Assignment Despite Objection: What to Do When Your Assignment Feels Unsafe
You can take the assignment and still put your concern on the record. Here's how to do both.
Photo: RDNE Stock project / Pexels
You look at the board and know it's too much: too many patients, too high an acuity, not enough help. Walking out isn't safe for your patients or your license. Saying nothing isn't either.
Photo: RDNE Stock project / Pexels
ANA's position is that registered nurses have the professional right to accept, reject, or object in writing to any patient assignment that puts patients or themselves at serious risk of harm, and the professional obligation to raise those concerns (ANA Position Statement, Patient Safety: Rights of Registered Nurses When Considering a Patient Assignment, 2009, nursingworld.org/practice-policy/nursing-excellence/official). ANA's companion guidance describes "good faith" acceptance: you take the assignment because patients need care now, while documenting that you disagree and asking that the pattern be reviewed. It also notes that an ongoing staffing pattern may warrant a request for "safe harbor" and/or peer review (ANA, Questions to Ask, nursingworld.org/practice-policy/nurse-staffing/questions-to).
That written objection often goes by the name Assignment Despite Objection (ADO) or "assignment under protest." Many unions supply these forms, and some hospitals have their own. The form isn't a refusal. It's a record that you raised a concern, at what time, to whom, and what you were told.
A few states go further and write a formal process into law. Texas is one we've confirmed. Under Texas "Safe Harbor" nursing peer review, a nurse who is asked to do something they believe violates their duty to a patient can request a peer review committee determination, on a form or orally if immediate patient care needs prevent writing. A nurse who makes the request in good faith may not be disciplined or discriminated against for making it, may carry out the assignment while the review is pending, and can't be disciplined by the Board of Nursing for that conduct during the review (Texas Occupations Code §303.005, texas.public.law/statutes/tex._occ._code_section_303.005, official text at statutes.capitol.texas.gov/Docs/OC/htm/OC.303.htm). Texas Board of Nursing rules add that safe harbor must be invoked before engaging in the assignment, and that a written request must be completed before leaving the work setting at the end of the shift (22 Tex. Admin. Code §217.20, law.cornell.edu/regulations/texas/22-Tex-Admin-Code-SS-217-2). Outside Texas, check your state board of nursing for any similar process.
Practical takeaways:
- Use the chain of command in order: charge nurse → house supervisor → manager or administrator on call. Note names and times.
- Be specific about risk: acuity, number of patients, missing skills, missing equipment. Numbers and facts beat "it's too much."
- Fill out your hospital's or union's ADO form (or a written objection) before the end of the shift and keep a copy where policy allows. Don't include patient identifiers.
- Keep caring for your patients. Objecting in writing and abandoning patients are very different things.
- In Texas: if you're invoking Safe Harbor, do it before you start the assignment, and complete the written request before you leave at the end of the shift (22 TAC §217.20).
Scripts:
- To the charge nurse: "I'm concerned this assignment isn't safe. I have [number] patients, including [brief acuity, no names]. What help can we get?"
- Escalating: "I've raised this with [charge nurse]. I'm asking you, as house supervisor, to review the assignment. I'm taking it in good faith and documenting my concern."
- Closing the loop: "I'm submitting an assignment despite objection form for tonight. I'd like to talk about this pattern at staffing committee."
Sources: ANA Position Statement (2009), link above · ANA, Questions to Ask, link above · Texas Occupations Code §303.005, link above · 22 Tex. Admin. Code §217.20, link above