When refusing to work is considered abandonment?

[Leonardo Del Toro, RN]

If a nurse is given an unsafe assignment, say with patient rations she/he deem to be unsafe what is the consequence to simply refusing to take the shift?

Agreeing to an unsafe situation and making a mistake will likely be blamed on the nurse and not the employer. You signed for therefore you are responsible. But refusing to stay can be considered abandonment? That seems to be the only option left for these kinds of situations. Calling the state will do nothing because the facility is "under safe ratios"

If the employer refuses to hire sufficient staff, there is not mechanism for the nurse to protect themselves, because state ratios are not always clear due to different working situations or pt's acuity. So it is really for the nurse to judge what is safe and what is not.

What are your thoughts?

[Been there,done that, ASN, RN]

If you do not take report...you have not accepted responsibility for the patient. I knew many times I was being handed an unsafe assignment. I stayed to keep my job. Before I took report, I went to the nursing office..wrote them up.. kept a copy. Cover yourself.

[JBMmom, MSN, NP]

It's reasonable to think that someone might not know the assignment was unsafe until report was received, then they're stuck. A tough situation, I'm sure. I would hope that coworkers would recognize a disproportionate workload and help their fellow nurse by trying to even out the assignment, or at least chipping in to help. I'm fortunate to work with some great nurses, we're always offering to help each other out during the shift and it helps everyone at different times. I agree that keeping track in writing could be important. It's ridiculous what meets the minimums on paper by comparison with what's reasonable as far as a workload. But, to keep a job, I think most people would have to stay.

[Leonardo Del Toro, RN]

I guess what I forgot to mention is that this is a SNF facility. 2 nurses per PM shift with a 35 (average) pt load. Some are very sick an demanding and really impossible to have just one RN. The other RN is sick and no one else will stay to work. So you're left along with these 35 patients. What do you do? Do you leave or stay?

[Sour Lemon]

I guess what I forgot to mention is that this is a SNF facility. 2 nurses per PM shift with a 35 (average) pt load. Some are very sick an demanding and really impossible to have just one RN. The other RN is sick and no one else will stay to work. So you're left along with these 35 patients. What do you do? Do you leave or stay?

I would probably stay and do what I had to do to keep everyone alive, but not much more. I'd also make sure to contact every person in a position of authority and keep detailed records of the contact along with their responses. Then I'd start looking for a new job ...particularly if this was not an isolated type of situation.

[Kooky Korky, BSN, RN]

Talk to a couple of attorneys and find out exactly what the correct answer is.

I THINK but am not certain that you do not have to stay beyond the quitting time of your original shift.

If no one comes to relieve you and to take report and count narcotics, you can write out your report and hand it to the Nursing supervisor. I guess you can't make anyone count with you, but hand the keys to the supervisor - put them right in her hands.

Let the staffing supervisor know at least two hours in advance that you are not going to stay. Four hours would be better, or whatever the policy is at your job.

This stuff happens all the time. You must start informing your state legislators so they can make some laws. Do it as many times as this stuff occurs.

Good luck. TALK TO ATTORNEYS TO GET THE REAL ANSWER.

[Been there,done that, ASN, RN]

"really impossible to have just one RN." You answered your own question. Administration has put you and your patients in an unsafe situation. I would give notice now.Not gonna do it fat cats. Plenty of better jobs out there.

Peace to you. Leave.. without taking report. Protect your license. Administration will have to deal. STOP letting them beat you up... for THEIR almighty dollars.

[Castiela]

Talk to a couple of attorneys and find out exactly what the correct answer is.

I THINK but am not certain that you do not have to stay beyond the quitting time of your original shift.

If no one comes to relieve you and to take report and count narcotics, you can write out your report and hand it to the Nursing supervisor. I guess you can't make anyone count with you, but hand the keys to the supervisor - put them right in her hands.

Let the staffing supervisor know at least two hours in advance that you are not going to stay. Four hours would be better, or whatever the policy is at your job.

This stuff happens all the time. You must start informing your state legislators so they can make some laws. Do it as many times as this stuff occurs.

Good luck. TALK TO ATTORNEYS TO GET THE REAL ANSWER.

In our facility, if you leave before your replacement shows up, it is abandonment

[Leonardo Del Toro, RN]

Yes...that seem to be the best option. Hopefully this is an isolated incident. Looking for another job, maybe, all these SNF's are about the same, you're just changing one problem fro another...at least I like the people I work with and that means a lot to me...

[countrynurse09, LPN]

I guess what I forgot to mention is that this is a SNF facility. 2 nurses per PM shift with a 35 (average) pt load. Some are very sick an demanding and really impossible to have just one RN. The other RN is sick and no one else will stay to work. So you're left along with these 35 patients. What do you do? Do you leave or stay?

My first LPN job at a skilled LTC was night shift. No RNs in the building (just the DON at home but on call). There were only 2 LPNs for the 8 hr night shift, each on opposite sides of the facility, with a handful of CNAs. Each LPN had 50 patients to herself with her CNAs. Talk about trial by fire, lol.

[TriciaJ, RN]

If you had a union there would be a mechanism for accepting an unsafe assignment under protest. It would be a form that you would complete stating why in your opinion the assignment was unsafe, to whom you spoke to request additional staffing, and an assertion that you will do your utmost to prevent a bad outcome but you can't be held ultimately responsible.

If you have no union and no pre-printed form, you can put this information on a blank sheet of paper. You keep a copy, management gets a copy and you send copies to whatever outside entities have an interest in the quality of care. (State nursing home licensing agency, Medicare, etc.).

But don't do this without starting a new job search. Because this is going to enrage your management and without a union your goose will be cooked. If I was in your shoes, I'd find a new job first, then drop a dime on my way out the door. Good luck.

[Susie2310]

If I was in your situation I would begin by checking what my state BRN web site says constitutes abandonment of patients, and whether receiving report but refusing the patient assignment based on report without having established a nurse-patient relationship is considered abandonment. If I couldn't find sufficient information there I would call my state BRN for guidance.