Assignment Despite Objection- TUHNA

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This notice will document that the below mentioned supervisor has been informed at the below date and time that I have accepted an assignment upon direct order, despite my professional opinion as a Registered Nurse that it is inappropriate.

Supervisor Name:

As a result of the following factors, I cannot guarantee that patients will receive optimal care:

The assignment is too large, given the acuity of the patients.

I have been reassigned to a unit where I am not oriented to unit procedures.

I have been reassigned to a specialty unit where I am not trained or qualified.

I have been mandated to work ___ (see below Notes) consecutive hours and fatigue may impact my judgment.

Notes:

Your Name

Your Email *

Unit

Date

YYYY

Time

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