Client Abandonment

Recently, I was part of a meeting where another manager was describing a situation of client abandonment on their unit and how they dealt with it. Now I am confused because my perceptions on this issue are quite different. How does the CRNS define this?

Client abandonment may be considered to be professional misconduct. It occurs only in situations where the nurse has established a nurse-client relationship or has accepted responsibility for a care assignment, then chooses to discontinue the nurse-client relationship without taking at least one of the following three actions:

• ensuring the arrival of the nurse’s replacement, where the failure to do so may place the client at risk;
• allowing the employer a reasonable opportunity to arrange appropriate alternative or replacement services to be provided; or,
• if the nurse is self-employed, negotiating with the client to develop a plan for withdrawal of services. In addition, in accordance with the Registered Nurse Practice Standards and other ethical obligations that apply to any transfer of care, the RN must provide an appropriate report and/or ensure that all necessary documents are completed and communicated. Documentation is part of the care provided.

EXAMPLES OF WHAT CRNS CONSIDERS CLIENT ABANDONMENT

• Not reporting to the employer any recognized actual or pending staff shortages that have the potential to negatively impact client care;
• Leaving the client care area for personal reasons without taking steps to ensure appropriate coverage for safe client care while they are absent, or leaving the client care area for a timeframe long enough that safe care could be compromised;
• Being within the client care area during paid work time but failing to provide client care due to engagement in non-work related personal activities (cell phone/electronic device use for texting, phone calls or gaming; sleeping, etc.);
• Leaving work prior to the arrival of the nurse’s replacement (even if the replacement is late or a no show) without providing notice to the employer and giving them a reasonable opportunity to make alternate arrangements for ensuring client safety;
• Leaving the client care area during a unit/facility emergency (e.g. code blue) without ensuring a safe transition of client care to an appropriate replacement, including the provision of any applicable reports;
• Refusing to provide client care to an individual after accepting accountability for this care assignment; and/or,
• Knowingly transferring care to a replacement who lacks the professional competencies or credentials to safely meet the client’s care needs.

 EXAMPLES THAT ARE NOT GENERALLY CONSIDERED CLIENT ABANDONMENT

• Withdrawing from care or not accepting an assignment because of personal health issues (including fatigue) with reasonable notice. The length of the notice required may vary depending on the urgency of the situation and the risks to health and safety of both the client and the RN. Nurses are obligated to work with their employer in terms of reasonable notice and are accountable for collaboratively considering all possible outcomes and options as decisions are made regarding patient safety and care needs. If you cannot extend your shift, advise your manager/designate and provide them with a reasonable amount of time to find an alternate registered nurse to assume care, transfer patients or find another alternative solution.
• Declining offered overtime or extra shifts for which nurses have not been previously scheduled to work. Overtime is voluntary except in emergency circumstances as defined by the employer and/or union.
• Refusing an unfamiliar assignment without adequate training to develop competence or being given a modified assignment that is congruent with the nurse’s competence, but giving reasonable notice of the refusal. This allows the employer to seek alternative arrangements.

RNs and RN Manager Responsibility and Accountability

• RNs are accountable and accept responsibility for their own actions and decisions (1).
• Registered nurses practice in accordance with the current CNA Code of Ethics for Registered Nurses (2).
• RNs demonstrate a professional presence and model professional behaviour (3).
• RNs contribute to a professional ethical and safe practice environment to support the provision of optimal health care outcomes (4).
• Registered nurses manage resources to provide safe, effective and efficient care (5).
• RNs identify and address ethical (moral) issues using ethical reasoning, seeking support when necessary (6).
• RNs recognize, act on and report actual or potential workplace and occupational health risks (7).
• Nurses have a responsibility to conduct themselves according to the ethical responsibilities outlined in the CNA Code of Ethics and in practice standards in what they do and how they interact with persons receiving care and other members of the healthcare team (8).
• When resources are not available to provide appropriate or safe care, nurses collaborate with others to adjust priorities and minimize harm…They inform employers about potential threats to the safety and quality of health care (9).
• Nurses practice within the limits of their competence. When aspects of care are beyond their level of competence, they seek additional information or knowledge, report to their supervisor or a competent practitioner and/or request a different work assignment. In the meantime, nurses remain with the person receiving care until another nurse is available (10).
• Nurses maintain their fitness to practise. If they are aware that they do not have the necessary physical, mental or emotional capacity to practise safely and competently, they withdraw from the provision of care after consulting with their employer. If they are self-employed, they arrange for someone else to attend to their clients’ health-care needs. Nurses then take the necessary steps to regain their fitness to practice, in consultation with appropriate professional resources (11).

Non-RN Manager Responsibility

• Managers of Registered Nurses have an obligation to understand the practice standards and professional expectations that guide and enable safe, competent and ethical RN practice.

CRNS Resources

Registered Nurse Practice Standards (2024)

CNA Code of Ethics (2017)

Registered Nurse Entry-Level Competencies (2019)