I can't do chest compressions (CPR) will I be terminated?

[42pines]

I'm 66 and on Occupational Health Nurse Manager at a Fortune 500 company. In November one morning I woke up unable to stand on my right leg. Subsequently I was hospitalized, had a MRI then a CAT and given an spinal epidural of steroids whereupon I recovered over the next two months. I have severe bilateral neuroforaminal stenosis. This was quite to my surprise as I work out regularly in the gym (aggressively which may have caused the issue) and my lumbar radiograph is none to pretty.

I returned to work half days and my doc said: "What do you want for restrictions?" I answered: "Stand no more than one minute; Walk no more than 5 minutes and No lift/push/pull greater then 7 lbs. Well, I was at work for about two hours and someone came running into my clinic: "Come quick, someone is having a heart attack."

Indeed, that appeared to be the case. I said to one of our first responder team: "I can't do compressions, you do compressions, I'll bag." We did exactly that. The person giving compressions did an excellent job, we ventilated him, I shaved, slapped on the pads, analyzed and shocked. I thought we might save the fellow because of "shock advised," but it wasn't to be. It was great teamwork and I'm proud.

However, my CPR card just expired and now I must get a AH CPR card but I should not do compressions. Since CPR is an essential function of the job, I could be terminated because of this. So I wonder, am I covered under ADA?

I'd argue yes, as I would never be doing CPR one on one and there would always be another first responder to do compressions.

Any thoughts? Anyone face this sort of issue before?

[blondy2061h, MSN, RN]

When you said you were an occupational health RN, I assumed within the setting of a hospital. But it sounds like you're in a free standing clinic? You do not need to be an RN to do CPR. Are there secretaries or UAP's there that would be able to become certified, if not already certified?

[Ruby Vee, BSN]

elkpark said:

I wish the OP no ill, but just have to say that, if I were going to be the "another first responder around," I would not be happy about having to work with someone who couldn't do her/his fair share in a code, just as I would not be happy about being expected to pick up the slack for a co-worker who couldn't do any other part of the basic responsibilities of the job.

The OP is in occupational health, unless I misread the original post. As I understand it, that's mostly a desk job, with just the occasional need for CPR when one of the employees goes down. I would think that would be rare. I'm not advocating (nor would I) that a bedside nurse who couldn't do CPR, stand for more than one minute or walk for more than five be allowed to keep their job.

[Meriwhen, ASN, BSN, MSN, RN]

Flatline said:

"Essential job functions are the fundamental duties of a position: the things a person holding the job absolutely must be able to do. Essential job functions are used to determine the rights of an employee with a disability under the Americans with Disabilities Act (ADA). An employee who can't perform the essential job functions, even with a reasonable accommodation, isn't considered qualified for the job and isn't protected from discrimination."

Essential Job Functions Under the ADA - Disability Discrimination | Nolo.com

This. The ADA is not bulletproof as some are quick to think.

Does this mean I think you should be fired, as your poll suggests? Not necessarily.

Are you protected under the ADA? I'm no employment lawyer, but if the ability to perform CPR is required and you are unable to perform compressions--which BTW is the most critical part of effective CPR--I'd say No, you're not protected as you're not able to adequately perform CPR.

You could certainly ask and see how your employer will handle this...but be prepared should they decide it's too great a liability.

Best of luck whatever happens.

[Meriwhen, ASN, BSN, MSN, RN]

blondy2061h said:

When you said you were an occupational health RN, I assumed within the setting of a hospital. But it sounds like you're in a free standing clinic? You do not need to be an RN to do CPR. Are there secretaries or UAP's there that would be able to become certified, if not already certified?

Anyone who takes and passes the course can be certified to do CPR, even if you are as far away from the healthcare field as one can possibly be. It would be wise for others in your clinic to pursue CPR certification if they haven't already done so. Especially if you are unable to do compressions.

[Horseshoe, BSN, RN]

42pines said:

Horseshoe asks: Just curious, are you able to exercise anymore? Swimming, water aerobics, etc.

I am, within limits and am working diligently w/ a PT and progressing nicely. I'm told that the sort of forcible bending will come much later in PT. I'm hopefully expecting to be able to pass an AH CPR practicum within 6 months or a Red Cross CPR practicum in May. I'd so much love to be able to use a pool, as you know the absolute best thing for lumbar issues. I do use an exercise bike and miss my rower but the PT people say no on that for now. It's the bending that is the issue.

Good to hear you can do some exercise. I've had decades of back and neck problems. My back problems are usually lumbar, and bending has been the culprit of injuries every single time, even if picking up something as a light as a piece of paper or a kitten.

Several months ago, I hurt my UPPER back. I believe I torqued it pushing heavy beds from the recovery room to pre-op-I had to make several turns throughout the building every time I did it, which was many times that day. The next day, it felt like there was a knife literally stuck into my back. Every time I breathed, it was excruciating. I've never felt so horrible. At least with low back pain, I can breathe easily, and I know how to handle it. This was awful awful awful. I haven't worked there since, because after I recovered from that, I hurt my knee biking and had to have surgery. I will likely tell them I'm done if they call me again because I don't ever want to feel that way again, and they have not shown a willingness to hire aides to wash the beds and take them back to pre-op between patients (very busy endo facility). I work prn there and at an OR, so I have the option to work or not. Not all people can say that, so when the body of a nurse breaks down, it can be physically, emotionally, and financially devastating.

All of that is to say that I feel your pain and frustration with physical limitations and hope you recover soon.

[calivianya, BSN, RN]

I see you have other people working with you, and it's mostly a desk job... but you're still a RN, and scarily enough, you're the ONLY RN. The only RN working in your workplace should be able to do compressions.

I would say go back to the hospital, where you'll be surrounded by RNs who could do compressions (full staffing on my unit is 17 nurses per shift, so one person not able to do compressions wouldn't ever be a problem because we usually have to shoo extra nurses out of the room anyway), but your no lifting/no walking restriction wouldn't work in a hospital.

Good luck whatever happens.

[I<3Nursing]

Well, I am a manager for someone that couldn't do CPR, and at my facility there is a waiver process involved. My staff member did receive a waiver bc of the proximity of other CPR trained staff in the area and her medical condition. If you are an otherwise excellent employee I see them accommodating. This may actually be more a reasonable accommodation request than an ADA issue. You may want to ask in those terms. Good luck with your health and employment.

[lasvegasnurs]

Lots of good answers already but I doubt the job description specifically says you must be able to perform chest compressions. You can still lift 40lbs I imagine like many nursing jobs will say but certain limitations is expected. I used to work as a Rapid Response/Code Nurse in a large busy hospital and returned to work after having surgery on a broken clavicle. I technically met the stated job requirements but I would not assist in CPR. Now it was very rare that I would help with CPR anyway since I was more involved in the code management but nevertheless I was physically unable to participate with chest compressions for about a month during work.

Honestly there were several people that I would swap out of CPR rotations because good CPR isnt easy. Its not a requirement of a nurse to be able to perform amazing CPR. There however should always be a way to give a patient effective CPR at any location. Most floors always had the same couple people that would be involved in CPR every code and I saw no problem with that.

[pfongk]

What are the chances of people needing CPR on the floor and not a bed? The reason I ask this is the last time I did my CPR update the guy that ran it was an ex paramedic and rode bikes, he taught us how to do chest compressions with our feet so if we'd been pillioning on a bike and had come off, we could still perform the compressions with broken arms. He also taught this way to people who were smaller such as teenagers and the elderly.

[LessValuableNinja]

Others have commented on your current position, so I won't other than to say that if it doesn't work out, there are others. Someone mentioned telephonic jobs. Another option is hospice. There are no compressions over the phone or in hospice.

[PnwRN84]

If you were to walk in to a room and find someone who needs compressions and died because you could not perform them; could you imagine the lawsuit to follow? Your guilt?

You should immediately notify your employer of your condition. I'm also a little surprised that your doc allowed you to pick your restrictions. Our facilities RN job description states you have to be able to lift up to 50 pounds, so even beyond the CPR requirement, what if someone collapses in front of you? It's a danger and liability to your license and the facility to allow you to continue in your current condition on the floor.

Thats not to say you need to be terminated. Your facility should have RN work that's not direct patient care. Resource utilization? Social work? Patient referrals and call backs? The Robert Wood Johnson Foundation has published many papers about the aging and retiring nursing workforce and the need of facilities to adapt jobs to keep those who want to work working.

I think that realistically.. if you're at the best condition you can be with your back problem and will never do CPR again; on the floor is too risky to patients, yourself, and your employer. Move to a non clinical position and 'nurse on'. Good luck.

[YoutubeTheNP]

I really hope you have more than just foraminal stenosis that is preventing you from doing CPR. This is a very common finding on anyone over age 50. Your excuse and your restrictions is a true slap in the face to medical professionals everywhere who have ever sustained a real back injury from pulling/lifting dead weight. Really? Standing no more than 1 minute? This is a joke right?