Is it abandonment or taking a moment to collect myself?

[Mollythenurse]

For 2 years I have worked in a family practice medical clinic. The NP I work with, whom up until approximately 1 month ago, have had a very good working relationship with. She recently began treating me very differently. She's dismissive, hateful, condescending and NOTHING I do is right in her eyes. I just can't please her. The stress and tension I've been feeling over this is really wearing me down. I spoke to my clinic manager about it two days ago. Wednesday I triaged a patient as I normally would, updated the EMR chart to show ready for provider, and as I was leaving the exam room pts mother asked for some info on a different child. I left the exam room, and pulled the other pts chart(we just went EMR and her other child's record is still paper) and began to gather the information. At that time the NP came to my work area and began YELLING at me for not walking back to her office to notify her that she had a pt ready, that I had turned the chart "green" saying she had a pt so WHY didn't I go to her office and tell her!!! Then she walked into the pts exam room. She did this in front of 3 other employees and 1 student NP. I wanted to crawl under my desk! I was embarrassed and humiliated I knew I was going to cry, so I grabbed my purse, and walked outside and went and sat in my vehicle to let the waterworks commence. Our clinic is super small, not even a breakroom, and I needed privacy for a few minutes. My clinic manager came out less than 5 minutes later. We talked and I told him that I wanted to talk to HR. He told me to take the rest of the day off and he would have HR call me. HR guy called, and he said some things that alluded to pt abandonment and safety issues. How would it be pt abandonment when the NP was in the room WITH the pt when I walked outside? I would have went back inside after a few minutes had my manager not told me to go home.... I would think the concern for pt safety would be greater having a distraught nurse caring for them. Additional info, pt was there for a runny nose..Any advice or input is greatly appreciated!

[Kooky Korky, BSN, RN]

That to me does not sound like patient abandonment. However I am also not well versed in what that means according to the regulations of your Board of Nursing.

I would check with them and explain the situation - but the only problem I see is that you should have just said, "I need some air," and then gone to the car.

Do NOT contact your BRN. Also, do not contact your malpractice insurer. You might want to talk to an attorney or 2 or 3.

[Kooky Korky, BSN, RN]

Straight up, not patient abandonment. Some of these companies are overstepping boundaries and treating employees like crap. Plain and simple. You did a good thing by stepping out to gather thoughts. If you were told to go home, then you have absolutely nothing g to worry about.

I'm not so sure it's not abandonment. She left the building without telling anyone, for Heaven's sake.

[Kooky Korky, BSN, RN]

Abandonment only applies in situations where patients require ongoing care to avoid harm, in a clinic setting these are generally not patients reliant on continuous nursing care.

She did abandon her post, as she left the building and went to her car. I'm not sure if she abandoned her patient.

[Emergent, RN]

My feeling, after reading your account, is that management is riding the NP lately over productivity. That probably contributed to her public temper tantrum toward you. You are a very convenient scapegoat. If you weren't so slow, she wouldn't be always running behind!

Sadly, medicine has become assembly line work, and workers widgets.

It sounds like management in that office sucks. Sorry you're going through this. I don't think it's patient abandonment for people coming in to get checkups, that sounds like scare tactics.

Find a better job asap!

[hppygr8ful, ASN, RN, EMT-I]

My first nursing preceptor (who was actually) a very good preceptor. Nursing is a tough job and there are times you will want to cry. Still you have patients and people who depend on you. So if you have to cry go to the restroom and do so. Then wipe your eyes, splash some water on your face and get back too it. People in today's world have been taught to show all their feeling and expect everyone to understand and pat our backs. It's just not true life or real world thinking. I don't mean to sound harsh but you walked out on your patients and colleagues and you need to be sure this does not become a pattern.

Peace and Namaste

Hppy

[Ddestiny, BSN, RN]

I'm really having difficulty finding this to be patient abandonment. These are people that walk in on their own accord, manage their own ADLs, are not required to stay in that building like a LTC or Acute Care patient/resident... if they cannot handle their own needs then they have someone else (hired or family) that does it for them. The office may be slower without your presence, but no one is in danger in family practice if you are not there. Many offices don't even have nurses doing their initial assessment and rooming, they use medical assistants, CNAs and/or train non-certified people how to do things to the provider's liking.

I started off in a Primary Care office and had a similar day really early on. The day was just very hectic, I was just off training and had a lot of outside stress that just contributed to things going to a head when I was literally asked to be in 3 places at once within a 1 minute period (phone call, room the next patient and help with an impromptu procedure) . I sat down in my chair and fell apart. God-bless-her, our pod secretary noticed and got my nurse manager, who invited me back to her office, where we talked about it and she told me to go home. It was absolutely not an ideal situation (though admittedly an important lesson to learned about how personal BS can really bleed through into work if you don't get it fixed) and I felt awful for it for a long time due to the inconvenience and the overall embarrassment; but I would never have considered the idea of being at risk for patient abandonment because of two things that our scenarios have in common: 1. The boss encouraged me to go home and 2. It's a PCP office, not a hospital, NH, dialysis clinic where people are being actively hooked up to machines, etc. Maybe I'm just lucky that this was such a great, supportive environment, as there were no repercussions for this and I continued to work there for 3 years until I moved away. Things would have been very different if they took your HR's method of attempting to "straighten me out".

[LibraSunCNM, BSN, MSN, CNM]

I agree that they are trying to intimidate you and make you think you are at fault, to avoid you taking action for a hostile work environment. I also cannot see how "patient abandonment" applies in an outpatient family practice setting. You probably should have told someone you were stepping outside for some air, but still, not abandonment to my thinking.

Talking to a lawyer well-versed in healthcare employment issues would probably be helpful if you are able. Finding a new job might be the most practical solution to avoid further headaches, but I don't know how easy that is in your area.

[canoehead, BSN, RN]

The fact that the NP was in the room, and she was told to leave by the clinic manager are irrelevant. If she left without turning nursing care over to another nurse, it might be considered patient abandoment. I do agree that her best option eould be to consult with an attorney; preferably one with experience handling issues before the BON.

OP, best wishes as you work through this issue.

I disagree. The NP took over care of the original patient. As for patients yet to be seen, she has not started care with them, and therefore cannot abandon them. (plus her boss told her to go, and staffing is the responsibility of the facility) Unless there are more patients involved, I think she's OK. Next time, just say "I need a few minutes, I'll be back" to most anyone.

About the original conflict...you had the pt ready, then as you were walking to inform the NP, mom asked an additional question. You were working on addressing her question, so *technically* she WASNT ready, and the NP can go pound sand. Who's needs come first, the NP or the patient? You acted correctly.

I think this calls for a meeting between you, the NP and manager. Yelling at staff in front of clients is ALWAYS incorrect. Generally you don't assume someone is slacking, you go and communicate, politely. NP is probably doing this with other staff as well, and hopefully will leave soon, or have a major attitude change.

[Here.I.Stand, BSN, RN]

I would seriously consider securing an attorney, just to be safe.

That said: 1) abandoning whom? It's an outpatient clinic whose pts/parents drove themselves there. Unless I'm missing something (e.g. receiving procedural sedation), they are able to leave. Heck they can drive to an urgent care, retail clinic, even the ED if they decide the service is too slow. These are not people in need of continuous nursing care. 2) your manager told you to leave. To stay would be insubordination. 3) you have no nurse-pt relationship with pts you have not seen 4) were you doing triage or pt education? Your post sounds like you were rooming pts, maybe taking VS or updating med lists? One doesn't even need a nursing license for that. Nearly all of the clinics in my area utilize MAs for that stuff. and 5) the pts ARE under the care of an RN -- an advanced practice one at that!

[doodlebuttRN]

Do NOT contact your BRN. Also, do not contact your malpractice insurer. You might want to talk to an attorney or 2 or 3.

Then WHY in the world (if, as your next comment says, you don't believe it isn't abandonment- I can't figure how to quote both posts) would you tell her not to contact her BON (which can be done anonymously) or contact her malpractice insurer (who are paid for this exact situation)!? I was falsely accused once to the BON (not by my employer but a patient) and I cannot FATHOM why you would tell a fellow nurse not to get legal advice from someone who is paid to protect her license. This isnt just against TOS, it defies common sense.

OP, from your post I don't think you are in the wrong. HOWEVER, anyone can make a complaint to the BON, no matter how false that compliant is. The BON does not exist to protect nurses. That is why you should get legal advice from someone who does. I wish you the very best of luck, and I am sorry you are in this situation. Please protect yourself and your license. And please don't give too many details on a public forum. ((Hugs))

[anitalaff, BSN, RN]

Great perspective on this!

[Jolie, BSN]

This is not legal advice, just my personal impression. I think some are confusing "patient abandonment" with "job abandonment."

I believe each state BON has a definition of "patient abandonment," spelling out circumstances in which a nurse could be disciplined by the state. To my understanding, these are generally circumstances in which patient(s) potentially needing immediate care are at risk of harm due to the lack of presence of a professional nurse capable of delivering that care. For example, a nurse providing 1:1 care to an ICU patient departs the unit unannounced to go to her car and collect herself, leaving the patient unattended and fellow staff unaware.

Job abandonment is defined by the individual employer and may differ from one employer to another or even one job description to another within the same facility. If that same nurse notified her co-workers that she was leaving the unit to collect herself and her co-workers agreed to assume care of the patient, there would not be "patient abandonment," but the facility may discipline her for job abandonment because hospital policy requires nurses to remain in the building while on duty.

While I sympathize with the OP's situation, I believe it was inadvisable to leave the building without notifying someone first. I think it's a stretch to call this patient abandonment, but the employer may consider it job abandonment.