LEARNING EXERCISE 5.

9: TO FLOAT OR NOT TO FLOAT

Situation: You have been an obstetrical staff nurse at Memorial Hospital for 25 years. The
obstetrical unit census has been abnormally low lately, although the patient census in other
areas of the hospital has been extremely high. When you arrive at work today, you are told to
float to the thoracic surgery unit. This is a specialized unit, and you feel ill-prepared to work
with the equipment on the unit and the type of patients who are there. You call the staffing
office and ask to be reassigned to a different area. You are told that the entire hospital is
critically short-staffed, that the thoracic surgery unit is four nurses short, and that you are at
least as well equipped to handle that unit as the other three staff who also are being floated.
Now, your anxiety level is even higher. You will be expected to handle a full RN patient load.
You also are aware that more than half of the staff on the unit today will have no experience in
thoracic surgery. You consider whether to refuse to float. You do not want to place your nursing
license in jeopardy, yet you feel conflicting obligations.

1. To whom do you have conflicting obligations?

As we have learned in the Decent Work course by Ma’am Mabini, we have a conflicting
obligation to our nurse-manager because he/she is the one who delegates the task to his/her
subordinate.

The shortage of qualified practicing nurses is not new. The American Nurses Association
has backed the nurse’s right to refuse an unsafe assignment. The current position statement,
“Rights of Registered Nurses When Considering a Patient Assignment” (ANA, 2009) expressly
states that nurses have “the professional right to accept, reject or object in writing to any
patient assignment that puts patients or themselves at serious risk for harm. Registered nurses
have the professional obligation to raise concerns regarding any patient assignment that puts
patients or themselves at risk for harm” (Emphasis added).

2. You have little time to make this decision. Outline the steps that you use to reach your final
decision.

1. The first thing I will do is to identify what is the problem. I might ask myself “is the
assignment outside the scope of your practice or your experience and knowledge level?”
2. If not, I will be polite and factual when I follow the chain of command through the charge
nurse, unit leader, or nursing office. “I am not qualified to care for these patients because I
don’t have the knowledge or the experience. I am concerned for the patients’ safety and I need
your help to find a safer way to take care of these patients.”

3. Next, I will write a letter and put my objections or refusal in a nice manner. It is important
when writing an objection or refusal letter to include the date and time, and why you are
refusing or objecting, and don’t use subjective or accusatory terms such as “short-staffing”.
4. And, the most important thing is, I will sign the letter. I will give a copy to my leader and keep
one for myself.

3. Identify the legal and ethical ramifications that may result from your decision.
The nurse is legally accountable to accept only those assignments that are appropriate
in terms of their nurse practice act and their scope of practice, and only those that the nurse
believes that they are competent to perform. For this situation, the legal ramification is
professional negligence under failure to meet the standard of care (breach of duty). Due to the
nurse not accepting the float duty. Not giving the care that should be given under the
circumstances
4. Are they in conflict?
Yes, they are conflicting. In terms of familiarization of one’s regular shift to floating to
another unit not very much similar to the one used to, there will be conflicting knowledge most
especially in a workplace where all of the staff are also floating and have no clue what happens
in and around the thoracic surgery unit, therefore increasing one’s anxiety level. It conflicts
because its one’s license at stake. It is always going to be a heavy adjustment.

Lesson learned by the group:

Nurses and leaders must speak up when circumstances put the nurse and the patient at
risk of harm because not being careful can cause harm or injury to the patient. Even if you have
never been in a questionable situation, you should know your organization’s policies and your
state’s laws and regulations regarding refusing an assignment. And lastly, Nurse leaders should
take note of Provision 6 of ANA’s Code of Ethics for Nurses (2001): “acquiescing and accepting
unsafe or inappropriate practices, even if the individual does not participate in the specific
practice, is equivalent to condoning the unsafe practice”.

GROUP 2
Allawi, Lovi Ann
Caruncho, Jeremiah
Denum, Alleyan Hannah
Gumban, Alexander Keith
Mendoza, Michaella Janine
Padilla, Francis Rafael
Sasan, Aubrey Richelle
Villanueva, Ma. Theresa

BSN III- Nigtingale

Professor Maria Luisa Lopez
NCM 119 Adviser

BETA