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.