Abandonment - Legal Question

[Kooky Korky, BSN, RN]

Say an RN with an active license is working in a non-clinical position, such as MDS Coordinator or Medical Records or other non-direct care position. (not CNO, DON, ADON, Unit Manager, House Nursing Supervisor) or any other position that might be considered in the line of direct care.

The Team Leader (or Charge nurse) doing meds, charting, and treatments, writing care plans, and whatever other RN duties becomes ill on duty or has some emergency necessitating that she/he leave before the shift is over, or the nurse who is supposed to relieve her at shift change calls off and there is no one to relieve her.

The DON/CNO/ADON or House Sup tells the MDS RN that he/she must take over.

If the non-clinical nurse refuses, due to health or other obligation or lack of transportation or whatever other reason (like going to a once-in-a-lifetime event, such as graduation of her only child or the wedding of his only grandchild), she will likely be threatened with abandonment.

Does liability for abandonment start the minute the non-clinical RN comes to work to do the non-clinical job for which she was hired?

Is the non-clinical RN guilty of abandonment for refusing to jump into the clinical work, even if she was hired for other than clinical work? What if she herself is not feeling well or can't be on her damaged leg enough to work the bedside normally (which is why she didn't hire on to a bedside job in the first place)?

Most jobs do say that the worker must do other work as assigned. Does that phrase (in a non-union position, that is, there is no contract, the state in which this occurs is at-will employment) mean that an RN working in a non-clinical capacity can be held guilty of abandonment if he refuses a last-minute direct care assignment?

In an emergency, a true and sudden emergency - mass casualty, unforeseen severe weather, fire or explosion at the facility, death or serious incapacity of a coworker on duty - it might be a different situation.

But staff shortage happens all the time due to call-off's and the facility simply doesn't have a float pool and doesn't want to pay an agency nurse. Therefore, the shortage can't really be considered an emergency.

My understanding is that one must first accept an assignment in order to abandon it. But that might not be correct.

Any clarity you can shed is appreciated.

BTW, the state's statutes about abandonment are not rock solid. Each case is considered on a case by case basis, which seems unfair to nurses, IMHO.

Another question: If the non-clinical nurse says he or she will help feed patients, answer phones at the Nurses' Station, work as Receptionist, work as Ward Clerk, maybe even do a few dressing changes is she opening herself up to charges of refusing to do meds, charting, responding to emergencies? In other words, does no good deed go unpunished?

Has anyone ever "volunteered" to do some of the foregoing things but not agreed to be Charge, do the meds, Admits, etc. and lived to tell about it?

[Closed Account 12345]

Abandonment can't occur until you have accepted a patient assignment. Failure to pick up a shift, or even decline a patient load, is never abandonment. Your facility may tell you it is, and they may really think so because there's such confusion on the topic, but that's incorrect. This is not a Board-reportable issue.

Now, if your employer has properly oriented you to a clinical role, you may be expected to help in the unit. Typically, non-clinical nurses aren't even to require the basic orientation RN skills, which makes sense, but also means you shouldn't be staffing a unit. If you have a physical disability that impairs your ability to staff a unit, that's another consideration. Your employer is required to verify your clinical competencies before you accept a patient load independently. Nurses are not interchangeable. Each individual nurse has a unique scope based on licensure, education, certifications, work experience, specialty, and which competencies you have had validated.

For example, I spent years as a charge nurse. I have never worked Med Surg. I am not competent to charge on a M/S unit. I would 100% decline a request to staff as a clinical RN on a M/S unit.

But no matter what - not abandonment!

[Kooky Korky, BSN, RN]

6 minutes ago, FacultyRN said:

Abandonment can't occur until you have accepted a patient assignment. Failure to pick up a shift, or even decline a patient load, is never abandonment. Your facility may tell you it is, and they may really think so because there's such confusion on the topic, but that's incorrect. This is not a Board-reportable issue.

Now, if your employer has properly oriented you to a clinical role, you may be expected to help in the unit. Typically, non-clinical nurses aren't even to require the basic orientation RN skills, which makes sense, but also means you shouldn't be staffing a unit. If you have a physical disability that impairs your ability to staff a unit, that's another consideration. Your employer is required to verify your clinical competencies before you accept a patient load independently. Nurses are not interchangeable. Each individual nurse has a unique scope based on licensure, education, certifications, work experience, specialty, and which competencies you have had validated.

For example, I spent years as a charge nurse. I have never worked Med Surg. I am not competent to charge on a M/S unit. I would 100% decline a request to staff as a clinical RN on a M/S unit.

But no matter what - not abandonment!

Did you accept an assignment merely by reporting for duty (your duty as an MDS Coordinator or other non-clinical staff member)?

Or must you specifically accept the direct care assignment in order to be considered as abandoning it, should you be told you must do the direct care assignment.

Does the direct care assignment come under "other duties as assigned"? Would you be insubordinate for refusing to accept those "other duties"?

I fully understand and agree that, in today's circumstances, (too many patients, meds and equipment you likely don't know, etc.), you should not work M/S if you have never worked it, even though you have Charged in a different area. Your "requesting" boss might not see it that way and might try to pressure you mercilessly to get you to accept the assignment.

[Crash_Cart]

Abandonment can only occur after you have accepted an assignment, not before.

Abandonment assumes there's an existing individual in your present care, not where no such care exists.

To properly understand it's proper context and meaning, one must apply it's implied intent during the original historical time when such requirement was first written and implemented.

Clearly, it simply means you cannot "abandon" any patient that is deemed to be officially under your care. This obviously doesn't apply when they are not, such as when you are not required to be at the workplace, or when you have not accepted them as an assignment.

[Jory, MSN, APRN, CNM]

10 hours ago, Kooky Korky said:

Did you accept an assignment merely by reporting for duty (your duty as an MDS Coordinator or other non-clinical staff member)?

Or must you specifically accept the direct care assignment in order to be considered as abandoning it, should you be told you must do the direct care assignment.

The true purpose of "report" in nursing is to see if you are willing to take the assignment. No report for the type of patient care you are describing = no obligation to take care of the patient.

It is no different if you were scheduled for work that day and didn't show...that isn't patient abandonment either.

Question: Have you ever been oriented to direct patient care in your facility? If it not, you have every right to refuse any direct care assignment.

The patient abandonment threat is very common threat and falls on deaf ears with the BON.

Their staffing is their problem. Just because you have RN after your name doesn't mean you can safely do any job in your facility.

That would be like you working as a med-surg nurse and a facility trying to force you to work on a cardiac floor with fresh post-op cardiac patients because someone called in...that is not a safe assignment and you would be a fool for accepting it.

[Closed Account 12345]

14 hours ago, Kooky Korky said:

"Does the direct care assignment come under "other duties as assigned"? Would you be insubordinate for refusing to accept those "other duties"

(My response to the above-listed quote is below, but I don't know how to correct it from looking like another quote. Sorry!)

Quote

Jory's answer is correct about when your duty to a patient begins. You make the decision to actually accept the patient assignment after hearing report and determining if you're willing.

As for this question, when a hospital hires you, it is into a specific position that you sought and agreed to fill. To me, "other duties as assigned" means those related to your employed position. As a clinical nurse, that may mean stocking rooms with supplies, checking emergency equipment, checking expiration dates on supplies, reviewing charts for an audit, regulatory preparedness activities, attending in-services and staff meetings, sitting on committees, helping peers in the unit, cleaning up spills, etc.

My interpretation is that it does NOT mean I am "generic employee #3,076" and can be sent to the cafeteria to cook. Similarly, I don't believe "other duties as assigned" ever means someone hired into a non-clinical position, and oriented as such, can randomly be asked to work in a clinical role.

With that said, remember Board issues and employment issues are two different beasts. Refusing an assignment is never a Board issue, but it could certainly be treated as an employment issue depending on your employer.

[JKL33]

14 hours ago, Kooky Korky said:

1. Did you accept an assignment merely by reporting for duty (your duty as an MDS Coordinator or other non-clinical staff member)?

2. Or must you specifically accept the direct care assignment in order to be considered as abandoning it, should you be told you must do the direct care assignment.

3. Does the direct care assignment come under "other duties as assigned"? Would you be insubordinate for refusing to accept those "other duties"?

1. No.

2. Yes.

3. Yes, and very possibly yes. But that's a far cry from being guilty of patient abandonment.

Now if the direct care is assigned and you decline to accept the assignment and there is a show down where you are told you will do it or else - - then if you choose not to you have likely abandoned your job. You have walked away and said, 'No, I'm not doing that; I'm outta here." But job abandonment is also not patient abandonment unless you happen to decide to abandon your job while you are also working in a patient assignment.

*All of this is my best understanding, YMMV.

[traumaRUs, MSN, APRN]

Just FYI from staff - allnurses can not provide legal advice and recommends contacting an attorney familiar with nursing employment law.