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Discussion

Abandonment?

After clocking in and walking to my station I was alerted to the fact I would have a heavy load of patients. I expressed my concern for pt safety to my manager who asked if I was refusing report to which I said yes and that I would like to have a change in assignment or for additional staff to be called in to assist. I was then told to clock out while she called the DON. I wrote a note explaining my concerns for patient safety and gave to my manager. I was asked to leave and told I could be charged with abandonment. I expect a call later today telling me I have been terminated or requesting me to resign. What are your thoughts on resigning or allowing them to terminate me? I do not think it is abandonment if I in no way assumed a patient-nurse relationship. Thanks!

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    • Featured Replies

    The heaviness of the patient load can be subjective. If you are a new hire who's not used to a full load, what others see as heavy but doable may seem insurmountable to you. Precedents will be important here.

    Assuming, however, that the assignment was genuinely unsafe for the patients (not just uncomfortable for you) : You did not take report or accept responsibility for the patients. Therefore it's a common, but baseless, threat. It is the institution that is responsible for adequate staffing, not the staffers with no control over it. Hope you kept copies of what you gave them. If not, make detailed notes today to share with your malpractice insurance-supplied attorney.

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    As far as I know, if you didn't accept report, it's not abandonment.

    For good measure, contact a lawyer. And print up a copy from a real legal source, or better yet, BON, defining abandonment, then show them.

    Now, can they fire you? If you are in a right to work state, sure. If you have a union, call them too.

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    Is it really abandonment if you were told to leave? Wouldn't that automatically put the nurse manager in charge of the patients?

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    • Experts

    Florida law stated......

    When a nurse receives a work assignment that she does not feel can safely be performed, the nurse

    has a right and a duty to consult with management to receive a modified work assignment that the nurse

    can safely perform. A nurse may refuse a work assignment. However, the refusal may be considered

    insubordination or abandonment. Therefore, a nurse should become familiar with the organization's

    policies and procedures regrading refusal to accept an unsafe assignment. If the nurse performs the

    assignment, she should utilize an assignment dispute objection form. The American Nurses Association

    has adopted a standard form which may be used. The health care facility may also have an appropriate

    form. These forms assist the hospital in identifying and following staffing problems.

    http://www.thehealthlawfirm.com/uploads/Ch-6%20Florida%20Nurse%20Practice%20Act%20and%20Scope%20of%20Nursing-revised.pdf
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    • Author

    Thank you for the replies. I was unable to find the Florida law regarding the issue so thanks for posting it. I placed a call to the BON regarding it but have not received a response. Unfortunately, I let my personal malpractice insurance drop off so I won't be able to use that. You can be sure I will reinstate it though!

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    It varies state to state however it is usually the accepted guideline that if you have not accepted the assignment and taken report it is not abandonment. http://www.nursetogether.com/what-every-nurse-should-know-about-patient-

    an example of a state position on abandonment....NYS Nursing:Practice Information:RN & LPN Practice Issues:Abandonment

    Call your malpractice insurer and ask their advice.

    If you are halfway through report before you realize that the patient is above your abilities to care for safely, is it still abandonment? I have refused two patients before when floated to a higher acuity area not in my area of expertise. I had no clue how to care for these patients with their specific conditions and medical devices. I told the charge my concerns and she said she was told I was qualified and trained. There was some kind of miscommunication. I explained my background and she agreed I should not take these patients. I was given different patients I felt safe with and that was that.

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    • Experts
    If you are halfway through report before you realize that the patient is above your abilities to care for safely, is it still abandonment? I have refused two patients before when floated to a higher acuity area not in my area of expertise. I had no clue how to care for these patients with their specific conditions and medical devices. I told the charge my concerns and she said she was told I was qualified and trained. There was some kind of miscommunication. I explained my background and she agreed I should not take these patients. I was given different patients I felt safe with and that was that.
    If you walked away without resolution maybe. You spoke up, it was agreed that you were not able to care for those patients and they were assigned to someone who could...no abandonment here. The key here...you ensured they were turned over to someone competent to take care of them. When they accepted the assignment they are now responsible.
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    • Experts

    Clocking in does not mean you have accepted a patient assignment. Clocking in is reporting to work.

    Most if not all BONs leave it up to the NURSE to determine if an assignment is safe before accepting, because should the nurse choose to accept an assignment that he or she feels is unsafe, the nurse is liable for anything that may happen. You need to find out where your BON stands on this.

    In many states, if you do not accept an assignment, there has been no nurse-patient relationship established and thus there is no abandonment. This doesn't mean that an employer can't fire you for not accepting that assignment: they very well can do so, and do so legally in most cases. But that would be an employment issue, which BONs as a rule stay out of.

    IMO, it is far easier to find a job if you've been fired in the past, than if you have BON discipline on your license.

    Call/write/visit your BON and see what they have to say, as it's what they think that matters the most. In the meantime, get your malpractice insurance renewed ASAP. And it wouldn't hurt to consider getting legal advice depending on how things play out. You can find lawyers experienced in nursing matters, including dealing with BONs, here: http://www.taana.org

    Good luck.

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    • Author

    I appreciate all the feedback. I have contacted the BON and from the wording of the response it seems that it is seen only as unprofessional conduct. That being said my employer may still terminate me, but I feel better knowing that the board does not see my action as abandonment. I feel I made the right decison in protecting my patients as well as my license.

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    I have reported to work and looked at the assignment, notified my supervisor that I was not available to work in those conditions and left. I was fired by the hospital and they reported me to the BON, who took no action.

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