Protect patients, yourself from ‘abandonment’
Don’t be bullied by false threats


By KATRINA HOWARD, RN
Patient abandonment is a term often used by management when staffing is short to intimidate nurses into working mandatory overtime or temporarily working in an area outside their area of expertise to ensure adequate staffing.

Beyond its negative effect on nurses, mandatory overtime may erode the quality of patient care.

The Institute of Medicine, the foremost authority on patient safety practices, stated in a report released November 4, “to improve patient safety, nurses need to work shorter hours and at better staffed health care facilities.”

Follow BORN guidelines
To address the abuse of mandatory OT and to give nurses guidance on how to protect their licenses and their patients, the state Education Department and Board of Registered Nursing (BORN) issued a memo to clarify what may be characterized as patient abandonment.

For patient abandonment to occur, the nurse must:
• have first accepted the patient assignment, thus establishing a nurse-patient relationship, and then;

• have disengaged that nurse-patient relationship without giving reasonable notice and without giving a report to another qualified person (supervisor, nurse, etc) so that arrangements could be made for continuation of nursing care.

A nurse-patient relationship begins when you accept responsibility for providing nursing care based upon a written or oral report of patient needs. The relationship ends when you transfer responsibility to another nurse and give that nurse a patient report.

Examples of abandonment include:
• accepting a patient care assignment then leaving the worksite without notifying appropriate personnel and giving adequate notice;

• leaving without giving a report to a qualified person; and

• inattention to or leaving a patient in acute distress, without notifying the supervisor and without making appropriate arrangements for continuing care.

Failure to work beyond your scheduled shift does not constitute patient abandonment, nor does refusal to work in an unfamiliar, specialized or “high tech” area when you lack competence due to lack of experience and/or orientation.

If you arrive at work and believe the unit is understaffed, you must immediately notify the supervisor and request assistance.

Your responsibilities
Certain activities must be carried out, regardless of staffing. These include: accurately administering medications; protecting clients who are at risk for harming themselves; monitoring a client’s response to medical and nursing interventions; notifying the physician of a deterioration or change in patient status; and, accurate documentation of patient care that has been delivered.

You are accountable for the nursing assignments you accept and the care you provide.

Before accepting any nursing responsibility, you must have the knowledge and skill to safely perform the task.

You must be able to recognize when the ability to safely provide care is compromised and you are responsible for reporting this to your supervisor.

The state’s responsibilities
State agencies and health care facilities are responsible for providing and maintaining adequate licensed staff to care for the patients they accept.

The nurse manager/supervisor is accountable for assessing the capabilities of personnel in relation to client needs. It is the manager’s responsibility to make judgments about situational factors which influence the nurse’s capability to deliver safe nursing care.

It is inappropriate for management to threaten you with charges of abandonment to coerce you into working additional hours or caring for patients beyond your level of expertise.

Your manager should be aware he or she may be subject to disciplinary action by BORN for assigning patient care responsibilities to you, when the manager knows that such an assignment may be affected by your competency and compromise the safe delivery of care.

Protect your license, patient
Patient abandonment can lead to charges of unprofessional conduct which, under the state Nurse Practice Act, is subject to disciplinary action up to and including removal of your license.

If you follow the BORN guidance statement, you will not be considered to have abandoned your patient for purposes of BORN disciplinary action.

However, BORN has no jurisdiction over employment and contract issues, and you may be subject to discipline by your employer if you refuse an assignment. Nevertheless, you don’t have to accept it without question.

Document unsafe staffing situations by filing a formal protest of assignment (POA).

It is imperative that you fill out and submit the POA form, because if your employer files an abandonment complaint against you, SED/BORN can only review actual objections or protests that have been put on the record.

The POA also establishes shared responsibility with health care facilities if there is an adverse event. It is an undeniable record of unsafe or potentially unsafe assignments and is evidence that concerns were brought to management’s attention.

Get copies of the new PEF
protest-of-assignment forms from your PEF regional office or PEF’s nurse organizer, or go to www.PEF.org and click on RN

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