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.

45 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.

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      • June 14, 2019 at 10:43 pm
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        I have to say that in the midst of an acute active shooter situation, each of which is unique, all of which are extremely stressful, you will not be in occupational or professional jeopardy if you do whatever to try to save your life. This might include distancing yourself from a vulnerable patient. Active shooter education in MA hospitals specifically states this. To me, this makes sense. You can’t put workers in double jeopardy, having to worry about losing job or license in the moments when they are worrying about losing their life. It fits perfectly with what some philosopher said during WW2: “Heroism is something that cannot be compelled.” Of course if at all possible under these conditions you try to arrange for continuing care for your patients. But I can imagine that some persons might be so acutely traumatized they simply walk out.

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        • June 15, 2019 at 10:16 am
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          First, let’s hope that active shooter situations don’t become an issue for anyone. Second, you follow your facility’s protocol during ANY dangerous situation, whether it is an active shooter, a fire, a natural disaster, or something else. The last thing anyone in a dangerous situation should be worrying about is what the BON will say afterward. We train, we prepare, and we do the best that we can under the circumstances. No one, least of all the BON, expects you to put yourself in harm’s way.

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          • June 15, 2019 at 8:19 pm
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            Agreed.

  • 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..

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    • January 27, 2019 at 11:46 am
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      This is an employment issue, not a case of abandonment. Can your employer discipline you for not going to the assignment? Yes. Would the BON consider it patient abandonment? Unlikely because it does not fit the legal definition. You have a communication problem with your employer. Your employer expects you, as part of the job requirements, to drive to wherever the assignment is. Supposedly they will either increase your pay to cover the additional time and costs or reimburse you for the mileage. As for whether you can set conditions on the terms of your employment, that is between you and the agency. If you put limitations in writing when you joined the company, and the company accepted those limitations, you might have a legitimate grievance and should talk to an employment attorney if you’ve suffered any negative consequences. Otherwise, you may want to consult a Pennsylvania attorney regarding your rights for an “implied” or “oral” contract. I don’t know Pennsylvania law and cannot advise you as to whether oral limitations are allowed in employment settings. Good luck!

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  • January 19, 2019 at 11:51 pm
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    Im a cna schedule 2/10 is it considered abandonedment if i leave. At 10 before my relieve arrives. And am i obligated to work extra hour .

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    • February 6, 2019 at 4:47 pm
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      You are not an RN so Board of Nursing regulations probably wouldn’t apply to you. However, every healthcare worker has an obligation to continuing caring for their patients until someone else has assumed responsibility. While you may not have a duty under a nurse practice act, you do have one as an employee of the facility. Talk to your supervisor if you have to leave on time for some reason or if this happens frequently. Don’t leave unless someone has agreed to care for your patients.

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      • May 13, 2019 at 8:10 am
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        I’m a CNA. I work 2nd shift at a long term care facility in TN. We’ve had a lot of aids quit on all shifts which has left us short handed. A nurse tells me and my co worker last night that one of us has to stay because their was only one aid that came to work. There are 62 patients on the hall and there was two LPN’s and one aid in my hall. We have 189 beds in the facility. I’m not sure how many other aids where in the building but there were 6 LPN’s and one RN in the building. Our facility isn’t full with residents. My question is, can an aid be made to stay if another aid calls in? Remember, there was two LPNs and one aid on my hall. Company policy doesn’t state that it’s mandatory overtime if call ins happen. I feel like we are being harassed and they are trying to scare us. Please advice. Thank you

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        • May 14, 2019 at 1:27 pm
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          This is an employment law question and it is one I’m hearing more frequently these days. You ask if you can be forced to stay over when another CNA calls in. The short answer is that your employer cannot FORCE you to do anything. Will your employer take action against you if you don’t? Possibly, and that’s something you have to weigh when you are deciding whether to stay or go home. As long as there is no disaster or other emergency where all hands are needed, and as long as there are licensed personnel present, if you respectfully decline to stay over, that’s your call. The facility sounds as though it has problems and is unable to keep a stable staff. This is a separate issue that you may want to think about — whether you want to continue to work there in view of the problems or can you work with administration to find solutions to the problems? If you feel threatened or unsafe, I advise talking to the LTC licensing board in Nashville or to an attorney who has experience in employment law so that you can know your options.

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  • February 5, 2019 at 11:25 am
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    I am a nurse working 8 hour night shifts in a facility on a unit that has 30 patients; I am the only nurse. I usually have two support staff sometimes three. One patient is very challenging to work with because of very poor ADLs related to an ostomy. The patient has a treatment plan in place. The staff on third shift are following the treatment plan checking the appliance regularly and encouraging/assisting with good hygiene practices while I also assist with stoma care/appliance changes. The patient sleeps on night shift unless third shift staff wakes the patient up. According to the patient’s treatment plan, at 0700 (day shift) the patient is to shower, clean room, attend to ADLs. Last night I personally changed the appliance on two separate occasions with the last change occurring at 0530. At 0630 while I was giving report to the incoming nurse and day shift staff, a day shift staffer abruptly came in stating the patient was “completely dirty.” I know that third shift staff is doing their job. I know that at 0530 the patient was clean. Everything is documented. It should be noted that patient also has a history of personally causing the ostomy appliance to malfunction. The incoming nurse is a regular employee who is specifically assigned to this unit. The incoming nurse proceeds to basically tell me that the patient needs to be “clean” and night shift needs to do it before going home. I attempt to explain to the incoming nurse that night shift can’t necessarily prevent the patient from getting dirty just prior to shift change. I explain that night shift is following the treatment plan and at 0530 the patient was clean. I add that no one is trying to “not do their job” and push things off to the next shift. I feel like we do what we can on our shift and whatever cannot get done is passed off to the next shift no matter which shift it is. The incoming nurse then tells me that due to “health” reasons the patient cannot be dirty out on the unit and therefore the incoming nurse will not accept hand-off report from me on this specific patient until the patient is totally cleaned up. The incoming nurse then states that third shift staff should get patient up earlier and showered before day shift arrives (which is not suppose to occur until after third shift leaves according to the treatment plan). The patient’s hygiene/ADL issues are long-standing (years) that the incoming nurse is quite familiar with. Has the incoming nurse abandoned her patient? Employment abandonment? Both? The incoming nurse has accepted the assignment working for this facility on this specific unit but refuses to provide care to this one particular patient for “health reasons” on this particular day until someone else cleans the patient up.

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  • February 6, 2019 at 4:54 pm
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    This definitely sounds like something you should address with the nursing supervisor or director. The on-coming shift may not like that a patient has soiled themselves but they can’t make the departing shift stick around to continue caring for the patient and they don’t have the authority to unilaterally change the care plan. I don’t know whether this would qualify as abandonment per se but she/he is trying to refuse the assignment unless certain conditions of his/her making are met, in effect she/he is trying to hold you over. Most of us have, at some time or another, rounded on patients at the start of a shift and found one who needed cleaning up. You just do it as part of good patient care. Talk with your director and ask how you should handle this.

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  • February 7, 2019 at 1:08 am
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    I am a nurse working through agency at a facility an hour after I got to work a nurse came and said the supervisor wants you to move to pathways which is in a building you have to drive to, we counted I gave her report then I drove to this building the doors were locked and and I didn’t have an employee badge because I am agency, I used my cell phone and called the facility the security guard answered and said he would send someone down I waited for 15mins standing at the door at 12am no one shows so I go back to my car and I call again no one answers so 30mins later I call the agency and tell them what happened and express that I’m going to go home if no one comes to the door, she tells me she will call back and I’m waiting another 10mins after trying to go back to the other doors and then being locked too I leave the facility the agency then calls me back saying the supervisor was going to come let me in by this time I tell her I left as that I quit, I was nervous and kind of scared to be out in a parking lot that late, they say this could be an abandonment, is this true?

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    • February 9, 2019 at 2:16 pm
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      I recommend calling your board of nursing and talking to an advisor there, just to put them on notice about the facility. The facts of this situation are that you started a shift and then were reassigned to another building. You handed over your current patients and duties and spent an hour trying to get access to the building, making phone calls and repeated attempts to find an open door or someone who could let you in. You weren’t assigned to any patients and so this is not patient abandonment. Is it employment abandonment? A good lawyer would say no because you acted in good faith after repeated attempts to comply with directions. While you have an obligation to patients, you also have the right to exercise safety for yourself. It would be different if you’d only knocked once, didn’t call anyone, and left but that’s not what happened. Notify the BON and then talk with the agency and ask them what else you reasonably could have done (spend the night in the parking lot? No.)

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    • May 9, 2019 at 8:08 pm
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      Hello ma’am,
      I am an Occupational Health RN case manager. I work in a plant that gives no support and the management has made this a very hostile work environment. I sought help through EAP, have be one symptomatic with elevated Blood Pressure readings ( I never have been diagnosed with HTN, my normal pressure readings are 100-118/60-70s). I plan to leave immediately without notice, I dont give direct patient care, but do the FMLA, Short-term disability pay, and worker’s compensation. I attend to occupational illnesses and injuries. Can my employer report my not giving notice as patient abandonment?

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      • May 14, 2019 at 1:17 pm
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        Quitting under the circumstances you describe is not abandonment. Is it unprofessional conduct? That’s a different question. Boards tend to shy away from employment matters. If you are worried about any kind of report to the BON, I recommend calling the board and talking with someone there to feel out their take on what constitutes unprofessional conduct. Preserving your health in a hostile work environment sounds like a pretty good reason to leave though.

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  • February 8, 2019 at 3:23 am
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    I reported to a scheduled shift and was told by the charge nurse when entering the unit that I would have to give report to another RN that was called back in to work (she was placed on what’s called a “low census” day until it was determined that “she” was needed) when she arrived around 7:30pm and then I would float to another unit. She started the xo versatile with “I am so sorry”. I voiced my concern with the decision and also my disagreement with it based on the fact that I was the last nurse to float there. She then attempted to verify my statement and followed it by, “well it doesn’t matter because our policy is that the nurse with the least seniority floats twice consecutively within the quarter”. I then expressed the fact that there were two least senior nurses on the unit other than me, and also that I saw my name where I was already assigned to the patients on my unit and someone came in behind her and re-arranged the assignment list (which is often done to cater to the more senior nurses who dislike floating or taking care of certain patients on the unit). I made it clear to my charge nurse at the time that the float was unfair. The nurses who were present had not been oriented to the other unit; however, the patient assignment on the other unit was within the scope of practice and level of care for any and all licensed RNs on our unit to care for. I was once again, being manipulated into taking an unfair assignment based by means of indirect discrimination. I expressed my concerns and also told the charge nurse whom was the most superior professional present at that time, that I was not going to accept the floating assignment. She then said, “the next time write it in this book and once you float for two consecutive days you will no longer have to within this quarter”. So she blatantly ignored my concerns and disagreement. I went on to scrub in on the unit and received report from the nurses for whom patients were assigned to me. After receiving report, I started to care for my assigned patients on my unit until the other nurse arrived from home. The nurse arrived to the unit about 7:40pm. At that time, I gave hand-off report to her on the infant’s I assumed care for. I then washed my hands, grabbed my bag, walked off of my unit, got into my car and went home. So I decided to quit my job not only for this one instance, but repeated instances that led up to this moment. I refused to float and did not give a sufficient notice to my employer, which I agree it’s very unprofessional. However, my supervisor and manager contacted me via phone that night and following day and voiced concerns saying they wanted to make sure I was okay. I refused to respond without legal counsel first. I received a message from my supervisor threatening to report me to the board of nursing for my behavior that night which would “jeopardize my nursing license”. My behavior was polite, non-violent, and professional, as always during the entire discussion with my charge nurse and during hand off report. I have witnesses but aren’t sure they’ll vouch for me given the circumstances and the retaliation they could receive from the facility. I never accepted another assignment, which means I never abandoned my patients. Although, not as professional as I wanted to be I had no intentions of this happening. Is this in any way a violation of the Nurse Practice Act or could I face any problems with the BON in the state of S.C.?

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    • February 12, 2019 at 8:28 pm
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      I’m not licensed in South Carolina and I can’t give you legal advice. I can say that, based on the definition of patient abandonment, your attorney there should be able to successfully argue that this is an employment issue, not a patient abandonment issue. You’ve acknowledged that it wasn’t the most professional way to quit but since you had no assigned patients and had made it clear you weren’t going to float, it comes back to employment concerns. If you haven’t already, I recommend finding an attorney in your state who can advocate for you. If the facility does file a complaint with the BON, they will first have to investigate and should talk to you before deciding whether or not to consider disciplinary action. It won’t happen overnight. If you have your own malpractice policy outside work, call them and see if they can connect you with an attorney who knows how to handle professional board complaints or check with TAANA (The American Association of Nurse Attorneys) to see if they have anyone in your state. Good luck!

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  • February 9, 2019 at 3:21 pm
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    I quit my job after refusing to float to another unit. I did not have a patient assignment nor did I ever pick up the patient assignment on the other unit. I walked out and never returned. My job is turning me into the BON. Can they do this? And, for what violation?

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    • February 12, 2019 at 8:36 pm
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      I’m sorry you’re having this problem. Employers can file complaints with the BON but under the limited circumstances you’ve given, I would doubt the board would take any action. The first thing a board does upon receiving a complaint is to investigate it. You may get a certified letter or a phone call from someone assigned by the board to conduct investigations. The board is concerned about patient safety and the professional appearance of nurses to the public, not employment disputes. Once the investigation report is complete, the board decides whether to pursue disciplinary action and on what grounds. They have to let you know in writing and give you an opportunity to respond. Most boards would kick this back to the employer but it depends on the initial investigation results. You may want to talk with an attorney (preferably an RN/JD) who knows how to handle professional board complaints just so you’ll have someone to call in case the board decides to take the complaint further. (See the answer to the previous post for suggestions on that.) Good luck!

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  • March 10, 2019 at 9:47 pm
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    I work 12 hour night shifts in an assisted living facility in ohio which is currently short staffed and is also in between DON’s at the moment. With other nurses there have been situations where there is no relief and the executive director threatens abandonment if we do not stay to cover the shift. I know that ohio is still in the process of passing a law that prevents forced overtime but do I have any other options to prevent being forced to stay and work? What if I fo not feel safe to work the shift due to night shift fatigue?

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    • March 11, 2019 at 10:52 am
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      You are definitely between a rock and a hard place here. You actually ask about two problems here. The first is whether the director can force you to stay over and complain to the BON about abandonment if you don’t. The second is about being unsafe to work.

      The first thing I recommend that you do is to keep a written log of all information about these situations — what happens, when, who you talked to, what was said (in quotes, if possible), etc. The second thing is to make a couple of phone calls. First, contact your state nurses’ association and talk with someone there about the situation. Even if you are not a member, they can talk with you about the status of any changes in the law, whether Ohio nurses have a “safe harbor” provision, and what they recommend you do. Also ask them if they can recommend any attorneys who have worked with nurses on employment issues.

      Third, call and talk to an attorney who specializes in employment law. At least do an initial consultation — if you aren’t happy or don’t connect with the first one you talk with, try another. You don’t necessarily need to retain the lawyer just yet, but it is helpful to talk with one about your options under Ohio law.

      Last, if you don’t already have your own malpractice insurance policy, get one. STAT. There are several companies that cover nurses — the state nurses’ association can give you names — and the premium is quite reasonable. (See my post on professional liability insurance.) This will give you a safety net and your own lawyer if something happens, either while you’re working or if the director files a BON complaint.

      I wish I had better solutions for you today but these steps are the best you can take right now to protect yourself, your patients, and your license. Good luck!

      Reply
  • April 10, 2019 at 4:59 pm
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    Florida. The hospital system I work for is cracking down on overtime. (which 90 % of us would rather not do anyway). Each of us (including travelers) received a write up last week, with a page attached, showing us our overtime in the last pay period. I had 1.75 hours of overtime in the last 2 weeks. The issue is not in the write up (well it is because it is ridiculous), but in how they want us to handle our hand-off if a co- worker hasn’t shown up within the time limit given. As night shift, we are to have given report/hand- off and be punched out by 7:21 am. Each “violation” of this is a new write up. The hospital actually wrote that we are to write down shift report and hand it to the charge nurse, who would in turn hand it to the oncoming nurse. Or we can give the charge nurse shift report orally. (uum yeah that’s going to happen). We are then to punch out and leave the premises. (BTW.. by the time we know the on coming nurse is late, and we write down or orally give report to the charge nurse, it’s likely after 7:21 am…resulting in overtime.) Is this abandonment if we do this shoddy handoff? It is not what a prudent nurse would do. How can I leave my 7 PCU patients to the charge nurse? What if something happens to the oncoming nurse that she never shows up? What if 2 night shift patient assignment’s oncoming nurses do not show up for some reason?

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    • April 29, 2019 at 10:10 am
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      This is a dangerous safety issue and I strongly recommend you contact both the facility risk manager or attorney and the state BON. You raised some serious questions and I would be checking my personal malpractice insurance coverage to be sure it is up to date. In this situation, if something were to happen, you absolutely could not count on the facility to properly defend you under their policy. They would look out for themselves first, last, and always. If I were the charge nurse, I don’t know how she/he could justify taking on your patients and perhaps others, even for a few minutes, to save the facility a few dollars. I would rather stay and do a direct hand-off and have the facility/system grouse about overtime than to have to explain to a patient, family, or attorney why I acquiesced to this policy. If they fire you, they’ve hurt themselves even more.

      Reply
  • April 20, 2019 at 1:29 pm
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    Hello I am a new recent grad nurse (LPN) I’ve been working for this company for approx 6 months it’s substance abuse. I put my resignation letter that I would be leaving the company. My supervisor (who isn’t a nurse, because we have no DON) tried to talk me out of it. I told her I would think about it. After careful thinking I let her know that I won’t be returning after my last shift the following day. She told me to at least stay until the date I provided for my last day. So the following morning before going into work I noticed on the schedule she had me floating between two units and one of the units I am not fully trained in that unit yet and I have told her repeatedly I need more training but she brushes it off and keeps scheduling me in there. In addition to having me float she was requiring me to work 16 hours that I never agreed to. So I called out and told I will not coming in. She basically threatened me and told me my license is at jeopardy because “she left that unit unattended because she thought I was coming in”. Mind you there was a nurse there waiting for relief. So I told her I never accepted the assignment nor accept keys or even came in to clock in at the job. So she told another employee that she was going to report my license. She also called me unprofessional and told me that I don’t care about my career or saving lives. I just want to know would BON consider this abandonment and do I need to take legal action?

    Reply
    • April 29, 2019 at 10:00 am
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      This is purely an employment issue, not a case of abandonment. You have the right to refuse an assignment and you have a professional obligation to refuse to work where you are not qualified, whether by skills, training or experience. If you accept an assignment, you are held to the standard of care of someone who does have the requisite skills and training. It is a safety issue for patients as well as a professional practice issue. I suspect that if this person called the BON, they told her something along those lines. I suggest calling the BON and talking to them to clarify by your state’s rules. You could also call the licensing board for that type of agency and put them on notice that someone is assigning inexperienced/untrained personnel to units and let them handle it. Good luck!

      Reply
  • April 27, 2019 at 1:29 am
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    Am a nurse, so I went to work in the morning 7am, and after passing my morning meds I got a call from the DON by 10am that I should go to another floor and work, after pass meds to 25 patient. I refuse to take another assignment from her, she asked me to leave, and threatened me she will call BON for job abandonment, I didn’t leave I stay on the floor where I was assign to work….The DON later came with the corps to assist me out of the building, that am terminated. Am a new nurse, and am confuse as to refusing to take extra work load is abandonment. Pls explain to me, thank you.

    Reply
    • April 29, 2019 at 9:53 am
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      I don’t have all of the facts so it is hard to know what was going through your DON’s mind. If I understand you correctly, you started on one unit but were pulled to another, which happens from time to time. One unit may need more help at the moment. Your charge nurse (if you had one) should have reassigned your patients. If you had no charge nurse, you should have had someone else to take over for you. Refusing to take another assignment is not abandonment. It sounds as though your DON went over the top, firing you and escorting you out of the building. I recommend calling both your BON and your state nurses’ association to talk with them about the situation. You won’t get your job back but you will get some clarity and you’ll get the facility on record as one that uses extreme tactics. Good luck!

      Reply
  • May 31, 2019 at 7:17 pm
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    I am a nurse at an inpatient dual diagnosis (mental illness and substance abuse) rehab. We have a men’s side of about 45 patients and a women’s side of the same amount. Then we have a extended stay facility next door with both sexes which hold approx. 45 more patients. Our facility continues to cut back on staff and recently we have had only two nurses to care for the entire facility on night shift. I was working a full 12 hour shift with a nurse who was only scheduled for a few hrs. There was another nurse scheduled to come in to relieve that nurse and finish the pm shift with me . The nurse who was waiting for her coverage had to leave bc she was finished her part of the shift but her coverage didn’t show up( due to an emergency). I was told to count narcotics with that nurse so she was able to leave but I didn’t know if someone was coming to replace her. I told the manager that I didn’t want to count bc I didn’t want to take that assignment due to having a very large assignment already and did not feel like it was safe. I feel like I get put in similar situations a lot and I don’t want to be accused of patient abandonment. Am I in the wrong? Do I have to accept the assignment bc I am the only nurse there? I feel like it’s very unsafe for me to be responsible for that many patients by myself.

    Reply
    • June 5, 2019 at 3:29 pm
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      This is a truly unsafe and untenable position to be in and I’m sorry you are caught in it. If you were to walk out, obviously that would be abandonment. As a practical matter, I’m not sure that refusing the assignment if there is no one else to cover would accomplish anything useful. I don’t know what state you are in but I recommend that you keep a careful diary or log of these situations — what happened, when, who you talked to, the resolution (such as it is), etc. This is for your own protection. If you do not have your own malpractice insurance, you need to get coverage STAT. As long as you work there, if something goes wrong, you can’t expect support from the facility. Next, find out if your facility has a risk manager or quality improvement person. Inform him/her about this situation. Third, find out if your facility gets funds from Medicare. If yes, the facility has to comply with “conditions of participation” which include adequate staffing and safe conditions. Notify CMS or the Joint Commission, or notify your state’s facility licensing board. There are risks to doing this — whistleblowers aren’t loved — but patient safety MUST come first. And, if you haven’t already, consider looking for another job. Decide whether staying is worth the risk to your license and to your patients vs asking (quite reasonably) for safe staffing levels. Good luck!

      Reply
  • June 6, 2019 at 12:27 pm
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    Hi,
    I am a home health nurse, and working full time days which is going well, in CO. I picked up a night shift with a different agency (that I sometimes PRN for, ) a couple weeks ago, and the pt was sleeping at about 4 am I fell asleep on the couch. I got up and checked on my pt an hour later. I fell asleep again. The day nurse came.at 730 and I ran to the pts side immediately, changed diaper etc. Also his GJ tube was pulled on. From kicking on his tubes.it wasnt pulled out and I wanted to fix it by checking the balloon. There was no syringe available to use for this. The day nurse then pulled further on it and pulled it all the way out.
    I left since my shift was over and the day nurse refused to accept report from me. She was on the phone. I called the clinic supervisor to report an issue with the GT
    The next day I was called into the office and told that I was bring reported to the BON. I admit that I was sleeping earlier, but I saw her pull the tube out. I heard that the pt was taken to the ER that morning to replace the GJ tube.
    Anything you want to comment would be appreciated. I have insurance.

    Reply
    • June 6, 2019 at 1:27 pm
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      If the agency says you abandoned the patient, I think you have a good argument that you didn’t. The day nurse might have refused report but by her actions, she assumed responsibility for the patient’s care. Sleeping on the job is a different issue and the BON may investigate but typically this is something between the employer and the nurse, especially in a first time, no prior occurrence situation. The tube is a toss-up — could you have prevented dislocation even if you were standing right there? Maybe. Maybe not. Should the other nurse have pulled it out? I don’t know but having to have the tube re-inserted is not unusual. It is not an issue for the BON. Go ahead and put your insurer on notice about the alleged report to the BON and then, if an investigator contacts you, you’ll know what actions your insurer recommends.

      Reply
  • July 18, 2019 at 12:41 am
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    Arizona. As a “part-time” job I do skilled visits for a home health company. I was going to work 3 times a week and seeing 2 patients . I went to work as I always did. Then I just stopped going to work one week before my wedding. It was to much going on. I was getting married a week later, and was going to be out for a week for that. Then I started a new primary job a week before the wedding, and my schedule was W-Sa, 10+ hours. This took away from seeing my clients on TH/Sa. So, when I came back from the wedding I didn’t go back to work for them. Also, 4 days after getting home from the honeymoon I took in 3 kids on top of my 3 kids to help a friend out during her DCS case. Again I did not think about calling the office to resign once. They waited about a month and a half to tell me to call them and talk. This talk was to fire me and tell me they are going to report me to the BON for patient abandonment. I never was at the house and never walked out during the visit. They were my scheduled clients I would see T/TH/Sa on a regular basis, but then I just stopped going. Can they get me on patient abandonment if I just stopped going to work? They said they have proof of me abandoning them since they have no time sheets showing I was at work. They have no time sheets because I didn’t show up to work. It took them almost 1.5 months to talk to me about it and threatening to report me. I am very scared to have my license taken or have a bad mark on it. I have worked on and off with this company since 2013. They know how I work. I have never done this to them before, but they don’t see that part of me at all. I always worked extra when they needed it. I was the go to person when someone would call off. What do I do?

    Reply
    • July 18, 2019 at 2:58 pm
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      Yes, you should have called in, asked for a leave of absence or resigned but you already know that. To the core issue (Did you abandon your patients?), under the strict sense of the law, you abandoned work. You didn’t get up and walk away from your patient in the middle of a visit. From the employer’s perspective, they had no idea what you were doing, whether you were coming back, or if something happened to you. They should have called, but whether they did or not, they still had to find other nurses to care for your regular patients. What I suspect will happen, if they report you to the BON, is that someone from the board will investigate. They may or may not contact you in the process. Although to an attorney, this is clearly an employment matter, not a case of patient abandonment, that doesn’t mean the board will close the investigation with no action. They might have an informal hearing and they could reprimand you. Is this bad enough to revoke your license? Based on what I’ve heard about BON actions around the country, I doubt it. However, I do recommend that you contact your malpractice insurance carrier and let them know. If you don’t have your own policy, you should find an attorney in your state who has experience helping professionals defend their licenses (contact your state nurses’ association or The American Association of Nurse Attorneys for starters) and talk with that person. You’ll have to pay a consulting fee but you should NOT go to any hearing or sign any paperwork from the board without first talking to an attorney. As any attorney will tell you, your prior work history is one factor that may or may not work in your favor. Offering excuses doesn’t help — put yourself in your supervisor’s position. What would you think of a nurse who did what you did? Is this the behavior of someone who is an accountable, responsible professional? Focus on behaviors you would expect from a nurse caring for you or someone close to you. Own what you did, talk with an attorney, and use this experience to improve your professionalism and you’ll go a long way toward avoiding future problems.

      Reply
  • August 3, 2019 at 7:00 pm
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    I am a nurse i work in a facility where the DON is a past State Surveyor. I was assisgned to do treatments for that shift. I completed my treatments and i quit without notice. I notified the RN supervisor that was working also. Now the DON says she is going to report me to the BON for abandoment when there was adequate staff and nurses in the facility and my work was done. I was scheduled for a double shift never accepted report from the nurse going off shift i left 1 hour before shift change. Its a very hostile and i did not abandon any patient.

    Reply
    • August 4, 2019 at 2:10 pm
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      The question the BON will ask is, Did you leave your patients in the middle of an assignment with no handoff and no care? If the answer is no, you didn’t abandon them. Going back to my post, there is a difference between patient abandonment and employment issues. Compare these scenarios: (1) A nurse has been at work for several hours and decides she/he has reached a limit and that quitting is the only option. The nurse signs off charts, gathers up his things and leaves without telling anyone. He emails his resignation “effective immediately.” (2) A nurse works 7 of 8 assigned hours and finds out that she is now scheduled to work another 8 hours after this shift. No one asked her. The nursing office just called and said “you’re staying over.” The nurse has completed all care for her assigned patients and is charting, getting report ready. She tells her supervisor that she’s had enough and is quitting, effective immediately. She gives report to the supervisor, doesn’t stay to the end of the shift, turns in her badge and leaves. (3) Same as #2 except that the nurse stays for the last hour, notifying the supervisor that she’s quitting as of the end of this shift. She gives report, refuses to accept the next assignment and leaves.
      Most authorities would agree that scenario 1 is abandonment while scenario 3 is strictly an employment issue. Scenario 2 teeters right on the edge. As long as the nurse notified the chain of command, reported off, and didn’t leave patients without anyone to care for them, most authorities would view it similar to a nurse becoming ill or having an emergency that required her to leave early. No notice, no handoff, patients unattended, no one aware the nurse has left would equal abandonment.
      I recommend notifying your professional liablity insurance carrier and keeping careful documentation about what happened, when it happened, who you talked with and all the other important details. If the BON does notify you of a complaint, be sure to talk with a lawyer in your state who is knowledgeable about professional license boards and disciplinary actions. Do not try to handle the matter yourself.

      Reply

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