You took issue with me advising someone to fill out an incident report stating that the nurse would STILL be responsible for their actions. However, I clearly state that “filling out an incident report will probably not absolve you of responsibility if something bad were to happen”.

I think you misunderstood this tactic as simply that: a tactic to push back against unfair treatment. This is a trick that has worked for me and therefore enabled me to keep my job. It would be wonderful to be able to maintain the high standard of patient care you spoke of, but that often comes at such a very high price that makes the situation such a dilemma.

If you would, could you please elaborate on the entire situation? When you walked off your contract, what price did you pay for such action? What did your travel company say? Did they levy any penalties? Did you have to tap into savings for the lost work and having to abruptly travel to the next assignment or home? It’s unfair to simply tell readers to refuse and walk out without telling them the price they would pay for doing so.

Additionally, any of us who have traveled for any period of time have been put into a situation where we questioned those placing us in that situation. Those above us play fast and loose with situations that could cost us our license and that is the immediate thing we all think of when being put into such a situation. It’s not selfish for me wanting to protect my license to be able to continue to work in a career I love (and where I can continue to help that many more people).

Without knowing a specific situation, it’s easy to judge from the outside. I don’t know your specific situation, but it would be easy for me to say that you were only thinking of self preservation when you refused to go to ICU. What if the ICU was extremely short staffed and they had several tele patients that were able to move, but the hospital had no tele beds. They had a nurse that would have been able to safely come in and take care of those patients, but she went home because she refused to float to ICU. Doesn’t that put those patients at risk? See how easy it is to judge a situation without knowing the full extent.

Bottom line is that you should always consider patient safety when practicing. Built into our nursing license is the agreement that we will act in our patient’s best interest and we will advocate for their safe care. So when someone makes an argument that they are protecting their license, aren’t they also saying they are protecting patient safety?

Most of us know when to draw the line. If I were made to float to OB, sure I would initially refuse. If I was told that I would only be taking vitals and assisting other nurses, I might very well accept knowing that I could ease the work of others to do more specialized tasks. If I was then asked to keep an eye on a fetal heart monitor to look for early or late decelerations, I would wholeheartedly refuse as this would clearly be outside my comfort zone and outside of my scope of practice.

Nursing is rarely black and white. We all exist in continuing shades of grey. You should not be afraid to branch out a little from your normal comfort zones, but you also need to know your limitations and when you are in over your head.

Again Betty, if you would be so kind, please let us know how your travel company reacted and what that process entailed.

I agree completely with your advice about float to different unit that a nurse did not have an experience. However, you suggested that fill out the incidence report which made the nursing supervisor to be accountable for her dangerous and unsafe decision , then accept assignment. I think a nurse should not do that. Why shouldn’t nurse do that because she/he is a primary care giver and give direct pt care. If something happened she is the one who is resposible for this pts. Is it the same concept that if the pharmacist dispensed the wrong dosage by miscalculation, a nurse administer the medication, she is the one who is accountable for her action, not the pharmacist. What if a doctor order wrong meds or wrong dose, and the pharmacist missed to question that, and a nurse administer meds to pt. Who is accountable for this mess? Not the doctor, not the pharmacist. To the State Board: a nurse. Over all, we are nurses, we must stand up for our pt’s safety. We are pt’s avocate. Pt are helpless, they depend on us and trust us as nurses to take care of them. Our most ultimate in nursing care is providing an excellent and best care for our pts based on experiences and knowledges we have gained in our specialty that will save our pts lives. If we accept the assignment in a particular floor that required a specialty, and we are unable to do that, we are cheated our pts. Over 10 years working in the US, I have been standing by my pts, fighting for them, caring for them and having a nerve to chalenge doctors to save my pts lives in many cases. I would not accept the assignment in this case. First of all, you mentioned travel nurses should protect their licences, I think it is selfish to say that. What’s about protect pts safety and their lives? It happened to me 4 years ago, when I got a local travel contracts, the charge nurse sent me to ICU which I had never trained or worked in ICU. Not only I did not have experiences in ICU, but also no ACLS. (It was expired 1 years ago). I told the charge nurse I could not work in ICU and she called the nursing supervisor. This nursing supervisor came to the unit and said: “You have no choice, you either go to ICU or you go home.” I said to her “Yes, I have choice, I go home, you can work in ICU tonight”. I left the hospital, went home and broke the contract. I felt good by doing that. I have been practiced safely for over 10 years, and I have saved so many lives because I do care about patients and their well beings and that is the reason I come to work everyday.

To simply tell a hospital that they are in breach and not return is a BIG deal and advice that should not be followed unless you truly understand the consequences (both professionally and financially). All situations will not be the same. If I walked on a contract every time I have been floated to a unit outside what it stipulates in my contract, I doubt many agencies would work with me. However, if the situation is unsafe and could cost you your license, then you might not have any choice.