment
Discuss patient safety with your nurse manager and document attempts to communicate your concerns
Facility policy and procedure regarding mandatory overtime
A pattern of inadequate staffing should be reported to risk assessment team; could lead to injuries
If facility consistently asks that staff work overtime, give written communication to managers about the need for more staff support
Saying no to a heavy caseload
If you refuse a work assignment after arriving for shift report, you may be charged with abandonment if you walk away without placing care of your patients with a qualified staff member
When interviewing for a nursing position, always ask for written job expectations
Saying no to an assignment outside your scope of practice
Always refuse assignments outside your legal scope of practice as defined by your state’s nurse practice act
If you accept responsibilities outside your scope of practice, you may be charged with practicing medicine/pharmacy without a license
Examples of practicing outside nursing scope of practice
Selecting medication for a patient not ordered by a HCP with prescriptive authority
Dispensing a drug permitted by physicians or pharmacists only
Other team members ask you to do something outside your scope of practice
Saying no to an assignment outside your skill level
Harmed patients can sue nurses for unsafe care within their scope of practice but that the nurse is not trained or educated in (e.g., a nurse being assigned to another unit; medical-surgical to ICU)
Always make manager aware of your skill level and refuse tasks beyond this level
Saying no to an assignment outside your skill level
Never attempt to perform treatments or use equipment without the knowledge required
Ask yourself if this is what any “prudent” nurse would do
Judges and juries consider your actions in light of well-established standards of care
Saying no when you’re busy with a patient
Consider whether you’ll be neglecting assigned duties while taking on additional responsibility
Instead of leaving your patient, find patient’s assigned nurse
In an emergency, evaluate the needs of your patient to assist another
Saying no to providing your own care strategies
If you’re knowledgeable about other care strategies, resist sharing with the patient unless you have HCP consent (in writing)
Speak with HCP if you believe the alternative to be beneficial and complies with protocols
If you proceed without consent, you may be charged with interfering with physician-patient relationship
The case of Nurse Tuma
In 1979, a nurse practicing in Idaho, Jolene Tuma, RN, MSN, was asked by her patient to provide information on an alternative therapy
She didn’t consult with patient’s HCP before giving the patient advice
The case of Nurse Tuma
Even though patient didn’t stop the medical regimen ordered by the HCP, Ms. Tuma was charged with interfering with the physician-patient relationship
Idaho State Board of Nursing suspended Ms. Tuma’s license to practice nursing for 6 months
The case of Nurse Tuma
If Ms. Tuma had initially approached patient’s HCP and discussed patient’s desire to learn more about an alternative therapy, the HCP may have given her permission to provide information
The HCP may also have learned of an alternative therapy that could benefit his patient if Ms. Tuma had taken this opportunity to inform him of alternative therapies available
Saying no to inappropriate delegation As an RN, you may delegate care to LPNs or
UAPs, but you’re responsible for the care
Know your colleagues scope of practice, skill level, and limitations to delegate safely
Document the supervision you provide
You can be held legally liable for inappropriate delegation if colleague harms the patient doing a task you delegated
How to say no like a professional Be assertive; give reasonable explanations
Be respectful; offer helpful suggestions
Have a clear sense of your own priorities
Weigh the personal/professional risks of accepting/refusing a request
Determine how to set limits without jeopardizing your career
Six tips for saying no assertively
1. Listen politely to the request being made; avoid interrupting and objecting right away
2. Restate the request if you need clarification
3. Determine if you need time to verify if you can accept the assignment
4. If further deliberation results in having to say no, respond quickly to minimize delays for the nurse manager, who has to find someone else
Six tips for saying no assertively
5. Offer suggestions or alternative solutions when you say no to a request if you have ideas that may be helpful
6. If your no response isn’t being accepted, repeat it politely and assertively until it’s heard and accepted; don’t become angry or defensive, and don’t feel guilty for protecting your own (and your patients’) needs