No Call/No Show - Is My License at Risk?

meanmaryjean, DNP, RN · Sep 11, 2018

I see lots of confusion here on allnurses.com about risks to a nurse's license versus risk to their employment status and risk of being sued. For example, a member asked if her license was at risk for not reporting for work during a hurricane, another during a blizzard. Another thought action might be taken against her by the BON for allowing management to assign untrained staff (dietary and housekeeping) as CNA's. Recently, a member asked if others felt a nurse should be disciplined by the BON for being a no call/no show seven shifts in a row. As our legal expert, could you possibly shed some light on the differences in possible consequences for a nurse when bad things happen to good and not so good people in nursing?
I understand this whole thing can be confusing. You are talking about 2 areas of law. One is employment law which regulates what your employer can and can't do as well as when an employee can be terminated. And second is administrative law for reporting to the Board. However, those 2 areas can overlap.
The Board of Nursing considers that when a nurse does not call and fails to show up for work, it is patient abandonment. So, even if you may be terminated and think that would be the proper remedy, the Board can still act under the theory of patient abandonment.
Just remember, you are a nurse 24/7 and any actions you take in your personal life or in your employment can result in a matter before the Nursing Board. Anyone can report you to the Board.
I don't mean to scare you, however, ask yourself that if you were videoed 24/7, what would the Board think of your actions?

Respectfully- I think you are mistaken. Taking report/ accepting an assignment is needed in order for this to be consider PATIENT abandonment. The nurse did not appear to the workplace- so how could this meet the standard?

No call/ no show would be JOB abandonment, not patient abandonment.

Nunya, BSN · Sep 12, 2018

Respectfully- I think you are mistaken. Taking report/ accepting an assignment is needed in order for this to be consider PATIENT abandonment. The nurse did not appear to the workplace- so how could this meet the standard?
No call/ no show would be JOB abandonment, not patient abandonment.

Exactly. If I'm considered to be a nurse 24/7 then I'm never off duty, so that means I can't drink, take prescribed drugs that would alter my consciousness etc. If I'm late to work is that patient abandonment? I'd like to see that law in writing.

Katillac, RN · Sep 13, 2018

Respectfully- I think you are mistaken. Taking report/ accepting an assignment is needed in order for this to be consider PATIENT abandonment. The nurse did not appear to the workplace- so how could this meet the standard?
No call/ no show would be JOB abandonment, not patient abandonment.

I'm so glad this thread was started. Before this, I thought meanmaryjean was correct, and if a nurse didn't accept a specific assignment they could not be found to have abandoned their patients. My research shows I'm wrong, at least in New York State:

NYS Nursing:Practice Information:Abandonment of Patients Who Need Care

"New York law prohibits nurses from committing what is commonly referred to as "abandonment" or "patient abandonment". Abandonment typically occurs when:

A nurse, who has accepted a patient care assignment and is responsible for patient care, abandons or neglects a patient needing immediate professional care without making reasonable arrangements for the continuation of such are.
A nurse abandons nursing employment without providing reasonable notice and under circumstances that seriously impair the delivery of professional care to patients."

But I think it's disturbingly and unnecessarily alarmist to suggest that a nurse needs to behave in ways the BON would approve of 24/7. While it's possible to be reported for anything to the BON, the matters on which they can take action are fairly narrow and specific including, at least in New York, the definition of good moral character.

However, the Boards of Nursing in various states have differing standards. For example, California's definitions include:

Failure to notify the employing agency that the nurse will not appear to work an assigned shift is not considered patient abandonment by the BRN, nor is refusal to accept an assignment considered patient abandonment.

https://www.rn.ca.gov/pdfs/regulations/npr-b-01.pdf

But unlike New York, California's BON has no morals clause in their unprofessional conduct provisions, and again, the issues on which the Board will take action are specific and narrow.

Codes Display Text.

I hope in future responses it's made clear what states the answer pertains to and being unnecessary alarmist is avoided.

TheDudeWithTheBigDog, ADN, RN · Sep 13, 2018

Meanmaryjean is correct. If you do not accept the assignment, you have no obligation to the patients. If you read farther down that page you linked, it literally explains all of this.

Basically, if you're in the middle of your shift and just leave and go home, that's abandonment. Reasonable notice is basically just handing your patients off to another physical person. Usually, that means that you have to finish your shift. If it's in a facility, there's usually someone you can go to above your boss to get your patients covered in a situation that finishing your shift isn't an option.

You can't lose your license just for not showing up to work at a hospital. It's impossible to abandon a patient who's not in your care.

The exception is when you're doing home/private care. Typically you're the only nurse that shows up all day, you have to give notice in that situation so that somebody else can accept care of that person.

Basically, it's common sense. If you ACTIVELY have patients in your care, you have to work. If you don't actively have patients in your care, you're free to quit or just stop showing up to work. When you're off the clock and at home, it's just not possible to abandon a patient. That would go against multiple employment laws, and you'd actually have a very nice lawsuit against your state's BON if they took your license just because you didn't show up for your shift at a hospital.

FolksBtrippin, BSN, RN · Sep 13, 2018

I resent the suggestion that I imagine that I was under 24 hour video surveillance in response to a question as to what the BON can do to me. I'm a nurse, not a prisoner.

JKL33 · Sep 13, 2018

I'm so glad this thread was started. Before this, I thought meanmaryjean was correct, and if a nurse didn't accept a specific assignment they could not be found to have abandoned their patients. My research shows I'm wrong, at least in New York State:
NYS Nursing:Practice Information:Abandonment of Patients Who Need Care
"New York law prohibits nurses from committing what is commonly referred to as "abandonment" or "patient abandonment". Abandonment typically occurs when:
A nurse, who has accepted a patient care assignment and is responsible for patient care, abandons or neglects a patient needing immediate professional care without making reasonable arrangements for the continuation of such are.
A nurse abandons nursing employment without providing reasonable notice and under circumstances that seriously impair the delivery of professional care to patients."

Katillac,

If you continue reading information just beyond what you quoted at the link you provided, you will see it is likely that the latter application applies to someone who "abandons nursing employment" pretty much during the shift.

Otherwise nearly anyone who resigns from any job even with notice these days could be guilty, since staffing is, by design, right on the brink of being inadequate in so many places.

I think the verbiage on that page is meant to convey that a nurse can abandon patients by directly abandoning or neglecting patients who need care or by resigning from a position in a manner that accomplishes the same - and that you can't avoid abandonment charges by resigning during a shift.

Leader25, ASN, BSN, RN · Sep 17, 2018

Sorry with all due respect for your knowledge you are confusing the issue .No RN is a 24/7/365 that is management job description.The staff RN is paid an hourly wage not a salary like mangers/administration.So in essence the staff nurse is a piece worker.Patient abandonment after taking report and job abandonment ie not returning from vacation without notifying.We have challenged these with the labor board many times.Reportable events are a separate list,such as giving wrong blood.

allnurses Guide · Sep 17, 2018

If I need to imagine I am under surveillance 24/7 to imagine what the BON can do to me, I am in the wrong profession and so is everyone else who takes on this line of work. I love being a nurse, don't get me wrong. But I am not about to sacrifice my life to it, nor should anyone else. The implication that we should is definitely frightening.

Lorie Brown RN, MN, JD · Sep 17, 2018

Each state is different. Whether you call it job abandonment or patient abandonment, the point is leaving without taking an assignment, or a no call no show is unprofessional and can get you in front of the Board. I know it is frustrating to go to work and find out you are short staffed. In such case, I recommend writing a letter about your concerns to your supervisor and keeping a copy for yourself. That way if something does happen, you have evidence that it was a facility issue. Yes, you are a nurse 24/7 even though you only work certain hours. Any conduct such as getting a DUI or other criminal matter, the Board can take action against your license.

Katillac, RN · Sep 18, 2018

Each state is different. Whether you call it job abandonment or patient abandonment, the point is leaving without taking an assignment, or a no call no show is unprofessional and can get you in front of the Board. I know it is frustrating to go to work and find out you are short staffed. In such case, I recommend writing a letter about your concerns to your supervisor and keeping a copy for yourself. That way if something does happen, you have evidence that it was a facility issue. Yes, you are a nurse 24/7 even though you only work certain hours. Any conduct such as getting a DUI or other criminal matter, the Board can take action against your license.

In your OP, you state, "You are a nurse 24/7 and any actions you take in your personal life or in your employment can result in a matter before the Nursing Board." In the post above, you've changed it to, "Any conduct such as getting a DUI or other criminal matter, the Board can take action against your license." Which are you purporting as allnurses' legal expert, to be the case? If I miss a mortgage payment is my license at risk? How about if I get a speeding ticket? How about if my landlord takes me to small claims court for damage done to a common area while I was out of town? They are, after all, criminal matters. Can you please cite any reference to license action against a nurse for activity outside work unrelated specifically to patient well being while the nurse is working?

Further, it's not a question of what any reader thinks is job abandonment or patient abandonment, it's a matter of the definitions of the BON of the state the nurse is licensed in. Can you please cite any case in which action has been taken against a nurse's license for not being a no call no show and the state where it happened? Your peer B J Strickland MSN, JD believes the delineation is clear:

"The following behaviors are not patient abandonment but they are employment issues which can lead to facility or organization action, even though the board of nursing refuses to get involved:

Failing to call in, not showing up, or arriving late for a shift

Refusing an assignment for religious, cultural, legal or ethical reasons

Refusing to work in an unsafe situation

Refusing to give care that may harm the patient

Refusing to delegate patient care to an unsafe caregiver

Refusing to work mandatory overtime

Not returning from a leave of absence

Ending employment without sufficient notice for the employer to find a replacement

Refusing to work all remaining scheduled shifts after resigning

Refusing to work in an unfamiliar, specialized, or other type of area when you have had no orientation, education or experience in the area - such as refusing to float to an unfamiliar unit

Refusing to come in and cover a shift

Giving notice and working only part of the remaining time"

Abandonment: What It Is And Is Not – Nurse Guidance

It's critical that nurses have qualified guidance when the question of, for example, being asked to take an unsafe assignment or one for which the nurse is unqualified comes up. I was taught specifically in school and find scores of references online which say that it's the nurses duty and obligation to refuse any unsafe assignment - not write a letter of protest and work in a situation where patients are at risk. Is that no longer the case? Can you please cite for us the wording in the nurse practice act of any state that says I should take the unsafe assignment and just write a letter of protest to cover my six if something happens?

meanmaryjean, DNP, RN · Sep 18, 2018

In your OP, you state, "You are a nurse 24/7 and any actions you take in your personal life or in your employment can result in a matter before the Nursing Board." In the post above, you've changed it to, "Any conduct such as getting a DUI or other criminal matter, the Board can take action against your license." Which are you purporting as allnurses' legal expert, to be the case? If I miss a mortgage payment is my license at risk? How about if I get a speeding ticket? How about if my landlord takes me to small claims court for damage done to a common area while I was out of town? They are, after all, criminal matters. Can you please cite any reference to license action against a nurse for activity outside work unrelated specifically to patient well being while the nurse is working?
Further, it's not a question of what any reader thinks is job abandonment or patient abandonment, it's a matter of the definitions of the BON of the state the nurse is licensed in. Can you please cite any case in which action has been taken against a nurse's license for not being a no call no show and the state where it happened? Your peer B J Strickland MSN, JD believes the delineation is clear:
"The following behaviors are not patient abandonment but they are employment issues which can lead to facility or organization action, even though the board of nursing refuses to get involved:
Failing to call in, not showing up, or arriving late for a shift
Refusing an assignment for religious, cultural, legal or ethical reasons
Refusing to work in an unsafe situation
Refusing to give care that may harm the patient
Refusing to delegate patient care to an unsafe caregiver
Refusing to work mandatory overtime
Not returning from a leave of absence
Ending employment without sufficient notice for the employer to find a replacement
Refusing to work all remaining scheduled shifts after resigning
Refusing to work in an unfamiliar, specialized, or other type of area when you have had no orientation, education or experience in the area - such as refusing to float to an unfamiliar unit
Refusing to come in and cover a shift
Giving notice and working only part of the remaining time"
Abandonment: What It Is And Is Not - Nurse Guidance
It's critical that nurses have qualified guidance when the question of, for example, being asked to take an unsafe assignment or one for which the nurse is unqualified comes up. I was taught specifically in school and find scores of references online which say that it's the nurses duty and obligation to refuse any unsafe assignment - not write a letter of protest and work in a situation where patients are at risk. Is that no longer the case? Can you please cite for us the wording in the nurse practice act of any state that says I should take the unsafe assignment and just write a letter of protest to cover my six if something happens?

Thank you! I am troubled by the 'legal advice' given here that is just plain incorrect. Why have a prohibition against giving legal advice by non-attorneys in the TOS if this is what IS allowed?

smh