The Ins and Outs of Patient Abandonment
As a nursing student, you know that you should never “abandon” a patient. But what exactly is patient abandonment? And how do you protect yourself from being accused of this type of unprofessional conduct?
When a nurse deserts or neglects a patient with whom he or she has an established provider-patient relationship without making reasonable arrangements for continuation of care and without reasonable notice, that nurse may stand accused of patient abandonment.1 In other words, once you receive report on a specific patient, that patient is your responsibility—until you pass report to another nurse or the patient is transferred or discharged. Nursing students may not realize how easy it is to meet this definition of patient abandonment, said Gloria F. Donnelly, PhD, FAAN, RN, Dean of the College of Nursing & Health Professions at Hahnemann University. For example, a student nurse who has been assigned to care for a patient and runs to the coffee shop without telling anyone has abandoned his patient. The same is true if he rushes off to meet his instructor at a post-care conference without turning his patient back over to the nursing staff. If the patient were harmed because of the student's absence, a malpractice claim could be filed against the facility, the supervising nurse and the nursing program, and the student could face disciplinary action or be terminated from the program.
When patient care is at risk
These examples of patient abandonment may seem straightforward, but other situations are not so cut and dry. What if you're assigned a task or procedure for which you do not feel adequately qualified? Would refusing mean you've abandoned the patient?
The answer is “no,” as long as you refuse in an appropriate manner. It is your responsibility to immediately inform your instructor or preceptor, said Donnelly, and let her negotiate the assignment on your behalf. This may mean amending the assignment to include only tasks for which you have been trained, or ensuring that you receive direct supervision for any procedures that are new to you.
Agreeing to perform a task beyond your skill level would be akin to acting outside your scope of practice, which can lead to severe consequences, including termination from your program or malpractice charges. So, if your instructor fails to step in, take your concerns up the chain of command, all the way to the head of your nursing program, if necessary. Document your objections, including the task you don't feel equipped to handle and why, the training you would need to safely perform the assignment, the person/people with whom you spoke, and the outcome of the situation.
Once you're licensed and working independently, other situations that could be construed as patient abandonment may arise. Let's say that you have just finished a 12-hour shift, only to find out that no other nurse is available to relieve you. On the one hand, you have already accepted report for your patients, establishing the provider-patient relationship. But many states say that refusing mandatory overtime does not constitute patient abandonment. To deal safely with such situations, you must know the rules of your state's Board of Nursing. Often, it's up to you to decide whether or not you can continue providing safe patient care. If not, notify your supervisor of your decision, and write a memo documenting the specific reasons.2
Whatever the particular situation, you are individually responsible and professionally accountable for the patient care you provide. Nursing students are held to the same standards of care as licensed nurses, so make sure you understand the ins and outs of patient abandonment. This knowledge will equip you to ensure quality patient care—and protect you from a charge of patient abandonment.
1.Nursing Spectrum. “Are you at risk for patient abandonment?” 2003. (3 Oct. 2005).
2.Office of the Professions, New York State Education Department. “Abandonment in nursing.” 2002. (3 Oct. 2005).