When Nurses Pushback on Assignments

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

I am hearing from an increasing number of nurse managers, clinical managers, and charge nurses that many nurses are vigorously pushing back on patient care assignments they have been given. One permanent night charge nurse gave the following case example during a program:

Jason is an RN on your unit who recently completed his first year of practice. As a charge nurse, you are pleased with the progress he is making with his skills and competency development. The challenge you have with Jason is that he routinely complains about the patient care assignments he receives, contending that you give him the most difficult patients, and is resistant to taking new admissions when it is his turn. He has accused you of being unfair to him and has threatened to contact the union representative on several occasions. You have discussed this and reviewed his assignments with your nurse manager, and she sees no issues of unfairness.

This charge nurse is far from alone in her experience. One of the trickiest operational challenges facing nurse leaders at all levels today is managing assignment pushback. The contemporary nursing workforce is highly vocal, much more willing to speak up, and increasingly comfortable pushing back on assignments they perceive as unfair or unmanageable. When a nurse reacts with displeasure or resistance to a shift assignment, it can easily feel like a personal challenge to leadership authority. However, in today’s complex clinical environments, the goal of a nurse leader shouldn’t be to “shut down” pushback, but rather to navigate it constructively while maintaining unit safety, equity, and accountability.

The reality is that there are many things that could be driving Jason’s behavior. Several workforce studies indicate that male nurses do report feeling that they are more frequently given the “heavier patients” and those who present behavioral management issues. This charge nurse met with her nurse manager who reviewed the assignments and felt they were fair so this perception may not be the problem in this situation. Jason may feel very underappreciated in his role and could be lashing out and pushing back in response to this. If this is part of the issue, the night nurse needs to provide more frequent affirming feedback and recognition.

But the reality is that for some nurses, pushing back on assignments has become habitual. Here are strategies nurse leaders can use in these situations to have the difficult conversation and handle assignment pushback effectively:

1. Always begin with the WHY. 

When staff nurses do not understand the rationale or logic behind an assignment, they frequently default to assuming favoritism, unfairness, or managerial oversight. The challenge today is that unlike hospital patient populations in the past – there are NO easy patients. Leaders must share their “why” upfront. Briefly explaining the complex puzzle required to build the schedule—balancing patient acuity, clinical continuity of care, and overall team skill mix—instantly defuses the feeling of being singled out. One leader in the session said that her manager sometimes gives nurses paid time and a shadowing exercise with charge nurses to better understand how assignments are made.

2. Separate the emotions from the facts.

Assignment resistance is rarely personal although it can certainly feel that way. It is often fueled by underlying anxiety, physical exhaustion, or a genuine fear of a heavy workload. De-escalate high-emotion situations by stripping away the emotional language and pivoting entirely to objective, data-driven facts. Instead of arguing about the abstract concept of fairness, look at the concrete details together. Use phrases like: “Let’s look at the acuity scores together. You have two total-care patients and one discharge. Tell me specifically what part of this clinical mix feels unsafe.”

3. Carefully listen to the nurse whether or not you agree with what is being said.

The natural human reaction to pushback is defense or immediate refusal. When confronted by a frustrated staff member, leaders must actively resist the urge to interrupt or double down on their authority. Implement a mandatory “pause” and actively listen for at least 60 seconds without interrupting. Sometimes, a nurse simply needs to feel heard and validated after a grueling week. Acknowledging their current baseline stress (“I know you had a brutal shift yesterday, and I see why you’re worried about this assignment”) lowers psychological defenses and opens the door to an objective, professional conversation.

4. Manage pushback as a coaching opportunity with novice staff.

Often, vocal pushback from newer or novice staff stems from a fundamental lack of clinical confidence rather than defiance or bad behavior. They may feel genuinely overwhelmed by a specific, highly complex patient type because they haven’t encountered it frequently. Dig deeper by asking a targeted coaching question: “What specific support or resources would make you feel comfortable and supported taking this patient today?” OR “Let’s talk through how you will prioritize the care over the next hour.”

5. Agree on next steps and how you will support this nurse during the shift.

Despite excellent communication, there will inevitably be shifts where an assignment simply cannot change due to strict staffing constraints, call-outs, or immediate patient safety needs. In these moments, leaders need a firm, highly professional script to hold the line without burning bridges. An example would be to tell the nurse, “I hear your concern, but based on the layout of the unit and our staffing numbers today, this is the safest configuration we have. I cannot alter the assignment right now, but I will prioritize checking in on you first during my rounds to help you catch up and ensure you have the support you need.”

Given the escalating volume and acuity level of patients across the United States today, nurse leaders should expect but also learn to effectively manage pushback on patient care assignments. Keep in mind – these reactions from nurses are not a personal reflection on the leader, but rather often reflect the burnout and exhaustion that nurses are reporting.