Patient Abandoment

[miss_c]

i know this has been discussed before, but i had an issue last night and wanted some input! the oncoming shift was short staffed d/t a call off; i agreed to stay over 4 hours. during that extra 4 hours we got multiple admits, when it was getting close to my time to leave, the supervisor was talking about mandating me for the rest of shift.

i informed the supervisor that i would be able to stay until a specific time (later than i originally agreed), but i would be leaving at that time, mandated or not. since i informed the supervisor well in advance of my departure time, i do not believe this would have been patient abandonment, however, my co-workers were telling me it would. everything worked out in the end and a nurse was floated from another unit.

[RadRNMSN]

It depends on how many hours you are allowed to work. I believe in VA where I work, we cannot work for more than 16 hours straight. If they were keeping you past 16 hours, that is unsafe and I believe unlawful as well.

[grandmawrinkle]

This all has to do with your facility policy and the employment laws in your state.

I do not believe in most states you can be forced to work more than 16 hours.

I have mandatory OT where I work as well, and where I work, if you have already volunteered to stay over and are on voluntary OT, they cannot mandate you for time after that. For us, it's a good loophole. You know if you work an 8 hour shift and they are talking about mandating, if you volunteer for an extra four hours (to stay for 12), they can't make you stay for a 16. BUT -- that's MY facility policy.

I bet you anything your charge RN has the OT policy somewhere readily accessible. I would recommend you familiarize yourself with it very, very well, so you know what management can and cannot do especially if you have mandatory OT. There will come a time when management tries to pull stunts with making people stay and it's wise for you to know what they can and cannot do to you.

[Asystole RN]

may depend upon what state you are in but many (all those i have checked...which is a lot) do not define forced overtime as patient abandonment, more of a employee employer issue.

only in rare cases of emergency...ie mass casualty/natural disaster can an employer use the abandonment/forced overtime excuse.

some states require the nurse to give a "reasonable amount of time" for the employer to replace them...fortunately nearly all companies have defined "reasonable amount of time" in their call in policy. at my current facility they require a 2 hour grace call in period, if they are short staffed i give them 2 hours to get registry there...

here is arizona's bon position on the matter.

http://www.azbn.gov/documents/advisory_opinion/ao%20abandonment%20of%20patients.pdf

arizona state board of nursing

advisory opinion

abandonment of patients

statement of scope

registered nurses (rn) and licensed practical nurses (lpn) are required to provide reasonable notice to the supervisor for the continuity of patients care, rather than terminate the relationship without notification, which is defined as abandonment. the following requirements constitute patient abandonment:

i. general requirements

a. the nurse must have first accepted the patient assignment, thus establishing a nurse-patient relationship. accepting a patient assignment varies from setting to setting and requires a clear understanding of workload and agreement to provide care, and then

b. disengaged the nurse-patient relationship without giving reasonable notice and report to the qualified person (supervisor, nurse, etc.) so that others can make arrangements for continuation of nursing care.

c. examples of patient abandonment include, but are not limited to:

i. leaving without giving the supervisor or qualified person adequate notice

ii. leaving without giving report to a qualified person

iii. accepting an assignment of patient care and then leaving the nursing unit or patient care setting without notifying the qualified person

d. situations not considered to be patient abandonment, but are examples of employer- employee or contract issues of which the board has no jurisdiction (salary, work conditions, hiring and termination policies):

1. no call/no show for work

2. refusal to accept an assignment or a nurse-patient relationship

3. refusal to work mandatory overtime

4. refusal to work additional hours or shifts

5. ending the employer-employee relationship without providing the employer with a period of time to obtain replacement staff for that specific position

6. refusal to work in an unfamiliar, specialized, or "high tech" area when there has been no orientation, no educational preparation or employment experience

7. resigning from a position and not fulfilling the remaining posted work schedule

8. refusal to "float" to an unfamiliar unit to accept a full patient assignment

ii. rationale to provide the nursing community with guidelines to clarify those circumstances which may be characterized as patient-abandonment.

iii. references

california board of nursing, (2009). scope of practice. retrieved from http://www.rn.ca.gov/practice/rns/htm

kentucky board of nursing. (2009). scope of practice. retrieved from kentucky: board of nursing - advisory opinion statements

maryland board of nursing. (2009). scope of practice. retrieved from http://www.mbon.org/main.php?v=norm&p=0&c=practice/decregs.htl

texas board of nursing. (2009). scope of practice. retrieved from general nursing practice information

[grandmawrinkle]

It's not patient abandonment if you have someone to report off to when you leave, no matter who that person is or how many patients they have. If they assume responsibility, it's on them.

[miss_c]

Thanks for the responses! At the time, I was not concerned with facility policy (I would accept my punishment), but, I was concerned with the threat of patient abandoment. However, my husband had to leave for work at a certain time and I had to be home to be with the children. I would rather have gotten in trouble at work, then to put my children in an unsafe situation!

[Esme12, ASN, BSN, RN]

Thanks for the responses! At the time, I was not concerned with facility policy (I would accept my punishment), but, I was concerned with the threat of patient abandoment. However, my husband had to leave for work at a certain time and I had to be home to be with the children. I would rather have gotten in trouble at work, then to put my children in an unsafe situation!

You accepted the assignment.......nurse patient relationship established.

You told the supervisor in a timely manner which is the begining of disengagement but........if there is no one to give report and no one is willing to accept your assignment and take report and you leave anyhow......abandonment!

PER Asystole:

I. GENERAL REQUIREMENTS

A. The nurse must have first ACCEPTED the patient assignment, thus establishing a nurse-patient relationship. Accepting a patient assignment varies from setting to setting and requires a clear understanding of workload and agreement to provide care

B. DISENGAGED the nurse-patient relationship without giving reasonable notice and report to the qualified person (supervisor, nurse, etc.) so that others can make arrangements for continuation of nursing care.

C. Examples of patient abandonment include, but are not limited to:

i. Leaving without giving the supervisor or qualified person adequate notice

ii. Leaving without giving report to a qualified person

iii. Accepting an assignment of patient care and then leaving the nursing unit or patient care setting without notifying the qualified person

Pretty common jargon for abandonment issues. If another reasonable or prudent nurse would not have acted in the same manner.......liable.

[Asystole RN]

you accepted the assignment.......nurse patient relationship established.

you told the supervisor in a timely manner which is the begining of disengagement but........if there is no one to give report and no one is willing to accept your assignment and take report and you leave anyhow......abandonment!

pretty common jargon for abandonment issues. if another reasonable or prudent nurse would not have acted in the same manner.......liable.

you missed number 3 and 4 under part d

d. situations not considered to be patient abandonment

3. refusal to work mandatory overtime

4. refusal to work additional hours or shifts

now i would have to assume that there is some other rn on staff, including the supervisor or don who is capable of assuming care.

report does not have to come in the fashion of a face to face conversation, a written report would suffice.

they cannot simply just refuse to replace you and leave you sitting there for the next 87 days. you can hand a written report to any other rn, including the don, house supervisor, or charge nurse and say adios.

i was unable to locate an example of a nurse being cited with patient abandonment for refusing to work overtime, maybe you know of one?

[kcochrane]

Citing patient abandonment is the #1 threat they like to pull on nurses. Supervisors at my old job tried to pull this after NYS passed the law against mandation.

Personally I think its pretty nasty to threaten someone after they had already stayed over to help out. Way to go to get more people to help out.

Asystole pretty much summed it up and is right on the money.

[shiccy]

Wow I think you need to find out what your max hours for shift is. I'm in OH and it's 16 w/ at least an 8hr break between shifts. I would NEVER imagine this happening to somebody.

I personally would write an incident report on that person stating that she made threats of patient abandonment if she did, indeed do this as it's #1- blatantly against the law in many or most states #2- unsafe for patients to have a nurse for 20 hours straight #3- Unethical behavior.

I'd also recommend possibly taking this issue to your director as she should know that this happened. She/he will probably not be pleased.

[nurse2033, MSN, RN]

The hours aside, you have to hand off responsibility for your patients. Meaning there has to be a nurse that is directly responsible for each patient. If that is you, you can't do that from the parking lot or your couch. Someone else has to assume responsibility for your patients before you leave, whenever that is.

[nursinger]

Why couldn't they float the RN from the other unit in the very beginning then you wouldn't have had to stay at all and this wouldn't have been a problem for you.