American Journal of Nursing 2000 June Volume 100, Issue 6

Patient vs. Employment Abandonment

The difference could mean your license.

After declining to stay for an additional shift, two nurses on my unit gave report to another nurse and left. They were charged with patient abandonment, and disciplinary procedures were initiated. Is this appropriate?

Although some employers consider declining to work overtime and actually abandoning a patient to be the same thing, clear differences exist. For example, the Alabama Board of Nursing (BON) states, “When a nurse on duty is mandated to remain on duty for an extra shift or period of time beyond his or her established work schedule and is unable to do so, it is not considered abandonment if the nurse leaves the facility after exercising prudent judgment, notifying the supervisor, and appropriately reporting off to another nurse who accepts the report.” Three other BONs—in California, Oregon, and Ohio—have also defined the difference between these types of abandonment.

The nurse probably isn’t considered to be abandoning the patient if she doesn’t accept an assignment (for example, by declining to take report and accept a patient or by informing the employer that other responsibilities, a lack of expertise, or fatigue limit her ability to stay and provide safe and appropriate care). The issue would then be addressed as a labor dispute between the employer and the employee. Concern for patient well-being isn’t the only reason to differentiate between patient and employment abandonment; the career implications associated with these types of abandonment vary considerably. If found guilty of patient abandonment, the nurse could lose her license as well as her job. If found guilty of abandoning employment, the nurse’s professional licensure remains safe, but she may lose her job. Despite clear differences between these types of abandonment, employers consistently raise the specter of patient abandonment when trying to enforce mandatory overtime.

Employer directives that attempt to supersede the professional judgment and prerogatives of a licensed clinician, such as requiring a nurse to work an additional shift when she believes it’s unsafe, clearly overstep the boundaries of what is appropriate. Clarifying one’s response by asserting that one made a professional assessment of patient safety puts employers on notice that they are legally responsible for the provision of sufficient staffing.

Quantifying the frequency, abundance, and location of overtime work provides a more objective assessment of the problem. Find out whether patient outcomes have declined, the incidence of error has increased, or health care workers have experienced more work-related illnesses and injuries in settings in which overtime work is prevalent. Perhaps elective procedures need to be canceled or beds should be closed until safer solutions can be found (the cost of closing beds may also be far less than the costs of patient lawsuits and worker’s compensation).

During the 2000 ANA House of Delegates meeting in Indianapolis this month, the delegates will debate and discuss mandatory overtime proposals. The proposal, if passed, will prompt

• an ANA position opposing mandatory overtime except in cases of defined emergencies
• an ANA definition of patient abandonment based on the ANA’s Code for Nurses, current case law and advisory opinions, and position statements from the National Council of State Boards of Nursing and its state affiliates
• a definition of an equitable process for the assignment of overtime, should an emergency arise
• an outline of the rights and responsibilities of nurses faced with mandatory overtime
• support for research that examines the relationship between hours worked and the ability to provide safe care

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