[psalm]

I had 8 patients, and was about to be given an admit on a short-staffed night shift. I was already stretched to the limit of good pt. care. I wondered, if I refused an admission, since he/she wasn't already in my pt. assignment, would that be considered patient abandonment?

I did take the pt who turned out to be actively dying COPDer, DNR with a BP of 77/44 getting a NS bolus of 500cc/hr from the ER. If he hadn't had a caregiver with him from home I don't know how I would have handled it. He arrived at 0645 and I was still getting blood from piccs and ports from my other pts. Really rough night.

So, would I have been abandoning him if I refused his assignment?

[vamedic4]

Originally Posted by jackie53

I had 8 patients, and was about to be given an admit on a short-staffed night shift. I was already stretched to the limit of good pt. care. I wondered, if I refused an admission, since he/she wasn't already in my pt. assignment, would that be considered patient abandonment?

I did take the pt who turned out to be actively dying COPDer, DNR with a BP of 77/44 getting a NS bolus of 500cc/hr from the ER. If he hadn't had a caregiver with him from home I don't know how I would have handled it. He arrived at 0645 and I was still getting blood from piccs and ports from my other pts. Really rough night.

So, would I have been abandoning him if I refused his assignment?

I'm so very sorry this happened to you!! No, it's not abandonment because you're not the one who is legally responsible for this patient at this point. Had you already taken report on this person and knew he/she was assigned to you, then that's a different matter altogether.
Were there no other nurses who could take this patient?? Eight seems like an assload of an assignment!!
Hopefully you explained yourself well convincingly enough to the charge nurse and convinced her to give them to someone else!!!

Is this normal practice in adult facilities?? Just wondering - I haven't worked with adults in 10+ years.

Hope you never have another night like that again

Have a good night!

vamedic4

[Mayflye]

vamedic is right. Until you take report, it is not your patient. Now you know for next time!

[psalm]

...thank you for the replies! We often have 7-8 pts on nights. The other nurses all had 9 pts already, they started at 7pm, I start at 11pm so I was in line for the next admit. I was with another pt. when he was wheeled up to his room. I did a partial assessment, made sure his O2 was on and IV going on our IVAC and had my aide do the admit with the caregiver...while I finished up on two other pts.

...trying to get information, I saw lots about mandatory overtime, but nothing about refusing a new admit once a shift starts.

[LPN1974]

I'm not wanting to start an argument or a big huge debate here,
but I went to a conference once in Little Rock, AR, by a nurse, RN, who also became a lawyer. I went to get some of my CEU's that year.
She gave an example......and this is her example.....that if a patient is brought up from ED onto one of the regular floors, even tho, he has not yet been admitted, and no one has taken report......that patient is in the hospital, and yes, the nurses are responsible for this patient.

Now that was the example she gave.
Personally, I think it would be wise to consult an attorney, who knows these kinds of things for nurses, for advice before you refuse to take another patient.....before the situation comes up again.

Now don't fuss at me.......I'm only passing along what that RN attorney said.
This woman was out of Texas, but she was up here in Arkansas giving this kind of advice, so I would assume she's saying that this is the standard all over.

[barbyann]

A few years back I was working a night shift with one co-worker. We had 20 patients between us. Booking called and wanted to book two more. I was at my physical limit with the ten I had and so was he. I called the supervisor and told her I was not comfortable and felt incapable of handling this caseload. I also reminded her that at my hiring when I asked about nurse patient ratios I was told I would never have more than eight patients on the night shift. She apologized but was firm that the patients were on the way up to the floor. I calmly told her that I was scared of being accused of abandonment and that I would care my best for any patient on my floor. I also told her my resignation would be typed and presented to her before I left the hospital in the morning and went home. She said OK. Within 5 minutes of our conversation she called back and told me the patients would be sent to another floor. Its the only time I ever used this tactic but it worked for me. I was serious about the resignation, I would never work for an organization who didn't heed my warnings of dangerous care about to take place. If it had been a day shift I would have called Risk Management and reported the conditions. Also, I have always coded my nursing notes to reflect ratios. My signature is like this, Jane Smith, RN/10 ( the 10 stands for 10 patients in my care, I use "F" for float, "-NA" for no nurseaide, etc.) This is a secret code that I use in case I ever go to court and need to represent my situation accurately. The hospital is in possession of all the written documentation surrounding the shift. You owe it to yourself and your lawyer to document out of the norm situations.

[CHATSDALE]

i think that this is something they teach the nursing supervisors..be firm and tell the nurse that she has take this pt, in the in you are going to be legally responsible for anything that goes wrong...now is the time for you to decide if you are going to continue employment with this facility, if it happen before it will happen again..you will be no good to pts in future years if you lose your license over a situation that you had no control over

if something were to happen the supervisor would get up on the stand and swear that if she had been informed of the problem she would have made other arrangements

advise from barbyann about coding is magnificant...if you are served with papers on a pt a year or two down the road you will be able to go back and refresh your memory

[pickledpepperRN]

In California for abandonment to occur the nurse must first accept the patient assignment thus establishing a nurseatient relationship and
then sever that relationship without giving appropriate notice to the appropriate person (such as the supervisor)
http://www.rn.ca.gov/practice/pdf/npr-b-01.pdf

That said as a nurse and human being I have cared for a patient brought up from ER by a tech lying flat on a cart. The tech was taking the portable O2. There had been no report or notification this patient was coming.
I called out, pushed the cart into the room, pushed the "code" button, put O2 on the patient, and by then the code team arrived. The patient was becoming cyanotic.
Turns out the tech brought the patient to the wrong unit!

I don't know what happened to the tech. I filled out an incident report after the patient was stabile (usual CHF protocol, better just raising the HOB).
I also wrote the ER manager a factual description. The tech is still there. So far as I know he has never just left a patient or taken away O2 despite instructions from an RN. Now he helps get the patient into the bed and so on.

EIGHT PATIENTS IS TOO MANY! UNSAFE!

[lindarn]

Originally Posted by barbyann

A few years back I was working a night shift with one co-worker. We had 20 patients between us. Booking called and wanted to book two more. I was at my physical limit with the ten I had and so was he. I called the supervisor and told her I was not comfortable and felt incapable of handling this caseload. I also reminded her that at my hiring when I asked about nurse patient ratios I was told I would never have more than eight patients on the night shift. She apologized but was firm that the patients were on the way up to the floor. I calmly told her that I was scared of being accused of abandonment and that I would care my best for any patient on my floor. I also told her my resignation would be typed and presented to her before I left the hospital in the morning and went home. She said OK. Within 5 minutes of our conversation she called back and told me the patients would be sent to another floor. Its the only time I ever used this tactic but it worked for me. I was serious about the resignation, I would never work for an organization who didn't heed my warnings of dangerous care about to take place. If it had been a day shift I would have called Risk Management and reported the conditions. Also, I have always coded my nursing notes to reflect ratios. My signature is like this, Jane Smith, RN/10 ( the 10 stands for 10 patients in my care, I use "F" for float, "-NA" for no nurseaide, etc.) This is a secret code that I use in case I ever go to court and need to represent my situation accurately. The hospital is in possession of all the written documentation surrounding the shift. You owe it to yourself and your lawyer to document out of the norm situations.

That is actually a really good idea. I hope that you are making copies of your nursing notes, and incident reports. I know of nurses notes disappearing from charts, along with MD Consult sheets when the consulting MD disagrees about is wrong with the patient.

Lindarn, RN, BSN, CCRN
Spokane, Washington

[crb613]

Originally Posted by lindarn

That is actually a really good idea. I hope that you are making copies of your nursing notes, and incident reports. I know of nurses notes disappearing from charts, along with MD Consult sheets when the consulting MD disagrees about is wrong with the patient.

Lindarn, RN, BSN, CCRN
Spokane, Washington

I like barbyann's advice on how to code your nursing notes! I am graduating in May, and I need all the advice/tips I can get. Now for the making copies part.....can you do this legally? I was also wondering if you do make copies, and your employer finds it out.....what happens then. Thanks for the help.