RN With Family Crisis Put on Leave for Patient Abandonment

An RN received a call during her shift that there had been a death in her family. She left work immediately without administering medications, without counting narcotics, and without documenting her nursing notes for her patients. The next day, the RN’s director of nursing put her on administrative leave due to the RN abandoning her patients.

The DON then notified the RN’s colleagues that the RN was on administrative leave and would be fired when the leave was over. The RN wants to know if she has any legal recourse.

What Is Patient Abandonment in Nursing?

The American Nurses Association’s (ANA) definition of patient abandonment is “a unilateral severance of the established nurse-patient relationship without giving reasonable notice to the appropriate person so that arrangements can be made for the continuation of nursing care by others…”.

It is clear that this RN was quite distraught about the death in her family and that is understandable. However, leaving her job immediately was not the best choice.

The RN did not share whether or not she informed any of her coworkers or her supervisor that she was leaving. If she did not notify anyone that she was leaving, this was a critical mistake.

When on duty, an RN must inform someone in nursing administration of the need to leave so that patient care and other nursing responsibilities are completed by another nurse or healthcare provider. This is essential so that patient safety is not compromised.

Consequences for Patient Abandonment

Known as a patient handoff communication, the transfer of patient care and responsibility from one healthcare provider to another through the accurate and complete sharing of information is a critical step if a nurse must leave her post.

Leaving work without this kind of communication clearly puts patients at risk of injury or death. If such a risk occurs, the RN, the healthcare facility, and other healthcare staff — including other nurses, could be named in a professional negligence or wrongful death suit.

The RN also faces the very real possibility of a professional disciplinary action by her state board of nursing. State nurse practice acts and rules forbid unprofessional or unsafe conduct by licensed nurses. Leaving work without a patient handoff communication under the circumstances the RN describes breached her legal and ethical responsibilities.

The Director of Nursing’s Conduct

There is no doubt that the director of nursing had the right to place the RN on administrative leave. Also, she most likely has the right to terminate her employment.

However, the sharing of the RN’s discipline with co-workers may be a breach of the RN’s privacy and confidentiality in the workplace.

State laws vary on a worker’s privacy and confidentiality, so it would be necessary for the RN to seek legal advice on this issue from a nurse attorney or attorney who concentrates their practice in employment law and who represents employees.

Lessons Learned From This Case

What this case clearly underscores is that no licensed nurse should leave patients without arranging for continued nursing care. This is a requirement if you work in an acute healthcare facility or a nursing home.

It is also a requirement if you work in other healthcare settings. For example, if you work in home health care, you cannot simply stop your home visits. Rather, you must give adequate notice to the patient and the family that home healthcare services will no longer be provided, but continued emergency services will occur for a reasonable period of time (e.g., 30 days). This gives the patient and family time to obtain other home care services.

APRNs also can be accused of patient abandonment. As with your colleagues in home care, you must inform the patient and the family within a reasonable time frame that your services will no longer be provided and continue any care needed for a specified period of time.

If you’re an employee like the RN here, you may face employer action against you, including termination.

Other lessons from this case include:

• Once a nurse-patient relationship is present, you cannot abruptly end that relationship without providing for the safety and care of your patients.
• Learn as much as you can about patient handoff communication and incorporate it into your practice.
• Review your employee handbook, which may include guidance on whom to notify if you must leave the workplace.
• If you’re in a more “independent” practice setting, be certain to provide adequate and reasonable notice that your services will no longer be provided and allow a specified time for services to continue so the patient can obtain care elsewhere.
• Those of you in independent practice settings need to document the termination of care in the electronic medical record and in a letter to the patient and/or family via certified mail, return receipt requested.
• Know the difference between patient abandonment, which the board of nursing has jurisdiction, and other employment issues that are addressed by the employer.