unsafe assignment

Refusing an Unsafe Patient Assignment

As a travel nurse, you’re expected to be flexible, fill in staffing gaps, and help wherever needed.  Sometimes, however, nurses are asked to accept patient assignments that aren’t necessarily safe. So what should you do if you find yourself in that situation?

 What’s considered an unsafe assignment?

Some of the more common examples of unsafe assignments can involve (1) not receiving any type of orientation to the unit; (2) a discrepancy between the patient’s needs and the nurse’s skill set; (3) an inappropriate number of patients assigned to one nurse, with respect to patient acuity; and/or (4) a critical lack of unit resources such as basic equipment and supplies.

  • Orientation to the unit: Nurses should receive some type of orientation to the unit.  It might be brief, but they should learn where resources and supplies are, who their “go-to” person is for questions, and how to access emergency support.
  • Nurse’s skillset vs. patient population: This is a common issue when a nurse is floated outside of their “home” unit. A nurse should only be placed in a unit in which he/she has some level of knowledge and work experience, especially when it comes to the patient acuity level. Nurses who only have experience in Med/Surg level acuity should not be sent to higher patient acuity levels such as Step Down or ICU. Likewise, ICU or Step Down nurses shouldn’t be sent to Med/Surg units, because typically they’re not experienced in caring for a higher ratio of patients.
  • Inappropriate patient ratios: California is the only state that has mandated nurse-to-patient ratios. Otherwise, the facility has the authority to determine patient ratios as they see fit. Nurses are encouraged, per the ANA, to use their educated judgement on whether or not they feel safe enough to care for a certain number of patients. They should consider the patients’ acuity levels, available support/resources, and their personal experience with patient ratios.
  • Critical lack of basic equipment/supplies: Sometimes items can be on back order and nurses are good at improvising. However if the unit lacks very basic equipment – monitoring equipment, IV fluids, oxygen tubing, etc. – supplies that impact safe care, nurses should notify management and work with them to find a solution.

You’ve been given an unsafe assignment – now what?

According to the American Nursing Association (ANA), nurses are “professionally and ethically obligated to advocate for their patients and themselves by voicing any concerns about patient assignments.”

  1. Gather as much information as you can about the assignment. Ask patient ratios, available support/resources, procedures and diagnoses, etc.
  2. Professionally voice your concerns to a supervisor. If you are going to refuse an assignment, make sure you have accurate information and a good reason for refusing.
  3. Help find solutions. Could another arrangement be made? Maybe you can take certain patient types you have experience with and another nurse can take the other patients? If floating to a new unit, maybe they could give you a lower patient ratio, or ensure you have no discharges or admits during your shift? Could you provide basic care but another nurse could handle a specialized skill you’re not familiar with? (Perhaps you’re caring for an Oncology patient, and another qualified nurse can hang the patient’s chemotherapy.)
  4. If the hospital is still insisting that you take the assignment, contact your Aureus Account Manager.
  5. Most importantly – do not accept an assignment and then decide later that you can’t do it. This causes numerous problems such as delay in care, loss of continuity of care and you could even be considered to be abandoning your patients.

Don’t forget – you’re there to help!  You should feel confident that you have the tools needed to provide safe care.  However, we should reiterate that if you are given a reasonable assignment, the goal is to provide care for patients who really need it. Reasons that are NOT acceptable for refusing to float are:  (1) claiming you don’t “like” a certain patient population even though you’re qualified to care for them; (2) saying you don’t like certain tasks that a patient requires; (3) having personality conflicts with staff; or (4) not personally agreeing with unit policies.

Betsy Martin, RN, BSN, is a Quality Assurance Nurse for Aureus Medical Group


  1. I am an OR NURSE, because Of the Coronavirus Covid-19 our surgical schedules has been just emergency cases or no surgery at all. So, we were told that we will be assigned to Medsurg & ICU. Oriented just a day and inexperienced as Medsurg or ICU NURSE. My question: are we mandated or do we have a legal & ethical obligation to refuse such unsafe assignment considering our being inexperience & compromising the patients safety?

  2. Thank you for your question! You are not required legally or ethically to work in a unit you’re not clinically qualified to work in. One day of orientation is not enough to make you a fully competent nurse in that area, caring for your own patient assignments. One option would be to help by “tasking” which means you provide assistance and support to the nurses on those units who are the primary nurses for patients. This means you could perform tasks by placing foleys, getting vital signs, measuring I’s and O’s, checking blood with another nurse, doing blood sugar checks, getting supplies, etc.

    To avoid confusion, have a conversation with your supervisor regarding what you feel comfortable doing BEFORE you show up to any shifts. If you report to your shift and decide to refuse an assignment, make sure you do that before getting report or accepting the assignment to avoid patient abandonment. It’s possible that your employer might require you to take PTO or not receive pay if you’re not working. That depends on the facility’s own policies. Good luck and stay safe!

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