POSITION

It is the position of the New York State Nurses Association (NYSNA) that there are inalienable rights afforded to all nurses that ensure their right to equality in interdisciplinary practice, right of self-determination, right to advocacy, and to respect from interdisciplinary colleagues and employers. As a statement of professional rights, these privileges offer nurses support while navigating workplace issues (Academy of Medical Surgical Nurses, 2012; ANA, 2011). These rights include, but are not limited to:

• Nurses have the right to practice in a manner that fulfills their obligations to society and to those who receive nursing care.
• Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice.
• Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for Nurses with Interpretive Statements.
• Nurses have the right to continuing orientation and staff development opportunities.
• Nurses have the right to freely and openly advocate for themselves and their patients, without fear of retribution.
• Nurses have the right to object in writing to an unsafe patient assignment without fear of retribution.
• Nurses have the right to fair compensation for their work, consistent with their knowledge, experience and professional responsibilities.
• Nurses have the right to a work environment that is safe for themselves and for their patients including reasonable shift assignments, adequate staffing levels, sufficient support, and appropriate supplies and equipment.
• Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings.
• Nurses have the right to trusting relationships with the patients, families, and the multidisciplinary teams involved in meeting patient needs, and to be included in all discussions to maximize the effectiveness of patient care delivery.
• Nurses have the right to educate the public about health issues.
• Nurses have the right to seek alliances with other patient-oriented groups and build community coalitions.
• Nurses have the right to a balance between personal and professional roles.
• Nurses have the right to work in solidarity with other members of the healthcare team while working for the patient’s best interest.

In the application of these rights, registered nurses need to understand and exercise their professional responsibilities, which include but are not limited to:

• Assessing the patient assignment and workload;
• Clarifying the facts;
• Assessing one’s own competence;
• Seeking additional information as needed;
• Seeking additional supports as needed;
• Choosing an action after careful evaluation of all options;
• Notifying the appropriate individuals of the chosen action in a timely fashion;
• Recognizing that all actions have consequences (professional, legal, ethical, and employment).

Background  

Nursing’s bill of rights are built upon the premise that the more knowledge the registered nurse has about one’s own entitlements and how they can be utilized, the more effective they will be not only at advocating for themselves, but also for their patients’ rights. It is important to recognize that there is no single or easy answer to the complex professional issues associated with nurses’ rights.

Each professional nurse, when confronted with an untenable practice situation, is required to pursue all available resources in resolving the situation.  Even after all alternatives have been incorporated, the professional nurse may find that a difficult and risky alternative is the only option. While this may leave the nurse in an uncomfortable situation, it must be recognized that the professional nurses’ right to exercise options and to make decisions is inalienable. 

The process of exercising rights impacts on the registered nurse, the patient, the employer, the profession, and ultimately, society (Wiseman, 2001).  In 2009, the American Nurses Association (ANA) released guidance regarding nurse’s rights when considering a patient assignment.  ANA affirmed that nurses: (1) are obligated to raise concerns about a patient assignment that may place either the patient or the nurse at risk, (2) know about and utilize a process for the filing of the concern, (3) become involved in development of a process if one does not exist, and (4) ensure they maintain current competencies required for the patient population routinely cared for (ANA, 2009).

To that end, a registered nurse receiving an assignment that in her/his professional judgment places the patient(s) at risk not only has the right, but also has an obligation under law and ethics to take action. In acting in the interest of the patient, the nurse is required to notify the administrator on duty to whom she/he is reporting to and who has the authority to make staffing decisions. 

The New York State Nurse Practice Act, the Code of Ethics for Nurses, and the mandates under the New York State Board of Regents Rules related to Unprofessional Conduct hold the nurse responsible and accountable to her/his patients for the quality of the nursing care provided. However, the responsibility and accountability for the overall level of care ultimately resides with the hospital/agency, including all hospital and nursing administration staff.

Protest of Assignment forms are used when nurses are expected to assume responsibilities and accountabilities that exceed their experience and educational preparation and/or the volume of care is more than the nurse can, in her/his professional judgment, safely administer. Protest of Assignment forms are also used when the nurse has been given an assignment that is beyond the legal scope of nursing practice under the New York State Nurse Practice Act.  For any single situation, multiple forms may be completed if there are multiple nurses who feel care is compromised. More frequently, however, due to time constraints, multiple nurses will file one form objecting to the conditions under which the nurse(s) must practice. This singular form, then, represents multiple nurses’ levels of analysis of the patient care situation.

The Institute of Medicine (2010) reinforced the need for nurses to (1) practice to the fullest extent of their professional education, (2) attain higher levels of competency and education (as supported through lifelong learning), (3) collaborate within the profession to ensure accountability for quality healthcare, and (4) hold leadership positions within all areas involved in healthcare decisions and care practices.  These recommendations support nurse’s rights and responsibilities in transforming healthcare to meet the obligations of caring for patients in a safe and ethical manner (Fowler, 2010). 

Recommendations 

To fulfill these expectations, Registered Nurses must:

• Understand their ethical, legal, and professional rights and responsibilities;
• Articulate the importance of exercising rights to empower themselves as well as the  nursing profession;
• Exercise their rights in the interest of advocating for and safeguarding the public;
• Utilize available resources to guide decisions in unsafe practice situations;
• Share in the creation of a culture which embraces safety, equity, collaboration and education which contributes to nursing satisfaction, recruitment and retention (Fowler, 2010);
• File a Protest of Assignment (POA) whenever necessary;
• Take collective action to support nursing’s ethics and values;
• File regulatory complaints against an employer whenever the employer violates any of these rights.

Employers must:

• Support registered nurses by assisting in public awareness campaigns related to changes to the Penal Law, subdivision 3 of Section 120.05 that added registered nurses to the list of those protected professionals who are legally protected against assaults of emergency medical professionals and which provides for a Class D felony for serious physical injury to those injured professional (NYS Penal law, §120.05); and
• Ensure paid time off opportunities for registered nurses to continue their education and maintain and grow their competencies, and to practice within their obligatory scope of practice (Fowler, 2010).

Note: The use of the term “patient” anywhere in this document is intended to be generic and refers to the recipient of nursing care.

Approved by the NYSNA Board of Directors on September 16, 1988; September 17, 1997; August 30, 2005; and November 16, 2011.

Reviewed and revised by the Expanded Council on Nursing Practice on July 22, 2005; Council on Nursing Practice August 19, 2011.

Reviewed and revised March 6, 2018.

REFERENCES

Academy of Medical-Surgical Nurses. (2012). Nurses’ Bill of Rights. Retrieved from https://www.amsn.org/practice-resources/position-statements/archive/nurses-bill-of-rights

American Nurses Association. (2001). Bill of rights for registered nurses. Retrieved from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/ workforce/Work-Environment/NursesBillofRights.aspx. 

American Nurses Association. (2009). Patient safety: Rights of registered nurses when considering a patient assignment. Retrieved from http://www.nursingworld.org/rnrightsps

American Nurses Association. (2011). Bill of rights frequently asked questions (FAQs). Retrieved from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/ workplace/Work-Environment/NursesBillofRights/FAQs.aspx

Fowler, M.D.M. (Ed.). (2010). Guide to the code of ethics for nurses: Interpretation and application. Silver Spring, MD: American Nurses Association.

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. [Report Recommendations]. Retrieved from http://www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-of- Nursing/Future%20of%20Nursing%202010%20Recommendations.pdf

New York State Penal Law. (2010). Title H, Article 120, Assault and related offenses, §120.05, Assault in the second degree.

Wiseman, R. (2001). The ANA develops bill of rights for registered nurses: Know your rights in the workplace. American Journal of Nursing, 101(11), 55-57.