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- Guidelines -
Michigan Nurses Association Economic and General Welfare Program
Documentation of Practice Situation

A registered nurse receiving an assignment that in her/his professional judgment places the patient(s)at risk has an obligation to take action. In acting in the interest of the patient, the nurse should promptly notify the nurse on duty to whom she/he is responsible and who has the authority to make staffing decisions.

In the MNA Guidelines to Facilitate Decision Making in Giving/Accepting Assignments the following statement appears:

  • "Nurses are individually accountable for the 'diagnosis and treatment of human responses to actual or potential health problems' (ANA Social Policy Statement, 1980, p.9).  Fulfillment of this responsibility is contingent upon the availability of an adequate number of nurses who are able and qualified to carry out this clinical judgment activity at a level consistent with patient needs. All nurses share a responsibility within the context of their positions to ensure that safe nursing care is delivered at an acceptable level of quality"

In addition, the ANA Code for Nurses states, in part:

  • "The nurse acts to safeguard the client and the public when health care and safety are affected by the incompetent, unethical, or illegal practice of any person."
  • "The nurse assumes responsibility and accountability for individual nursing judgments and actions"

The nurse must formalize the fact that the appropriate hospital/agency representative(s) has been notified. This confirmation does not change the individual nurses liability, but it does establish a shared responsibility and accountability. The nurse must avoid any allegations of patient abandonment.

- Documentation Form -

The accompanying "Documentation of Practice Situation" form can be used:

  • 1) when nurses are expected to assume responsibility that exceeds their experience and/or educational preparation;
  • 2) when the volume of care is more than the nurse can safely administer; and/or 3) when an assignment is beyond the legal scope of nursing practice.

This form must be utilized carefully and should not be used in isolation from other activities including contact with your staff council chairperson and your MNA staff member. Documentation is also essential

To understand the basis for the protest and to enable staff council representatives to initiate proper follow-up.

This memorandum does not attempt to summarize the law on the subject nor does it attempt to give direction that can be followed in every situation a nurse may find her/himself. Therefore, it should not be used as a substitute for a nurse's professional judgment and what the individual nurse deems prudent and essential action.

- Download and Form submission -
  1. Click on the document name below to download.
  2. Print document and complete the accompanying:
  3. Give copies to all of the following:
    • Nursing Manager
    • UMPNC Chairperson

      Fax to: (734) 663-0212 or
      Mail to: 
      • UMPNC
        117 E. Ann St.
        Ann Arbor, MI 48104 
        Nurse submitting form keeps one copy

- Forms -
Documentation of Practice Situation: In Patient  |  Protest of Assignment  |  Documentation of Practice Situation: Ambulatory Care
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