Nurses can’t choose who they care for.

Q I’ve been a charge nurse for several years and find passion and purpose in my responsibility directing the care team and being a nursing leader. Sometimes, however, I face challenges when creating assignments for nurses. I’ve received push back from nurses for assigning them certain patients they don’t want to care for, going so far as to ask for their assignment to be changed. I’ve never asked for one of my assignments to be changed, so I’m finding it difficult to understand why nurses seek changes or why some get so upset when I can’t accommodate their request. What resources can I use to support my decisions?

A Your question raises several important issues in direct nursing care. The nursing profession has a set of unique values and ethics that guide our interactions with patients and recipients of care, other professionals, and the public at large. Nurses remain the most trusted professions in the United States because we practice with honesty and have a high ethical standard. The privilege we have as nurses to care for the public at its most vulnerable underscores why we maintain this standard. Those we serve deserve positive interactions, transparency, and excellent nursing care regardless of who they are. Nurses are expected to meet the needs of all patients.

Provision 1 of the Code of Ethics for Nurses with Interpretive Statements (the Code) addresses the fundamental respect of all patients and the nurse’s duty to care for every individual (nursingworld.org/coe-view-only). According to the Code, a nurse establishes a relationship of trust according to need, setting aside any bias or prejudice. Culture, value systems, religion or spiritual beliefs, and lifestyle are some of the factors we consider when planning patient care, but these factors aren’t reasons to refuse to care for a patient. Nurses, as well as other healthcare professionals, can’t choose who they care for. By becoming RNs, we’ve made a commitment to care for patients and have a duty to maintain their trust.

In its resource for nurses in considering staffing assignments, the American Nurses Association (ANA) advises critically assessing the needs of each patient, including their complexity, stability, and acuity, as well as the resources available to meet those needs. As the charge nurse, you also want to consider the nurse’s expertise, experience, and knowledge to manage any patients you’re assigning to them (tinyurl.com/yvrj9m58).

You may find it difficult to manage these ethical commitments in practice. Consider discussing this issue with your leaders since it could be a symptom of a broader problem. Developing conflict management skills may help you become more comfortable when addressing concerns like these. ANA offers strategies for managing conflicts at tinyurl.com/yx2rcyu8. Your organization also may have resources you can access. In addition, team-based professional development and education could enable your team to strengthen its conflict management qualities together.

Response by Sophia Robinson-Harris, DNP, RN, FNP-C, PMHNP-BC, member of the ANA Ethics and Human Rights Advisory Board

American Nurse Journal. 2024; 19(11). Doi: 10.51256/ANJ112442

Reference

Brenan M, Jones JM. Ethics ratings of nearly all professions down in U.S. Gallup. January 22, 2024. news.gallup.com/poll/608903/ethics-ratings-nearly-professions-down.aspx