Date of Graduation

Fall 12-18-2015

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions



First Advisor

Amy Nichols, RN Ed D

Second Advisor

Timothy S. Godfrey SJ, DNP, RN, PHCNS-BC

Third Advisor

Ian Johnson, MD


Primary care providers have terminated patient-provider relationships when they deem them no longer therapeutic. Healthcare providers are increasingly considering this an acceptable practice. However, the criteria for this decision remain unclear. As providers discharge challenging or difficult patients from their practices, questions to support this decision arise. Discharged patients face displacement and healthcare is disrupted. This project will (a) describe problematic patient-provider relationships and its effects, (b) identify possible alternatives to the firing of patients, (c) list appropriate reasons for termination, and (d) present recommended procedures to avoid allegations of medical abandonment. The project's product is an Appropriate Discharge or Transfer of Care Packet (ADTP) containing a questionnaire, a sample discharge letter, and the organization's written policy for termination. The project was designed as a resource to guide clinicians when the decision to fire a patient becomes necessary. The project was introduced by means of a PowerPoint presentation to two community clinics in Sacramento, California. After the presentation, the ADTP was introduced. Outcome measures were pre- and post-tests that assessed the knowledge of primary care providers on the necessary elements that should be established prior to the firing of a patient. Change was measured by comparing pre- and post-test scores for each attendee and revealed improved provider knowledge. A survey was distributed to assess providers' receptiveness to the use of the ADTP packet. A positive overall response was received. The Medical Director decided to adopt the use of the ADTP with revision for use in three clinics.