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Do not sleep on the job without permission

Patient abandonment is grounds for nursing license discipline.  In general, a nurse knows it is mandatory to finish a shift.  This includes giving a report to the incoming nurse.  Leaving assigned patients during a care period without arranging continued nursing care, is a clear form of patient abandonment.   But other nursing situations  constitute patient abandonment. What are they?

My nurse lawyer defense normally starts with a look at the law. However, the term ” Patient Abandonment” is not defined in the Missouri Nursing Practice Act .  This has caused much confusion.  So, the Missouri State Board of Nursing has published a  Position Statement on “Patient Abandonment“.  This blog post discusses examples of patient abandonment.  Conversely, it discusses what is  NOT “patient  abandonment”. Lets get to it.

Patient Abandonment

The Board’s Position Statement specifies 6 examples of patient abandonment. It also  emphasizes that each case is different.  So, the following are generally abandonment. But your situation may have mitigating factors.  If you receive a Board complaint for abandonment, contact an experienced nurse lawyer.

1.  “Leaving the place or area of employment during an assigned patient care time period without reasonable notice to the appropriate supervisor, so that arrangements can be made for continuation of nursing care by qualified others.”

This is the literal example of patient abandonment.  Don’t walk off the job without your boss’s advance approval. Period.

2.  “Leaving the workplace without adequately providing a patient status report to oncoming qualified personnel.”

You unexpectedly worked overtime and  rush off to pick up your kid, or get to the birthday party.  Don’t clock out without giving a good and full report to your oncoming nurse. Not only will you risk getting a Board complaint, but you are not getting points from your employer.

3.  “Leaving an emergency patient care situation that would be considered overtly dangerous based on the standard of actions of a similarly qualified reasonable and prudent licensed nurse.”

Don’t walk out at the end of your shift if your patient is in an emergent situation, or in stress. Pass all meds your patients are due, don’t leave it to the oncoming nurse.  It’s on you.

4.   “Showing lack of competent attention to or leaving a patient in acute distress without proper notification of appropriate personnel and/or without making appropriate arrangements for continuation of nursing care.”

You healthcare professionals may correct me.  I read this to overlap #3, and add psychological distress such as hallucinations and hypervigilance.

5.  “Making inadequate patient contacts, assessments, or interventions either directly or indirectly through improper supervision of other nursing care providers.”

This is for  Charge Nurses,  DONs and ADONs. You are responsible for your floor nurses.  Don’t defend a Board complaint against you by blaming  your floor nurse.  Just because you were not directly caring for the patient, you may still be on the hook.

And for you floor nurses, this is why your supers are on you all the time.  Make each other look good, have each other’s backs.

6.  “Sleeping while on duty.”

Nurses work incredibly hard, often overtime on 12 hour shifts.  You owe  your patient a standard of care.  If you need a break, get permission from your supervisor. Tell where you will be. Keep your cell phone on you, and make sure your super has it. Leave your number clearly at the nurse’s station.

Not Patient Abandonment

The Board considers issues between employee and employer to be outside the area of patient abandonment. Here are general scenarios which do not constitute patient abandonment.

1.  “Failure to work beyond previously agreed upon work time period.”
2.  “Refusal to work in an unfamiliar, specialized, or ‘high tech’ patient care area when there has been no orientation, no educational preparation, or employment experience, without reasonable notice to the appropriate supervisor.””
3.  Refusal to report to work.
4.  “Failure to call employer or arrive for assigned work time period.
5.  “Accumulation of ‘too many’days not worked.”
6.  “Failure to return to work from a scheduled leave of absence.”
7.  “Resignation from a position after completion of assigned patient care time period, such as an assigned shift, and not fulfilling the remaining posted work schedule.”
8.  “Termination of employer-employee relationship, after completion of an assigned patient care time period, by licensed nurse employee without providing employer with a period of time to obtain replacement for that specific position, such as resigning without notice.”

Summary

Patient abandonment is a violation of the Missouri Nursing Practice Act. Unfortunately the legislature has not clarified what constitutes patient abandonment.  Thankfully, we have guidance from the Missouri Board of Nursing.

P.S. I am currently defending a nurse from a complaint of “job abandonment”.   There is no mention of job abandonment in the Nursing Practice Act.  Nor is it in the Position Statement we have discussed today.  When the complaint is resolved, I’ll blog about it.

Until then, let me know your experiences with job abandonment. We can help each other understand what it is, and maintain good nursing practices.

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