The Right of Nurse to Refuse Patient Allocation Essay Example

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The Right of Nurse to Refuse Patient Allocation



Nursing practices in Australia are regulated by the Nursing and Midwifery Board of Australia under the Practitioner Regulation National Law. The general idea about the regulation is to make sure that the health care practices meet the minimum the minimum standards (Zwerdling, 2015). This is a crucial element and one that safeguard the kind of health care delivery approaches along with the level of patient health outcomes. As such, it important to note that, one of the key functions of the NMBA is to make sure that the public is well protected. At the same time the board regulates every aspect of practice by the health care professionals to ensure high quality care. To establish this level of quality in the public and private health care delivery systems, the board works with a set of professional codes, standards of practice, registration standards and guidelines on how best the medical professionals can maintain high quality health care delivery (Budryk, 2015). In the case of the nurses, there are quite a number of elements to consider, to ensure that they deliver quality care. This paper reviews the guidelines, ethics policies, professional codes, practice standards and ethical dilemma associated with the right for nurses to refuse patient application (Graner, 2015).

Guidelines established in June 2016 for the nurses and the midwives are a crucial to the quality of care then can deliver and the level of skills that they have. For the nurses and the midwives, the guidelines act in supplement to the registration standards, with reference to the continuing professional development. Ideally nurses have to make sure that their skills match the industry standards. As such, nurses are required to take part in CPD activities as part of the registration standards on an annual basis. This is the case given that for a nurse, learning is a continuous process, at takes on a lifelong approach. that aim of the ;earning process integrated with the CPD requirements is that, they hey help the nurses to broaden their knowledge professionally, improve on their skills, enhance competence and expertise. This way they will be in a position to meet their obligations from an ethical, safety, effectiveness and competent approach in their practice. There are indications that the CPD approach in the guidelines helps with enhancing the outcomes and some significant evidence based changes with reference to practice (Graner, 2015). Using the guidelines the nurses are able to organize their career development and skills along with it. The nurses are able develop programs that best match their objectives with aspects such as taking part in post graduate studies, in-service education, authoring a book, attending conferences, publishing articles and participating in journal clubs.

The code of ethics used by nurses in Australia helps with the establishment of the best standards of care. This is a code that is largely based on the principles and standards of United Nations in light of Universal Declaration of Human Rights, International Covenant on Economic, Social and Cultural Rights and International Covenant on Civil and Political Rights. There are eight value statements that act as the guiding code of ethics and policies for the nurses across the nation. The ethical values can be organized into four main categories, which is self, person, colleagues and the community.

The value statement include;

  • All nurses should value quality care to all the people.

  • Nurses should have respect for self and for others.

  • Nurses should value people diversity.

  • Nurses should always value quality care and health care access for all persons.

  • Nurses should always value informed decision making processes.

  • Nurses should value and practice the culture of safety.

  • The nurses value patient information management ethically.

Nurses value an environment that is sustainable, economical, ecological and social with reference to promoting health and well-being.

Registered nurses are also guided by seven main standards of practice (Registered nurse standards for practice, 2016). This is to enhance the level of care that is offered by the nurses. Ideally, registered nurses should make sure that they offer the patient centered and evidence based care (Harris, 2016). The Australian community is one that has a very rich culture, social, spiritual and history. This is especially the case when considering the rich culture and history associated with the aboriginal communities (Registered nurse standards for practice, 2016). This is an aspect that every other registered nurse should make sure that they are able to internalize. The seven standards that guide the professional registered nurses include;

  • Comprehensively conducting assessments

  • Critical thinking and analysis

  • Developing a plan for nursing practices (Registered nurse standards for practice, 2016)

  • Evaluating outcomes to inform nursing practices

  • Maintaining capability for practice

  • Providing safe, responsive and appropriate quality nursing practice

  • Therapeutic and professional relationships (Registered nurse standards for practice, 2016)

Professional nursing practices are highly regulated to ensure that nurses act and operate in a professional manner. Other than the fact that nurses are supposed to uphold the above standard, there is also a set of codes of conduct that they are supposed to observe at all times to enhance their professional capacities. These are codes that mark the position of the bar that the nurses are supposed to make sure that they can achieve at all times when their working (Budryk, 2015). As such the purpose of the codes includes the element of setting the minimum national standards of conduct for the nurses to uphold at all times. At the same time the codes assist with informing the community on the basic or simply the minimum standards that they can expect from the nurses. This also means that the consumers, employers, professional bodies and regulatory agencies a means that they can use to gauge the level of professionalism between for the nurses. There are total of ten code of professional conduct for nurses that include;

  • Nurses should always practice in a competent and safe manner.

  • Nurses will always practice professionally and in accordance with the broader health system.

  • Nurses should always conduct themselves in a manner that upholds the relevant laws and professional nursing practices (Code of Professional Conduct for Nurses in Australia, 2016).

  • Nurses to observe culture, ethnicity, beliefs and values through showing respect.

  • Nurses should always handle personal patient information as confidential.

  • Nurses to provide accurate, impartial and honest information when offering nursing care.

  • Nurses should support the wellbeing along with informed decisions for the people requiring of receiving care.

  • Nurses should always promote and build on the community’s confidence and trust within the profession.

  • Nurses should always observe reflective and ethical nursing practice (Code of Professional Conduct for Nurses in Australia, 2016).

Purpose of the paper

Problem/ nursing dilemma

Nurses have the duty to care for the patient and ensure that they give the best level of care. It is also crucial that the nurses do not harm their patients in any way. However, there is also an element of care that can pose great danger to the nurses in question. This raises the question, as to the issue of the safety and comfort of the nurses. There are situations that place the lives of the nurses at risk and it is crucial to make sure that they have the right to withhold their services as much as they have the duty to take care of the patients. It is important to note that nursing is one of the professions that comes with significant risks (Beardwood and Kainer, 2015). There are times that, a nurses health and wellbeing are put in a compromising position. In an example the nurse may be assigned to a patient that has a contagious disease, which could easily affect the health and wellbeing of the nurse (Safety and quality guidelines for nurse practitioners, 2016).

A nurse may also be assigned to patient that has a condition that the nurse does not have the skills to attend to them (Hawkes, 2015). The nurses have the right to delegate the tasks that they feel they may not deliver on (Victorian Health, 2016). Ideally in this case, a registered nurse may have been sent to a clinical area that they not familiar with. As such they may end up injuring the patient, themselves or even their colleagues and implicating the health care organization in the process. This means that the nurse is going to compromise the health of the patient along with the expected outcomes. The dilemma discussed in this paper thus relates to the rights of the nurses. This is with respect to whether the registered nurses have the right to refuse patient allocation. Nurses tend to face dilemmas, especially where there is a cross between their needs and those of the patients (Litschka, Suske and Brandtweiner, 2011).

Overview of structure

The paper first addresses the issue of whether it is right to refuse an assignment as a registered nurse. The paper then addresses the issue of handling a board meeting to discuss the decision aforementioned. The paper then offers concluding remarks.

Turning down patient allocation

Recently, the medical world was awakened by the return of the Ebola virus. This is a virus that affects the patient is less that humane ways, leading to dehumanizing discharges from the body and terrifying death patterns. There are some several points to be taken from the Ebola virus outbreak in relation to health care provision. One of the main aspect to note is the mode of transmission of the disease. This is a disease that is transmitted through bodily fluids, when comes into contact with patients that are sick, surfaces they have touched or even their bodies. While that is the byline in the disease and the danger it possess, it is the prevention and the risk of exposure that have the most significant impact to this discussion. According to the CDC, the persons that are at the highest risk of exposure, are the health care workers and the family members. This is relative to the level of contact that these two parties have with the sick and the dead. At the same time, the CDC also indicates that, under the aspects of prevention, the health care workers should be protected as they are the most likely to contract the virus along with the family and friends to the victims.

In the months following the outbreak, most of the health care professionals were faced with the dilemma of treating patient. As such, most of them chose to forfeit their career altogether other than risk exposure to the virus. It is common for nurses to be exposed to contagious diseases. This has thus always formed some element of conflict over where the nurses should draw the line, with reference to where they duty to the patient ends and their safety starts (Hawkes, 2015).

Professionally and even personally, no nurse wants to abandon their patient as it is part of their duty to the patient in question. According to the sixth standard of registered nurses practices, it is important that the nurses always make sure that they offer their patient safe, appropriate and responsive quality care, through matching quality practices. This is further amplified under the Code of ethics especially with reference to the first value; which indicates that nurses should value quality care for all people. This thus point points to the obligations of the nurses to their patients.

Further, as of the 1st of June 2016, a registered nurse should always offer their patient evidence based care, preventative, curative restorative, supportive, palliative element and person based centered care. It is also crucial to note that registered nurses work with communities, groups and individuals and as such are likely to form both professional and therapeutic relationships with all of this parties in a complex embroidery. The nurses are held to higher standard when it comes to connecting with their patient and offering them a more focused health care approach to their needs.

Given the element of safety to the patient and to the nurses, the latter have the option of refusing patient allocation. The fifth value in the code of ethics for the registered nurses, is indicative of the making decisions that are informed. This is one of the areas that informed decisions can be applied. If a nurse is allocated to a patient in an area where they are not familiar with they have the right to turn down the offer. The first aspect to consider is that, taking on a case that a nurse is not familiar with is a risk to the patients’ health, their own and those that they are in contact with. In the case previously used in the paper, a nurse working with an Ebola patient is at a high risk of contracting the disease. This then poses a risk to the colleagues that they come in contact with or even other patients. In retrospect, it is crucial for a nurse to consider this issues before coming up with a decision. With respect to the fact that, such a situation would limit the ability of the nurse to deliver safe and quality care.

Responding to the decision criticism

Responding to claims made to the Director of Nursing and/or Nursing Midwifery Board of Australia, it is important to indicate that nurses have the right refuse allocation of a patient. It is also important to note that, nurses have a legal backing that is rested in the Conscientious objection. This is a set of policies that protects the nurses and the midwives under the Nursing and Midwifery Federation (Conscientious objection, 2015).

There are nine policies that nurses can use in their defense, especially where they are placed in a position that they feel may not be appropriate for them or even their patients and colleagues. However, relative to the case in question it is not all the policies that are going to be used. Some of them may not apply as directly. One of the policies that crucial in this case is first one, which indicates that nurses have the right to refuse participation in a procedure that that they feel is going to be strongly unacceptable relative to their morals and/or religious believes. This is crucial relative to the fact that, in some of the cases the nurse may feel that they are violated relative to the religious beliefs. Relative to the case of responding to the nursing director, this is a policy that is going a major role in support the decision to refuse allocation to a patient (Thompson and Dowding, 2009). For a nurse, it is important that their personal beliefs are put into consideration such that, they also feel respected (Conscientious objection, 2015). Violating personal beliefs of a nurse is abusive approach, given that they too are supposed to respect that of the patient and those that they work with. Before anyone is a nurse, they also have a personal life and personal beliefs and values that observe, such as religious and a moral compass. This is an aspect that can be put across to the board, quoting the policy and the beliefs that are violated in the instance.

The second policy also applies to this case, as it indicates that, nurses are supposed to make sure that the level of care and the safety of the patient should not be compromised. When placed in an unfamiliar position or clinical area, it is likely that the level of care provided will not match that which is expected and may implicate the directives of care. Given that the allocation is likely to compromise the health of the patient, it is imperative to explain to the board that, taking on the case is likely to impact the health of the patient negatively. As such, in the light of the fact that as nurse one has the duty to ensure that they take care of the patient and do not harm them but offer positive outcome, it is important that they turn down the case.

Using the eighth policy to further support their claim, it is important that the nurse expresses their right to not be discriminated against on the grounds of their refusal to take on the case. As such a nurse may choose to pass on the duties to another nurse who has the relevant skills (ANMF Guideline, 2016). This is crucial as it is a means to protect the nurse from possible backlash from their employers. Ideally one of the most common issue that is associated with refusal for allocation of patients, is the discrimination that comes with it (Conscientious objection, 2015). Most of the employers, will tend to discriminate the nurses that have refused to take up cases either for professional or even religious reasons. It is important that nurses are protected from abuse, from employers an aspect that the board should look into with reference to the case at hand. Nurses should not be punished for their legitimate request, especially where they feel that their participation will easily implicate the health of the patient negatively and at the same time pose a risk to the nurses or violate their values and beliefs.

In this case, the nurse is allowed to refuse to take on a case that they feel they may not deliver as expected, especially with reference to the level of skills. However, it is also good to consider the health of the patient. If it is possible, the nurse can be assisted to make sure that they are able to offer the patient the best level of care without incidences of compromise (Conscientious objection, 2015).


Conclusively, it is common for nurses to be asked to take up cases that they are not comfortable with, cases that they cannot deliver on. However, it is crucial to note that while it is the duty of the nurses to offer care to the patients, sometimes the level of skills is lacking and the case offered may also violate the values of the nurse in question (Fink, 2013). Taking on a case that is in an unfamiliar clinical area is risky. If a patient is brought in with an infectious disease, such as Ebola, and the nurse in question does not have the skills level to handle the case, it is possible to turn it down. The nurse however has the option of requesting assistance, where possible to save the life of the patient (Fink, 2013).


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