Patient Abandonment

[Weebee]

So at what point is Patient Abandonment actually abandonment?

Example, if your assignment was 5 patients, you received report on 3, when you realize you would not able to mentally care for the 3 let alone the other 2 you have not yet gotten report on.

Would you be abandoning all 5 or just 3 or none at all

Another words are you considered abandoning your patients.

When you step into the hospital.

When you take report.

When you finish report.

or

When you visit the patient and introduce yourself as their nurse.

[MouseMichelle]

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...?

That's a good question. When I had to run IV's for a while, I didn't really know how to use the machine as the machines I was used to were ones used in home health. So I asked the nurse prior to me to quickly go over it. If it is a feeling of not knowing how to deal with it, then ask for advice or a quick lesson.

Great post

[Popwhizbangz, LPN]

There have been a few times when I feel unable to guarantee safety with new admission(s) forced on me, or with a refused staffing request, and I have made it quite clear 1) that I can't ensure unit safety under those demands, 2) that others have concurred (sometimes a doc if I can find one in time), and 3) that I am documenting such as we speak.

Often helps, risky of course - kicks shins that might kick back.

Sometimes things change positively when you can make the winds of liability and politics shift that way. Make sure you're right AND its clear you're right.

[steelydanfan]

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.

Let's make this clear once and for all. It does not matter if you are taking report, or if the pt. is on the floor or is in ER or wherever. If you are in report, and it is clear to you after 2 or 5 pt. reports that the assignment is too big to handle, you have the right to refuse the assignment. Period, no matter if the supervisor, the CEO or your Aunt Fannie says otherwise. Make it clear to the off going nurse: "I am refusing this assignment, wait a few minutes until the supervisor arrives, please".

If you refuse the pt. who is in the ER, it is NOT abandonment; since you never assumed care in the first place. You would be AMAZED at the hospital supervisors who either don't know, or willfully disregard the law under pressure from higher ups or staffing needs. Your license is NOT a thing to be trifled with, so LEARN your state practice act by heart, and think about how you would defend yourself in a legal action should you disregard it and a pt. be harmed.

[steelydanfan]

There have been a few times when I feel unable to guarantee safety with new admission(s) forced on me, or with a refused staffing request, and I have made it quite clear 1) that I can't ensure unit safety under those demands, 2) that others have concurred (sometimes a doc if I can find one in time), and 3) that I am documenting such as we speak.

Often helps, risky of course - kicks shins that might kick back.

Sometimes things change positively when you can make the winds of liability and politics shift that way. Make sure you're right AND its clear you're right.

"Kick shins that might kick back" - Love it!

Actually, yours would be the last ones they would kick, because YOU know what you are about, know your rights and don't mind standing up for them.

But if they try to fire you for your 'inapropriate" tatoo, or your "excessive sick time"; wave your documentation in thier faces and tell 'em you will see them in court!

[locolorenzo22, BSN, RN]

it is very apt to mention this, in this time of staffing cutbacks/funding issues/and hospitals trying to make us do more with less. I am certainly always staff first, hospital needs second.

The other day a CNA walked off the unit (14 pts, one tech, 3 RNs) after feeling like she wasn't getting any help. may be true, but if you walk off after 8 hrs of a 12 hr shift, you're certainly abandoning...or does it work different for CNAs since they work under RNs, and RNs are capable of taking over said care?