A school nurse in a public school district asked me about her potential liability when she and her colleagues leave their respective school buildings for an hour lunch period.
Some school nurses have paid lunches so they can stay in the building for students needing medications for specific conditions during that time period. But she is concerned about liability for a school nurse who is out to lunch when a medical incident involving a student occurs. She specifically identified abandonment as her main concern.
Historically, the law defined patient abandonment within the context of the physician-patient relationship. When a physician unilaterally no longer provided care to an individual and no time was allotted for the patient to obtain care elsewhere, the potential for abandonment was present.
More recently, however, and certainly in today's world, patient abandonment has been applied to nurses. In a 2009 position statement, the American Nurses Association defined patient abandonment as a "unilateral severance of the established nurse-patient relationship without giving reasonable notice to the appropriate person so that arrangements can be made for continuation of nursing care by others."
Abandonment issues that could effect nurses
Patient abandonment is not the same as employer abandonment. The latter has been defined as a nurse failing to give reasonable notice to an employer of his or her intent to terminate the employer-employee relationship under circumstances that seriously impair the delivery of professional care to patients or clients. Obviously, the employer in such a situation is affected by the nurse's conduct, but that impact is an employer issue. Boards of nursing have no jurisdiction over employer abandonment or employer-related issues. The most immediate liability for a nurse who unilaterally leaves a patient without continued nursing care faces a professional disciplinary action from the state board of nursing. Such behavior is seen as "unprofessional conduct." A nurse practice act and/or its rules also can list abandonment of patient care as grounds for disciplinary action. All nurses, including school nurses, are accountable and responsible for their own conduct and judgments. A careful assessment of specific students' nursing needs must be made by the school nurse.
The decision to leave a school building for a lunch hour when there are students who, based on their diagnoses or treatments, may need a nurse present, is not a wise one. If there were a medical incident, the school nurse might be charged with patient abandonment.
In addition, if the student suffered an injury or died, a lawsuit may be filed by the parents. Although the school district would certainly be named as a defendant in the suit, the school nurse might also be named individually for failing to meet his or her overall legal standard of care and standards of practice.
How to avoid patient abandonment allegations
You can avoid patient abandonment allegations by, first, staying in the school building during the lunch hour even if you are not paid to do so and carefully evaluating the student population and its needs. If the school nurse believes, in his or her best professional judgment, that there is the potential for harm to a student or students in his or her absence, lunch "breaks" should be taken in the building.
Another option would be for someone to cover for the school nurse who leaves the school building for lunch. This person might be an RN who is not employed by the school district, but who contracts with the district to be present during the time when the school nurse is offsite.
The school nurse's "handoff" to the RN covering while he or she is away must be thorough. The RN should be instructed to call the school nurse immediately if something occurs. In addition to orienting this RN to the students' needs, policies and procedures need to be in place for all personnel left in the building to follow if a medical incident arises, such as:
- Who is to call for paramedics and when?
- Who notifies the school nurse immediately if an incident occurs?
- Who accompanies the student during a transport by ambulance to the hospital?
- Who calls the parents?
Tapping into the resources of a school nurse consultant is another option. He or she may have realistic solutions when a school nurse leaves the school building under these circumstances. Voicing the concerns of this arrangement with the administrator and/or school superintendent might result in more coverage for those school nurses who do leave the building for lunch breaks. Finally, delegating the responsibility to one or more unlicensed individuals to intervene in an emergent situation when the school nurse is away is an option, but a somewhat precarious one at best. A good resource for this last option can be found in a 2010 article by Cheryl Resha, "Delegation in the School Setting: Is it a Safe Practice?"
It is important to keep in mind that the law does not require any nurse to prevent all risks of harm to those to whom she provides care. Rather, the law requires a nurse to prevent a reasonable and foreseeable risk of harm to patients/students.
If you are a school nurse, how do you handle short absences from the school building where you work?
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