Patient abandonment policy statements are oftentimes straightforward, but can easily be confused in certain situations. To clarify things, below are three instances in which patient abandonment could be construed. Although each instance represents a fictional situation, these types of circumstances result in negative consequences for both the patient and caregiver if not handled appropriately. Learn how to recognize these situations and respond diligently.
Example 1: Accepting responsibility
Joanne White is a new RN with less than one year of work experience. She reports to work her usual 11 to 7 shift on a busy 36-bed medical-surgical floor. She learns as she's taking off her coat that the other RN scheduled to work on the floor has called in sick. She's informed by the evening supervisor that she'll be expected to run the floor with two nursing assistants, and that the night supervisor will be available by page if she becomes overwhelmed.
[check mark] If White doesn't accept responsibility for the assignment as presented, will that constitute patient abandonment?
Example 2: Extended shifts
Paul Geary is an experienced nurse in a large long-term care facility. One day after completing a particularly busy 3 to 11 shift, he's told by his supervisor that the nurse scheduled to work 11 to 7 had a death in the family, and won't be able to work that night. As a result, Geary is told he must stay and work 11 to 7, as there's no nurse to replace him.
[check mark] If Geary leaves after his 3 to 11 shift, has he committed patient abandonment?
Example 3: Insurance issues
Kathleen Bowen is a home healthcare nurse caring for Mrs. Smith, a 60-year-old woman with chronic heart failure. Mrs. Smith is noncompliant with her low sodium diet, and requires frequent adjustment of her diuretics to manage her symptoms. After 3 weeks of care, Mrs. Smith's insurance carrier will no longer pay for any skilled nursing visits. Mrs. Smith has stated her intention to sue Bowen and the home care agency if she's discharged.
[check mark] Is this circumstance a case of patient abandonment?
[check mark] If White doesn't accept responsibility for the assignment as presented, will that constitute patient abandonment?
ANSWER: White hasn't yet accepted the assignment in question. If she doesn't feel competent to accept the assignment, and doesn't do so, the first required element of a patient abandonment judicial claim isn't present. White doesn't have a duty to the patients on that assignment and therefore couldn't be held liable for patient abandonment in a court of law.
[check mark] If Geary leaves after his 3 to 11 shift, has he committed patient abandonment?
ANSWER: Geary has an established relationship with the patients in question, as he has been caring for them for the previous several hours. If he were to leave knowing he wouldn't be replaced, there would clearly be a breach of his duty to provide care to the patients. In a legal action, if Geary did breach his duty, and any of the patients suffered harm as a result of that breach, a successful case for patient abandonment could be made.
[check mark] Is this insurance issue a case of patient abandonment?
ANSWER: Most home care agencies have internal policies and procedures to deal with denial of coverage by third-party payers. The agency will look to other factors such as physician orders, appropriateness of referral to alternate care settings, and reasonable notice being given to the patient, which may be specified by regulation. There may need to be a referral to a skilled nursing facility, or an alternative living arrangement considered. If there have been discussions with the patient's physician who's in agreement with the discharge, and reasonable notice given to the patient and any appropriate caregivers, the home care agency wouldn't be liable for patient abandonment.1
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