Patient Abandoment?

[JBizzleRN, ADN, RN]

Okay here is a senario:

On our Med/Surg floor it is normal to have 7-9 patients (yeah crazy), but whatever. So let's say you have eight patients...it's you and a nurse RIGHT out of orientation on the floor. You have no tech, you have no secretary. Your have many a nursing home patients that have to be turned, changed, ect. You are basically having to help the new nurse with all of her duties, ect. You have a patient's vital signs that are acutely changing for the worse. ER calls and is trying to send you a 9th patient. There is literally no way you can take the patient at the moment. You tell ER they will have to call back in an hour or so until you get a chance to settle down. Well ER calls the house supervisor. The house supervisor comes up and tells you to take the patient or he will take your badge, you will go home, and you will not work at the hospital anymore.

A) You take the patient knowing that you are never going to be able to do an assessment in an hour, your 10pm meds are now over 4 hours late. You haven't even begun to think of taking your 12am vital signs and everyone else is needing pain meds, nausea meds, dressing changes, colosotomy changes, ect.

B.) You don't take the patient. The H.S. takes your badge and makes you leave the hospital. Is this considered patient abadonment if you are forced to leave?

It was a bad night, I ended up taking the 9th patient (pancreatitis with pain meds q 2 hours...). I was 1120am leaving that morning, and THAT was pushing some of my work off on the day shift (which I refuse to do under normal circumstances because I don't like it being done to me.). So what would you have done?

[TheCommuter, BSN, RN]

I would have let the house supervisor take my badge and allow him to send me home. If the supervisor is sending you home, it's not abandonment. They're simply sending you home because they perceive you're being insubordinate by not accepting additional admissions. If a manager or supervisor sends you home, you're not abandoning your patients.

However, I'd cover my butt by having the supervisor document that he is sending you home, and specifically have him put in writing that you did not abandon the patient load. Demand that he signs the document, and then keep a copy for your records. If the hospital falsely accuses you of abandonment at a later date, you'll have documented proof that your supervisor sent you home.

[JBizzleRN, ADN, RN]

Thanks. That was my thinking but I wasn't for certain so I did not want to leave. I mean I've had bad nights before, but this takes the caked, the frosting, the pan, and the serving knife. I have never teared up on the job before...but haha...had some "allergy" eyes that morning.

[Batman24]

I'd also leave and let them have my badge. That's a dangerous place to work. I agree with having them document the situation and keeping the copy for your files.

[litbitblack, ASN, RN]

LOL I would have handed them my badge.....No way would I stay in that situation.

[CoffeeRTC, BSN, RN]

I don't think that would be abandonment. You want to work, but just not taking an unsafe assignment. You wouldn't want to leave, they would send you home. If I would refuse and they would tell me to go home, I would insist that they note that "nurse refused to take and unsafe assigment and put his/her pts at risk" and "House Super, sent that nurse home" yeah...see if that floats.

[classicdame, MSN, EdD]

How would the HS handle the distribution of patients that you leave (those 9)? Sounds ridiculous to me. Also, seems the charge nurse could have called the Director (even at night!) to overrule such an action. In my state we have a safe harbor law. I would be sure to file for safe harbor as well.

[JBizzleRN, ADN, RN]

I was the charge nurse, our charge nurse has full patient loads here..

[classicdame, MSN, EdD]

sounds like an ego trip for the HS. I still think someone else should have been contacted, per your facility chain of command. How did the CNO react afterwards?

[oramar]

The nightmare stories from nurses in the front line continue. God bless you and everyone who continues to try to take care of people they way they deserve to be taken care of inspite of the impossible situations they are put into by managment. PS That supervisor was a bully PLUS she was bluffing to boot.

[JBizzleRN, ADN, RN]

Bluffing? Maybe, however the same situation happened on the Telemetry floor. The nurse took the 8th patient, then put in her resignation that next day. They didn't let her work her notice out just told her not to come back.

[iluvivt, BSN, RN]

Many states have a position statement on what they consider abandonment and most definitions go something like this......you must first accept the assignment (or in this case the additional patient) and all that goes along with that. Once you accept the assignment and the BREAK that agreement and all that is entailed in caring for the patient(s) (by say stressing out and leaving the hospital) you have broken the agreement and abandoned the patient. The key here is that you accept the assignment. Even if at the beginning of a shift you express reservations and refuse to accept the assignment,this is not abandonment either.

What is troubling here,is that no one accepted your professional assessment of the situation and searched for an acceptable resolution. They opted instead to use intimitation and threats!!!!!! OUCH!!!!!! Unfortunately,you have to dish out the correct jargon b/f you will be listened to and must know the law. The law says that if you notify your supervisor (and this includes anyone in the chain that has been notified) that their decision is placing patients in an unsafe enviroment and god forbid anything happens....they will be just as liable as you. I used to apprise the supervisor of the situation and if they were still pushy and with no solutions...I would tell them OK ..I will accept the patient,but I am officially notifying you that in puts this patient as well as those in my care in an unsafe situation and that I will be making a record of this notification and the situation in my personal records,should I need it later. Please be ever so nice. Somehow.there would always be a resolution. Somehow ER could suddenly keep the pt for awhile until we could get more staff or suddenly there was another unit for the patient to go to or we could move a patient to accept this one. Funny how there were no solutions until I let them know I knew how to work the system