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Nurses have the Right to Refuse a Patient Allocation
Nurses have the Right to Refuse a Patient Allocation
In many instances, nurses find themselves in the ethical dilemma, especially when trying to meet the required standards of service delivery in relation to the code of ethics and professional practice (Timmons 2013). The issue of ethical dilemma is more profound in healthcare facilities with insufficient staff, which makes registered nurses overburdened with tasks. The dangerous impact of unsafe staffing on the quality and safety of patient care is evidenced in a growing body of research. In line with the reduced number of nurse staffing in different facilities, nurse managers and directors assign tasks to nurses without considering if they are in a position to deliver quality services to the patients. Over the years, the debate on whether nurses should refuse to take up a patient’s assignment has been going on (Mendonca & Kanungo 2006). Briefly, different reasons can make a nurse refuse to accept an assignment, which includes poor compensation, high risk of infections, insufficient skills or competencies to deal with a case, and poor working environment without proper facilities. In references to these reasons, nurses find themselves in the dilemma as they try to meet patients’ needs as well as the professional requirements.
Despite the continued dilemma for registered nurses, the following paper wishes to emphasise the fact that nurses have the right to refuse a patient assignment. Although there are several reasons that can make a nurse withdraw from a patient allocation, two of these reasons are compelling enough for nurse managers to consider, which include if the patient is suffering from a highly infectious disease or when the nurse is not competent enough to provide quality services to the patients. Therefore, this paper supports the argument that under such circumstances, nurses have the right to refuse patients allocation.
Key Words: Ethical Dilemma, Patient Care, Patient Allocation, Patient Care Assignments,
Part 1: Refusal of Patient Allocation
Refusing Allocation due to a Patient Having a Highly Infectious-Communicable Disease
In a situation where a patient has a highly risky and infectious disease, a nurse’s dilemma is whether to accept the assignment and risk his life or risk to take the task, which may attract some disciplinary actions from the management (Nesse et al., 2010). Under the Code of Ethics for Nurses in Australia, nurses are required to provide quality services to patients without discrimination. In fact, under these codes, one of the key responsibilities of a nurse is to provide not only physical assistance to a patient, but also offer psychosocial support to the sick persons. With this in mind, it becomes even more confusing for a nurse who feels that his life is threatened from an infection.
Connectively, nurses find themselves in a dilemma on different occasions. For example, sometimes nurses are assigned patients that have highly infectious diseases, which is risky to the caregivers (Hooker 2012). Firstly, it must be agreed that the decision to refuse a patient assignment is a wrenching one, but all registered nurses have been taught to be critical thinkers in making well-informed decisions as well as in providing the most suitable solutions to patients’ problems (Tännsjö 2013). Although all nurses should be concerned about patients, they are also expected to analyse the circumstances and assess the risks involved when attending to their patients (Single 2009). In this regard, highly communicable diseases, such as Ebola pose health risks to healthcare professionals including death. Despite the notion that it is challenging for nurses to know when to refuse a patient assignment, they should critically think before making a decision. The presence of the high risk of infection, especially when the proper protective gear is not provided to nurses, forms one of the main reasons why nurses should not take a patient assignment (Mendonca & Kanungo 2006). Other causes could be having too many patients at one time, being too fatigued, and lack of competence, qualification or training among others (Mendonca & Kanungo 2006).
In reference to high risk of infection due to a communicable disease, a nurse has the right to oppose the assignment, based on several reasons (Single 2009). Notably, this section will focus mostly on Ebola as one of the fatal and highly infectious diseases. Recently, many nurses and caregivers in Liberia and some other West African nations died due to infections as they were attending to Ebola patients. Only on this premise, the question that comes up is whether it is right for nurses to refuse patient assignments based on highly infectious diseases (Mendonca & Kanungo 2006). In order to prove that nurses have the right to reject allocation that would risk their health and their life, this argument will be based on three key documents, which include the Code of Ethics for Nurses in Australia, Code of Professional Conduct for Nurses in Australia, and the National Competency Standards for the Registered Nurse.
Critically to note is that The Code of Ethics for Nurses in Australia is a document expected to provide an internalised interpretation of situations before making any step (Nursing and Midwifery Council of Australia). Notably, this document is always a platform through which a nurse asks if it is ethically correct to behave in a given way. Therefore, the most important aspect of any nurse, once faced with a situation, is to underscore the internal willingness of serving the patient faithfully (Mendonca & Kanungo 2006). Connectively, if a nurse is not willing to help a patient, but he is forced to do so, the outcome of the process may not be positive or as expected. Therefore, it is on this basis one should not accept any assignment that he or she feels unwilling to undertake.
The guiding framework of the Code of Ethics for Nurses in Australia has eight value statements, which are based on four categories, including self, person, colleague, and community (Nursing and Midwifery Council of Australia). Under the four categories, “self” refers to a nurse that is either enrolled or registered. The term “self” also applies to the student of nursing. One of the value statements of the Code of Ethics for Nurses in Australia is the “Nurses value quality nursing care for all people,” which has emphasised that nurses, under “self,” need to be not only responsible but also accountable when making decisions regarding the care they are giving to patients. On the same note, this part gives nurses the conscientious refusal or objection of participating in care that they believe is based on the religious or moral ground that are unacceptable (Nursing and Midwifery Council of Australia). In this regard, refusing an assignment, whereby the patient has highly infectious disease such as Ebola is the moral decision, needs to be respected as such. Further, it is necessary that nurses also respect their self-worth when attending to patients (Hooker 2012).
Under value position two, “Nurses value respect and kindness for self and others” the code of ethics underscores the need to ensure that nurses also recognise themselves when serving the community (Nursing and Midwifery Council of Australia). Self-respect involves fostering nurses’ personal well-being, which helps them in acting and making decisions based on their sense of self-worth. The statement emphasises that nurses should also take care of their health, while at the same time acknowledging their psychological and physical strengths and weaknesses (Nursing and Midwifery Council of Australia). Therefore, by nurses accepting to attend to patients with highly infectious diseases, against their wishes, means that they do not recognise their self-worth.
Under “Conduct Statement 6” of the Code of Professional Conduct, nurses are expected to provide accurate information to patients or clients on not only the health care products, but also the care (Nursing and Midwifery Council of Australia). The nursing, in this case, involves expressing personal opinions regarding the services expected or being provided in a given situation. On this breath, it is the right of nurses to be given the opportunity of explaining their misgivings or reservations about a give patient assignment (Germano 2006). Instead of compromising the quality of healthcare in an institution, nurses will be providing managers and senior personnel with an opportunity of making well-informed decisions to attend to the patients.
Finally, under the “National competency Standards for the Registered Nurse,” nurses should be allowed to think critically and analyse situations before making decisions (Nursing and Midwifery Council of Australia). The standards call for nurses to recognise that decisions and judgments are aspects of nursing care as well as the variance of the contexts of practice (Fluker 2009). In line with this premise, nurses are expected to make decisions based on their judgments.
Refusing Allocation Due to Lack of Competence in Specific Area
Nursing competencies are the key requirements needed in nursing professionals’’ behavior or conduct in order to provide quality care in the practice.
Nursing competence and qualifications are some of the key considerations before one is employed as a registered nurse. They may vary from one country to another but some of the general nursing competencies include, patient-centered care, evidence-based practice , leadership , professionalism, informatics and technology, communication , quality improvement , teamwork and collaboration , safety, and systems-based practice.On the other hand, registered nurses are considered as competent professionals who should be able to take up complex assignments (Nesse et al., 2010). However, in some instances, they find themselves in the dilemma, when they feel that they may not be able to offer the expected quality services. Under National Competency Standards for the Registered Nurse, a nurse is supposed to show high levels of competency in the work. In this regard, nurses may be in the dilemma when thinking of refusing an assignment based on skill. However, despite the fact that nurses may be considered as “qualified” to take a given assessment, he should be given freedom to question his ability in attending to a patient.
In the Code of Ethics for Nurses in Australia, a “person” is defined as the consumer of services of a health facility (Nursing and Midwifery Council of Australia). In this case, the code notes that nurses have the responsibility of recognising that the society is entitled to receive quality health care. Thus, nurses should strive in securing patients the best quality services available. Further, nurses are encouraged to participate in decision making regarding the nursing care provided to a patient (Nesse et al., 2010). In addition, they are also expected to question the unethical or illegal nursing care, while actively participating in minimising the risks involved with patients. Based on these considerations, it is clear that nurses will be going against the provisions of the code of ethics, when they provide nursing care in areas they know they do not have the required competence.
In the code of ethics, under the “Value Statement 2” in the “Nurses value respect and kindness for self and others,” nurses need to have respect on the people they are serving, by ensuring that they are providing the best services (Nursing and Midwifery Council of Australia). By respecting the dignity of a patient, a nurse is required to provide the best nursing care that is available and avoid bias in care delivery (Hickey & Brosnan 2012). However, it is not possible for a nurse to provide services, while at the same time lacking the necessary competencies. In fact, by accepting to serve a patient without relevant qualifications or skills, nurses will be showing contempt for the patient’s life. In this case, the dignity will have been lost.
Additionally, under “Value Statement 4”, in the “Nurses value access to quality nursing and health care for all people” of the code of ethics, nurses should underscore the need to provide quality care to the patients, which is not possible for an incompetent nurse (Geller 2006). The value statement notes that the health consumer has the right to receive non-harmful and non-discriminatory care from nurses (Nursing and Midwifery Council of Australia). In this regard, nurses are required to identify the needs and demands of a patient, while at the same time seek to eliminate prejudicial attitudes that may compromise the outcome of a process (Thompson & Dowsing 2009). Incompetent nurses will be failing the healthcare industry, including the organisation or agency that one works for, when pretending to offer quality services to a patient. Instead of helping a patient to recover, the patient may become worse or even die in the process.
Besides the Code of Ethics for Nurses in Australia, the National competency standards for the registered nurse provides the basis through which a nurse should not accept to take up an assignment on competency grounds (Nursing and Midwifery Council of Australia). The competency standards are based on four main domains, including professional practice, critical thinking and analysis, provision and coordination of care, and collaborative and therapeutic practice (Yitzchak et al. 2011). In reference to these domains, a nurse should not provide nursing care services without the necessary competencies. For example, the professional practice relates to the legal, ethical, and professional responsibilities that are required in demonstrating knowledge of the nursing practice, which is not possible for the incompetent nurse (Nursing and Midwifery Council of Australia). Further, critical thinking and analysis provide that a nurse should exercise self-appraisal, which include assessing one’s ability in providing the necessary nursing care services (Nursing and Midwifery Council of Australia). Therefore, if a nurse, for any reason, feels that he is not able to adequately serve a patient refuses to take an assignment, such personal decisions should be respected to ensure that a competent nurse helps the patient.
My Response to the Complaints
In responding to the Director of Nursing of Australia, I would write a letter to the Director highlighting some of the key issues and the grounds on which I refused to take the patient assignment. The objective would be to convince the director that I made the right decision as a registered nurse. In my response, I would concentrate on the three documents mentioned in the (Nursing and Midwifery Council of Australia), which include the Code of Ethics for Nurses in Australia, Code of Professional Conduct for Nurses in Australia, and the National Competency Standards for the Registered Nurse.
Firstly, I would emphasize the role of the code of ethics in providing for internalized morality for all nurses. As noted, the code of ethics is established to guide a nurse in making well-informed decisions in any assignment (Cranmer & Nhemachena 2013). In this regard, one of the key aims of codes of ethics is to ensure that a nurse is internally convinced beyond reasonable doubt that the action that is about to be taken is ethically acceptable. On this note, it would be unfair for a nurse to pretend that he or she has accepted an assignment and willing to do all what it takes to provide the best services to the patient. In an instance where a highly infectious disease is involved, I would be reluctant to take up the assignment since my life would be in danger. In this regard, if a nurse is forced to attend to such a patient, the supervisors, and the entire management should not expect quality services. Therefore, it would be prudent for the Director and the Nurses’ Manager to exempt me from taking the assignment.
In addition, under the code of ethics, the conscientious objection gives a nurse the right to refuse a given assignment (Beardwood &Kainer 2015). In reference to conscientious objection (Nursing and Midwifery Council of Australia), I would emphasise that it is morally wrong to accept an assignment under coercion. In this case, I would not let down my moral standings since I would be unable to provide the expected services. Notably, it would be high time that nursing professionals and stakeholders recognised the need to have the proper mind set and mental strength when taking up assignments. Evidently, more than eighty per cent of the complaints from patients are based on poor attitude and moods from caregivers. Partly, such poor attitude is due to unhealthy working conditions, whereby a nurse is forced to take an assignment even when clear reasons are given for refusal. On this base, I would urge the director to accept my decision to maintain positive reputation from the clients.
In reference to the Bill of Rights for Registered Nurses (Grant & Ballard 2013), I will ensure that I remind the Director about the right that nurses are entitled. For example, the Bill notes that nurses have the right of practicing ways that fulfil their role to the society, as well as to the patients. Evidently, this right provides nurses with freedom of assessing themselves in light of the task they are required to undertake. If a nurse feels that the he will not be able to serve the patient in a manner that fulfils that obligation, he has the right to withdraw for the sake of patients (Benjamin & Curtis 2010). At the same time, the bill of right underscores the need to respect the Interpretative Statements contained in code of conduct, ethics or standards (Grant & Ballard 2013). On this premise, I would urge the Director to respectfully consider the Statements included on the three documents mentioned above, which highlights the basis under which a nurse can reject or refuse an assignment. Further, besides being given freedom of openly advocating for themselves and patients without retribution, nurses are also entitled to have negotiations for either individual or collective purposes on the terms of their employment, which includes taking up patient assignments.
Finally, under “National competency standards for the registered nurse” (Nursing and Midwifery Council of Australia) , I would remind the Director that as a professional and a registered nurse, I would not like to undermine and provide poor services , especially where I feel that I am not competent enough to offer competitive services. Connectively, to respect my professionalism and the reputation of the institution, it would be prudent to withdraw from the assignment.
Despite refusing to take a patient allocation however, the best strategy is to exercise collaboration so that the patient can be attended to. Collaboration refers to working as a team in all areas to ensure efficient service delivery. Collaboration is vital in nursing as without it one cannot be in a position of offering good services to the patients, which involves solving problems, assumption of responsibilities, communication, setting of goals and so on (Melnyk & Fineout-Overholt 2011). As a core element in healthcare organization and services, it would be prudent to report my decision to the manager in good time, so that the most suitable and willing nurse can take up the assignment.
Concerning competence, there is need for healthcare organizations to ensure that they have qualified personnel, who can handle complex cases. In this way, nurse managers need to understand the capabilities of every nurse and the type of skills and knowledge they have, which informs task allocation.
Based on the above brief analysis, it is clear that despite having strict codes of ethics and standard to follow, nurses have the right to refuse assignments in specific areas. In this connection, the paper has provided different highlights in the three documents, including Code of Ethics for Nurses in Australia, Code of Professional Conduct for Nurses in Australia, and the National Competency Standards for the Registered Nurse. Therefore, nurses have the right of not accepting assignments where their health and life is threatened due to highly infectious diseases or when their competency is questionable.
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