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There are many reasons why a nurse might refuse to care for a patient. The nurse manager needs to be aware of the nexus between moral dilemmas in healthcare and the right of providers to refuse to participate in certain controversial procedures, as well as other professional and ethical reasons such as lack of training or fatigue that may lead a staff nurse to refuse a patient care assignment. This article explores each of these situations and outlines federal and state laws that impact this situation. Suggestions are given for the nurse manager to help himself/herself and his/her staff avoid the potential negative consequences of refusals to care.