Ohio, California, Washington and other Collective Bargaining states have incorporated language in contracts that recognize the bargaining unit's right to use and review ADO forms. In addition the ethical dilemmas and the underlying issues identified by MNA in 1981 take on an added urgency in today's practice environment. The ANA supports the professional obligations of the nurse to safeguard patients. The right to refuse an assignment should be narrowly construed and the nurse must balance such a refusal against the obligation to provide for patient safety and to avoid abandonment. Exercise informed judgment and use individual competence and qualifications as criteria in giving, accepting or rejecting an assignment.
Nurses are individually accountable for the care of each patient.
Clarify assignments, assess personal capabilities, jointly identify options for patient care assignments when the nurse does not feel personally competent or adequately prepared to carry out a specific function. Determine what will put a patient in immediate, serious danger. The nurse may be held legally responsible for judgments exercised and actions taken in the course of nursing practice. The likelihood of a satisfactory solution will increase if prior consideration of the choices is available. This consideration of available alternatives should include recognition that nurses are professionals and need to be involved in the decision-making process.