Staffing and patient abandonment

westieluv · Aug 9, 2013

I know what I would do. I would have to stay, because ultimately, it isn't the patients' fault that they are in such a poorly staffed facility. However, I would make it known that I will not be staying again in the future, that I will not be in at 7 AM since I had to work over, and I will be looking elsewhere for a job if this type of thing continues.

I have worked in several hospitals over the past several years, and never have I been put in a situation like that. We have worked short, but never that short, and they have always seemed to come up with a nurse from somewhere, even if it meant pulling a nurse from another unit and leaving each unit just a little bit understaffed instead of one unit dangerously understaffed. There are also nursing agencies for just this type of emergency. To ask nurses on a busy Med/Surg unit to take ten patients each, regardless of if it is on day or night shift, is completely out of line and a great risk to patient safety, IMHO. I don't know how long you have worked at this hospital, but I think I would be looking for a safer work environment.

ETA, one thing I didn't quite get about your post, though, is how one nursing being a no call, no show meant an extra three patients for everyone else. Was she going to be assigned to nine or twelve patients, or was she supposed to have six patients and there were only two other nurses working the shift? Just curious.

LightMyFire · Aug 9, 2013

Another called and was going to be late. I applied to other jobs already and there are lots more I can apply for in my area. My facility refuses to get agency because they're expensive but having no one to take care of pts is more expensive IMO.

sapphire18 · Aug 9, 2013

I wouldn't be able to live with myself as a nurse- or a human being- if I left helpless, hospitalized people to fend for themselves just because my shift is over.

If they truly had no one to help pick up the slack until they could get someone else in, and this is the norm, find another job. But don't just up and leave those poor patients with no one to take care of them!

Aurora77 · Aug 9, 2013

I would stay, but would have no qualms about calling off for the next shift. I would also meet with my director about why the House Supe refused to assist with ensuring adequate staffing. Does your facility have a float pool? Why can't they get a PRN or float nurse to come take your place? If this is an ongoing problem, I'd look for another job. If it's a one time only, very rare occurrence I would be much more forgiving.

Esme12, ASN, BSN, RN · Aug 9, 2013

Here is the problem....if you do not turn your patients over to a competent practitioner after accepting them as an assignment....it is abandonment and you are negligent. Your coworkers do not have to accept an assignment that is unsafe. Your nurse practice act is one thing the law is the other.

Patient abandonment is defined as the premature termination of the professional treatment relationship by the health care provider (HCP) without adequate notice or the patient's consent. This is a form of negligence in nursing with the unilateral termination of the provider/patient relationship, despite the patient's continued need for care.
Patient abandonment occurs after a nurse has accepted responsibility for an assignment within the scheduled work shift. It may also occur if a nurse fails to give reasonable notice to an employer of the intent to terminate the employer/employee relationship or contract leading to serious impairment in the delivery of professional nursing care to patients.
The nurse-patient relationship begins when the nurse accepts responsibility for providing nursing care based upon a written or oral report of the patient needs. It ends when that responsibility has been transferred to another nurse along with communication detailing the patient's needs.
Once a nursing assignment has been accepted, it is the duty of the nurse to fulfill the patient care assignment or transfer responsibility for that care to another qualified person.

LisalaRN99, BSN, RN · Aug 9, 2013

Very poor staffing indeed! Unfortunately, I would have to say that it would be patient abandonment if you left without giving report to another nurse! I would think that the charge RN would need to step up to the plate and take the assignment! Is this a hypothetical situation or reality? How long did you end up staying, if this really did happen to you? Just curious. I had to stay a whole extra shift one time. Fortunately we only worked 8 hr shifts and not 12's. In my current job where we work 12's, I have stayed an extra 4 hrs until another nurse could come in for night shift at 11 pm, after being called at 5:30 pm and agreeing to come in. At least they got a chance to sleep for 4 hrs before coming in!

HouTx, BSN, MSN, EdD · Aug 9, 2013

Since by virtue of the limitations of US Federal jurisdiction, issues of this type are regulated at the state level - along with regulation of all professional licensure - the exact interpretation of patient abandonment may vary significantly between states. I encourage the OP to investigate this issue in terms of specific state rules.

Logically, it seems ludicrous to me that once you accept responsibility for a particular patient assignment you cannot EVER cease this task unless you are officially relieved, despite the fact that your original assumption of responsibility was based on the fact that it was for a specific period of time/shift. What would be the end point? When you collapse from exhaustion? I would love to see some case law on this issue. I am just curious about the legal boundaries - where does the individual practitioner's liability end? Is it like CPR where you have to continue until you are physically no longer able to continue if there is no one qualified to relieve you?

In TX, and some other states as well, we have a "Safe Harbor" process by which a nurse can formally express her/his opposition to a particular assignment - before accepting it - because it is perceived to be unsafe. The nurse is then protected from personal liability if problems do arise due to the reasons/situation that was reported. The law is specific in that it has to be done prior to accepting the assignment. So, I wonder how it would apply to the OP's situation... I am going to investigate this to satisfy my own curiosity.

LightMyFire · Aug 10, 2013

I stayed until the issue was resolved. Another nurse from my shift agreed to stay an extra four hours. The charge nurse had a full patient load already.

My problem with the situation was not just that I had to stay after my 12 hours but that if there was no one, how long would I have had to stay. The supervisor said there was no one and wasn't even trying at that point. What's next, stay for another 12 hours? That's not only impractical from a personal standpoint but also dangerous.

We have float pool but not enough and they are staffing the already understaffed floors. This has never happened before. my concern is that it puts me in a bind and having to choose one unsafe thing over another. I know exactly what our NPA says about abandonment but am concerned that a facility is allowed to force a nurse to work indefinitely and risk patient safety.

**canoehead, BSN, RN** · Aug 11, 2013

In the state of Maine we need to give notice that we must leave, and then we are covered license wise, but the hospital can still fire you. When asked, the person representing the BON said 2hours notice is adequate, but it would depend on the situation. For example, if you find out about a death in the family it is foolish to expect coherent thought...

westieluv · Aug 11, 2013

And all I keep thinking is that there are so many, many new grads who would jump at the chance for a hospital job and nursing units would not be left perpetually short staffed. Of course, we all know that it's all about the bottom line, the money, pleasing the suits, yada, yada, yada, blah, blah, blah.

Ugh.

azhiker96, BSN, RN · Aug 12, 2013

Your state nurse practice act and board of nursing are what matter. I think two things could put your license in jeopardy. One would be abandonment and the other would be to care for patients when you are too tired to do so safely. I would have done the same thing the OP did including seeking alternative employment.

In my state we would not have to stay past the shift as far as the BON is concerned. I could give report to my supervisor. If she already had a full load that would suck for her but I don't make staffing decisions. Of course, my employer would probably fire me if I didn't stay and I wouldn't want to leave my friends and coworkers in a much worse position. The bottom line is I like to sleep at night but I also would not continue to enable management to under staff my unit. Either they would change the staffing or I'd change my employer.

Here's an excerpt from an advisory opinion on my BON website.

Situations NOT considered to be patient abandonment, but are examples of employer- employee or contract issues of which the Board has no jurisdiction (salary, work
conditions, hiring and termination policies):
(1) No call/no show for work
(2) Refusal to accept an assignment or a nurse-patient relationship
(3) Refusal to work overtime
(4) Refusal to work additional hours or shifts
(5) Ending the employer-employee relationship without providing the employer with
a period of time to obtain replacement staff for that specific position
(6) Refusal to work in an unfamiliar, specialized, or "high tech" area when there has
been no orientation, no educational preparation or employment experience
(7) Resigning from a position and not fulfilling the remaining posted work schedule
(8) Refusal to "float" to an unfamiliar unit to accept a full patient assignment