Most Common Situations When Nurses Are Within Their Rights To Refuse A Patient


Written By: Darby FaubionDarby Faubion RN, BSN, MBA

Darby Faubion is a nurse and allied health instructor with over 20 years of clinical experience. Darby lives in Louisiana and loves exploring the state’s rich culture and history. Darby has a passion for caring for veterans and a special interest in those affected by post-traumatic stress disorder. In her quest to make a difference for veterans, she founded a non-profit called “Operation Battle Buddy.” Read Full Bio »»
RN, BSN, MBA


From the time patients enter any healthcare facility, nurses play a vital role in providing quality patient care. Patients, their loved ones, and our team members look to us for help and encouragement. In some situations, however, nurses are faced with the dilemma of deciding whether accepting an assignment for patient care is appropriate or if they should refuse a patient. Many nurses wonder, "Can nurses choose when to accept a patient assignment, and if so, when are nurses within their rights to refuse a patient?"

Knowing your rights as a nurse and how to protect your patients and yourself is essential. In this article, I will share with you 10 most common situations when nurses are within their rights to refuse a patient. Every nurse and patient is different. So, it is important to consider each situation carefully and know your rights before deciding whether to accept a patient assignment or refuse.



When are Nurses Within Their Rights to Refuse a Patient?

(The following are the 10 most common situations when nurses are within their rights to refuse a patient.)


SITUATION #1: Religious Conflicts

One of the most common reasons nurses refuse to provide patient care is because of an ethical dilemma, such as a religious conflict. While nurses may not try to impose their beliefs on patients or coworkers, if a procedure conflicts with a nurse’s religious beliefs, then nurses are within their rights to refuse a patient assignment.

For example, nurses may refuse to participate in patient care in cases of abortion or gender reassignment based on religious beliefs. However, it is important to note that refusing to provide patient care based on personal dislike or discrimination is not acceptable. The American Nurses Association’s Position Statement on Reproductive Health, for instance, states healthcare clients have a right to make decisions about their personal health. It also says, “Nurses have the right to refuse to participate in a particular case on ethical grounds. However, if a client's life is in jeopardy, nurses are obligated to provide for the client's safety and to avoid abandonment."


SITUATION #2: Excessive Patient Load

Providing safe, competent care is every nurse’s responsibility. In cases where the nurse-to-patient ratio is stretched, causing nurses to have an excessive patient load, doing so can be challenging. Having an excessive number of patients who require care is physically and mentally demanding, which can lead to fatigue, poor concentration, and slow response time.

One of my friends shared with me an experience she had when she first began her nursing career. On one of her scheduled workdays, the unit was short-staffed, and her nurse manager assigned additional patients to the nurses who were present. In the rush to take care of all her patients, she overlooked a change in the patient’s medication orders. As a result, the patient received a medication that should have been discontinued and ended up in intensive care for monitoring. Although she did not lose her job, my friend was reprimanded for the error.

In cases like this, although the nurse manager assigned the extra patients, it was my friend’s responsibility to gauge whether she was capable of handling the excessive patient load. The best option would have been to voice concern for patient safety and refuse to take on the extra patient assignments. Remember, at the end of the day, if you accept an assignment, it is your responsibility, no matter the outcome.


SITUATION #3: Personal Illness

I cannot tell you how many times I have gone to work when I did not feel well or when I got sick while at work and felt like I should stay at work anyway. Many times, nurses are faced with deciding whether to work despite feeling ill. It is hard when you are a nurse working short-staffed, so it is understandable that you may consider staying at work to relieve the stress of your coworkers. However, if you are sick, especially if you have a fever or other symptoms that may be contagious, it is wise not to work.

In fact, if you are experiencing personal illness, it is within your right to call in sick or refuse a patient assignment and go home. Of course, that does not mean that every time you have a runny nose, you should avoid working, but if you are truly ill, protecting the patient and staff's well-being by staying home until you are well is best. To protect your job, I do recommend knowing and abiding by your company's policies regarding sick days, such as getting a doctor's excuse for missed work or a release to return to work.


SITUATION #4: Patient Being Aggressive or Threatening

There is always some risk involved when dealing with other people. Some settings, such as psychiatric units and emergency rooms, can be especially volatile clinical settings for nurses. Although patient care is a priority in nursing, it should never be at the cost of jeopardizing your own safety. When a patient becomes aggressive or acts in a threatening way, nurses are within their rights to refuse a patient assignment.

Anyone who knows me knows that I am not easily intimidated, but I am also not one to put myself in harm’s way. As a nurse, there have been times when patients acted aggressively or made me feel threatened. Years ago, I worked in a large hospital that had a very busy emergency department. Although I usually did not work in the emergency room, I was often called to assist if they were short-staffed and also received patients from their care when they were admitted to the hospital.

One night, I was asked to help out in the ER, and a patient who had been in a fight with someone else was brought in. The patient did not have any weapons, but he acted belligerently and began to curse and throw things at the staff. His behavior got so out of hand that I chose to refuse providing care until we called hospital security to accompany us and monitor the situation for our safety as well as the patient. In a situation like this, be sure to report any incidents to your supervisor promptly to ensure safety protocols are followed and, above all, document, document, document!


SITUATION #5: Lack of Training/Competence

When deciding if nurses are within their rights to refuse a patient, it is necessary to consider all the facts. Being assigned to a new or unfamiliar clinical area is not uncommon in nursing, and, in most cases, it is not problematic. However, if you are ordered to perform a task or procedure that you lack training or feel incompetent performing, you may be within your right to refuse the assignment.

One thing I cannot stress enough is that if you accept an assignment and then do not complete it, it may be considered patient abandonment. Therefore, if you are asked to take on a patient assignment that you feel uncomfortable with, it is crucial that you decide whether it is appropriate to do so or not. For example, if you are asked to fill in for the nurse supervisor on a critical care unit where all patients are on mechanical ventilators, but you have never worked with a ventilator patient, it would be understandable to question your ability to perform the job safely or effectively. In this case, it may be more appropriate to tell your supervisor you are willing to assist in the CCU but that you lack the training and experience to act as the charge nurse.


SITUATION #6: Unsafe Work Conditions

If there is anything I can get in a fuss about quickly, it is nurse safety. As nurses, it is our responsibility to provide efficient, professional, and safe nursing care. It is just as important to protect our own safety on the job. Ideally, employers ensure work conditions are safe, and in all fairness, most employers do. However, in cases where work conditions are unsafe, nurses are within their rights to refuse a patient assignment.

Several factors may lead to unsafe work conditions for nurses. For example, unsafe nurse-to-patient ratios can cause nurses to feel rushed, which increases the chance of injuries and errors in care. Another example of unsafe work conditions is when employers fail to provide adequate supplies of personal protective equipment. In both examples, an imbalance between a nurse’s responsibility to provide patient care and to protect their own safety occurs creating a scenario when refusing an assignment is appropriate.


SITUATION #7: When Beneficence Conflicts with Patient Autonomy

Beneficence in nursing is doing what is best for a patient to promote their well-being. Autonomy is the patient’s right to make decisions about their own care. While nurses have a professional and moral obligation to act in the best interest of patients, if a patient is of sound mind and capable of making independent decisions and refuses or declines treatment, nurses must respect their wishes.

In some cases where autonomy and beneficence conflict, and a patient refuses care, you may not refuse the patient assignment. However, if your clinical judgment indicates the risks of the patient refusing care outweigh the benefits of them accepting it and you feel conflicted about withholding care, you are within your right to question the assignment. If you feel taking a patient assignment is inappropriate because of the conflict, it is crucial that you discuss the situation with your supervisor and document carefully.


SITUATION #8: Controversial Procedures

Some nurses feel conflicted about certain treatments or procedures, especially if they are controversial or go against their personal views of what is morally acceptable. A few examples include administering off-label medications, participating in electroconvulsive therapy, and assisted suicide. Nurses are within their rights to refuse a patient if they feel morally conflicted about these types of care. Keep in mind, though, that once you accept a patient and begin any care, if you refuse to continue caring for them, it could be considered abandonment.

For example, one of my best friends is a registered nurse who lives in a state where "Death with Dignity," or physician-assisted death, is legal. She shared with me that, although nurses do not administer lethal medication to assist patients with death, they may be called upon to be present when a patient takes the medication or to monitor the patient for signs of life after they take the medication. My friend told me that she feels that assisted suicide or "Death with Dignity" is morally wrong, and she refuses to accept patient assignments in these cases, which is within her rights.


SITUATION #9: Unequal Distribution of Low- and High-Acuity Patients

Patient acuity refers to the severity level of a patient’s illness or medical condition. High acuity patients are severely ill or injured, requiring more immediate, typically higher-level care. In settings where there are increased numbers of high acuity patients, the nurse-to-patient ratio should be lower than the ratio in areas where low acuity patients receive care.

While it is the nurse supervisor's responsibility to give patient assignments, it is the nurse's responsibility to know whether they believe they can safely provide care for those patients. If you are assigned too many high-acuity patients, it could lead to an increased risk of harm for both patients and nurses. In this situation, it is advisable that nurses discuss their assignments with their nurse managers and express their concerns. If a resolution cannot be reached where nurses feel they can safely provide care, then nurses are within their rights to refuse a patient assignment. Remember, if this happens to you, be sure you discuss the assignments before accepting care of the patient to avoid being accused of abandonment, and document everything!


SITUATION #10: Lack of Essential Equipment

As a nurse, you have an obligation to assess whether you can safely and effectively provide patient care. Part of providing appropriate care means having access to essential equipment. Having inadequate or poorly working equipment poses a risk to patient safety and could lead to nurse safety risks, as well. If healthcare facilities do not provide adequate essential equipment and supplies to safely and effectively care for patients, nurses are within their rights to refuse a patient assignment.



My Final Thoughts


From the time you go to nursing school and throughout your nursing career, you have been taught that providing for patient care needs is a nurse's top priority. While that is true to an extent, there are several factors to consider, and in some cases, agreeing to accept patient assignments and providing care may not be the best option. In some cases, it is necessary for nurses to refuse a patient, which begs the question, "When are nurses within their rights to refuse a patient?”

In this article, I shared the 10 most common situations when nurses are within their rights to refuse a patient. As a nurse, it is your responsibility to weigh the facts of each situation carefully before refusing a patient assignment. However, if you feel any of the situations mentioned in this article apply to you, or if you have other concerns about accepting a patient, it is important that you address those concerns immediately. Talk to your nurse supervisor or manager to try and find a reasonable solution, and always document everything. Remember, at the end of the day, it is not always what we do that makes a difference for our patients. Sometimes, the things we choose not to do make a difference.


List Of Sources Used For This Article


1. American Nurses Association
2. “20 Common Examples of Ethical Dilemmas in Nursing + How to Deal with Them” (nursingprocess.org)
3. “10 Most Common Examples of Patient Abandonment in Nursing” (nursingprocess.org)


Darby Faubion, RN, BSN, MBA
Darby Faubion is a nurse and allied health instructor with over 20 years of clinical experience. Her work history includes clinical experience in pediatrics, mental health, addiction and behavioral disorders, geriatrics, wound management, and communicable disease. Darby has worked in hospitals, long-term care facilities, and home health and hospice agencies. Darby also has experience as a nursing and allied health educator at both community college and university levels. Her love for nursing and nursing education led to her becoming a test-taking strategist and NCLEX prep coach.