What is patient abandonment, and why do nursing students need to know about it?
No patient should ever be abandoned, as even the greenest nursing student would intuitively agree. But beyond intuition, patient abandonment has a formal definition with practical implications for how professionals and students alike treat their patients in order to provide the very best care while preventing accusations of this type.
When a nurse deserts or neglects a patient with whom they have established a provider-patient relationship without making reasonable arrangements for the continuation of care and without reasonable notice, that nurse may stand accused of patient abandonment.
1 In other words, once a nurse receives a report on a specific patient, that patient is their responsibility—until they pass that report to another nurse or the patient is transferred or discharged.
According to Gloria F. Donnelly, PhD, FAAN, RN, Dean of the College of Nursing & Health Professions at Hahnemann University and Dean Emerita of the College of Nursing and Health Professions at Drexel University, nursing students often do not realize how easy it is to meet this definition of patient abandonment. 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 their patient. Rushing to meet an instructor at a post-care conference without formally turning the patient back over to the nursing staff also qualifies as abandonment, even if the patient is at a large, well-staffed facility. 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.
Key Consideration: When Patient Care is at Risk
The aforementioned examples of patient abandonment may seem straightforward enough, but other situations are not always as clear-cut. For example, what if a nurse is assigned a task or procedure for which they do not feel adequately qualified? Would refusing mean they've abandoned the patient? The answer is generally no—but only if the nurse refuses in an appropriate manner. “It is your responsibility to immediately inform your instructor or preceptor,” says 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.”
In fact, agreeing to perform a task beyond their skill level is akin to acting outside their scope of practice, which can itself lead to severe consequences, including termination from the program or malpractice charges. In the event an instructor fails to step in, concerns should be escalated up the chain of command, all the way to the head of the nursing program if necessary. As always with formal procedures, it is vital to document and memorialize objections, including the requested task, the reason the nurse feels inadequate, the training needed to safely perform the assignment, and the outcome of the situation.
Once a nurse is licensed and working independently, other situations that could be construed as patient abandonment may still arise. Let's say a nurse has just finished a 12-hour shift, only to find out that no other nurses are available to take over. On the one hand, the nurse has already accepted reports for patients, establishing a provider-patient relationship and—in theory—the potential risk of abandonment. However, many states stipulate that refusing mandatory overtime does not constitute patient abandonment. In order to safely navigate such situations, all nurses should familiarize themselves with the specific provisions of their state's Board of Nursing. Often, it's up to an individual nurse to decide whether or not they can continue providing safe patient care. If not, the nurse should notify their supervisor of their decision, and document each reason in detail.
2
Going Forward
Whatever the particular situation, all nurses are individually responsible and professionally accountable for the patient care they provide. Nursing students are held to the same standards of care as licensed nurses, and must therefore understand the ins and outs of patient abandonment just as well. A thorough understanding of expectations and requirements in this regard is central to ensuring the best interests of patients and practitioners alike.
REFERENCES
1Nursing Spectrum. “Are you at risk for patient abandonment?” 2003. (3 Oct. 2005).
2Office of the Professions, New York State Education Department. “Abandonment in nursing.” 2002. (3 Oct. 2005).
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