Nursing

Practice Alerts & Guidelines

Patient and Employer Abandonment - Frequently Asked Questions & Answers

Introduction

1. Why is this information important for me?
   The New York State Education Department (SED) has received numerous requests from nurses and health care employers seeking clarification about actions that could be considered abandonment and lead to charges of unprofessional conduct against a nurse's license. Staff nurses were informing us that employers were threatening them with charges of abandonment to coerce them to work additional hours or to care for patients beyond their expertise. A memo was developed to clarify situations that the State Education Department would or would not consider to be patient abandonment. It was mailed to all currently licensed and registered Nurse practitioners (NPs), Registered Nurses (RNs) and Licensed Practical Nurses (LPNs).
   
   
2. Who determines whether a complaint of abandonment is professional misconduct?
   The State Education Department's Office of Professional Discipline in consultation with the State Board for Nursing determine whether specific situations rise to the level of professional misconduct.

Patient Abandonment

3. What factors are required for a nurse to be charged with patient abandonment?
   For patient abandonment to occur:
   
   • The nurse must have first accepted a patient assignment, thus establishing a nurse-patient relationship;
   • The nurse must have severed the nurse-patient relationship without giving reasonable notice to the appropriate person so that arrangements were made for continuation of nursing care;
   • The patient(s) must be in need of immediate professional care or circumstances must exist which would seriously impair the delivery of professional care to patients or clients.
   
   
4. Can you please give examples of patient abandonment?
   Examples of patient abandonment may include, but are not limited to:
   
   • An RN or LPN accepts an assignment for patient care and then leaves the facility without transferring patient care to another qualified individual, when this would seriously impair the delivery of professional care;
   • An RN leaves the operating room during a surgical case without transferring patient care to another qualified individual, when this would seriously impair the delivery of professional care;
   • An RN or NP withdraws from a contractual relationship with a patient to provide home health, counseling, daily nursing care or another similar service and fails to provide sufficient notice to the patient.
   
   
5. What situations would probably not be considered patient abandonment?
   The Education Department evaluates complaints of patient abandonment on an individual basis taking into consideration the unique characteristics of each situation. In general, the Education Department would probably not consider that patient abandonment has occurred in the following situations:
   
   • Refusal to accept an assignment when the nurse has given reasonable notice to the appropriate person that s/he lacks the competence to carry out the assignment, or that s/he is too mentally or physically exhausted to provide safe care, or that expected resources to support safe delivery of care are not available;
   • Refusal to work additional hours or shifts beyond the posted work schedule when proper notification has been given.
   
   
6. The answer to Question 5 states that refusing to accept an assignment when the nurse has given reasonable notice would in all probability not be considered patient abandonment. Could you further clarify what a "reasonable " notice would be?
   Reasonable notice depends on the distinctive nature of a particular circumstance, which will change from case to case. For example, in the situation where a nurse has worked a 12-hour shift and is required to work an additional shift, reasonable notice might be at the time the mandate is made.
   
   
7. Is a hospital allowed to make a nurse work beyond her or his 12 hour-shift if hospital administration is aware of a shortage in staff on the next shift for several days in advance?
   The Education Department does not have jurisdiction over employer-employee policies for facilities that provide patient care. However, it is unlikely that the State Education Department would consider a charge of patient abandonment when a nurse refuses to accept an assignment for additional hours beyond the posted work schedule when administration has been aware for several days of the presence of a staff shortage on a particular shift and when the nurse has notified the employer of refusal to accept the assignment.
   
   
8. I am frequently required to float to an unfamiliar unit and feel that I am not competent to safely care for some of the patients on that floor. Can I be charged with patient abandonment?
   In most instances, the Education Department would not consider a charge of patient abandonment when a nurse refuses to float to an unfamiliar unit when there has been no orientation, preparation, or appropriate modification of assignment (such as another RN providing assistance in the care of select patients for which you are not competent to provide care). However, to become licensed as an RN or LPN, you met educational and examination requirements that assure minimal competence in the delivery of basic nursing care. Refusing to float, based on your statement that you are not competent to provide patient care to an entire unit of patients, when there has been good-faith efforts to re-assign only those duties that fall within your expected level of competence, may be considered abandonment.
   
   
9. What are my responsibilities as a nurse manager? Could I be implicated in a patient abandonment charge?
   It is the responsibility of the licensed manager or supervising nurse to delegate professional responsibilities only to persons who are qualified by education, experience or by licensure to carry out the responsibility. An investigation by the State Education Department of abandonment charges would consider whether administrative and supervisory personnel have made adequate provision for staffing, as discussed below, to ensure necessary patient care in all situations. The action of administrators or supervisors who are licensed by the education Department may lead to charges of unprofessional conduct depending upon their role and the relationship of that role in providing necessary professional services.
   
   Responsibilities of the nurse manager/administrator in patient care include:
   • Assuring that the qualifications and capabilities of personnel are appropriate to patient needs;
   • Accepting a nurse's reasonable notice to terminate the nurse-patient relationship and seeking a qualified replacement; and
   • Addressing known vacancies in a timely manner.
     
     
   In instances of inadequate staffing, the manager should take one or more of the following actions:
   • Make every possible effort to acquire additional qualified staff;
   • Assign "periodic" assistance from another area for delivery of specific services;
   • Prioritize the care activities that will be delivered during the tour of duty; and,
   • Notify administration of the limitations in providing optimal care during periods of understaffing.

Employer Adandonment

10. Could you please clarify a charge against a nurse for employer abandonment?
    Employer abandonment may occur if a nurse fails to give reasonable notice to the employer of her or his intent to terminate the employer-employee relationship or contract, under circumstances which seriously impair the delivery of professional care to patient or clients.
    
    Examples include:
    • The nurse walks off duty without notice to the employer-when the patient(s) is in need of immediate care and when this would seriously impair the delivery of professional care;
    • The nurse notifies the supervisor or other responsible party of the intent to leave immediately but does so without transferring her or his responsibilities and reporting to another nurse, when the patient(s) is in need of immediate care and when this would seriously impair the delivery of professional care.
    
    
11. Can you provide examples of situations that may not necessarily be considered employer abandonment?
    The Education Department cannot interpret issues limited to employment and contract disputes. However, the following examples of employer abandonment, in which patient care is not seriously impaired, would probably not alone subject the nurse to disciplinary action by the Department:
    • A licensed nurse completes her/his assigned shift and then notifies the employer that the employment relationship between the nurse and the employer is being ended immediately--other staff are available to provide nursing care;
    • The nurse fails to return from a scheduled leave of absence;
    • The employer-employee relationship is ended without providing the employer with a period of time to find a replacement;
    • The nurse resigns but does not complete the notice period given.

More Information

12. How can I get more information?
    If you have additional questions, please contact Barbara Zittel, Executive Secretary to the State Board for Nursing, by mail: Education Department Building, 89 Washington Ave., Nursing Board Office, Second Floor, West Wing, Albany, NY 12234, e-mail: nursebd@mail.nysed.gov, phone: 518-474-3817 Ext. 120, or fax: 518-474-3706.