Excessive Hours of Work: Professional and Union Considerations

Professional and Union
Considerations

Table of Contents
Introduction……………………..…………………………………………….………………………..… 1
Background……………………….………………………………………………………………………… 1
Professional and Contractual Framework………………..……………………………………..… 2

Strategies for Registered Nurses in Direct Care…………………………………………..… 4
Strategies for Registered Nurses in Management and
Leadership Roles…………………………………………………………………………………… 5
Conclusion……………………..………………………………………….……………………………..… 6
References…………………….………………………………………………………………………….… 7
Appendix A……………………..………………………………………………………………………..… 10
•
Decision-Making Framework for Consultation with ARNNL
and RNUNL
Appendix B……………………..………………………………………………………………………..… 11
• Excerpts from Code of Ethics for Registered Nurses (CAN, 2008) and
ARNNL Standards for Nursing Practice
Appendix C……………………………………………………………………………………………….… 12
• Abandonment: College of Registered Nurses of British Columbia (CRNBC)
Appendix D……………………………………………………………………………………………….… 15
• Saying No: Excerpt retrieved by S. Brook in Nursing 2009

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The Association of Registered Nurses of Newfoundland & Labrador (ARNNL) and the Registered
Nurses’ Union Newfoundland & Labrador (RNUNL) share an ongoing concern about registered nurses
(RNs) working excessive hours and the impact this can have on quality of care and, client and nurse safety.
Working excessive hours is an issue that has professional, labour and liability implications.
This document provides RNs in direct care, management, and other leadership roles with information to
consider when working, or requesting others to work, excessive hours. Strategies that nurses may utilize
when addressing concerns related to excessive hours of work are proposed. Also included is a decisionmaking framework (Appendix A) to assist RNs to determine when to consult the ARNNL and RNUNL.

The information provided is based upon the Newfoundland and Labrador Registered Nurses Act (2008),
Standards for Nursing Practice (ARNNL, 2007), and the Code of Ethics for Registered Nurses (Canadian
Nurses Association [CNA], 2008). The information also incorporates other legislation, labour laws, and
collective agreements that address the health, safety and rights of employees. This document reflects the
premise that nurses owe a “duty of care” to clients and are responsible to provide safe, competent and
ethical nursing care under all circumstances; yet, at the same time, nurses have the right, as well as the
responsibility, to take care of themselves.

Background
Research demonstrates the relationship between excessive hours of work, fatigue 1 and, client and nurse
safety (Canadian Nurses Association [CNA] & Registered Nurses Association of Ontario [RNAO] 2010).
Between 1997 and 2005, RN overtime rates increased by 58 percent (CNA, 2006), with RNs from all
practice areas reporting they worked, an average of 6.4 hours of paid and unpaid overtime per week.
Nationally, this equates to 349,800 overtime hours per week or the equivalent of 10,054 full-time nursing
jobs (CNA, 2006). The Nurse Fatigue and Patient Safety Research Report (CNA & RNAO, 2010) identifies
inadequate recovery time between worked shifts as a causal factor for fatigue. Key survey informants
further identified that the risk of physical injury increases with fatigue. The 2005 National Survey on the
Work and Health of Nurses (Statistics Canada, 2006) has highlighted the physical toll that workplace
challenges, such as overtime, are having on nurses. The national survey identified that 12 percent of
nurses who reported absenteeism indicated it was due to injury.
Summarizing the potential impact, Maddalena and Crupi (2008) state “working in areas that are short
staffed, working excessive paid and unpaid overtime, being called into work on days off, and the
Inability to take vacation time are all common place and contribute to fatigue and burn out ” (p.45). The
ability to provide nursing care in such an environment can lead to moral distress and directly influence the
quality of the professional practice environment (CNA, 2008).
Compounding the issue of overtime is a shortage of health care professionals. Working short staffed was
identified as the second most important reason for reported levels of fatigue (CNA & RNAO, 2010). The
__________________
1

Nurse Fatigue definition – The subjective feeling of tiredness (experienced by nurses) that is physically and mentally
penetrative. It ranges from tiredness to exhaustion, creating an unrelenting overall condition that interferes with “an
individual’s” physical and cognitive ability to function to their normal capacity. It is multidimensional in both its causes and
manifestations; it is influenced by many factors: physiological (e.g., circadian rhythms), psychological (e.g., stress, alertness,
sleepiness), behavioural (e.g., pattern of work, sleep habits), and environment (e.g., work demand). Its experience involves
some combination of features: physical (e.g., eepiness) and psychological (e.g., compassion fatigue, emotional exhaustion). It
may significantly interfere with functioning and may persist despite periods of rest (CNA & RNAO, 2010).

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Canadian Nurses Association’s (2009) report on the health human resources landscape, Tested Solutions
for Eliminating Canada’s Registered Nurse Shortage, provides new projections for how the shortage will
grow by almost five times over the next 15 years.
The report shows that if the health needs of Canadians continue to change according to past trends, with
no policy interventions implemented, Canada will be short almost 60,000 full-time equivalent RNs by
2022. Nurses are worried that the growing shortage of RNs will result in requirements to further increase
the number of hours of work and thus exacerbate existing concerns about the quality and safety of client
care and the health and well-being of nurses.

As professionals, nurses must adhere to provincial standards and uphold ethical values (see appendix B).
As employees, nurses must also meet the terms of their employment contract and related labour laws.
Nurses in management and other formal leadership positions face the difficulty of appropriate staffing
when resources are lacking. Consequently, dealing with matters related to excessive hours of work can
result in nurses, at all levels, being confronted with apparent conflicts between coexisting responsibilities
and reality. Thus, professional and employment consequences when working excessive hours must be
addressed.

Professional and Contractual Framework
This section provides information for RNs on their professional and contractual obligations when working
excessive hours.

Excessive Hours
The phrase ‘excessive hours’ has not been specifically defined in any nursing resource, nor are there
professional guidelines or legislation that stipulate the maximum number of hours a RN can work in
Newfoundland and Labrador (NL).
An RN in NL may work under one of a number of collective agreements with a variety of hours of work
arrangements. For example, the provincial collective agreement (RNUNL, 2009), identifies overtime as
work in excess of an employee’s normal hours of work. The normal hours of work under this agreement
are eight-hour shifts or 12-hour shifts, totaling 37.5 hours per week for a nurse working full-time. This
agreement references ‘required’ overtime and contractual clauses which address adequate rest periods.
Overtime can be required at any time with no limit on the number of hours of overtime. For example, an
employee can be mandated to work on her/his days of rest and she/he can be mandated to stay beyond
the end of their regularly scheduled shifts. However, an employee should not be mandated to work
overtime “if another qualified employee is willing to work that overtime, provided that there is no
additional cost to the employer and provided the employee is available” (article 9.05 p.23). As well, an
employee cannot be compelled to work ‘double shifts’ (e.g., back-to-back shifts) without her/his consent.
Generally speaking, and even when an employer requires mandatory overtime in possible breach of the
collective agreement, an employee is expected to “work now, grieve late.” There are exceptions to the
“work now, grieve later” principle such as, a refusal based upon the Newfoundland and Labrador
Occupational Health and Safety Act, 1990, but these are not the norm.
ARNNL has no mandate regarding the maximum number of hours or overtime, as this historically is a
legislative and employment issue. As a part of its public protection mandate however, the Association

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identifies that a nurse’s physical and mental state must be such that the nurse is able to provide safe and
competent nursing care. The nurse must therefore determine if she/he is ‘fit’ to work the overtime hours.
There is no set definition of being fit. Fitness includes assessment of the potential impact of fatigue or
other causes of physical or emotional distress that could compromise care or safety for the client, coworkers, or the nurse. The Code of Ethics for Registered Nurses (CNA, 2008), under the value
Accountability, states:
•

Nurses maintain their fitness to practice. If they are aware that they do not have the necessary physical,
mental or emotional capacity to practice safely and competently, they withdraw from the provision of
care after consulting with their employer or, if they are self-employed, arranging that someone else
attend to their clients health-care needs. Nurses then take the necessary steps to regain their fitness to
practice (p.18).

Consequently, it is up to the individual nurse to assess her/his ability to work overtime hours and for the
manager/employer and the nurse to work collaboratively to reach a resolution.

Liability Protection
All practicing RNs in NL must have liability protection in the event of an unfortunate occurrence and a
client is harmed (RN Act, 2008). Liability protection is not affected by the number of hours worked, the
length of a shift, or the number of consecutive shifts worked. Liability protection is a condition of
licensure. RNs licensed to practice in NL have liability protection through the Canadian Nurses Protective
Society (CNPS)2. The CNPS is a non-profit legal service. Most nurses are also provided liability protection
through their employer. The law holds the employer legally responsible for the acts of its employers that
occur within the course of their employment (CNPS, 1998).

Workers Compensation
The NL Workplace Health, Safety and Compensation Commission (WHSCC) oversee the no-fault
insurance system commonly known as worker’s compensation. The WHSCC provides short-term and long
-term benefits to employees who are injured through work-related activities. These benefits may include
wage loss benefits, rehabilitation benefits, loss of earnings capacity benefits, etc. Benefits are not
determined by hours of work, (e.g., if a RN is injured on the job during regular working hours or while
working overtime). The RNUNL provides representation in the worker’s compensation process.

Occupational Health and Safety Legislation
Employees can refuse ‘unsafe work’ that they reasonably believe to be dangerous, either to themselves or
to others in the workplace, as per the Newfoundland and Labrador Occupational Health & Safety Act
(1990). Unsafe work means any work that is dangerous to the health and safety of employees or others in
the workplace. There is a specific process to follow when refusing unsafe work. The employee must:
1. Report the unsafe work and remain on-site for the manager/employer to investigate the situation.
2. Contact an occupational health and safety representative or, where personal safety or client safety is
involved, the RNUNL or ARNNL as appropriate for guidance.
3. Formally challenge or report the unsafe work to the Occupational Health & Safety Inspections
Division.

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When employees refuse unsafe work which is not remedied by the employer, they should be transferred
to other equivalent work without loss of pay. If employees cannot be reassigned to other work, they
should be paid even while refusing unsafe work. Employers are not permitted to discipline or terminate
employees for refusing work that employees reasonably feel is unsafe.

Abandonment
Although the term ‘abandonment’ has not specifically been defined by ARNNL, the term is linked to an
established duty of care. CNPS identifies that nurses “do not have a duty to treat everyone they meet but

if a person relies on their professional skill and knowledge, a legal duty to take reasonable care is
established” (CNPS, 2006). If a duty of care has been established and the RN is requested/mandated to

work extra hours (including on-call) she/he is required to determine and acknowledge their capacity to
fulfill the request. If she/he can work the overtime, but for a limited period, (e.g., four hours versus 12
hours) or, in a limited capacity (e.g., limited client assignment), their first responsibility is to immediately
notify the manager/employer of the situation and clearly state what she/he is able to work. It is the
employer’s responsibility to arrange for a replacement. Until a successful compromise is accomplished
that assures client safety is not jeopardized, the nurse should not leave. Doing so could be considered
abandonment. The College of Registered Nurses of British Columbia (CRNBC, 2007 &2008) has
developed detailed guidelines to address concerns regarding abandonment which are provided, for
information, in appendix C.
Both RNUNL and ARNNL recognize there will be times when a nurse is unable to work requested
excessive hours. This may not constitute abandonment. Refusal to come to work for an unscheduled shift
does not necessarily constitute abandonment.

Strategies to Address Concerns Regarding Excessive
Hours of Work
A summary of strategies that reflect a professional approach that all nurses should utilize when
addressing concerns related to excessive hours of work are presented below. For managers, this includes
consideration of skill mix, client care assignments, and resource allocation. For direct care providers this
includes consideration of assignment and delegation, participation in staffing decisions, and when
necessary, advocating for staffing levels that meet client population needs (ARNNL, 2006a). The Canadian
Nurses Association’s position statement Taking Action on Nurse Fatigue (CNA, 2010) also outlines
strategies that can be used to mitigate and manage nurse fatigue. Additionally, appendix D provides RNs
with tips for saying “no”, when warranted, in an assertive yet professional manner.

Strategies for Registered Nurses in Direct Care
Short Term
Identify, to your immediate manager, any limitations/restrictions to your ability to safely provide a level
of care. Include an accurate reflection and portrayal of your level of fatigue.
Request an appropriate assignment based on your capacity.
Prioritize activities that are necessary to be done and activities that can safely wait to be dealt with later
in the shift or during the next shift.

•
•
•

___________________________

2

For more information on CNPS RNs should visit www.cnps.ca user name: ARNNL password: assist

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•
•
•
•
•
•

Determine which tasks can be safely delegated or assigned to others (e.g., support staff). If
delegating, provide guidance as necessary.
Seek assistance as needed, in a timely manner.
Notify the manager if your situation changes (e.g., increased client acuity).
Maintain client trust and confidence. Inform clients there may be delays, etc., in a manner that does
not associate blame or negate the importance of safe and competent care.
Ask to be informed about the status of your manager’s efforts to obtain a replacement.
As needed, document concerns using a professional practice issues form or an appropriate agency
form or process.

Long Term
•
•
•

Advocate for changes or improvements in the workplace. Work with management, RNUNL and
ARNNL where appropriate, to help find solutions to staffing concerns.
Learn to be aware of and recognize signs, symptoms and responses to personal fatigue and initiate
personal measures to reduce fatigue as appropriate (CNA, 2010).
Familiarize yourself with ARNNL’s process as outlined in the RNs Professional Duty to Address Unsafe
and Unethical Situations (ARNNL, 2008).

Strategies for Registered Nurses in Management and Leadership Roles
Short Term
•
•
•
•
•
•
•

Assess the appropriateness of cancelling other forms of leave, if permitted, prior to obliging someone
to stay extra hours.
Support nurses working overtime by offering such things as access to snacks, rest breaks, assistance
with addressing client concerns and flexible scheduling.
Seek out strategies to minimize workload where possible, such as decreasing non-nursing tasks (e.g.,
use of other staff to assist with services such as portering, clerical and/or housekeeping duties).
Work with nurses to address all concerns of client safety.
Encourage and support nurses to work within their professional, ethical, and legal boundaries of
practice.
Keep the nurse informed about the development of solutions to address the situation.
Monitor the situation on an on-going basis and report to senior management in a timely manner.

Long Term
•

•
•

•
•

Promote and initiate measures to create practice environments that support professional
accountability and personal health and safety (ARNNL Quality Professional Practice Environment
Standards, 2006b).
Plan for staffing with sufficient numbers of nurses and/or support staff, taking into consideration client
needs and the practice setting/client population.
Adopt and/or promote the utilization of an evidence-based approach to determine, implement and
evaluate staffing levels, skill mix and models for care delivery, and the impact of these on client, nurse
and system outcomes (e.g., ARNNL Staffing for Quality Care in Institutional Settings).
Advocate for the need to develop and implement measures to address the potential negative impact
of RNs working excessive hours.
Communicate relevant information to non-RN managers of RNs.

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Conclusion
ARNNL and RNUNL are available to provide consultative services to registered nurses. Although the
mandate and focus of these organizations are different, both recognize and support the need for safe,
competent, ethical care and safe, quality work environments. Appendix A can be used to help identify
when an issue with excessive hours of work can or should be referred to ARNNL, RNUNL, or both. ARNNL
workplace representatives and RNUNL shop stewards may also serve as resources for RNs seeking
guidance on how to direct their concerns.

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References
Association of Registered Nurses of Newfoundland and Labrador. (2006a). Staffing for Quality Care in
Institutional Settings. St. John’s: Author.
Association of Registered Nurses of Newfoundland and Labrador. (2006b). QPPE Standards, St. John’s:
Author.
Association of Registered Nurses of Newfoundland and Labrador. (2007). Standards for Nursing Practice.
St. John’s: Author.
Association of Registered Nurses of Newfoundland and Labrador. (2008). Registered Nurses’ Professional
Duty to Address Unsafe and Unethical Situations . St. John’s: Author.
Brooke, S. (2009). Legally speaking…when can you say no? Nursing, 39 (7), 42-46
Canadian Nurses Association. (2006). Trends in Illness and Injury-related Absenteeism and Overtime
Among Publicly Employed Registered Nurses . Ottawa: Author.
Canadian Nurses Association. (2008). Code of Ethics for Registered Nurses. Ottawa: Author.
Canadian Nurses Association. (2009). Tested Solutions for Eliminating Canada’s Registered Nurse
Shortage. Ottawa: Author.
Canadian Nurses Association. (2010). Taking Action on Nurse Fatigue. Ottawa: Author.
Canadian Nurses Association and Registered Nurses Association of Ontario. (2010). Nurse Fatigue and
Patient Safety Research Report. Ottawa: Author.
Canadian Nurses Protective Society. (1998). Vicarious Liability. InfoLAW. Ottawa: Author.
Canadian Nurses Protective Society. (2006). Negligence. InfoLAW. Ottawa: Author.
College of Registered Nurses of British Columbia. (2008). You asked. What is client abandonment?
Nursing BC, 40(3) 12-13.
College of Registered Nurses of British Columbia. (2007). Duty to Provide Care: Practice Standard.
Vancouver: Author.
Government of Newfoundland and Labrador. (1990). Occupational Health and Safety Act. St. John’s:
Queen’s Printer.
Government of Newfoundland and Labrador. (2008). Registered Nurses Act. St. John’s: Queen’s Printer.
Maddalena, V. and Crupi, A. (2008). A renewed call for action: A synthesis report on the nursing shortage
in Canada. Ottawa: The Canadian Federation of Nurses Unions.

Registered Nurses’ Union Newfoundland and Labrador. (2009). Collective agreement between Her

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Majesty the Queen in Right of Newfoundland and Labrador and the Newfoundland and Labrador
Health Boards Association and the Registered Nurses’ Union Newfoundland and Labrador. St.
John’s: Author.

Statistics Canada. (2006). Findings from the 2005 National Survey on the Work and Health of Nurses.
Ottawa: Author.

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Acknowledgement
ARNNL and RNUNL gratefully acknowledge the use of the Nurses Association of New Brunswick and New
Brunswick Nurses Union’s publication Nursing Shortage: Workload and Professional Practice Concerns in
the development of this document.

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Appendix B
Code of Ethics for Registered Nurses (CNA, 2008)
There are a number of resources available in the Code of Ethics, (see appendix D) to help nurses
understand their ethical obligations and to apply the Code in the following circumstances:
• Responding Ethically to Incompetent, Non-compassionate, Unsafe or Unethical Care
• Ethical Considerations in Addressing Expectations That are in Conflict with One’s Conscience
• Ethical Considerations for Nurses in a Natural or Human-Made Disaster, Communicable Disease
Outbreak or Pandemic
• Ethical Considerations in Relationships with Nursing Students
• Acting Ethically in Situations That Involve Job Action.

Specifically applicable indicators derived from the Standards for Nursing Practice:
(ARNNL, 2007)
1.3

Practices in accordance with current legislation, standards, best practice guidelines, and
policies relevant to the profession and area of practice.

1.7

Maintains a professional image that enhances public confidence and reflects positively on the
nursing profession.

1.9

Responds to, and reports situations that may be adverse for clients and/or health care
providers. When adverse events occur, uses opportunities to prevent harm and improve the
system.

1.11

Documents adherence to responsibilities and accountabilities appropriately.

3.9

Recognizes any limitations to safe, competent, and ethical care and reports concerns, and
consults and/or initiates appropriate changes as necessary.

4.1

Demonstrates honestly, integrity and respect for others.

5.2

Demonstrates respect for the knowledge, expertise, and contributions of colleagues and
others.

5.5

Questions practices and contributes to improvements to support client and nurse safety.

5.7

Promotes and contributes to the development of quality professional practice environments.

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Appendix C
Abandonment: College of Registered Nurses of British Columbia (CRNBC)
The following material is an excerpt provided from CRNBC Resources (2007-2008)
for information only.

Abandonment
Abandonment occurs when the nurse has engaged with the client or has accepted an assignment and
then discontinues care without:
• Negotiating a mutually acceptable withdrawal of service with the client; or
• Arranging for suitable or replacement services; or
• Allowing the employer a reasonable opportunity for alternative or replacement services to be
provided.
Situations related to insufficient numbers of competent nursing staff or inadequate resources and
supports are different than situations involving the responsibilities and accountabilities that an individual
nurse has to clients. The former are employer responsibilities. The latter are the individual registered
nurses responsibility to provide competent ethical care.
Many of the situations our members encounter are employment issues rather than nursing regulatory
issues related to incompetent, unethical or unprofessional conduct and therefore do not constitute client
abandonment. For example, a decision by a registered nurse to refuse an assignment or discontinue
nursing services does not automatically mean the nurse has committed an act of professional misconduct.
These could include situations in which the nursing care would place clients at an unacceptable level of
risk, the activity is outside the scope of practice for registered nurses, or the required care is beyond the
nurse, or the required care is beyond the nurse’s level of competence.

Here are some situations involving registrants that could be considered
abandonment:
•
•
•
•
•

•

Failing to notify the supervisor of the nurse’s intent to leave, and leaving in the midst of a client care
assignment without the supervisor’s knowledge.
Leaving the assigned client care area for personal reasons and remaining gone or unavailable for a
period of time such that the care of clients may be compromised.
Leaving in the midst of a client care assignment without transferring the care to an appropriate care
provider.
Leaving work before the end of a scheduled shift without transferring the client care to an appropriate
care provider.
Sleeping, playing computer games or making excessive personal phone calls while on duty (which has
the effect of being unavailable to provide direct care or indirect care through improper supervision of
other care providers).
Refusing to care for a particular client for whom the nurse has accepted responsibility, without
transferring the care to an appropriate person or allowing the employer a reasonable opportunity for
alternative or replacement services to be provided.

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Here are some situations that would not be considered to be abandonment:
•
•
•
•

Refusing to work additional hours or shifts beyond the posted work schedule when the nurse has
given proper notification.
Refusing to accept an assignment when the nurse has given reasonable notice to the appropriate
person that she or he lacks the competence to carry out the assignment.
Resigning from employment without giving notice, assuming that the nurse has completed her or his
client assignment.
Refusing to float to an unfamiliar practice area when there has been no orientation, preparation, or
appropriate modification of assignment.

What can a nurse do when faced with these difficult circumstances?
1. Work now, grieve later
It is a longstanding principal of labour relations that a union member must ‘work now, grieve later’, with
few exceptions (such as being asked to commit an illegal act). This does not mean that a nurse must
remain silent and passive if, in his or her professional judgment, a situation is developing in which nursing
resources are stretched so thin that the impact on patient care is a concern. Try to get reinforcements.
Report the situation to management. Let your colleagues on shift know about the situation so they can
help. Consider options such as reassignment of work, realigning priorities, enlisting aid of physicians in
reassessing the level of care needed by patients, etc. The law requires that you do the best you can in the
circumstances. Simply refusing another admission to a busy unit that is already understaffed may be
considered insubordination worthy of discipline if some of these efforts to cope with the situation have
not taken place.
2. Report effectively
It is extremely important for nurses to report each clear occurrence of a staffing shortage to management.
The purpose of documenting staff shortages and their impact is to alert those who make staffing
decisions so they can take further action.
Nurses cannot divest themselves of responsibility for their own actions, or failure to act, by claiming such
in their written report to the employer. Nurses sometimes feel compelled to disclaim responsibility for any
harm that may result if patients are affected by a staff shortage, or fear that they may be found negligent if
harm occurs. Since nurses are accountable for their actions, or failure to act, a disclaimer statement would
not provide any legal protection. Bear in mind that the standard of care, a concept from the law of
negligence, is what the average, prudent, reasonable nurse would do in the circumstances. The law does
not expect perfection. Circumstances such as a nursing shortage could be taken into consideration in a
lawsuit for negligence. Nurses are not held accountable by a court for things outside their control, but for
their own actions in the circumstances.
If your employer or union has developed a specific form for this kind of reporting, use it to state the facts
and be specific. Avoid speculation, and encourage all of your colleagues to do the same since there is
strength in numbers. Be persistent. Reporting a serious situation entails more work on top of a busy
workload but it is necessary in order to bring it to the attention of those who can do something about it.

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College of Registered Nurses of British Columbia. (2008). You asked. What is client abandonment?
Nursing BC, 40(3) 12-13.
Article written by: Barb Wilson, CRNBC, Nursing Practice Consultant & Kathy Commons, CRNBC, Nursing
Concerns Coordinator.
College of Registered Nurses of British Columbia. (2007). Duty to Provide Care: Practice Standard.
Vancouver: Author.

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Appendix D
Saying No
Excerpt from Brooke, S. (2009). Legally speaking…when can you say NO? Nursing, 39(7), 42-46.
It isn’t always easy to say no to requests being made by peers and healthcare team members. The
manner in which a refusal is communicated can make a difference in how the message is received. Good
team relations as well as excellent communication are important to establish a foundation of the work
environment that allows you to say no.

How to say no like a professional
The positive traits that make nurses team players – a willingness to support colleagues, for one – may
make it all the more difficult to say no to anyone who requests assistance. You have to practice saying no
assertively. A reasonable explanation for saying no that’s assertively explained will be heard and accepted
better than one that’s aggressively or negatively presented.

Six tips for saying no assertively:
1.
2.
3.
4.

Listen politely to the request being made. Avoid interrupting and objecting right away.
Restate the request if you need clarification.
Determine if you need time to verify if you can accept the assignment
If further deliberation results in having to say no, respond quickly to minimize delays for the nurse
manager, who has to find someone else.
5. Offer suggestions or alternative solutions when you say no to a request if you have ideas that may
be helpful.
6. If your “no” response isn’t being accepted, repeat it politely and assertively until it’s heard and
accepted. Don’t become angry or defensive, and don’t feel guilty for protecting your own (and
your patients’) needs.
www.nursing2009.com July edition

15 |

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55 Military Road
St. John’s
NL | Canada
A1C 2C5
Tel (709) 753-6040
1 (800) 563-3200 (NL only)
Fax (709) 753-4940
crnnl.ca | @crnnlca