Nursing
Practice Alerts & Guidelines
Abandonment in Nursing
- To: New York State Licensed Nurses, Health
Care Facilities and Other Interested Parties
- From: Johanna Duncan-Poitier, Deputy
Commissioner, Office of the Professions, Deputy Commissioner,
Office of Higher Education and Barbara Zittel, Executive
Secretary, New York State Board for Nursing
- Date: September 2002
- Subject: Abandonment in Nursing
The New York State Education Department 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. As part of their work to ensure a strong future for the nursing profession, the New York State Board of Regents Blue Ribbon Task Force on the Future of Nursing recommended that the Department clarify its position in this area. We are pleased to provide you with this guidance memo resulting from the significant contributions of the State Board for Nursing, in consultation with the Department of Health, the New York Organization of Nurse Executives, the New York State Nurses Association and the Healthcare Association of New York State.
Provided below are key terms describing important aspects to help clarify abandonment as well as factors associated with assessing allegations of abandonment in nursing.
Responsibility of the Licensed Nurse
Nurses strive to protect the health, safety and rights of their patients. They are individually responsible and professionally accountable for the nursing care that they provide to their patients. Nurses are also responsible to preserve their own integrity and safety.
Responsibility of the Health Care Facility
Health care facilities are responsible for providing staff for the patients they accept, respecting the legal and ethical obligation of nurses to protect the safety of patients. Managerial or supervisory personnel should make adequate provisions for competent staffing to ensure necessary patient care in routine situations.
Nurse-Patient Relationship
A nurse-patient relationship begins when the nurse accepts responsibility for providing nursing care based upon a written or oral report of patient needs. A nurse-patient relationship ends when that responsibility has been transferred to another nurse and a report of patient needs has been communicated.
Objection to a Work Assignment
The decision to accept or reject an assignment must be based upon a critical judgement by the nurse of the nurse's ability to provide competent patient care. When a nurse is assigned to care for a patient or group of patients that is beyond the nurse's level of physical or professional competence, the nurse should immediately notify the first-line supervisor in writing of the objections to accepting the assignment. It should also be noted that future assignments in similar situations will be refused.
Definition of Abandonment
Abandonment results when the nurse-patient relationship is terminated without making reasonable arrangements with an appropriate person so that nursing care by others can be continued.
The legal definition of abandonment as found in section 29.2(a) of the Rules of the Board of Regents states that unprofessional conduct shall include:
Abandoning or neglecting a patient or client under and in need of immediate professional care, without making reasonable arrangements for the continuation of such care, or abandoning a professional employment by a group practice, hospital, clinic or other health care facility, without reasonable notice and under circumstances which seriously impair the delivery of professional care to patients or clients.
Abandonment and Unprofessional Conduct
The decision to charge a nurse with abandonment will depend on an examination of all of the circumstances surrounding a particular situation as assessed by State Education Department staff in consultation with a member of the State Board for Nursing. Key questions considered include:
- Did the nurse accept the patient assignment, which established a nurse-patient relationship?
- Did the nurse provide reasonable notice when severing the nurse-patient relationship?
- Could reasonable arrangements have been made for continuation of nursing care by others when proper notification was given?
An investigation by the Department of abandonment charges would consider whether managerial or supervisory personnel made adequate provisions for competent staffing to ensure necessary patient care in routine situations. The Department and the nurse may obtain a copy of the nurse's written notice of patient assignment refusal in the event of such an investigation.
In most cases, the following situations are not examples of unprofessional conduct nor automatic violations of the Regents Rule:
- Refusing to accept responsibility for a patient assignment(s) when the nurse has given reasonable notice to the proper agent that the nurse lacks competence to carry out the assignment.
- Refusing the assignment of a double shift or additional hours beyond the posted work schedule when proper notification has been given.
Employer Abandonment
Employer abandonment may occur if a nurse fails to give reasonable notice to an employer of the intent to terminate the employer/employee relationship or contract under circumstances that seriously impair the delivery of professional care to patients or clients. It should be noted that the Department has no jurisdiction to interpret or resolve issues limited to employment and contract disputes.
The State Education Department views abandonment as a serious charge. It is however, inappropriate for nurses to be threatened with charges of abandonment to coerce them to work additional hours or care for patients beyond their expertise.
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.
