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Accepting and refusing assignments

Powers, Judith L.  ; Chicago Vol. 24, Iss. 9,  (Sep 1993): 64. DOI:10.1097/00006247-199309000-00013

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Accepting an assignment on an understaffed unit exposes staff nurses, nurse managers, and healthcare institutions to liability. Standards established by the American Nurses Association (ANA), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and state regulations help to assure patient safety. ANA's Code for Nurses With Interpretive Statements specifies, "The nurse exercises informed judgment and uses individual competency and qualifications as criteria in seeking consultation, accepting responsibilities, and delegating nursing activities."(1) The specialized skills of a registered nurse include planning, supervising and evaluating each patient's plan of care.(2) As a result, nurses must develop and implement proactive strategies to alleviate unsafe staffing assignments.

As registered nurses, we are responsible not only to patients, but also to ourselves and to our profession. Patients have a fundamental right to receive safe, professional nursing; therefore, we must accept only those assignments we are qualified to perform. When confronted with assignments which exceed the scope, skills, or specialized knowledge required to care for patients safely, we are obligated to take action. Inadequate staffing jeopardizes the quality and outcome of patient care and diminishes the hospital reputation.


Under two legal theories, hospitals may be held liable if a patient is injured as a result of understaffing. The corporate liability theory asserts that healthcare facilities must provide adequate care to all patients and that the facility is legally responsible to provide this care. The theory of respondent superior extends liability to an employer for the actions of its employees, but it does not absolve the employee of responsibility.(3)

A court of law evaluates nursing care against minimum practice standards and considers what the reasonably prudent nurse should have done under similar circumstances.(4) When preparing assignments, nurse managers must be alert to their own staff's qualifications to protect both the hospital and individual staff...