a) Have first accepted the patient assignment, thus establishing a nurse-patient relationship, and then b) Severed that nurse-patient relationship without giving reasonable notice to the appropriate person (e. g. , supervisor, patient) so that arrangements can be made for continuation of nursing care by others. A nurse-patient relationship begins when the responsibility for nursing care of a patient is accepted by the nurse or certified nursing assistant.
Failure to notify the employing agency that the nurse will not be able to appear to work for an assigned shift is not considered patient abandonment by the Board of Nursing, nor is refusal to accept an assignment considered patient abandonment. Once the nurse/certified nursing assistant has accepted responsibility for nursing care of a patient, severing of the nursepatient relationship without reasonable notice may lead to discipline of a nurse/certified nursing assistant’s license.
Nurses/certified nursing assistant’s must exercise critical judgment regarding their individual ability to safely provide patient care when declining or accepting a request to work overtime. A fatigued and/or sleep deprived Nurse/Certified Nursing Assistant may have a diminished ability to provide safe, effective patient care. A refusal to work additional hours or shifts would not be considered patient abandonment by the Board of Nursing. The Nurse/Certified Nursing Assistant who follows the above Board of Nursing advisory statement will not be considered to have abandoned the patient for purposes of Board disciplinary action.
The Board of Nursing’s position on patient abandonment applies to all nurses as well as certified nursing assistants, regardless of their role, who provide direct patient care including: licensed nurses who are consultants, supervisors, administrators, volunteers and others who practice independently. The Board of Nursing will hold licensed nurses (Licensed Practical Nurses, Registered Nurses, Nurse Practitioners, Certified Registered Nurse Anesthetists and Clinical Nurse Specialists) to a higher standard of conduct regarding their commitment to complete a patient care assignment.
The Board of Nursing believes that a patient’s well being is placed at greater risk if a licensed nurse abandons their patient care responsibilities than if a certified nursing assistant (CNA) were to do the same, except in a situation where the certified nursing assistant is the sole care provider for the patient. The Board of Nursing views all patient abandonment as a serious issue. However, not all patient abandonment situations are grounds for disciplinary action.
The Board of Nursing believes that certain sanctions should be imposed for situations that place patients at risk for harm, or when harm has already resulted because the nurse/certified nursing assistant abandoned a patient care assignment. The focus for the disciplinary sanction is based on the relationship or responsibility of the nurse/certified nursing assistant to the patient. In a situation where the nurse/certified nursing assistant is the only assigned care provider, such as in a private home or homelike setting, abandonment is considered to be the most serious because there is no one else to provide the care.
The patient is dependent, vulnerable for harm and lack of care can go unnoticed for hours. Abandonment in a setting where there are other nurses/certified nursing assistants available, and where resources can be delegated to meet patient care needs, is considered to be less serious. There are a number of different situations that some members of the nursing community have traditionally believed to be considered patient abandonment, ranging from termination of employment without notice to leaving a patient care assignment in the middle of their assignment.
The Board of Nursing believes that many of these scenarios are employment issues rather than nursing regulatory issues and do not constitute patient abandonment under the Board of Nursing’s rules or by Board policy. To illustrate, the Board believes that: Resignation from employment without notification, assuming the previously agreed-upon patient care assignment has been completed, is not patient abandonment but is an employment issue. Refusal to stay and work an additional shift or a double shift is not patient abandonment, and is an employment rather than a nursing regulatory issue.
Refusal to float to an unfamiliar unit is not patient abandonment, but is an employment issue. However, the Board believes that the employer has a responsibility to clearly identify the expected patient care responsibilities to the floating nurse/certified nursing assistant, as there is a great difference between an expectation that the nurse/certified nursing assistant will carry a full patient assignment versus an expectation that the nurse/nursing assistant will be an “extra body” to assist licensed nurses who are familiar with the unit and its patients.
Failure to notify the supervisor of the urse/certified nursing assistant’s intent to leave, and leaving in the middle of a patient care assignment without the supervisor’s knowledge, is patient abandonment. Sleeping on the job, which has the effect of being unavailable to observe the patient or respond to the patient’s needs, is patient abandonment even though the nurse/certified nursing assistant is physically present. Failure to report for a patient assignment, or leaving in the midst of a patient care assignment when the nurse/nursing assistant is the sole care provider, or the licensed nurse is a consultant or supervisor in a home or homelike situation, is patient abandonment.