Abandonment: What It Is And Is Not

Over the years I have seen and heard many nurse leaders threaten to report nurses for patient abandonment. State boards of nursing report receiving a lot of abandonment complaints each year, many of which are not true abandonment cases. There are probably several reasons why this issue comes up as much as it does. The fact that boards reject a significant number of complaints suggests there is confusion about what constitutes patient abandonment. In this post, I will tell you what it is — and what it isn’t – in the professional context.

The average person intuitively thinks of abandonment as leaving with no intention of returning and no intention of fulfilling obligations. Medical and legal definitions refer to a doctor abandoning a patient as: “unilateral severance” or “negligent termination” of a professional relationship with a patient without notice, the patient’s consent, or providing a competent replacement, while the patient still needs care. The military concept of desertion is analogous, where someone leaves their duty station without permission or just cause, possibly putting others in danger.

Those boards of nursing that have issued a position or opinion statement on abandonment have adopted almost identical language. For a situation to constitute patient abandonment, two things must have happened: 1) the nurse must have accepted the assignment, which establishes a nurse-patient relationship, and 2) severed the relationship without notice to an appropriate person (supervisor, manager, etc.) so that another nurse can continue to provide care to the patient(s).

The issue that boards of nursing run into is the distinction between patient abandonment and employment abandonment.  Many complaints (and threats to report) are employment issues. These are distinct from unprofessional or unsafe conduct while caring for patients.

Both the nurse leader and the caregiver have legal duties in this area. Nurses caring for patients have a duty to provide safe, knowledgeable, competent, skilled care. They also have a duty to delegate care tasks to appropriate personnel. Bottom line: once a nurse accepts an assignment or agrees to care for a patient, he or she must complete the assignment or finish the care with a safe and competent handoff, unless there are extraordinary circumstances (think caregiver’s sudden illness, a natural disaster, active shooter.)

Nurse leaders also have legal duties. First, a leader has the duty to assess and know the capabilities of each of the staff members who are available to assume duties in that area, particularly as those capabilities relate to the needs of each patient. Leaders have a duty to appropriately assign staff members so that each patient has necessary care provided by a competent and skilled caregiver. Leaders also have an obligation, when considering staff assignments and delegation of duties, to evaluate factors such as fatigue, lack of orientation to the unit, the level of knowledge or experience a nurse has, and any other factors that affect a nurse’s ability to provide safe care.

Boards of nursing can investigate and discipline both nurses and leaders who breach these duties. Nurses who accept an assignment knowing they lack competency or that the assignment is beyond their scope of practice put patients at risk. Leaders who know (or reasonably should know) that an assignment is improper can also be disciplined. If, in a worst-case scenario, a patient is harmed, the caregiver, leader and facility could be sued for negligent supervision or delegation of duties, among other claims. The standard is always to provide safe, knowledgeable and skilled care by the best available staff.

What is patient abandonment and what isn’t? Here are the most common behaviors cited as abandonment by boards of nursing followed by those that are not.

Examples of abandonment:

  • Accepting the assignment and then leaving the unit without notifying a qualified person
  • Leaving without reporting to the on-coming shift
  • Leaving patients without any licensed supervision (especially at a long- term care facility with no licensed person coming on duty)
  • Sleeping on duty
  • Going off the unit without notifying a qualified person and arranging coverage of your patients
  • Leaving in an emergency situation
  • Overlooking or failing to report abuse or neglect
  • Giving care while impaired
  • Giving incompetent care
  • Delegating care to an unqualified caregiver
  • Failure to perform assigned responsibilities

The following behaviors are not patient abandonment but they are employment issues which can lead to facility or organization action, even though the board of nursing refuses to get involved:

  • Failing to call in, not showing up, or arriving late for a shift
  • Refusing an assignment for religious, cultural, legal or ethical reasons
  • Refusing to work in an unsafe situation
  • Refusing to give care that may harm the patient
  • Refusing to delegate patient care to an unsafe caregiver
  • Refusing to work mandatory overtime
  • Not returning from a leave of absence
  • Ending employment without sufficient notice for the employer to find a replacement
  • Refusing to work all remaining scheduled shifts after resigning
  • Refusing to work in an unfamiliar, specialized, or other type of area when you have had no orientation, education or experience in the area – such as refusing to float to an unfamiliar unit
  • Refusing to come in and cover a shift
  • Giving notice and working only part of the remaining time

Leaders: know the difference between patient abandonment and an employment issue. Listen and respect your staff members when they voice concerns. Know your staff members and delegate appropriately. Insist on qualified help when needed. Try to work with both your senior leadership and your staff members as much as possible and document the situation.

Nurses: know the difference between patient abandonment and an employment issue. Do not accept an assignment that you are unqualified to handle, whether it is because you are exhausted or haven’t been oriented or educated to the area. Once you accept an assignment, you have a duty to provide safe, competent care until you properly hand off care to another licensed provider. Ask for help. Document carefully. Be objective and professional when you decline an assignment. You do not have to give detailed reasons for refusing but you should understand what you can and cannot do.

BJ Strickland

Beth J. (“BJ”) Strickland is from Tennessee. She is an RN with Bachelor’s and Master’s degrees in nursing and a Master’s degree in history from Vanderbilt University. She is also a licensed attorney with her Juris Doctor degree from the University of Tennessee. She has practiced nursing since 1976 and has experience in clinical nursing, administration and teaching in several clinical areas. She has practiced law in state and federal courts in Tennessee since 1996 with an interest in healthcare risk management, employment law and medical malpractice. She retired from the U.S. Army in 2015 as a Lieutenant Colonel. This article is not legal advice. It is offered only as information about nursing topics of interest. If you have legal questions, please speak with a licensed attorney in your area. Neither the author or the website publisher are responsible for any actions a reader may take based on material in this article or on this website.

11 thoughts on “Abandonment: What It Is And Is Not

  • July 4, 2018 at 7:56 pm
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    I work for a company called Action Urgent care. It functions as a minute clinic, where there is only on person on site- the LVN. Who manage every aspect it takes to run the clinic and the doctors are over video chat. This company is very poorly managed. The make and change the nurses schedules without notice. They do not uphold the contracts they’ve promised at hire, with bonus pay. It’s extremely any help with anything because you never see a single coworker in person. So one day I came in to work and found they hired a new person and gave her my shift without notice. They gave her the only two I work out of that week and said I would continue working next week. I got fed and quit that day that I was not working. Is this abandonment? My supervisor is threatening to report this.

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    • January 4, 2019 at 4:36 pm
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      I just found your comment. It sounds as though you were in a horrible position. The short answer is that quitting when you aren’t working is not abandonment. Supervisors love to threaten when they are faced with a position to fill but, as my article said, state boards and the ANA specifically define abandonment as having taken responsibility for a patient and then leaving without arranging coverage/care or giving notice to the person in charge. I hope this helps and that you didn’t get flack from the board.

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  • July 15, 2018 at 2:08 pm
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    Hello there, I’ve been a nurse for 7 years now. Just recently I quit a correctional job without giving a notice. I went to work one morning, went to my post, seen what a mess it was, things that were left over from the day shift before me and I knew there was not enough time on my shift to complete everything I normally do plus the extra work that was leftover so I just left. There were two nurses there from night shift still charting their medications they gave all while complaining about what a night they had. I never took report from the night shift nurses, I did not take the keys to the medication cart, nor did I count the medication cart (such as narcotics, sharps, etc.). Now this facility said they were going to report me to the BON for abandonment. At first my agency said the facility was going to report me for “insubordination” but now they’re using the word “abandonment.” I know it was wrong on my part to just leave without talking to a supervisor first but I was overwhelmed and felt unsafe within my scope of practice to stay in that situation. I just think that it is very unfair that they are calling it abandonment. There were plenty of qualified professionals there to care for the offenders and I did not jeopardize the safety of anyone. Please provide any feedback anyone has. Thank you.

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    • January 4, 2019 at 4:45 pm
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      I just found your comment and apologize for not answering sooner. Based on what you said here, I think your board would likely reprimand you but I would hope they didn’t do anything more. Yes, talking with a supervisor first is important. While only Texas has what is called a “safe harbor provision” that allows nurses to formally protest an unsafe assignment, ANY nurse can and should notify the chain of command that they are not comfortable with the assignment because it is unsafe, jeopardizes patients and could jeopardize your license. It is up to the supervisor to then do whatever s/he can to remedy the situation. Document everything including the circumstances, who you told, what was said, etc. Quitting before taking the assignment is not abandonment by legal definition, but it doesn’t reflect well on you as a professional. On the other hand, if you had suddenly become ill or had a personal emergency and had to leave, they couldn’t call that abandonment either.

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  • July 24, 2018 at 8:37 am
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    I am a hospice nurse in Florida. I gave my 2wk notice. I had 3 days of my notice left to work. I am throughly disgusted with my department. We are responsible to drive anywhere in the county the schedulers want to send us. There is alot of clicks for which I refuse to be a part of and favortism. For the last 3 shifts Ive worked they had me go 225miles round trip for all 3 shifts when there were shifts much closer to my home. So this morning I got cancelled at quarter till 6 because my patient passed away during the night and at 7:15 the rude scheduler called me and told me she had a case for me to open which was 38 miles one way. I told her no I’m not going I’m done driving and I quit. I did not go to the patient’s house or accept the assignment or start working with the patient this was all on the phone when I found out on the computer where the patient lived I called back and told her no I’m not going I’m tired of driving and I quit. Now the manager is accusing me of job abandoment and states”I will be checking for other consequences. What consequences..I quit. I didnt work out my 2 weeks and I was not with a patient and walked out on them. Besides not being rehired at this company in the future, what other consequences would there be? Florida is an at will state.

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    • January 4, 2019 at 4:51 pm
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      I just found your comment and apologize for not answering sooner. Florida follows the definition of abandonment that other states use. If you haven’t accepted an assignment and aren’t already caring for a patient, you haven’t abandoned them. You were nearing the end of your 2-week notice period. Was it professional to quit sooner? Maybe not. Did you abandon the patient? No. Be careful about how you paint your experiences with the company and why you left when you interview with others but if I were on the BON and saw this, I wouldn’t call it abandonment, especially when there were other nurses in the vicinity to handle the case.

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  • October 16, 2018 at 9:54 am
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    Leaving in an emergency – such as an active shooter, or a hurricane hitting the hospital, is not abandonment. If you’re preserving your life you are not guilty of abandonment.

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    • January 4, 2019 at 4:57 pm
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      I’m going to disagree with you on this one. Assuming you are working your shift and have been caring for your patients, you have to follow hospital procedures. In an active shooter situation, you are not abandoning the patient when you take cover, barricade doors, etc. You ARE abandoning them if you leave the hospital, don’t tell anyone, and don’t arrange continuing care for your patients.

      In a hurricane, the hospital will have an evacuation procedure and all staff members, including nurses, are needed to carry it out. Again, leaving the hospital without ensuring that your patients are cared for and safe is definitely abandonment.

      If you have some specific circumstances that make the situation different, I’d still refer you to your hospital’s procedures and tell you talk to your supervisor — go up the chain of command if you have to — but don’t just leave.

      Reply
  • December 3, 2018 at 5:57 pm
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    Worked for nurse finders , showed up to a job after sitting for nearly an hr the nurse gave me a crappy report , never showed me where the AED was , asked me to sign a packet stating i was oriented to the facility , I said I have to get something in my car , called nurse finders and told them it was unsafe and I wouldn’t risk my license . I never took count . A month later They have reported me to the Bon in ma . Should I be worried ? I never took the keys and I called the agency right away , they told me I had to go back or I would lose my license . I refused .

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  • January 4, 2019 at 5:06 pm
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    Just now seeing your question. Be sure you document everything about the situation, who you talked to, when, who said what, etc. In the future, if you are faced with an unsafe assignment, make an official report up the chain (as you did), tell them it is against state and national nursing standards of practice to accept an unsafe assignment and that you will file a written statement with the BON. Ask them what they can do to help make the situation safer now and in the future. Be polite, but be firm. Don’t argue back. Just keep asking what can they do to make the situation safer right now?

    In this case, based on what you’ve reported here, you didn’t take the assignment so you didn’t meet the legal definition of abandonment. While a board might frown on you quitting at the start of the shift, as long as you can show unsafe conditions, you should be fine. Contact your malpractice insurance carrier for legal support if the board does issue a complaint.

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  • January 10, 2019 at 8:27 pm
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    Hello, I was working for an in home care agency, in PA as a caregiver. They wanted me to travel over 40 miles to my new client. Compared to the client I had a two weeks before that lived 5 mins away from me. They knew I didn’t want to drive that far, as it wasn’t worth my pay. However, this was my first shift with this client. & there was someone there to train me anyways. So, the patient wasn’t alone & I do have record of them saying it was a training day at the clients house, & so & so was waiting for me.. but now they are bringing up abandonment. Cause I was a no call/no show bc they knew I didn’t want to travel the distance.. but kept saying there will be a shift increase due to the distance. I don’t believe this is abandonment just bc there was still a caregiver there with the consumer..

    Reply

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