Free Standing ER Patient Abandonment

[Bekardi]

I currently live and work in Texas at a free-standing Emergency Room. The management is so horrible most of the Nurses are leaving if not gone already, including the DON (director of nursing). We are using a lot of agency nurses at this time. One day on shift I was not relieved by an agency nurse for the night shift, I contacted the Medical director as we do not have a DON to cover us. I was basically intimated by the Medical director that if I left I could be legally liable as I was the only nurse on duty. At the time I did not have any patients under my care, I have never been in this situation in 9 years of nursing. Being caught off guard I had to stay until a replacement was found. Does anyone have any experience or been in a similar situation like this? Thank you

[Guest219794]

I don't.

But, what does it matter?

Either you were mislead, or you were given accurate information. Either way, you are working in a place with horrible management that cannot keep qualified staff.

You need to consider whether this is the job for you. Given the big picture, I really don't think the answer to this question has much bearing.

FWIW, I don't think you can abandon a patient who has yet to arrive. And, as far as I can tell, nether does your BON:

"The Board believes that the following additional examples of employment issues would not typically involve violations of the NPA or Board Rules:

resignation without advance notice, assuming the nurse’s current patient care assignment and/or work shift has been completed;

refusal to work additional shifts, either “doubles” or extra shifts on days off; and/or

other work-related issues, such as frequent absenteeism or tardiness, or conflicts between staff/employees."

I can't figure out links, but her you go:

http://www.bne.state.tx.us/practice_bon_position_statements_content.asp#15.6

[Nunya, BSN]

It looks you'd be ok if there weren't patients, but I'd just call the BON and ask them.

[Lorri Cook, ADN, RN]

I'd leave it at, fool me once shame on you, fool me twice, shame on me. If you must hang around there until you find your next job, get clarification from your DON.

[Snatchedwig, BSN, CNA, LPN, RN]

I'm lost. Why you need a relief if your not doing patient care ? Just go on lunch.

[AnnaFender]

Yes...I have and yes you could have been liable until a replacement took over. You need to be prepared for taking responsibility for the job at hand even when it isnt predictable.

[JKL33]

4 hours ago, AnnaFender said:

Yes...I have and yes you could have been liable until a replacement took over. 

Held liable as related to which principle(s)? There were no patients present and there was no replacement for the OP at the end of a shift.

4 hours ago, AnnaFender said:

You need to be prepared for taking responsibility for the job at hand even when it isnt predictable.

Yes, and no. It is definitely more complicated than that.

Do you have specific information that can shed light on the OP's question?

[Closed Account 12345]

Thankfully, Texas is pretty clear on what constitutes patient abandonment. You can't abandon patients who do not exist. You can only abandon patients to whom you have an established duty of nurse-patient relationship.

It may be considered employment abandonment, and you could be fired, but in that case, good riddance. I feel like you'd have a pretty legitimate explanation on future applications of why you were terminated... You didn't want to indefinitely staff a 24/7 facility with no RN replacement/management and no patients. It is also not in a patient's best interest in an emergency to be cared for by a sleep deprived nurse who is 20 hours into a shift without rest; it would be in a patient's best interest to be transferred to a staffed facility.

[Jory, MSN, APRN, CNM]

Can you clarify?

You say you didn't have any patients under your care, the next nurse didn't show up, but yet you were the only nurse on duty.

Yes, that would be patient abandonment...as much as the staffing problem is not your issue, you still can't leave until your replacement comes and someone formally takes over that assignment. Your shift ending does not constitute the assignment ending. It has to be handed over.

Patient abandonment is when you have accepted the assignment and leave without someone taking over care.

[MunoRN, RN]

While there are "free standing ER"s that are actual acute care emergency rooms by regulatory definitions, these days the term more often refers to an urgent care clinic or walk-in clinic. Abandonment refers to abandoning care of patients that require ongoing acute care, which either way should be sent to an actual ER if you're at a clinic, so no, leaving a clinic, particularly when you already have no patients under your care is not abandonment.

[canoehead, BSN, RN]

I actually asked the Maine Board this question, but it was over fifteen years ago, so it would be worth asking your own Board. Their response is that you need to give sufficient notice to your boss that you cannot continue, and sufficient was seen as at least two hours. If you were currently in an empty ER, you could close the ER due to staffing issues, but you could not leave any current patients until the two hours notice was given. The Board was clear that staffing issues are the facility's issue. not yours.

If you close the ER other staff, like security should be notified so they can redirect patients or call 911 as needed. You should know that an answer from the Board will protect your license, but your employer will likely fire you for insubordination.

[AnnaFender]

So what if a patient were to arrive after you left and before the relief nurse clocked in? What definition would you give that ?