Abandonment or not? Need opinions! in Louisiana

[nicole8476]

Looking for some opinions please....

Recently a Louisiana nurse I know experienced a situation which we both are unclear about. Looking for some insight.

The nurse was working Mon - Fri with one patient providing patient care in home. This nurse had also picked up extra shifts with another patient on weekends to help cover a shortage. Less than one hour before the scheduled time to report to work for a weekend shift, the nurse is notified that her primary patient is moving immediately without notice, leaving the nurse with no full time job. Due to other circumstances in her life, this puts the nurse in an extreme bind financially and puts the nurse in a less than stable emotional state. Even though the nurse is basically an emotional wreck at this point, she pulls herself together and reports to work and does her best to hold it together. After the first few hours of her shift, the nurse feels she is having trouble emotionally holding it all together and reports to the supervisor that she needs to be replaced due to the circumstances. supervisor responds that there is no one to replace her. the nurse stays at work even though emotionally she is having hard time holding it together and hard time concentrating on care of patient. the patient care does not suffer in any way. the nurse notifies supervisor again an hour later that she needs to be replaced but no arrangements are made. The nurse notifies supervisor that she must leave the home at this time and leave the pateint in the care of the mother. afterwards the nurse notifies the mother and leaves the home. the patient is under the care of the mother for several hours each day so the nurse is not concerned about the patient having access to proper care. the supervisor then notifies the nurse that she will be reported for patient abandonment because of her actions. Is this abandonment or not if the patient was left under the care of his mother who is able to care for him?? what should have been done in a situation when there is no effort to provide another nurse? the supervisor states that the nurse should have stayed no matter what because there was no life or death emergency involved.

[Meriwhen, ASN, BSN, MSN, RN]

The only ones who can tell you for certain whether your friend has committed patient abandonment is the Louisiana BON. I would check their website for their definition of abandonment, or call/email (do it anonymously if you prefer) and ask them.

[caliotter3]

I work in home care and in similar circumstances where the nurse must leave the home, I have always been told by my agency supervisors that all is ok as long as proper report is given to someone capable and authorized to take over care and the agency is notified. She was notifying the agency, so her problem is with the agency not authorizing her absence. I would suggest that she contact her malpractice insurance provider and seek legal counsel, which we can not provide here. The agency will most likely fire her and report her to the Board and she is most likely going to have bigger problems than losing her full time case. I really don't know what else to say except to remark that she works for a less than desirable agency. Why they would want a nurse impaired by her emotional state in the house with a patient, I don't know. I think the bad judgement lies with them, if we are getting an accurate rendition of what happened.

[Esme12, ASN, BSN, RN]

I think your friend needs to call her malpractice insurance. If she left her shift and was not relieved by another recognized care giver (this is where it gets sticky in home care and the parent is another recognized care giver) she did abandon the patient.

She will probably have to argue this with the BON. If she doesn't have malpractice (ALL NURSES should have malpractice) she needs to contact a lawyer.

[MissyWrite]

Well, the answer is she will find out from the BON. The BON exists to protect the public, not nurses. But if she didn't leave a patient in jeopardy, and notified her supervisor, and the mother was competent to care for the patient and doesn't have a complaint, I think it would be reasonable to say she won't be disciplined. But then again, you just never know.

I had a friend who received a complaint (can't remember exactly what it was) which was eventually dismissed, but the bad thing about it was that immediately upon receiving the complaint, the BON website reported that a complaint against her license was filed and being investigated. Anyone who looked up her license could see it, and she was unable to find new employment until it was resolved a couple of months later. That seemed ridiculous to me -- what happened to innocent until proven guilty? She also said the BON investigator was very nasty to her.

[dudette10, MSN, RN]

Along with everything else others are saying, another point: is the mother a recognized, trained, documented caregiver on the care plan for the patient? If so, I think she will be able to fight this with the BON.

[Back2SchoolRN]

I wonder what happens when you feel you are in an urgent medical situation yourself, and must get help for yourself, but not quite 911? It seems to me that, because even a 911 illness could happen to a caregiver nurse, any agency MUST be able to provide back-up, even if it is for a short time the DON of the agency.

Surely that's true even if there is a family caregiver who is wiling and competent, because that person could get sick, too. (Speaking of getting your flu shot.....)

I think if I were stuck in this nurse's shoes, I would surely document everything, and when I called the supervisor, not only work my way up the ladder, but give the agency a deadline, because frankly they are more likely to come through if they know they must, and how soon.

I would also not share the nature of my illness, just that I was too unwell to perform my duties competently and needed relief for my patient's sake. Why open yourself up to questions about your sanity or mental stability, which could then raise doubts about anything you said or wrote or recall now?

If you did have to go, you would surely want to document the hand-off to the Mom, including that she is comfortable with that and knows where to call if she needs more help.

But I can tell you from close-up observation that, when it comes to a "he said--she said" at the BON, the party who reports the other first, especially if it is an agency/facility/employer, virtually always wins. Some agencies use this as a weapon of intimidation over their nurses, and so do some facilities that use agency staffing. Once you've been reported, anything you say about the reporting party only seems like retaliation, and not very credible.

BTW, if you need to report something you see at a place where you are sent as an agency nurse, keep your mouth shut and do it in writing, or by calling the authorities directly first; otherwise you may find yourself set up/reported for something manufactured just for that very reason--to get the "first complainer" advantage.

Keep in mind who will have custody of a paper record, and whether they can remove/replace and entire page of notes, if they are unethical enough to do so, in order to hide something. It has happened!

Some agencies, and/or places with chronic inspection or licensure problems that also use agency staffing, are old hands at such tricks. Meanwhile, any serious complaint follows you everywhere, even if it is determined unfounded. You will notice, if you apply for reciprocal licenses in non-compact states (and some school and job applications), that you are asked not whether you've been found guilty, but whether you've been ACCUSED of neglect, abuse, etc.

You will have space to write your story, but some damage is probably done, because we're inclined to believe there must have been something to it, aren't we? We assume the BON must have entertained the idea seriously, at least, after seeing the evidence, even if in the end you were judged innocent. Yet the BON field investigator must be groaning under stacks of cases like everyone else these days, and low-priority cases can sit for years before being investigated.

I'm not sure what the solutions to these things are. But I do think legal self-protection classes for nurses should go beyond simple charting improvement. They should include looking out for yourself against other entities, like businesses, whose needs may conflict with yours. You don't see that in nursing journal articles, I think.

There's a myth that if you do everything by the books, and document it all, you are safe. Also that if your heart's in the right place, and you didn't endanger your patient, and you document the patient's safety, you're probably basically okay. (Not necessarily. Not by any means.)

[mariebailey, MSN, RN]

I think she's fine, at least with the LA BON, because she notified appropriate personnel. See pg. 4 of an LA BON publication for how they define "patient abandonment". http://www.lsbn.state.la.us/Portals/1/Documents/Examiners/ExaminerNo22013.pdf