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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