Patient Abandonment

iluvivt, BSN, RN · Mar 5, 2011

You need to check the position statement at the Board of Registered Nurses in your state. Most will say that you are not abandoning the patient until you ACCEPT the assignment. How can you know that your assignment is safe and doable until you finish report. I am certain that if came onto a Med-Surg until day shift and you had 15 pts all to yourself you may even need report to see this was unsafe. So if you get report and then realize that this is unsafe.....report it to your immediate supervisor that you can not and will not accept the assignment as is. See if you can work out an assignment that is acceptable and safe. Anytime you report this to a supervisor they too are responsible under the law. If this happens to you DO NOT see any patient b/c was you have done then is accept to take are of them. I am sorry to say most managers do not understand what their board says about this or how to apply it in clinical practice. So say you accept the assignment and it becomes unsafe or unbearable you should always professionally report that to your immediate supervisor ..then keep some kind of personal documentation that you did so. Do NOT Do that in the patient's chart though. If you ever become ill during a shift you need to do the same thing..report it to your supervisor and follow the policies of your place of employment. If you do become ill and must leave this is not abandoning your patients.

GHGoonette, BSN, RN · Mar 5, 2011

iluvit is absolutely correct. It's like when you are asked to do something and you do not feel competent to do it. Better to state immediately that this is beyond your capabilities, because if you accept the task you are potentially endangering your patient.

merlee · Mar 5, 2011

I once worked on a 12 bed stepdown unit, and there were 3 nurses and 2 CNA's. I always felt overwhelmed.

So, one day, when I had only 3 patients, and was scheduled to work 8 hrs instead of 12, I was asked to work the rest of the shift. I said I would but only on the terms that I not get another patient, and if they did assign me another pt, I would leave at the end of my 8 hours.

It gets more complex, one of the other nurse made a snide remark to me, and I defended my stance so that she understood it.

It was only a few weeks later when they added a 4th nurse to our unit permanently.

Sometimes we need to make our priorities known LOUD and CLEAR.

And not accept report if it is way too much. You cannot abandon patients that you do not know.

Best wishes!

Whispera, MSN, RN · Mar 5, 2011

Here's another aspect to it. I've worked as the only staff person. Suddenly there are problems with the patients who are there, who I've accepted as my patients, AND there are people who are in the ER who need to be admitted, and I'm the only place they can go, but to have them come to me would mean I couldn't care for them or the other patients as they need. This has happened to me more than once. I've voiced my opinion. I've been told I take them and deal with it or face abandonment charges. I've felt I had absolutely no choice and it was a really bad situation. Everyone was stuck between a rock and a hard spot, especially the patients.

Orange Tree · Mar 5, 2011

Here's another aspect to it. I've worked as the only staff person. Suddenly there are problems with the patients who are there, who I've accepted as my patients, AND there are people who are in the ER who need to be admitted, and I'm the only place they can go, but to have them come to me would mean I couldn't care for them or the other patients as they need. This has happened to me more than once. I've voiced my opinion. I've been told I take them and deal with it or face abandonment charges. I've felt I had absolutely no choice and it was a really bad situation. Everyone was stuck between a rock and a hard spot, especially the patients.

They are treating you like a fool. You won't do any patients any good if you lose your license. :twocents:

Whispera, MSN, RN · Mar 5, 2011

I don't work there anymore.

MouseMichelle · Mar 5, 2011

Check with the board of registered nursing in your state. I've always believed once you've accepted the assignment then you're obligated and cannot abandon. I do remember a nurse way in the day while I was at SN school say that you are not abandoning if you do not accept the assignment.

elkpark · Mar 5, 2011

I agree that your best bet is to question your BON directly about how they define abandonment. Years ago, I worked in a psych setting where the staffing issues were so serious that we, the nurses, were truly, seriously worried about whether we were endangering our licenses and what steps we could legally take to protect ourselves. We contacted our BON and they were v. helpful about advising us about how "abandonment" is defined in our state, and what specific steps we would need to take to refuse an assignment without leaving ourselves open to charges of abandonment. It never came down to that -- I found other employment, and the hospital actually closed down (permanently) several months later.

Keep in mind that, if a situation ever comes to refusing an assignment, you can do it while protecting your license but it's safe to assume that your employer will fire you. There isn't really any way around that.

teeniebert, LPN · Mar 5, 2011

At my last employer (LTC) the policy was that when you accept the keys for the narc drawer, you are accepting the assignment. I always like to get report before counting the narcs, that way the keys are not in my hand until I know what I'm getting into. Technically, if someone came in and said, 'hey, can I borrow the keys for a minute to put my purse in the med room?' the offgoing nurse could say the incoming nurse accepted the keys and therefore the assignment...

mskate · Mar 5, 2011

One thing I am wondering about is how you said (and emphasized) being *mentally* unable to handle it. I'm not sure what that means to you... Generally, refusing to accept an assignment is based on things like "I don't feel comfortable with so many patients of such a high acuity." "I'm not trained on a particular device that a patient in my assignment has." "Mr. X's family fired me from the room, so I can't take this patient." When you say you "mentally" cannot handle it - is it because you are feeling overwhelmed, or...?

MouseMichelle · Mar 5, 2011

At my last employer (LTC) the policy was that when you accept the keys for the narc drawer, you are accepting the assignment. I always like to get report before counting the narcs, that way the keys are not in my hand until I know what I'm getting into. Technically, if someone came in and said, 'hey, can I borrow the keys for a minute to put my purse in the med room?' the offgoing nurse could say the incoming nurse accepted the keys and therefore the assignment...

Yes that's how it works in LTC, they accept the keys they accept the shift.