Do I Smell a Rat?

[CJ]

I am currently a Student Nurse. Hope to get my RN next spring and BSN the following year.

Part of my course work requires me to spend one day a week at an assisted living community of 50 residents. They have total staff of one LPN . I've never met her since she does not leave her office. All the work is performed by one other person who has no nursing credentials.

About 20% of these residents have a DNR on file there.

The regional office has sent a notice that all staff is to perform CPR to anyone needing it, including those with a DNR legally filed.

A little advice from a pro will be much appreciated.

[Blue11RN]

I wouldn't want to be there when CPR is performed on someone with a legal DNR. I cannot imagine how they plan to get away with that. Are looking to be sued?? Are people looking to lose there licenses?? I would talk to someone fast. Good luck.

[oramar]

Best to let the nursing school know about this as quickly as possible. Is it possible that the state you are working in has a DNR law pending and the situation is in a state of flux? I remember when DNR law in Pa was being written, we were all in a state of confusion and everywhere I went they had a different policy.

[CJ]

Please let me express my sincere appreciation for the responses that Blue11RN and oramar have made to my original question. THANK YOU!

With reference to Journal entries at our assisted living facility:

I am beginning to understand the complexity of the nursing practice as we strive to maintain professional ethics within the shadows of managed care cooperation. These "big business" insurance companies tend to direct their focus on pre-determined strategies that result in cost effective outcomes, that undoubtedly line their own pockets at the expense of their policy holders. Do they also hold the purse strings of the majority of the registered nurses? I fear they do.

One of the expectations of a person relocating from their home into an assisted living facility is that their autonomy and privacy will be respected and protected. The other student nurses and I have all observed the casual manner in which the UAP's access and refer to each client's personal medical records. We do not know if the LPN employed at this facility has delegated the distribution of prescription medication, including controlled drugs to the UAP's. However, we have all witnessed UAP's obtaining medications, including narcotics, from an unlocked drawer accessible to anyone within the facility.

We are currently working on an intervention to address this problem but fear our efforts will be resented, rejected or ignored. We are trying to solve this dilemma, by working with the guidance of our nursing department educators.

Even though we are in a very early stage of student nursing, I feel that we cannot ignore this observation. To do so would contradict the ethical standards of the nursing profession we have so recently embraced.

[nurse T]

Assisted living isn't what it should be. Many facilities do more for the residents than is legal because they don't want to lose that money. I work in home health. I had a PT at an assit. liv. fac. PT had leukemia, bad case of shingles and was very confused. I attempted to advise the Admin. to notify the UAP's to use universal precautions re: infectious waste, hand washing, cross contamination. Admin. was stiff, stating this was not necessary. I saw UAP's come in and pick up PT's soiled clothing, holding it next to their stomachs and taking it to the laundry room. Admin. told me UAP's were not allowed to give meds but I read notes from the UAP's to the PT's daughter re: that they had changed the duragesic patch as requested per daughter. As far as I was concerned, they were delivering medications and contaminating the rest of the population.

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