Patient Abandonment?!?!

  1. 1 I have been working for a home health agency that has used some questionable ethical practices, but this may be a new low! I was given a schedule one day that was just not humanly possible..a ten hour day by their points system and then an admit that evening at 5:15pm which takes 4 hours according to their points system (but really takes 6 hours for an admit with all of the paperwork). On top of that, I was to turn in all of the paperwork for that day INCLUDING that admit the next morning and then face another 10 hour day and go back to the newly admitted pts house the next evening at 7pm to initiate her TPN therapy for the day. I was also supposed to repeat that schedule for the next 4 days.
    Although that schedule was ridiculous, I would have tried my best to do it all and just keep my mumblings under my breath, my problem was the TPN therapy. I'm a relatively new nurse, having graduated in 08 and most of my nursing experience has been in the ER/Trauma setting. TPN therapy isnt something routinely done in the ER, therefore, I have NO experience with it whatsoever! I've never even seen it done!
    I understand that its basically run like an IV through a central line, which I've had plenty of experience, but I also understand that it can be dangerous d/t what is in it and effects on blood sugar, etc. I also know that in the hospital setting, two nurses have to sign off on the contents and make sure the label is exactly as the MD ordered and then there are protocols on how often to check blood sugar and other labs. The nursing agency however, was wanting to send me out to this patients house to initiate this treatment..her first ever TPN treatment...alone, knowing that I have never done this before (they keep checklists on what we are and are not signed off on). I immediately told my nursing supervisor as soon as I received my schedule that I did not feel comfortable doing the TPN and the reasons why. I was basically told that it was just like an IV and I'll just have to hope that the pharmacy mixed it correctly. I begged with other supervisors and got no help either, no one wanted to come and sign me off on it/ train me because it was after 5pm.
    I then notified my nursing supervisor that I refused the schedule and was not taking the assignment, and that I quit for that matter, and left. The agency has no safe harbor board and quitting was the only way I felt I could get out of the situation with my license intact.
    Now, I have received a certified letter from the agency stating that they have filed a complaint against me to the state board of nursing for patient abandonment?!?! Am I just crazy or does this seem ironic?!?
  2. Visit  TaylorMaidRn profile page

    About TaylorMaidRn

    TaylorMaidRn has '1' year(s) of experience and specializes in 'Telemetry, ER'. From 'East Texas'; 32 Years Old; Joined Dec '09; Posts: 19; Likes: 18.

    12 Comments so far...

  3. Visit  Horseshoe profile page
    11
    Quote from TaylorMaidRn
    I have been working for a home health agency that has used some questionable ethical practices, but this may be a new low! I was given a schedule one day that was just not humanly possible..a ten hour day by their points system and then an admit that evening at 5:15pm which takes 4 hours according to their points system (but really takes 6 hours for an admit with all of the paperwork). On top of that, I was to turn in all of the paperwork for that day INCLUDING that admit the next morning and then face another 10 hour day and go back to the newly admitted pts house the next evening at 7pm to initiate her TPN therapy for the day. I was also supposed to repeat that schedule for the next 4 days.
    Although that schedule was ridiculous, I would have tried my best to do it all and just keep my mumblings under my breath, my problem was the TPN therapy. I'm a relatively new nurse, having graduated in 08 and most of my nursing experience has been in the ER/Trauma setting. TPN therapy isnt something routinely done in the ER, therefore, I have NO experience with it whatsoever! I've never even seen it done!
    I understand that its basically run like an IV through a central line, which I've had plenty of experience, but I also understand that it can be dangerous d/t what is in it and effects on blood sugar, etc. I also know that in the hospital setting, two nurses have to sign off on the contents and make sure the label is exactly as the MD ordered and then there are protocols on how often to check blood sugar and other labs. The nursing agency however, was wanting to send me out to this patients house to initiate this treatment..her first ever TPN treatment...alone, knowing that I have never done this before (they keep checklists on what we are and are not signed off on). I immediately told my nursing supervisor as soon as I received my schedule that I did not feel comfortable doing the TPN and the reasons why. I was basically told that it was just like an IV and I'll just have to hope that the pharmacy mixed it correctly. I begged with other supervisors and got no help either, no one wanted to come and sign me off on it/ train me because it was after 5pm.
    I then notified my nursing supervisor that I refused the schedule and was not taking the assignment, and that I quit for that matter, and left. The agency has no safe harbor board and quitting was the only way I felt I could get out of the situation with my license intact.
    Now, I have received a certified letter from the agency stating that they have filed a complaint against me to the state board of nursing for patient abandonment?!?! Am I just crazy or does this seem ironic?!?
    If you never accepted the assignment, it cannot be construed as patient abandonment. Get a lawyer; I think you will be fine.
    LockportRN, xoemmylouox, Quark09, and 8 others like this.
  4. Visit  Meriwhen profile page
    4
    Check with your state's BON to see exactly what is considered abandonment. Generally, leaving a patient assignment without handing over to another nurse is abandonment. Refusing a assignment in the first place generally is not abandonment. The question is: did you have any assignment in progress when you quit and if so, did you hand off that patient to another nurse before leaving?

    Get a lawyer. Best of luck.
    LockportRN, lindarn, Altra, and 1 other like this.
  5. Visit  TaylorMaidRn profile page
    1
    No, I had not started any patient care yet for that day. I was just handed to the schedule and found out about the situation when I came into work, and I refused the schedule because it would put my nursing license and the patient's safety at risk.
    lindarn likes this.
  6. Visit  Meriwhen profile page
    3
    If you didn't accept the patient then you didn't abandon them. I'd still get the lawyer ready just in case the BON calls...but if it's as you write, I don't think you'll hear from them.
    lindarn, AngelfireRN, and Esme12 like this.
  7. Visit  leslie :-D profile page
    9
    first things first.
    here is a link that teaches you all about tpn - it was written for nurses who would like to obtain ceus.
    www.ceufast.com/courses/viewcourse.asp?id=180

    secondly, i agree with others, that since you never accepted assignment, the nurse/pt relationship was never established, therefore there's noone to abandon.
    since i don't know what state you live in, i checked out a random state board's policy, just to get an overall sense of expectations.
    the following is from mississippi bon.

    "Scope of Practice

    For patient abandonment to occur, the nurse must have:

    - Accepted the patient assignment, thus establishing a nurse-patient relationship.
    - Severed that nurse-patient relationship without giving a reasonable notice to the appropriate person (e.g., supervisor, employer)so that arrangements can be made for continuation of nursing care by others."
    (www.msbn.state.ms.us/pdf/Abandonment_2001.pdf)

    i don't know if your (former) employer is truly going to complain to the bon, or if it's an idle threat...
    still, forewarned = forearmed.
    at the very least, consult with a (nurse) attorney...someone who has experience in dealing with the bon and/or administrative law.
    do you have nursing insurance? (Professional Liability Insurance for nurses, nursing medical malpractice.)
    don't leave home without it.
    it wouldn't be able to help you with this particular incident, but just goes to show you how vulnerable each and every nurse is.
    seriously, i believe it's under $100/yr.

    here is the link for the American Association of Nurse Attorneys.
    call to see if one is in your area, or, to see if they could refer you to someone.
    www.taana.org

    and here is a list for the state bons.
    just find your state and proceed from there, should you wish to read their policy on pt abandonment.
    www.ncsbn.org/contactbon.htm

    i really do wish you well.
    good move in refusing assignment.
    trust me, you're much better off without these nuts.
    absolutely no ethics at all...
    which is scary for us as nurses, but esp scary for our pts. (ticks me off)

    let us know how it works out.

    leslie
    Last edit by leslie :-D on Jan 9, '12 : Reason: trying to fix link
    lindarn, Guttercat, wooh, and 6 others like this.
  8. Visit  TaylorMaidRn profile page
    3
    Quote from TaylorMaidRn
    I have been working for a home health agency that has used some questionable ethical practices, but this may be a new low! I was given a schedule one day that was just not humanly possible..a ten hour day by their points system and then an admit that evening at 5:15pm which takes 4 hours according to their points system (but really takes 6 hours for an admit with all of the paperwork). On top of that, I was to turn in all of the paperwork for that day INCLUDING that admit the next morning and then face another 10 hour day and go back to the newly admitted pts house the next evening at 7pm to initiate her TPN therapy for the day. I was also supposed to repeat that schedule for the next 4 days.
    Although that schedule was ridiculous, I would have tried my best to do it all and just keep my mumblings under my breath, my problem was the TPN therapy. I'm a relatively new nurse, having graduated in 08 and most of my nursing experience has been in the ER/Trauma setting. TPN therapy isnt something routinely done in the ER, therefore, I have NO experience with it whatsoever! I've never even seen it done!
    I understand that its basically run like an IV through a central line, which I've had plenty of experience, but I also understand that it can be dangerous d/t what is in it and effects on blood sugar, etc. I also know that in the hospital setting, two nurses have to sign off on the contents and make sure the label is exactly as the MD ordered and then there are protocols on how often to check blood sugar and other labs. The nursing agency however, was wanting to send me out to this patients house to initiate this treatment..her first ever TPN treatment...alone, knowing that I have never done this before (they keep checklists on what we are and are not signed off on). I immediately told my nursing supervisor as soon as I received my schedule that I did not feel comfortable doing the TPN and the reasons why. I was basically told that it was just like an IV and I'll just have to hope that the pharmacy mixed it correctly. I begged with other supervisors and got no help either, no one wanted to come and sign me off on it/ train me because it was after 5pm.
    I then notified my nursing supervisor that I refused the schedule and was not taking the assignment, and that I quit for that matter, and left. The agency has no safe harbor board and quitting was the only way I felt I could get out of the situation with my license intact.
    Now, I have received a certified letter from the agency stating that they have filed a complaint against me to the state board of nursing for patient abandonment?!?! Am I just crazy or does this seem ironic?!?
    Thank you all for your responses and advice...I appreciate it greatly! I have made an appointment with an attorney who represents nurses in these predicaments to aid me in how best to go foward, and already feel a little relief. It just dumbfounds me that 3 days after I quit, I went in to finish paperwork/make corrections and the administrator asked me to please come back, told me I was an "excellent nurse", and then told me if I ever changed my mind, that I always had a job waiting with them and then they turn around and do this!?! Insanity!
    lindarn, leslie :-D, and Esme12 like this.
  9. Visit  GrnTea profile page
    3
    aw, heck, you don't want to work for people like this anyway. consider it a growth experience and move on!
    lindarn, AngelfireRN, and Esme12 like this.
  10. Visit  classicdame profile page
    3
    This may backfire on the agency once an investigation begins. You counter with lack of competency documented. There may be issues to face, but I believe you will ultimately be ok. Good luck
    lindarn, AngelfireRN, and Esme12 like this.
  11. Visit  Esme12 profile page
    2
    I couldn't have said it better myself Leslie!!! and can I have an AMEN for Granted!

    You are better off without these folks. How scary for you and kudos for sticking to your guns!!! What sneaky A**holes...you cannot abandon a patient you never accepted. Another case in point to share with your friends. GET MALPRACTICE INSURANCE....for your protection against butt faces. They may have bitten off more than they can chew......I'd report them to The Joint Commission for unsafe practice and an inability to prove competencies....that will get them scrambling.

    Reporting Quality and Safety Issues - Joint Commission International

    I have personal knowledge they really do investigate claims. Positive thoughts for you!!!
    lindarn and leslie :-D like this.
  12. Visit  TaylorMaidRn profile page
    2
    Thank you all! I'm currently looking into the malpractice insurance and wondering why I didn't get it as soon as I step foot in the nursing field! Thanks for all the info!
    leslie :-D and Altra like this.
  13. Visit  Marie.rn profile page
    0
    I am just curious, but you say that it was the 1st TPN to ever be administered? If a patient needs TPN, how were they getting their nutrition before the order for the TPN?

    If you take an assignment (patients for that day) and you leave and abandon that assignment and do not provide care to those patients than you can get abandonment but otherwise no you cannot be charged with abandonment.

    Did you inquire with the agency and tell them you did not have experience with TPN? There are rules with blood sugar and so forth, but in home healthcare the rules change related to in home care vs hospital care. Like in the Nursing Home a sterile dressing change is clean because it is considered to take place within the patients home.

    I always ask for help, find an experienced nurse to ask for help and guidance. Sometimes I ask a nurse with experience (actually 99.9% of the time) and I research the topic thoroughly so I know what they told and demonstrated for me was correct. I have video's of all of the proper ways to do skills, you can get updated ones and books from ATI and other places. I read up on it from text books from my online college library, my textbooks from school, and on line references from distributors that tell me how to use their equipment.

    HOpe this helps you in the future.
  14. Visit  TaylorMaidRn profile page
    1
    Marie.rn- yes, this was her first TPN treatment, she was originally supposed to receive it in the hospital, however, she requested to the dr that she be able to do it at home and go back to work so that she could keep her medical insurance which covered her son who was on a transplant waiting list (all this according to info sent from hospital). I had not accepted my schedule for the day, this was the disagreement and the reason I left and they fully knew this was the reason I was quitting when I walked out. I try to learn as much as I can and update my education when I come across any new skills that I will need to be able to perform, however, up til this day, the agency had a policy not to accept TPN patients, so I did not seek any instruction on it before hand. The agency had just decided to accept this patient because they were desperate for money/having problems meeting payroll. They did not warn us ahead of time so that we could prepare by educating ourselves on this skill. As far as getting another nurse to help me, only one other in the field staff had any experience in this and she probably would have helped me, except that her schedule wouldn't allow..she was scheduled to see patients an hour away from our location. The nursing supervisors had experience with tpn but refused to help.
    The agency KNEW I didn't have any experience with TPN because they keep a skills checklist in our file, AND I told everyone who could hear me that date that I was inexperienced with this. Since this has occured and I am not currently employed, I have logged many hours reviewing material on TPN therapy.
    leslie :-D likes this.


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