That sinking feeling when the charge nurse approaches you with a clipboard: “We need you to float to the ICU today.” You’re a competent med-surg nurse, but the ICU? With ventilators, drips, and critically unstable patients? Your stomach tightens. This is the moment every nurse dreads, and it raises a critical question: can a nurse refuse to float to an unfamiliar unit? This guide will walk you through your legal rights, professional responsibilities, and the exact steps to take when an assignment feels unsafe. We’ll separate fact from fear so you can protect your license and your patients.
What Is Floating? Definition and Common Scenarios
Floating, in the nursing world, is the temporary reassignment of a nurse from their regularly scheduled unit to another unit that is experiencing a staffing shortage. Think of it as being the substitute teacher of the hospital—you’re expected to step in and keep things running, but you may not know the classroom’s specific rules or curriculum. This practice is incredibly common, used to maintain staffing ratios and prevent unit closures.
Here are some typical floating scenarios you might encounter:
- An experienced telemetry nurse sent to the post-anesthesia care unit (PACU) for a shift
- A labor and delivery nurse asked to cover the neonatal intensive care unit (NICU) nursery
- A medical-surgical nurse assigned to a skilled nursing facility within the hospital system
- An emergency department nurse floated to a different ED that uses a different electronic charting system
While the intention is to ensure patient care continues, the reality can put both nurses and patients at risk if not managed properly.
Clinical Pearl: Floating is an administrative decision, not a reflection of your clinical skill. Being asked to float doesn’t mean you’re a “super-nurse” who can do everything; it means the hospital is managing a resource shortage.
Legal Basis for Refusal: A Nurse’s Right to Safe Practice
Your right to refuse an unsafe assignment isn’t just a feeling—it’s backed by fundamental nursing principles and regulations. You are not expected to be an expert in every specialty. Several key bodies support this stance.
First, the American Nurses Association (ANA) Code of Ethics is clear. Provision 3 states that the nurse is responsible for “the protection, promotion, and optimization of health… for all persons.” It also asserts that the nurse must “protect the patient… by acting as a patient advocate.” Accepting an assignment for which you are not competent directly contradicts this duty.
Second, The Joint Commission (TJC) has standards that hospitals must follow regarding staff competence. TJC requires that hospitals verify the competence of their staff to provide care. If the hospital cannot prove you are competent to care for ICU patients, assigning you there is a failure on their part, not yours.
Finally, your State Board of Nursing (BON) is your ultimate authority. Your license is at stake. Nearly every BON has position statements or regulations stating that a nurse is accountable for their own practice and must only accept patient care assignments for which they are competent. Providing care beyond your scope or competence can lead to disciplinary action against your license.
When Can You Legally Refuse to Float? 8 Valid Reasons
Understanding when a refusal is justified is crucial. A general dislike of a unit is not enough. The refusal must be rooted in legitimate safety and competency concerns. Here are eight valid reasons you can legally refuse a floating assignment.
- Lack of Competency and Experience: You have not cared for this patient population in a clinical setting for a significant period (or ever). A med-surg nurse floating to a high-level ICU is a classic example.
- No Formal Orientation or Competency Validation: The hospital has not provided you with any orientation to the specific unit, its equipment, its charting system, or its emergency protocols. Effective floating isn’t just about showing up; it requires preparation that the employer must provide.
- Inadequate Staff Support: You are asked to float to a unit where you would be the only nurse, and there’s no charge nurse, resource nurse, or experienced clinician available for immediate guidance and backup.
- Improper Patient Assignment Ratios: The floating assignment would require you to care for a higher number of acutely ill patients than is safely manageable, even for an experienced nurse on that unit. For example, asking a float nurse to take five ICU patients.
- Lack of Familiarity with Critical Equipment: You are expected to manage patients on complex equipment (e.g., ventilators, intra-aortic balloon pumps, CRRT machines) that you have not been trained on or competency-checked for recently.
- Specific Patient Needs Beyond Your Scope: The assignment involves a specific patient procedure or condition that is explicitly outside your scope of practice, such as a pediatric patient when you are only certified for adult care.
- Emergency Situations Without Debrief: While nurses can be pulled in during a true mass casualty event or code, refusing a routine floating assignment outside of an emergency is valid. If you are not given a proper safety brief or assignment in an emergency, you can object.
- Violates Union Contract or Facility Policy: If your collective bargaining agreement or hospital’s own floating policy states a nurse cannot be floated to a specific unit without prior orientation, that policy is your legal backing.
The Unsafe Assignment: Documenting Your Concerns Properly
This can feel overwhelming, but clear documentation is your strongest defense. Saying “I’m not comfortable” is vague and easily dismissed. Saying “I have not managed a ventilator-dependent patient in five years and do not have a current competency check for the PB840 ventilator used on this unit” is specific, professional, and impossible to ignore.
Documentation happens before you officially refuse. It’s the paper trail that proves you acted responsibly.
- Write it Down Immediately: As soon as you receive the assignment, discreetly jot down the facts. Note the date, time, the name of the person who assigned you, the unit you were going to, and the patient details (age, diagnosis, primary equipment).
- Be Objective: State your lack of experience or training as a fact, not an emotion.
- Instead of: “I’m scared to take this patient.”
- Write: “My most recent clinical experience with chest tubes was over three years ago on a medical-surgical floor. I have not managed three chest tubes simultaneously on a single patient post-cardiac surgery.”
- Reference Official Sources: Mention the ANA code, your state’s nurse practice act, or hospital policy in your verbal refusal and note it in your personal documentation.
- Save the Documentation: Keep a personal copy of your notes. If the situation escalates, these notes are invaluable.
Pro Tip: Keep a small notebook in your bag or use a secure notes app on your phone specifically for documenting staffing concerns or tricky assignments. Date every entry. This habit will protect you throughout your career.
How to Professionally Refuse an Assignment: Step-by-Step Communication
How you refuse is just as important as why you refuse. The goal is to advocate for patient safety without creating unnecessary conflict. Follow this professional chain of command.
- Start with the Charge Nurse: Your first conversation is always with the person who made the assignment. Approach them calmly and privately.
- State the Specific Concern: Lead with your objective concern. “Sarah, thank you for the assignment. Before I accept, I need to let you know that I have not been oriented to this ICU’s specific drips and protocols, and I have not managed a patient on these particular vasoactive medications in over two years. I’m concerned I cannot provide safe care for this critically ill patient.”
- Offer Alternative Solutions: Show you’re a team player. “Is there another assignment on this unit that is within my competency, such as a stable post-op patient? Or could I be reassigned back to my own unit? I am happy to help where I can be safe.”
- Escalate if Necessary: If the charge nurse insists on the unsafe assignment, state your intention clearly. “I understand the unit is short-staffed, but I cannot accept this assignment as it falls outside my scope of practice and puts the patient at risk. I need to speak with the nursing supervisor.” Remain respectful but firm.
- Inform the Nursing Supervisor: Repeat your concerns professionally to the house supervisor. Document that you have now informed both the charge nurse and the supervisor.
- Fill Out an Incident Report: If you ultimately refuse the assignment, request to file a formal “Assignment Despite Objection” or “Unsafe Staffing” form. This creates a permanent, official record within the hospital. If they don’t have a form, submit a written memo to your manager and the supervisor.
Consequences of Refusal: What Really Happens
Let’s be honest—refusing an assignment is scary. You might worry about being fired or labeled “difficult.” When you refuse professionally using the steps above, you are protected. You are not engaging in insubordination; you are upholding your ethical and legal duties.
The best-case scenario: The supervisor recognizes the valid safety concern, reassigns the patient to a competent nurse, and finds a more suitable assignment for you or sends you back to your home unit. Your professional advocacy is respected.
The worst-case scenario: administration pushes back, writes you up for insubordination, or terminates your employment. This is rare, especially if you have followed the chain of command and documented everything. If this happens, your detailed documentation becomes critical. You may need to involve your state’s Board of Nursing or your union representative. Remember, a temporary job is not worth costing a patient their life or you your nursing license.
Common Mistake: Agreeing to the unsafe assignment “just this once” out of fear. This sets a dangerous precedent and puts you in legal jeopardy. If something goes wrong, your initial acceptance of the assignment weakens your defense that you knew it was unsafe.
State-by-State Variations: Key Differences to Know
While the core principles are universal, the specifics can vary dramatically by state. For instance, California has legally mandated nurse-to-patient ratios. A California nurse could refuse an assignment that violates these ratios, a powerful legal tool not available in every other state. Some states have BONs that are very proactive in supporting nurses who refuse unsafe assignments.
You must become an expert on your state’s specific laws. Here’s how:
- Visit Your State Board of Nursing Website: Search for position statements on “accepting assignments,” “floating,” or “scope of practice.”
- Consult Your Union Contract: If you are part of a union, your collective bargaining agreement is a legally binding contract that likely has specific language about floating rights and assignments.
- Review Your Hospital’s Policies: Your own employee handbook should have a chapter on floating and clinical practices. Know it inside and out.
Do your homework before you’re in the heat of the moment. Knowing your state’s specific position gives you confidence and adds weight to your professional refusal.
Real Scenarios: Case Studies of Floating Dilemmas Resolved
Theory is one thing; real life is another. Let’s walk through a couple of scenarios.
Scenario 1: The Med-Surg Nurse in the ICU
Maria, a med-surg nurse with 10 years of experience, is told to float to the surgical ICU. She hasn’t worked in an ICU since nursing school.
- Her Action: She immediately tells the charge nurse, “I appreciate you thinking of me, but my clinical experience is with stable medical-surgical patients. I am not competent to manage post-operative open-heart patients on ventilators and multiple titratable drips. Can I take a less acute patient or help on my home unit?”
- The Outcome: The charge nurse, not wanting to risk a patient, reassigns Maria to the step-down unit to care for a stable patient recently transferred from the ICU. Maria used her voice, provided a safe alternative, and protected both her license and a patient.
Scenario 2: The ED Nurse Without Orientation
David, an experienced ER nurse at a large urban hospital, is floated to a smaller, affiliated ER across town. He is assigned to be the sole charge nurse.
- His Action: David states to his manager, “I’ve never worked in this facility before. I’m not familiar with your charting system, crash cart locations, or transfer protocols to the local trauma center. It would be unsafe for me to be in charge without an orientation.”
- The Outcome: The administration agrees. They have David work as a staff nurse under the supervision of a locally hired nurse who acts as charge. David accepted a modified, safe assignment instead of a blanket refusal.
Quick Reference Guide: Your Floating Refusal Checklist
Feeling overwhelmed when a floating assignment comes your way? Keep this mental checklist handy.
When You Receive the Assignment:
- [ ] Identify the unit, patient needs, and required competencies.
- [ ] Honestly assess your own skills and recent experience. When was the last time I did this?
- [ ] Ask for orientation information. Has it been provided?
Preparing to Refuse:
- [ ] Write down the facts of the assignment (who, what, when, where).
- [ ] Formulate your specific, objective concern.
- [ ] Think of a safe alternative you can offer.
The Professional Refusal:
- [ ] Speak to the charge nurse privately and calmly.
- [ ] State your objective reason and the safety risk.
- [ ] Offer an alternative solution.
- [ ] Escalate to the supervisor if necessary.
- [ ] Document everything—your notes, your conversations, and the final outcome.
FAQ: Your Top Questions About Refusing to Float
Q: What if it’s a true emergency, like a mass casualty event? In a declared disaster or mass casualty incident, the rules shift. The expectation is that all licensed personnel help to the best of their ability within their scope. However, you still have the right to refuse tasks you are not trained for (e.g., inserting a chest tube if you’re not an APRN). Be clear about what you can and cannot do.
Q: Do I still get paid if I refuse an assignment? Yes. If you are at the hospital for your scheduled shift and refuse an unsafe assignment, you should be paid. Your employer must find another appropriate task for you. They cannot send you home without pay as punishment for a patient-safety-based refusal. This may vary by union contract and state law, but it is the general standard.
Q: What if I’m a new graduate nurse? New grads are in a particularly vulnerable position. You have a very strong case for refusing assignments outside of your residency program’s defined scope. Use your preceptor and nurse educator as resources. Your inexperience is not a failing; it’s a fact that must be managed safely by your employer.
Conclusion & Key Takeaways
Navigating a floating assignment is one of the toughest challenges in modern nursing. But you have rights, and you have a voice. Your primary responsibility as a nurse is to your patients, and that means providing safe care based on your proven competence. Remember that accepting a patient assignment is a voluntary, professional judgment. If it’s not safe, it’s not yours to accept. Trust your clinical judgment, document objectively, and communicate respectfully advocate for yourself and your patients every single time.
What’s the most challenging floating situation you’ve ever faced? How did you handle it? Share your experience and your best tips in the comments below—your story could help a fellow nurse navigate a tough decision.
Want a tool to keep in your pocket? Download our free “Floating Refusal Documentation Checklist” printable to guide you step-by-step the next time you’re faced with an unsafe assignment.
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