Withdrawing care

You may find yourself in a situation where you are considering withdrawing your care from a patient/client/service user. If so, you should consider your rationale for taking such action very carefully.

The following situations may justify a refusal to treat, the withdrawal of care or the finding of an alternative:

• where physical violence has occurred, or there is fear of it
• where there is discriminatory behaviour, including racism
• where there are health and safety hazards e.g. lack of appropriate equipment
• where the care required is outside the health care worker's scope of competence or training
• where there is a conscientious objection
• where the patient/client/service user is known to you in a personal capacity
• where you are asked to do something unlawful or in breach of the Nursing and Midwifery Council (NMC) Code.

Before you refuse care, you should:

• consult with your manager and make your concerns known verbally and in writing as soon as possible
• follow the agreed protocols and policy for your place of work and familiarise yourself with your local safeguarding policies where necessary
• if you are a nurse, nursing associate or midwife, consider the NMC Code, the NMC's 'Standards for competence for midwives' (where applicable) and your duty of care
• if you are not a registered practitioner you must nevertheless consider your individual accountability for your actions. For further information please see accountability and delegation
• consider the need for a risk assessment when taking these decisions. As always, the need to ensure safe systems of working is critical to patient and staff safety
• keep a copy of all documentation and keep a record of dates of any meetings/discussions
• consult with the patient/client/service user and (if appropriate) their family
• make an accurate record of the decision to refuse to treat, to include the reasons for the decision so that you are able to justify your actions later if care is withdrawn.

If you are considering withdrawing care because of inadequate or inappropriate PPE, please see our guidance on personal protective equipment (PPE) at work.

If you are concerned that you have been asked to do something beyond your capabilities, you should discuss your limitations with your manager and arrange for practical help, training and supervision as necessary. Your manager should then ensure that you only ever care for patients/clients/service users that you are competent to care for.

If you are involved in an emergency (e.g. where the procedure to be carried out needs to happen immediately but is beyond your current competence), contact your line manager immediately and seek advice on who can undertake the procedure instead of you.

There is a requirement for all registered practitioners to maintain and enhance their practice throughout their working life, and a responsibility to keep up to date. If there are areas where you are not fully competent then your manager will be able to provide appropriate supervision, training and support until you have acquired the knowledge and skills.

For information on the importance of acknowledging your competence and keeping your skills and knowledge up to date please see the NMC Code.

You cannot refuse to be involved in the care of patients because of their condition or the nature of their health problems. All blood and body fluids should be treated as infectious.

All health care staff should understand local and national standards for infection control precautions. Please also see our infection protection and control guidance. 

Your employer should make an assessment of the risk of exposure to biological hazards under the Control of Substances Hazardous to Health Regulations 2002 and put in place measures to minimise the risks, such as providing information and training and appropriate protective equipment like gloves and aprons. Under section 9 of the Health and Safety at Work Act (1974), personal protective equipment is required to be provided free of charge. You can read more in our guide on PPE at work.

Put any concerns regarding health and safety issues in writing to your unit manager and report your concerns to the health and safety officer in your workplace, and RCN safety representatives if there is one in your workplace. 

If a refusal to treat cannot be justified, possible sanctions (i.e. action against you) may include:

• disciplinary action and possible dismissal as a result of breach of your employment contract
• a negligence claim initiated by the patient if they suffer harm
• if you are reported to the NMC, action may be taken against you which could result in restrictions on your practice, up to and including removal from the register.

If you have any concerns, please contact us.

Patients may refuse treatment. A patient has the right to personal consideration and respect, however a patient cannot select who provides care for them on the grounds of prejudice.

If the patient insists on refusing your care, where possible talk to the patient about their concerns and discuss the situation with your manager.

A patient may request a nurse or midwife of the same or different gender to carry out certain procedures. There is no legal right to this, however best practice would be to make reasonable efforts to support the patient's request. Special consideration should also be given to young people and those with mental capacity concerns.

The Employment Rights Act 1996 says that no employee should suffer detriment or be dismissed or made redundant for, among other things, leaving or refusing to return to a place of work in circumstances of serious and imminent danger, or for taking steps to protect themselves or others.

If you believe you have suffered a detriment after taking action to keep yourself safe, contact us for further advice.

Violence in the workplace

Support for members during race riots

Health and safety at work

Prioritising personal safety

Personal protective equipment (PPE) at work

Accidents and personal injury at work

RCN position on work related violence in health and social care