Does work stoppage or strike create liability for patient abandonment?

A reader who is a school nurse at a private school is concerned about participating in a work stoppage or strike.

She points out that she would not be leaving the school or the students there — resulting in patient abandonment. Rather, this would involve never coming to work at all during the strike.

As I wrote in my blog, “Know How Your Union Is Legally Bound To Help You,” some nurses are members of unions, and school nurses are no exception. Member benefits include a union representative to help with potential problems in the workplace and negotiating your bargaining agreement with the union concerning wages, vacation time and staffing.

Concerted activities of employees

Another benefit of union representation is the member’s right to engage in “concerted activities for the purpose of bargaining or other mutual aid.” This ability to strike, and other components of the union and employer requirements, are governed by the National Labor Relations Act (NLRA).

The ability to legally strike can only occur if the bargaining agreement does not contain a no-strike clause.

When a strike is being considered by a union in a healthcare institution, which includes a health clinic, there are requirements that must be met before a strike can occur. One obligation is the union must not “engage in a strike, picketing or other concerted refusal to work” without first giving at least 10 days’ notice in writing to the institution and the Federal Mediation and Conciliation Service, according to the National Labor Relations Board.

How is patient abandonment defined?

Patent abandonment was initially used in legal proceedings when a physician unilaterally stopped care to an individual patient, and the patient was not given time to obtain care elsewhere.

Throughout the years, patient abandonment also has been, and is now, applied to nurses.

In its 2009 position statement, “The Rights of Registered Nurses,” 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.”

State nurse practice acts may or may not define patient abandonment for purposes of professional licensure discipline.

For example, the Iowa Board of Nursing rules do not specifically define the term “abandonment.” However, one of its rules does say it is unethical if a nurse fails to report to, or leaves, a nursing assignment without properly notifying applicable supervisory personnel to ensure the safety and welfare of patients.

In contrast, the North Dakota Board of Nursing defines abandonment as “accepting the client assignment and disengaging the nurse and client relationship without giving notice to a qualified person.”

The North Dakota board also provides examples of what is and is not patient-client abandonment.

Examples include sleeping on the job, thus being unavailable to the assigned patient, and leaving work without reporting to the oncoming shift.

Situations not considered patient-client abandonment by the board include instances often called “employer abandonment,” because they are events between the employer and nurse employee over work issues. …read more

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