Saying “No” to Your Patient Won’t Kill You

Article Categories: Legal and Ethics & CNA Skills

The healthcare industry abounds with stories of heroic acts where healthcare workers save the day. Hats off to these workers who make headlines because of their bravery. But not all stories of courage are that extraordinary.

Every day, healthcare staff, such as nursing assistants, show how brave they are when they have to say “no” to their patients. How hard can it be to refuse a patient's request? Other than raising a few eyebrows, you risk building up the patient's frustration, anger, and resentment, having them give you a poor rating in the patient satisfaction survey, or worse, causing them to file a lawsuit.

Yet, saying “no” to a patient is sometimes necessary. When you feel that you should refuse a patient, you need to both exercise critical judgment and keep in mind institutional policies. Here are some scenarios where CNAs must stand firm and hold their ground.

1. You’re doing your rounds and one of your patients, Mrs. Winters, keeps pushing the call button. You go to her room and she demands that you look for the book that she “lost.” You find her book under one of the pillows on the bed. As you are about to see the next patient, the same call light flashes again—this time, Mrs. Winters needs a cup of water. She has a cup and pitcher by the bedside and is without any restrictions in her movement.

As much as you want to help patients get well under your care, you may respectfully explain to this patient that you cannot oblige their every request because you have to attend to other patients’ needs as well. You may ask the nurse for assistance in this matter and have them note the conversation you had with the patient.

Another helpful strategy is to assist them with whatever they need while in their room, and then remind them that you are not able to be back for another half an hour or so. A nursing assistant must encourage independence and self-care in patients, as long as their abilities allow.

2. Ms. del Mundo, a resident at a nursing home, demands to know the results of her roommate’s most recent laboratory tests. She says she is so worried about her friend and wants to know the information to help her roommate get through difficult times.

It is very tempting to say yes to the patient in this situation, especially if you have witnessed their friendship. But a CNA should not disclose any private information of another patient regardless of how pressing the “need” is. It is a HIPAA violation and disrespects the patient whose privacy was violated.

3. Mr. Cane, a male patient in his late forties, is charming and witty. Although in pain, he never fails to make the staff smile. Mr. Cane shows particular interest in you and asks that you see each other on a date after his discharge.

You might think that dating a patient right after discharge does not cross professional boundaries because your service to that patient has ended, but no—it is still prudent and proper to refuse their invitation at this time because of the possibility of caring for the patient again on a return check-up.

4. Eva is 56-year-old patient at a skilled facility who is verbally abusive to the staff. She is also aggressive at times, throwing supplies and equipment during care procedures. During one episode, she yells at you, throws her food tray, and demands that you come that instant.

Understand that abuse is never okay. Be firm and tell them that their behavior is unacceptable. Have a colleague standby silently to witness the hostile behavior. Keep calm and do not take it personally. And when it gets worse, do not hesitate to call security.

When refusing a patient is absolutely necessary, brave it out and be firm. Saying no won't kill you, but it will save you from stress and burnout.

Try reviewing the course material on gentle teaching no 1 class from our course library.


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