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

The short answer to whether you can be charged with patient abandonment is .... probably not. But it depends. Read on to learn more... Nurses Nurse Beth Article


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.


  • 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.

Specializes in Critical Care.

It would be interesting to see what happens if you went public and asked your local news station to investigate...I would not want my family member to go to a facility where nurses are expected to work when ill and no replacement is available in an emergency.

Next time go to the emergency room. Technically you will have proof of illness (you are not pretending to be ill), and they can not fire you.

I personally believe you could be charged with abandonment, majority % due to the facility being shady enough to lie.

Here in California I have come across this while I was working as a case a manager. I am one of the people who was responsible to receive report on patients which is the only reason I even had anything to do with the entire mess of a situation. I will include what was found out after.

Nurse came in and complained to the previous shift floor supervisor that she wasn't feeling well and asked if she could go home AFTER she got report and did walking rounds. The previous supervisor said she'd see what she could do, she didn't tell the current shift supervisor during their hand-off. The "sick" nurse complained to the previous shift nurse that she was hungover. After lunchtime she complained to the day supervisor she didn't feel good and wanted to go home, she was told that they would see if they could get someone to come in early or get coverage. Around 4pm the nurse came up to me while I was doing my rounds and she told me about some things her patients needed addressing and mentioned a few other patients' needs that aren't on my case load. I jotted down notes and told her I would pass the note to their case manager. Around 4:30pm she went to the DON stating she was sick and had to leave which the DON told her they couldn't do anything and please finish the shift she'd see if the replacement would come in early but no promises. She handed the DON her keys and requested they count but the DON refused to accept her assignment stating she was unable to cover her patients which she actually wasn't since some were chemo. The nurse told her that she gave me report already and put the keys on her desk and walked out. The DON thought I was taking the patients so she sent her assistant to my shared office and left the keys on my desk while I was talking to a doctor. No words were exchanged.

She was reported and had to go in front of the board which suspended her license for abandonment and conducted an investigation.

From the rumor mill she lost her license completely and was not able to regain it due to the portion where she said she already gave report to another nurse. They felt she was purposefully misleading the DON into thinking another nurse was accepting responsibility so the patients were left 100% abandoned and no one was advised of their lack of care but instead were left under the impression of being cared for. Another thing that got her was she told a coworker she was hungover... which she admitted she was actually hungover but also felt she caught a cold/flu.

I also slightly blame my facility since I am a LVN and definitely can't take an active chemo patient. That should have occurred to my DON but when I pointed it out she told me she always forgets I'm a LVN since they only hire RNs for Case Managers and when I was working on the floor I was doing orientation so she admitted she spaced it. Her assistant also shouldn't have just left keys on my desk nor should a non-nurse been given keys to hand-off.

If if the nurse had asked me, I would have gladly picked up & helped a good majority of her patient load. She never once mentioned anything to me. IMHO she deserves to lose her license.

You not so much. You did abandon those patients but you have them multiple chances and more than enough time to cover the patients. With them threatening to report, I'd assume they will so start covering your tushy and get an attorney. I'd also preemptive file unlawful termination.

Sorry for the novel

Specializes in ER, Trauma, Med-Surg/Tele, LTC.
calivianya said:
I'm a little more pessimistic than some of the other posters, I think. I've always been told that if no one accepted report from you, the patients are your responsibility. The DON refused report. Therefore, I would say that is patient abandonment.

I have had times where I got sick during my shift and stayed because I couldn't find anyone to cover. My brain is going to be slower, for sure, and I hate it for the patients... but I can't pay my bills on minimum wage either, and I'm not really qualified to do anything other than be a nurse. I have to take care of myself, too, and taking care of myself includes providing myself a place to live and a way to pay my car payment.

Spreading communicable diseases to already sick and/or vulnerable patients is not taking care of your patients. Telling yourself that financially taking care of yourself indirectly contributes to taking care of your patients is a far fetched way of making yourself feel better for directly endangering them by continuing to care for them while you are sick. Yes, bills need to be paid, but that is what sick time is for.

Specializes in Geriatrics, Dialysis.
SquishyRN said:
Spreading communicable diseases to already sick and/or vulnerable patients is not taking care of your patients. Telling yourself that financially taking care of yourself indirectly contributes to taking care of your patients is a far fetched way of making yourself feel better for directly endangering them by continuing to care for them while you are sick. Yes, bills need to be paid, but that is what sick time is for.

I am not disagreeing with you at all. Quite the opposite as I also feel if there is even a chance that you could infect a patient you should not go to work. But the sick time may not be available to cover the financial loss. The facility I work for had an absolutely horrible sick policy that makes the sick time virtually useless. It can't be used until the third day you are out unless you have over 5 years of service. If you are out that third day then you need a doctor's note releasing you for duty again which of course means that a good portion of that day's sick pay will be eaten up by the doctor visit. Unless of course you have a decent relationship with your primary MD and they will write you the note without being seen, some might be willing to do that I guess. Either way you are out at least 2 days pay for the first 2 days you call in.

Fortunately we switched to PTO from the old vacation/holiday pay/sick time policy so that no longer applies.

Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
shoestring said:
Next time go to the emergency room. Technically you will have proof of illness (you are not pretending to be ill), and they can not fire you.

I would also suggest calling one's primary care provider for an acute appointment or visiting an urgent care if there is no life threat. Overburdened ERs don't need further overburdening just for a work note. ;)

In my state, I'm pretty sure you'ld get investigated by the board if an "abandonment" complaint was made under the circumstances you've outlined. Depending on how the complaint was worded & who the investigator believes, this could get messy. Best bet is to start looking for an attorney to help you defend your license. I personally wouldn't talk to /write to, or communicate with the board in any way until I'd spoken to an attorney who specializes in defending nurses. In my state, nurses don't have the same rights as other citizens - you can't plead the fifth, you're required by law to answer any charges & hearsay is admissible if any of your patients were "vulnerable adults". In addition to losing your license, you might even be criminally charged..

Conqueror+ said:
I would say yes because you simply handed her the keys and walked out. If they are nasty enough to report you they will also lie and say that you never requested relief and just walked off.

You did more than just hand over keys and leave. Have they been giving you a hard time about anything else? Are you one of the higher paid nurses there? Sometimes employers look for reasons to get rid of someone. I hope you fought for unemployment. Good luck.

Specializes in Psych,LTC,.

This is my opinion. I am not a lawyer, never played one on tV, and have never stayed at the holiday in express. It's probably more or less as valid as any other nurse's. You do have a legal duty to relieve yourself if you are unfit for duty (altered consciousness 2 infection, actual communicable infection). you do have a duty not to abandon the patient, and pass the responsibility to a properly qualified person. If the DON has a valid license, it's her, since she accepted the keys. If you just put them on the counter, it's not her.Not counting narcs are not pt abandonment, although failure to ensure the narcotics are counted,is probably a lesser offence. Not giving report, I' m not sure about. I don't know if there's any specific guidance on that. it certainly behooves the next nurse to do these things, and it is standard of care.since she'll have a bad count, not you.

That said, my gut feeling is that facilities don't like to draw attention to themselves, as god alone knows what they'll find if the DOH comes by. So long as there was no harm done to a PT and they need to CYA, there is never enough time in the day. Last thing they want is to waste it on something like writing a report, showing up for hearings, etc.

I never understand why people/nurses show up to work sick. In all the non-nursing and Nursing Jobs that I have had nurses would show up to work sick, clock in, take report and then turn around and say i am sick....Administration does not care!!! Because they know they can threaten nurses with abandonment issues, so most will not put in the effort to call for a replacement nurse, most nurses don't want to come in anyway. I personally don't care I start sniffing, coughing, fever, throwing up... I won't come in. I have missed the time frame to call in and have called in sick anyway. Yes I will be reprimanded from the facility but no way in hell would I compromise my license. I tell nurses all the time, you can not be so desperate to not lose your job where it clouds your judgement. And nurses let situations like these cloud their judgement everyday. You can always get another job but the day your license is revoked you are toast. You are on the pavement by yourself. And have to look for a lower paying job until you can pick your self back up. Let's see... that's about 2 yrs to pick yourself back into a different profession versus 2-3 months of looking for a different job.

I will not be in any profession where I bullied into caring more for anyone else first above myself. How is that helping the patient? How is that helping management be more efficient? Nope I refuse.

I honestly don't believe they will alert the BON. But I would be ready, just in case, as most people said to have a lawyer look into your case.

This scenario could have played soo many different ways. Please don't ever compromise your license for anyone...patient included. It's not worth it....the world will continue to run if you are sick, so will the patients, the hospital and the nursing homes.

Please keep us posted.

Specializes in Psych,LTC,.

many, many years ago I received some incredibly bad news as I was walking out the door on my way to work. about ten minutes in I realized I just read the same order three times and still didn't know what it said. I'd been working there a long time, and it was a union shop. My supervisor I'd known for years and knew I'd never called in sick since she knew me. It was night shift, and night shift workers are their own thing there. I guess she had the staffing that night to cover, when I told her I had to go home. She didn't raise a fuss. I also did a lot of extra shifts for her, so I'm sure that helped. I don't know what I would have done if she didn't let me. Maybe work it out with the other nurse for her to cover some of my slack and tells her if she ever needed a day off I'd switch. But it'd be the last time I ever help out that supervisor. Maybe ask the supervisor to help me out a little bit too. It depends on your relationship with your supervisor. An authoritarian figure is really bad news in this business.

Always document. In such a case, sending an email is good proof and would stand in court. Also, do you have a copy of company policy concerning sick staff providing care? If not, get a copy somehow. Most hospital infection control policies require you to stay home. They probably violated their own policy by requiring you to stay. Did you get a flu test or any other testing done? A doctor's note that you had any bug that was transferable to patients? Call your HR and ask them what did they document as cause of firing.

I would ask a nurse to invoke safe harbor in such circumstances. Can you invoke it now?

I think they endangered their patients by keeping you on the floor.