Is this pt. abandonment

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Im trying to find my state's advisory on this issue (Illinois) but, here's the scenario. I've been working at a post acute rehab facility for a year and 8 months. Nurse to pt ratio on average was 1:15. That was manageable. We had one wing that was LTC that was 1:24. It being LTC that was manageable too.

Recently they wanted to start making my wing LTC as well. So they have been giving us nurses on that side about 24 patients as well. The problem is, there are still many rehab patients on that side, and each week about 5 patients come and go. Multiple admits and discharges every day. It is NOTHING like the LTC side where the only patients leaving are when they pass away.

Ok so Ive been giving this change a chance, but it is not working out (which is an understatement.)

Just in the last week, we've had a code (I wasn't on shift at the time, but the nurse working didn't know the pt was on the BR floor unresponsive for who knows how long bc she was caring for 23 other patients. I had a pt have a stroke which I didnt notice, luckily a CNA did bc pt was eating at the time. I had a pt who is supposed to be a feeder aspirate. No CNA was in the room. We had 4 CNA'S in the building with 80 patients. I didn't notice til family came in and noticed something was off. Sent him out, he was admitted. The list goes on and on...

I've had it recently. It's not working out. Its too dangerous. I came into work Sunday (yesterday) for my 3-11 shift hoping for the best even though my ladt 2 days have been a disaster. The AM nurse had tears in her eyes, she wasn't done with work yet, a pt was just returning from the hospital that she had sent out earlier, plus she just had a fall (falls have been increasing a lot with this change.) She began giving me report, and I just HAD IT. It was sheer chaos. She only gave me repory on 3 patients when I was like, No. I'm not accepting this assignment. I went to our ADON and told her if the 3 nurses in the back station who had 14 patients didn't pick up about 6 of my patients (giving them 16 patients each) then I cannot in good conscious accept this assignment. She said either clock out and I report you to the BON or work the shift and write your letter of resignation tomorrow. Ive been telling them for a while now that it is dangerous to no avail. I told her I don't want to quit working here, I just want the patients to be safe. She restated herself, so I clocked out and left.

I didn't get full report yet, nor accept the keys to the medcart. But I DID clock in. Is this patient abandonment and a reportable offence to the BON?

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No, it's not abandonment because you did not accept the patient assignment.

She can report you all she wants and it won't end in anything. You saw an unsafe situation and reported it exactly like you should have. I highly doubt she'd report it anyways, given the state of that place. There are quite a few admins who try to scare nurses into taking on unsafe assignments.

Good luck finding something else, you did the right thing.

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No, it's not abandonment because you did not accept the patient assignment.

She can report you all she wants and it won't end in anything. You saw an unsafe situation and reported it exactly like you should have. I highly doubt she'd report it anyways, given the state of that place. There are quite a few admins who try to scare nurses into taking on unsafe assignments.

Good luck finding something else, you did the right thing.

Thank you so much. That makes me feel a lot better. í ½í¸Š

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Specializes in Med/Surg, LTACH, LTC, Home Health.

Unsafe staffing ratios leading to patient harm are required to be reported to my state's Dept. of Community Health. A facility like that here would receive multiple citations, fines, and possible revocation of permit if staffing is not adjusted to meet the needs of the population it serves. Anyone can and should make a good-faith (anonymous) phone call if people being injured and/or worse.

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The ANA Scope and Standards of Nursing Practice and their Code of Ethics, binding on all of us, will be your rock and shield. Make a pre-emptive report to the BON, mentioning the threat, and I'll bet you'll never hear from them again. But before you do that, report this place to the state STAT. That's something you will want to do for many reasons, prime being the patients who are suffering there. Second, you want to make sure the BON sees you are putting pt welfare above your own.

The next thing you do, and I am dead serious about this, is call the local TV station and ask to speak to the investigation team for health issues, and the newspaper investigation team too. Nothing like a call from a reporter (after the call from the state) to put the fear of God into an administration.

And you already know this, but give notice and get another job. Your observation and narration skills are very good; perhaps you could get work with the state. Think about it.

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Unsafe staffing ratios leading to patient harm are required to be reported to my state's Dept. of Community Health. A facility like that here would receive multiple citations, fines, and possible revocation of permit if staffing is not adjusted to meet the needs of the population it serves. Anyone can and should make a good-faith (anonymous) phone call if people being injured and/or worse.

Thanks. I told her I was reporting them when I left. But, I wasn't sure where to report them. I am so angry that she threatended my license, my career, my livelihood, my family.

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Specializes in Psych ICU, addictions.

As you didn't accept the assignment, there was no nurse-patient relationship established so it's not abandonment. However, I'm neither an attorney nor a member of a BON, so consult with an attorney versed in nursing matters and/or ask the BON what they think (you can do the latter anonymously by e-mail if you prefer) for the most accurate answer.

That being said, the facility can and may well fire you for the refusal. If that happens, the BON will not do anything to save your job for you. They're concerned about patient care, not nurse employment. They expect you to refuse unsafe assignments, but they won't go to bat for you for your job when your employer fires you for refusing an assignment. Go fig.

And if they don't fire you, I'd start looking for a new job ASAP. You have a pretty big target on your back now, so better you leave before you're terminated. This is one of the few times I'd say resign before you have the next job lined up, especially if this is how poorly the facility is staffed and managed. If you have to, sign up with an agency/registry so you can get some work while looking for that next job.

Whether you report them (I think you should, IMO) is up to you.

Best of luck.

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Thank you for all of your words of wisdom, everyone! I luckily have a HH agency calling me to talk about jumping ship to HH. My mom is a nurse who works with them and loves it. She gave her manager my number, and I missed her call as I was working at the time.

So I have options. Thanks again!

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Specializes in ICU.

No it is not since you didn't accept the assignment and didn't get report for your assigned pts. All the best, I've been in a similar situation before and it is the worst

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
Thanks. I told her I was reporting them when I left. But, I wasn't sure where to report them. I am so angry that she threatended my license, my career, my livelihood, my family.

I've had an admin threaten me with patient abandonment before. I quit when I wasn't even working, let alone in the same city. Nothing came of it but the fact that those types of admins stoop that low is scary.

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Specializes in Psych ICU, addictions.
I've had an admin threaten me with patient abandonment before. I quit when I wasn't even working, let alone in the same city. Nothing came of it but the fact that those types of admins stoop that low is scary.

Many years ago, I had a supervisor threaten me with abandonment when I wouldn't stay over because the next nurse was going to be late. Short-staffing and mandatory OT was a recurring problem at this facility, so I did a little research with the state BON. I showed her chapter and verse that they couldn't charge me with abandonment for refusing overtime because that was an employment issue and not a nursing care issue, and that the BON doesn't interfere in employment issues.

I did have to report off on my patients in order to transfer care, so I told her, "you're a nurse, here's your report," gave her a report and left.

They always asked me after that instead of trying to tell me. And they were too short-staffed to fire me over it :)

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
Many years ago, I had a supervisor threaten me with abandonment when I wouldn't stay over because the next nurse was going to be late. Short-staffing and mandatory OT was a recurring problem at this facility, so I did a little research with the state BON. I showed her chapter and verse that they couldn't charge me with abandonment for refusing overtime because that was an employment issue and not a nursing care issue, and that the BON doesn't interfere in employment issues.

I did have to report off on my patients in order to transfer care, so I told her, "you're a nurse, here's your report," gave her a report and left.

They always asked me after that instead of trying to tell me. And they were too short-staffed to fire me over it :)

If I would've been by the agency (it was PDN) I would've showed my boss that she was just blowing smoke. I quit because there was so much abuse & neglect that it was getting to me. I couldn't report it because I personally didn't see any of it, the day nurse did. Ironically, a week or two later the mom was arrested for drug use & the case was over. I don't feel bad for quitting, I just wish I could've reported something.

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