pt abandonment question

Chin up · Mar 27, 2011

According to your linked document, you did nothing wrong with the board, the facility probably won't call you back though. I was surprised to learn, sleeping on the job was abandonment. Wow. Anyway, If you did not accept the assignment, how could you abandon it? We also have rights to refuse unsafe assignments. Good luck.

Chin up · Mar 27, 2011

Continuation of patient care...that is the key phrase. You never started, relax. Peace!

highlandlass1592, BSN, RN · Mar 27, 2011

Most states I've worked in, once you take report you have then accepted responsibility for the patients. I have, in the past, refused to take report in an unsafe situation. Don't sweat it but do realize you may be DNR'd from that facility. But honestly, with all the calls I'm getting recently for agency shifts, it shouldn't be too big a problem.

BrookeeLou_RN · Mar 27, 2011

I agree not taking over the patient load should protect you. I had to do this once in LTC. I was supervisor but had 2 call ins so no RN and they wanted me to handle 2 units for 30 each plus a locked Alzheimers unit with 20. I said no unsafe, 7-3 nurse left, threw keys at me.. I called DON , she was in a meeting so called ADON (I felt bad as we were friends but I said I would not do this assignment..) offered to stay and split it with her but DON called back and fired me. I thought ADON was foolish for accepting it, later found out she just did what she could and kept doors locked to locked unit.. Families were very angry. I went in next day to speak to DON and Administrator.. Administrator agreed it was no safe but she upheld DON's decision to fire me.. Frankly she did not care for me and I did not fit in. ADON eventually left and went on to become NP with my encouragement.. DON was fired 2 months later as the corporation finally got one complaint too many.. She had started a CNA there and worked her way up, had ASN..refused to get BSN. ADON had BSN and was not liked or trusted either.

They fought my unemployment but I won. And I found out many years later, I am Rehireable! I was told record says there were management problems.

nurse2033, MSN, RN · Mar 27, 2011

Kudos for taking a stand!

eriksoln, BSN, RN · Mar 27, 2011

There is an exercise they do at management training sessions:

Scene: People sitting at a round table with an instructor at a podium, each seat has a paper bag and a telephone with the numbers out of order (4 where one should be, 9 where # sign goes etc, completely random).

"Everyone, put the bag in front of you over your heads."

Everyone does so, unable to see now.

"Now, I want you to dial your home phone number on the phone in front of you."

At this point, most people take the bag off their head and do so. Why? The instructor never said you could not nor was there any other reason to believe you could not. No one said "Put the bag on your head for the remainder of the class" or anything. Sometimes, there is one person who can't finish the exercise because they don't take the bag off their head, can't see where the numbers are on the phone in front of them.

The point of the exercise is to avoid "Self imposed limitations". The "rule" or belief that you can not take the bag off your head is "self imposed".

I think self imposed limitations and fear keep many from taking the stand you did. You hear many different variations on what is acceptable and what is not when refusing an assignment. The "trump card" is the nurse practice act for your specific state..................not what your co-workers do, not what management tells you, not anything else. Be familiar with your nurse practice act.

I refused to go to a unit once when I was a travel nurse. I was experienced in M/S only at the time. They wanted me to float to a tele unit. That was fine. Got there, and saw I had the largest assignment...........all of which were monitored..........and they were complicated tele patients (not people with NSR going on or people with stable A-fib, it was people on drips etc). I refused the assignment..............left the unit, made it clear to the supervisor I was not returning if I was given a pt. on a drip.

My co-workers on my M/S unit where in shock and walked around in awe over it all. "Oh my, you can't do that............this is BIG MAN, really big" :rolleyes:

Nothing came of it, and I reported the incident to my company. Turns out there actually was a nurse with tele experience they could have pulled there but she didn't want to and told them to float there..........so the unit didn't even go without help..........and instead they got the right help. The "clinician" of my company actually was very happy with me. I had stayed within the nurse practice act and did the right thing in her mind.

Point is, my co-workers at the time had a lot of "self imposed" limitations that kept them from refusing assignments they were not qualified for nor safe accepting. Don't be like that.

hope3456, ASN, RN · Mar 27, 2011

Just this AM (I worked NOCS shift last night in a LTC) one of the day nurses called in 45min before her shift and did not even give a reason why. I called the ADON as the DON is out of town at a conference and she told me to call around for a replacement. I found someone to come in at 10am. So I cant leave until then or it would have been patient abandonment. I started AM med pass but was extremely tired. In retrospect I wasn't safe working. Maybe i just shouldn't have passed the meds. then this irate family member starts in on me about his mothers oxygen not being on and some other crap. I probably was rude to him but I was extremely tired and felt like i was going to pass out. He looks at my nametag and writes my name down so i'm sure he will report me so I'll have all that to deal with when DON gets back. I shouldn't have been there in the first place. I should have been more confrontational with the ADON to come in but she lives 45 min away. Lesson learned but it seems you are dammed if u do dammed if u don't.

The nurse practice act is way to vague - almost pointless IMHO. I like how they make all these rules but then list all these other things that they *wont* deal with as it is an 'employment' issue but they are so intertwined. You can get fired for following the nurse practice act....hmmmmm

hope3456, ASN, RN · Mar 27, 2011

Okay i just reread the 'pt abandonment criteria' .....what if YOU the RN are hurt on the job or have an emergency of your own? What if you had a MI or CVA while working and were not able to give adequate report to the next oncoming nurse? could you lose your license for patient abandonment??

And what constitutes 'sleeping on the job?' I admit to getting tired and 'closing my eyes' for a short period of time....esp when called in for night shift and not being able to sleep before coming to work. What if u go take a power nap during a break? what if you accidentally fall asleep b/c you are sleep deprived while working overtime b/c there just simply is noone else???? In a recent nsg journal they were encouraging nurses to take 'power naps' as they reduce the # of errors d/t fatigue. WTH?

Ruthfarmer · Mar 27, 2011

Here's a link to the MO BON Abandonment Criteria
http://pr.mo.gov/boards/nursing/positionstatements/Patient%20Abandonment.pdf
I'm an agency nurse, showed up for my shift read my assignments on their sheet, and quickly ran through the H&P's... assignment was DANGEROUS and I wasn't about to lose my license for some extra money (felt unsafe practicing). I tried to find the charge... she didn't show up in 10 min... start time was approaching... nurse was pressuring me to start report... so I left. Called my agency, they couldn't get a hold of the charge either. They asked if I would take a reduced load. I said did the charge say I could? She said no, she wants you to come talk to her. I said no, they are going to try to force me to take report I want her to confirm via telephone first that they will reduce my load. She said they wouldn't do that. So I said I was leaving. I let my agency know I didn't feel safe working there and that I hadn't accepted report.
So what constitutes "establishing the nurse/pt relationship" is it accepting my shift... taking report....or what?
I hate the word "reasonable" .... did I give "reasonable notice" given the situation?
I think I'm ok but I just want some reassurance.

NEVER NEVER NEVER accept an unsafe assignment. Don't jeopardize your patients or yourself. If you haven't accepted report you can't abandon. Be true to yourself and your integrity. Do not compromise your integrity. It may cost you a job, but you will sleep better at night knowing that you did the right thing and that you didn't jeopardize a patient's safety. NURSES must realize it is up to them to insure patient safety. Management will push and pull and stretch nurses as thin as they please. It is high time for Nurse to realize that they have power and use it to insure patient safety.

Isabelle49 · Mar 27, 2011

You did the right thing to refuse the assignment. I was once pulled to a telemetry floor, nicu was my specialty. I told the charge nurse that I had no experience in cardiac care and cardiac monitors, she told me not to worry about it, I didn't need to know that stuff! I called the house supervisor and told her I couldn't work on that unit, if they tried to make me work there, I would tell the patients and families that I had no experience in the area of cardiac care. I was sent back to nicu. Never, ever, ever back down for what you know to be prudent!

becca001 · Mar 27, 2011

And what constitutes 'sleeping on the job?' I admit to getting tired and 'closing my eyes' for a short period of time....esp when called in for night shift and not being able to sleep before coming to work. What if u go take a power nap during a break? what if you accidentally fall asleep b/c you are sleep deprived while working overtime b/c there just simply is noone else???? In a recent nsg journal they were encouraging nurses to take 'power naps' as they reduce the # of errors d/t fatigue. WTH?

First, check with your BON to see if they have the same criteria. Your BON may further define sleeping on the job. Secondly, just off hand, I would say 'closing your eyes' for a short period of time is going to be considered sleeping on the job if you are supervising patients at the time. You and only you are responsible for being alert and able to do the job you've accepted with the patient load you took report for . If your facility will allow you to take a break, go into a break room and power nap for 15-30 minutes, then great but I would definitely check the policy on that and never, but never, count on that getting to happen. In other words, don't go to work expecting to get to sleep. Our main concern is patient care and safety. If you are not safe to work, then don't go to work. Trust me, I'm not going to have any sympathy for your sleep deprivation if my loved one dies because you were 'closing your eyes for a short period of time'. :twocents: