Call to ACTION - Nursing OT pay, RN licensure is in jeopardy!

Geeg · Nov 25, 2003

Do you think that it would do any good for nurses to lobby their state boards to remove the abandonement statements from the Nurse Practice Acts?

Mr_D · Nov 25, 2003

Originally posted by Geeg
Do you think that it would do any good for nurses to lobby their state boards to remove the abandonement statements from the Nurse Practice Acts?

I'm not sure -- don't have enough information.

It would be a good thing to research state by state -- just to find out what the rules are. One person pointed out that a nurse can't get charged with abandonment if they never formally take over a shift. Unless the article (link in the original message) was misleading, then the abandonment rules and the implications to nurses vary quite a bit.

I'll see what I can find out about Georgia's position on this. It may be a few days before I can post it.

a_clay · Nov 25, 2003

There was a new article the just 3 days ago online...I forgot where I found it. But the article said that Congress, etc. had given up the fight over this with Bush. Bush was bound and determined for this to pay. He said even if they voted against it that he'd veto it and it would pass anyway. I'd just like to know what he's trying to accomplish by doing this????? With 2004 right around the corner...he must not care if he gets re-elected. I can't see anyone wanting to re-elect after this and the war. He's crazy.

pickledpepperRN · Nov 25, 2003

The Advisory on Abandonment from the California Board of Registered Nursing:

http://www.rn.ca.gov/policies/pdf/npr-b-01.pdf

-jt · Nov 25, 2003

No. Refusing to accept an assignment of mandatory overtime is not patient abandonment and has nothing to do with those statements.

American Nurses Association

"Definition: PATIENT ABANDONMENT - a unilateral severance of the ESTABLISHED nurse-patient relationship WITHOUT giving reasonable notice to the appropriate person so that arrangements can be made for continuation of nursing care by others. REFUSAL TO ACCEPT AN ASSIGNMENT (or a nurse-patient relationship) DOES NOT CONSTITUTE PATIENT ABANDONMENT."

http://nursingworld.org/about/hod03/staffing6.pdf

Workplace Rights

Patient vs. Employment Abandonment

The difference could mean your license.

Q. After declining to stay for an additional shift, two nurses on my unit gave report to another nurse and left. They were charged with "patient abandonment", and disciplinary procedures were initiated. Is this appropriate?>

A. Although some employers consider declining to work overtime and actually abandoning a patient to be the same thing, clear differences exist. For example, the Alabama Board of Nursing (BON) states, "When a nurse on duty is mandated to remain on duty for an extra shift or period of time beyond his or her established work schedule and is unable to do so, it is NOT considered abandonment if the nurse leaves the facility after exercising prudent judgment, notifying the supervisor, and appropriately reporting off to another nurse who accepts the report." Other BONs - California, Oregon, and Ohio, for example, have also defined the difference between these types of abandonment.

The nurse probably isn't considered to be abandoning the patient if she doesn't accept an assignment (for example, by declining to take report and accept a patient or by informing the employer that other responsibilities, a lack of expertise, or fatigue limit her ability to stay and provide safe and appropriate care).

The issue would then be addressed as a labor dispute between the employer and the employee. Concern for patient well-being isn't the only reason to differentiate between patient and employment abandonment; the career implications associated with these types of abandonment vary considerably. If found guilty of patient abandonment, the nurse could lose her license as well as her job. If found guilty of abandoning employment, the nurse's professional licensure remains safe, but she may lose her job. (Unionized nurses usually have additional protections against such employer actions through the grievance process negotiated in their contracts.) Despite clear differences between these types of abandonment, employers consistently raise the specter of "patient abandonment" when trying to enforce mandatory overtime.

Employer directives that attempt to supersede the professional judgment and prerogatives of a licensed clinician, such as requiring a nurse to work an additional shift when she believes it's unsafe, clearly overstep the boundaries of what is appropriate. Clarifying one's response by asserting that one made a professional assessment of patient safety puts employers on notice that they are legally responsible for the provision of sufficient staffing......>>>

http://www.ANA.org

-jt · Nov 25, 2003

heres the rules in NY

REPORT: October/November 2002

New York State Nurses Association

State Board Clarifies Rules on Patient Abandonment

What is-and what is not-patient abandonment has long troubled nurses. Can refusing to work overtime put your RN license at risk? What about saying "no" to an assignment in an unfamiliar unit where you lack necessary skills?

In response to a rising number of questions about such issues, the State Education Department (SED) has issued a clarification that is now being mailed to every RN in New York State.

The good news is SED has made clear that, in most cases, refusing a double shift or additional hours beyond the posted work schedule when proper notification has been given is NOT patient abandonment or unprofessional conduct. Nor is refusing an assignment when you give reasonable notice that you lack competence to carry out that assignment.

Barbara Zittel, executive secretary to the State Board for Nursing, said, "The State Education Department views abandonment as a serious charge. It is inappropriate for nurses to be threatened with charges of abandonment to coerce them to work additional hours or care for patients beyond their expertise."

Words of Caution

This clarification applies to actions by the State Education Department and should help eliminate inappropriate management threats. But it does not protect you from separate and independent actions by your employer. A nurse who refuses an assignment or informs a supervisor that future such assignments will be refused might be disciplined or suspended for "insubordination".

Members who belong to NYSNA bargaining units may have additional protections through the grievance process negotiated in their contracts in regards to this kind of action. But no one should assume that these new guidelines automatically protect them from such employer actions. SED has no jurisdiction over employers.

From: Johanna Duncan-Poitier, Deputy Commissioner, Office of the Professions, Deputy Commissioner, Office of Higher Education and Barbara Zittel, Executive Secretary, New York State Board for Nursing:

Patient Abandonment -

The New York State Education Department has received numerous requests from nurses and health care employers seeking clarification about actions that could be considered abandonment and lead to charges of unprofessional conduct against a nurse's license. Provided is the opinion of the NY State Board Of Nursing to help clarify abandonment as well as factors associated with assessing allegations of abandonment in nursing:

Responsibility of the Health Care Facility:

Health care facilities are responsible for providing staff for the patients they accept, respecting the legal and ethical obligation of nurses to protect the safety of patients. Managerial or supervisory personnel should make adequate provisions for competent staffing to ensure necessary patient care in routine situations.

Nurse-Patient Relationship: A nurse-patient relationship begins when the nurse accepts responsibility for providing nursing care based upon a written or oral report of patient needs. A nurse-patient relationship ends when that responsibility has been transferred to another nurse and a report of patient needs has been communicated.

Objection to a Work Assignment: The decision to accept or reject an assignment must be based upon a critical judgement by the nurse of the nurse's ability to provide competent patient care. When a nurse is assigned to care for a patient or group of patients that is beyond the nurse's level of physical or professional competence, the nurse should immediately notify the first-line supervisor in writing of the objections to accepting the assignment. It should also be noted that future assignments in similar situations will be refused.

Definition of Abandonment: Abandonment results when the nurse-patient relationship is terminated without making reasonable arrangements with an appropriate person so that nursing care by others can be continued.

Abandonment and Unprofessional Conduct: The decision to charge a nurse with abandonment will depend on an examination of all of the circumstances surrounding a particular situation as assessed by State Education Department staff in consultation with a member of the State Board for Nursing. Key questions considered include:

* Did the nurse accept the patient assignment, which established a nurse-patient relationship?

* Did the nurse provide reasonable notice when severing the nurse-patient relationship?

* Could reasonable arrangements have been made for continuation of nursing care by others when proper notification was given?

An investigation by the Department of abandonment charges would consider whether managerial or supervisory personnel made adequate provisions for competent staffing to ensure necessary patient care in routine situations. The Department and the nurse may obtain a copy of the nurse's written notice of patient assignment refusal in the event of such an investigation.

In most cases, the following situations are NOT examples of unprofessional conduct nor automatic violations of the Regents Rule:

* Refusing to accept responsibility for a patient assignment(s) when the nurse has given reasonable notice to the proper agent that the nurse lacks physical or professional competence to carry out the assignment or that s/he is too mentally or physically exhausted to provide safe care, or that expected resources to support safe delivery of care are not available.

* Refusing the assignment of a double shift or additional hours beyond the posted work schedule when proper notification has been given.

It is unlikely that the State Education Department would consider a charge of patient abandonment when a nurse refuses to accept an assignment for additional hours beyond the posted work schedule especially when administration has been aware for several days of the presence of a staff shortage on a particular shift and when the nurse has notified the employer of refusal to accept the assignment.

Not coincidentally, fewer calls about threats of patient abandonment have been received since this opinion was released. >>>

http://www.op.nysed.gov/nurseabandon-qa.htm

###

PMHNP10 · Nov 25, 2003

For about the past week, I have been telling people about this mess. This CANNOT/MUST NOT be allowed to happen. Someone brought it up, and it is the most important thing to remember. No matter what the laws say is and isn't pt abandonment, admin are going to look at refusing an assignment as insubordination. So you might not lose your license, but know that you are going to be in jeopardy of losing your job. I think there are enough examples out there to prove that hospitals are as corrupt as they come, and they will go to any length to nail you. No one is perfect, and if you refuse enough shifts, management will look for one way or another to terminate you. This is a sad time for our profession. No more laissez faire attitude---take a stand!!!!!

Geeg · Nov 26, 2003

Nurses need to be prepared for unfair/unexpected termination. The majority of facility RN's are very vulnerable since they are "employees at will" and have no legally binding contract and can be terminated, basically, at any time for any reason. I say, get yourself signed up with an agency/registry or work part time or per diem at more than one facility if you can. It allows for max flexibility-I realize this is not practical for alot of people.

Joe Hill · Dec 1, 2003

In PA the Board of Nursing states that not accepting mandation will not put your license in jeopardy for PT abandonment.

Sheri257 · Dec 1, 2003

Originally posted by Mr_D
For more information on this, ideanurse provided the following link:
http://www.hpae.org/nursemobilizeforotpay062503.htm

Very interesting article, but I'm confused about something.

What if you make less than $65,000 but more than the minimum 22,100?

Does that mean they can make you work longer hours without overtime too? The article seems rather vague on this point.

"Workers whose salaries fall in the middle and whose job duties can be classified as administrative, executive or professional could be restricted for overtime. An executive secretary who holds "a position of responsibility" could be exempt, for example. Health care workers considered "learned professionals" could be exempt."

What does that mean? At their discretion, essentially?

-jt · Dec 2, 2003

It means that they have found a way, by hook or by crook, to eliminate as many people from overtime pay as they can - by salary, by reclassification of job, and by definition of employee. So if they dont get you with one, they can get you with another. It wouldnt be left up to their discretion - it would be the law. A done deal. And Bush promised to implement that law even though Congress already rejected it.

It means if your salary is $65,000 and above you automatically are not eligible for overtime. Since thats practically the starting salary for a New Grad ADN in NYC, that right there already knocks out almost every staff RN in NYC once our union contracts are expired. (We still get ot pay while its still in our union contracts.) If your salary isnt at that level, they can still eliminate you from ot pay by reclassifying your job acording to the new definitions they are proposing in the regulations.

In the regulation, "administrative employees" are those who have a measure of responsibility. Since registered nurses are licensed professionals who "have a responsibility" for the outcomes of nursing care, ALL nurses would be classified as "administrative employees" and, therefore, denied overtime pay - no matter what their salary is.

And if that doesnt exclude us enough, there is another piece of the new regulation that excludes anyone who is a "learned professional". The new broad definition of what constitutes a "learned professional" in that regulation would be anyone with "knowledge acquired by alternative means, such as a combination of intellectual instruction and work experience". That definition in itself will immediately exclude many health care workers, including registered nurses and LPNs from overtime pay.

And if they dont have to pay for it, mandatory ot usage will go right thru the roof.

http://www.ana.org/pressrel/2003/pr1003.htm

Makes you wonder if this guy really wants to get re-elected.