NCLEX-RNManagement of CareMedium
A charge nurse assigns a nurse eight acute medical-surgical clients, which exceeds the unit's established safe staffing ratio. The nurse believes the assignment is unsafe. What is the nurse's first action?
- AFile a formal grievance with the board of nursing
- BDiscuss the concern directly with the charge nurse and request an adjustment
- CRefuse to accept the assignment and leave the unit
- DAccept the assignment but only complete care for the most stable clients
Show answer & explanationAnswer & explanation
Correct answer: B. Discuss the concern directly with the charge nurse and request an adjustment
The appropriate first step when facing a concerning assignment is to communicate directly with the person who made the assignment, following the chain of command, to seek resolution before escalating further or taking unilateral action.
Why the other options are wrong
- A. Filing with the board of nursing is a later escalation step, not the first action.
- C. Leaving the unit without addressing the concern first could constitute abandonment.
- D. Selectively providing care to only some clients is unsafe and unethical.
Chain of Command for Unsafe Assignments
When a nurse believes an assignment is unsafe, the first step is to voice concerns to the immediate supervisor (e.g., charge nurse); if unresolved, escalate up the chain of command.
- Always start with the immediate supervisor
- Document concerns and actions taken
- Escalate through management before external agencies
- Never abandon an accepted assignment without proper handoff
Memory trick: Climb the ladder one rung at a time.