Patient Abandoment

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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.

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.

True. Also true is that the supervisor, charge, unit manager, CNO are all still Nurses and can take responsibility.

Like I said, report does not have to come in the form of a verbal discussion. A written report works just fine. ;)

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Management occasionally likes to mention this one because of its "cut and dry" definitive nature with every States B.O.N. It's a fallback position when things are so tight personnel wise as to be worrisome if staff compliance is an issue.

Here's where you have to be careful with this....

In the typical instance where your assigned relief nurse is officially present (clocked in, roll call, etc) your verbal report is actually substantially verifiable.

However,...

In those occasional instances where you give verbal handoff to someone who is ostensibly "watching" your patient until your assigned but late relief arrives, watch out! If Murphy's Law strikes and your patient goes south unnoticed, everyone may run for cover with you left holding the bag.

Cover yourself by charting "Verbal Hand-Off report given to Nurse Forgetmenot RN at direction of Charge Nurse Marquee de Sade RN."

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Specializes in Telemetry.

Wow! Thanks for all the replys! I think the supervisor was threatening me with mandation because it was the easy thing to do. When I agreed to stay the previous supervisor had stated that unless the other unit got slammed they could float a nurse for the rest of the shift, plus ratios stated the remaining nurses on my unit could handle the load (was the very high end of allowable ratios, but still doable according to our policy), and all assessments, meds, treatments were done on my stable patient's, and there were only 2 more hours left in the shift!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
You missed number 3 and 4 under part D

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?

BUt she already accepted the assingment.........if she didn't get some to accept the patients she could be accused of abandonment. Me? As a sup I have taken report knowing full well she already helped out and If I stiffed her then I would be up a creek the next time I sked for help...... but not all sups are the same.

I always tell people...you know what assume spells.......ass-u-me. Unfortunately I believe that per joint commision, report may not have to be face to face, but the hand--off must include the opportunity for dialogue and questions. I know of no abandonment cases for refusal of overtime but I do know of abandonment cases with failure to endorse the care of the patient to qualified personel if they leave and so not give report. YOu are responsible for the patient once you accept the assignment and are relieved of duty ( not neccessarily reesponsibility) when another license accepts the assignment.

It kind of falls under the "another reasonable and prudent nurse". If another reasonable and prudent nurse would not leave because it would cause an unsafe enviorment for the patient........you are at risk for liable and abandonment. There is not a real clear cut line but a lot of slippery slopes that can leave you vulnerable. Especially if the facility wanted to persue it with the board or a family sues and you become the easy scape goat..

Like I said.....2 hours left I would have taken report and let my staff member leave as long as there wasn't any big emergency in the facility.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
True. Also true is that the supervisor, charge, unit manager, CNO are all still Nurses and can take responsibility.

They can but ..........will they.?:confused::confused:

Like I said, report does not have to come in the form of a verbal discussion. A written report works just fine. ;)

Joint Commision states........hand off be a standarized process with the opportunity to exchange information and opportunity to ask questions

http://www.jointcommission.org/NR/rdonlyres/31666E86-E7F4-423E-9BE8-F05BD1CB0AA8/0/HAP_NPSG.pdf

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Nice article about mandatory overtime in different states. Some address abandonment:

Mandatory Overtime

For example in NYS:

New York enacted legislation that prohibits a healthcare employer (excluding home care) from requiring a nurse to work more than their regularly scheduled hours, except during a healthcare disaster, natural or other that increases the need for healthcare personnel unexpectedly, affecting the county in which the nurse is employed or in a contiguous county; or where a healthcare employer determines there is an emergency and has made a good faith effort to have overtime covered on a voluntary basis including, but not limited to calling per diems, agency nurses, assigning floats or requesting an additional day of work from off duty employees. Another exception includes an ongoing medical or surgical procedure in which the nurse is actively engaged and whose continued presence through completion is essential to the health and safety of the patient. Nothing in the law shall prohibit a nurse from voluntarily working overtime. Refusal to work beyond the regularly scheduled hours shall not constitute patient abandonment or neglect.
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My facility has a policy on mandation. You can refuse to be mandated (they will then mandate someone else in building) But, you will be given points for it. Attendance is also based on a point system. I think mandation is a good idea in emerg. situations/crisis, but too many employers use this way to frequently due to inadequate staffing levels to begin with.

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If you punch in and have to leave within 30 minutes and tell the supervisor, is that abandonment. No report was given, no information passed from shift to shift. Is that still abandonment?

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Specializes in Geriatrics.

Yes, unless you give report to the Supervisor & she/he takes your floor. Or are you saying if you punch in do not get report/ take the floor. If you have not take report and accepted an assignment then I would think it's not abandonment because you have no patients to abandon.

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no report, no count. Just had to leave, spoke to supervisor who said 'ok'.

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