I Left Work Sick- Can I be Charged With Patient Abandonment?

Nurse Beth, MSN

Dear Can I be Charged with Patient Abandonment?

I am so sorry this happened to you. Like you asked, it boils down to if you can be charged with abandonment by your state Board of Nursing (BON). Threatening (sick) nurses with their license and/or patient abandonment is a sign of a desperate nursing leader....lacking leadership skills.

The short answer to whether you can be charged with patient abandonment is .... probably not. But it depends.

First of all, it depends on whether or not your employer reports you to your BON. Unless they report you, there is no way the BON will have reason to investigate.

It would seem vindictive of your previous employer to report you, and it would not serve them any benefit, but it's possible. If you are reported, the BON could choose to conduct an investigation. Depending on the findings, you could be subject to the discipline of your license by your state BON. Here is what they will consider:

The BON will look at several things while conducting an investigation to determine if patient abandonment occurred. All three elements have to be met before you can be found negligent.

Did you accept the assignment, and was a nurse-patient relationship established?
Did you provide reasonable notice when severing the nurse-patient relationship?
Could the employer have reasonably made arrangements for continuation of nursing care by others following notification by yourself that you needed to leave?

Accepting the Assignment

Before it can be considered abandonment, a nurse-patient relationship must have been established. A nurse-patient relationship begins when responsibility for the nursing care of a patient is accepted by the nurse. The point at which you received report on your team of patients is when you accepted the patient assignment and the nurse-patient relationship began.

In your case, you accepted the patient assignment, thereby initiating a nurse-patient relationship.

Providing Reasonable Notice

You notified your employer that you were ill. Not once, but several times over several hours.

"I had multiple concerns with continuing my shift and felt I was providing unsafe care to my patients."

Working while you are sick is not safe. You are at risk for processing more slowly, and what I call "having the dumb". "Having the dumb" is what I experience when I'm ill. The way I tell I'm first getting sick is that I feel mentally slow, and I have difficulty concentrating. This before I even have aches and pains. I am absolutely not at my sharpest when I am sick or getting sick.

Nurses need to be alert and vigilant by nature of their job. Imagine an airline pilot working for American Airlines and reporting fever, aches, and shivering before take-off. It would never be allowed due to public safety.

Likewise, nurses should not be confounded by conflicting messages when sick: " Do not come to work sick and expose your patients and others" and "You are subject to discipline if you call in sick." Many nurses, when asked, would admit that they have gone to work sick or tried to stick it out because there was no one to cover. But how many coworkers and patients contracted their infection?

Facilities should support an ethical work environment.

As to "providing reasonable notice": you did.

Severing the Nurse-patient Relationship

In your case, the nurse-patient relationship was severed, and you left without a replacement for your patients.

Bear in mind that once an assignment is accepted, the nurse is responsible for its completion until responsibility can be transferred to another qualified person. You are not to leave until you have handed off care to another nurse.

Severing the nurse-patient relationship without giving reasonable notice to the appropriate person (e.g., supervisor, another nurse) so that arrangements can be made for continuation of nursing care by others is reportable. However, you made every effort for your employer to make other arrangements.

"Can I be charged with abandonment?"

Patient abandonment is defined as "when a nurse caring for a patient needing professional care ceases to provide care before transferring the patient to another nurse." In your case, there was no one to report off to, despite multiple attempts on your part.

In hindsight- one thing you could have done was write out a brief report and hand it to your DON, including a list of what still needed to be done for your patients, and their current status. If this ever occurs to you again, be sure and do this.

Reasonable Arrangements by Employer

You ask, "What responsibility does the facility have to the sick employee?"

The fact that you gave notice that you were sick and unable to provide safe care shifts the responsibility to your employer. They should have made arrangements to provide a replacement and cover the remainder of your shift if you were not well. It is not your responsibility to staff the facility, and employers have to plan for planned and unplanned time off in order to provide safe patient care services.

According to the Joint Commission, employers, not individual nurses, have the responsibility to ensure the continuous and timely availability of nursing services to patients. Employers must provide competent staff to ensure necessary patient care in routine situations.

Patient Abandonment

No nurse ever wants to abandon a patient or plans to abandon a patient or entire patient assignment.

In your case, the BON would look at the mitigating circumstances, including your employer's refusal to provide a replacement after notification on your part. You say you stayed at work several hours, and notified them several times that you were ill and needed to go home. It seems reasonable that your employer could have found a replacement for you in that time and with that much notice.

You:

Accepted the assignment and
Provided reasonable notice.

Your employer:

Did not make arrangements for your patients to be cared for

Please keep us updated. I sincerely hope you have found employment in a better environment, with an employer who respects and values you.