A nurse is not necessarily qualified or competent to practice in any area of nursing simply because the nurse has graduated from a school of nursing and has passed a licensure exam. . . . If a particular area is not a nurse’s major area of employment, the nurse has a right to refuse assignment to the questionable area. If an employer wants a nurse to rotate to an area that is not the nurse’s usual area of assignment, then the employer should provide for the nurse’s further education and training to prepare the nurse to work in the area.

In a 1986 case, Francis v. Memorial General Hospital, a New Mexico nurse was instructed to float from the intensive care unit to the orthopedics unit. He refused and was suspended for two days. On his return, he gave notice that he would not float if he felt incompetent to do so. He was given the option of being oriented to all the units, which would facilitate his floating. The nurse declined the offer and was suspended indefinitely. The court found that the hospital was authorized to discharge the nurse, and made the following observations:

Prior to his discharge, [the nurse] was presented with the opportunity for orientation to floors where he might "float" in the future to overcome his feeling of incompetence. This was done in deference to his ethical scruples, yet [the nurse] refused to find out whether he could ever become comfortable with "floating." Because he declined this deference to his scruples, he cannot complain now that he was fired for following them.

These cases show that you have the right to refuse to float if you think you are unqualified and you can request orientation and training if the administration insists that you do. However, if orientation or training is offered and you continue to refuse, you run the risk of termination.

Keep in mind that the administration also has a legal obligation to provide safe nursing care when relying on floating. A nurse manager can be held liable for delegating responsibilities to you that you are not educated or qualified to fulfill. The Joint Commission on Accreditation of Healthcare Organizations also requires facilities to have a systematic plan for cross-training to ensure competency.

Many states have laws that indicate that it’s considered negligent or unprofessional for a nurse to offer or perform services for which she is not qualified by education, training, or experience. Therefore, accepting floating assignments for which you are not qualified puts you in jeopardy not only of lawsuits but also of disciplinary action by the state board of nursing. Disciplinary action can include license limitation, suspension, or revocation, and possibly mandatory continuing education.

Finally, in respect to whether you’re safe if you restrict your activities when floating to those performed by a nursing assistant: in short, no. Many state boards have an informal policy of holding nurses to the highest standard of care. In other words, even if you practice at a level below that of your license, you are expected to function according to the description of the position for which you were hired.

References

1. Winkelman v. Beloit Memorial Hospital, 168 Wis. 2d 12, 483 N.W. 2d 211 (1992).
2. Francis v. Memorial General Hospital, 104 N.M. 698, 726 P.2d 852 (1986).
3. Joint Commission on Accreditation of Healthcare Organizations. Comprehensive accreditation manual for hospitals: the official handbook. Oakbrook Terrace: The Commission; 2001.

Linda Gobis is senior vice president of legal services and risk management at the Affinity Health System in Menasha, WI.

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