Termination of employment

  1. I was recently terminated because I failed to initiate CPR on a patient who had been expired for about 40 minutes. Administration informed me it was "policy" or protocol even though there was not chance of reviving the patient.

    Has anyone experienced this type of situation before?

    The incident was reported to my State Board and I am waiting to hear.

    Others thoughts would be appreciated.

    Thanks,
    DanielMark
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  2. 30 Comments

  3. by   live4today
    (((((((((((((danielmark))))))))))))))) so sorry this has happened to you. i hope your state board of nursing will be able to help resolve the matter to your satisfaction. i know of policies that substantiate what your administration informed you of, but that could vary state to state, so i won't elaborate on what i have experienced or seen or learned to do at various hospitals when situations like this arise. i'll pray that all works out well for you. let us know.
    Last edit by live4today on Jul 23, '02
  4. by   DanielMark
    THanks for replying. I have lots of friends praying for me already.
    Just a waiting game till I hear.
  5. by   NurseDennie
    Good luck, DanielMark! I don't really get it - why would a facility have a policy to start CPR on someone with no chance of coming back?

    Love

    Dennie
  6. by   shannonRN
    i'm am so sorry that this happened to you. thank you for sharing this with us tho...i will definately be reviewing the policies at my hospital. i hope things turn out in your favor.
    i just have a question. how do you know this patient had been expired for 40 minutes?
  7. by   DanielMark
    In answer to "why a facility has this policy", I was informed if a RN fails to initiate CPR/code blue, then the RN is acting as a physician by determining that death has actually occured and this act is not in the scope of a nurse's practice.

    Replying to the other question of "how did I know the patient had been expired for 40 minutes", the resident guessed this to be the case and even informed my manager that there was no chance of reviving the patient. He did not want the facility to terminate me when he was informed that would happen.

    Also, when I checked the patient, she was what we call "stone cold dead."

    THanks for your questions. This is helping me cope better with the situation.

    DanielMark
  8. by   shannonRN
    Originally posted by DanielMark
    then the RN is acting as a physician by determining that death has actually occured and this act is not in the scope of a nurse's practice.
    what?! omg, that is crazy. at my hospital, if a patient is a dnr...the nurse pronounces. not a doctor. if it is a code situation the code team is running the whole thing and we get the doctor on the phone and give him the 411... then the doctor can call it....so my question is, how can the md call it an not even be in the same building and we can be standing right next to the patient?! maybe it is so different because we aren't a teaching hospital and don't have all the residents, who knows.

    Originally posted by DanielMark
    the resident guessed this to be the case and even informed my manager that there was no chance of reviving the patient.
    the reason i asked was because rarely do we know how long a patient has been down. so, what's to say that the patient hadn't just coded....i wasn't meaning to sound rude when i asked the question, hope you weren't offended. :kiss
  9. by   CATHYW
    DanielMark, something similar happened to me (not the termination) when I was a volunteer FF/First Responder. We got a call that a man had DIED. We went flying out there, approx 10 min. drive with wings on the rescue truck. Ran up to the house, patient sitting in WC at lunch table, head bowed as though saying grace. Downtime at least 15 min., known hx cardiac and resp. probs. Family everywhere, all saying, "don't start CPR, don't start CPR." I checked for a pulse-there was none-what a shock! Anyway, the other 2 First Responders began getting the family out, as I was trying to obtain a correct sequence of what had happened. About that time, our Chief arrived, gave me a dirtly look, grabbed the man out of the WC, pulled him to the floor, and whipped out on EGOTA. He inserted it, and he and one of his best friends began CPR on this expired gentleman. In short order, the man's belly began to swell, and I suggested that the EGOTA might not have been placed correctly. No, that isn't possible! When the belly was so large and tight that they could not do effective ventilations and compressions, they began to consider that maybe something WASN'T right. They gave me access to the patient, and I immediately removed the EGOTA. I reinserted it, listening for breath sounds in both lungs-BINGO, it was placed and checked as it should have been. About then the ambulance arrived. Monitor shows agonal rhythm. Fire Chief and I ride in ambulance 30 mins through mountain roads to hospital, hanging like monkeys from the overhead grab bar, doing compressions while alternating doing CPR while the PM was bagging (after placing an ET tube) and pushing IV meds. We barely got the patient into the ER when the code was called. The Fire Chief sternly told me that I was to begin CPR on ALL down patients, no matter the down time, and no matter if all the family is requesting that it not be done. It was County policy! |As it turned out, the Chief wound up getting a good butt chewing because his First Responders didn't respond "appropriately." That was about 8 years ago, and there are still hard feelings by those family members against certain members of the department for beginning CPR on their husband and Daddy. Go figure. I absolutely draw the line at a stone cold, or stiff person. In FL, RN's used to be able to pronounce people. Here in GA, it is a coroner or ERP.
    Last edit by Cathy Wilson, RN on Jul 23, '02
  10. by   DanielMark
    These reponses are thought provoking. Perhaps I should have added that this particular patient was not a DNR. Therefore, according to this hospital's policy, CPR/Code Blue should have been initiated even though this patient was "stone-cold dead."
    The LPN who discovered the patient initially notified me and being the clinical supervisor it was my responsibility to initiate the code.

    Hindsight is marvelous, as they say, in that even the other staff nurses did not think to call the code or suggest to me to do so.

    Yes, it is a teaching hospital.

    Another note, this situation has really thrown me for a loop. My confidence is at a low level. I am also being very hard on myself which I know is not healthy and a typcial behavior of most nurses.

    This unplanned time off is providing lots of time to think and re-group but at the same time can be harmful since I have yet to start applying for other positions as I would definintely have to tell any future employers of this incident.

    Hopefully the State Board will take into consideration my exemplary career thus far and dismiss the matter. Termination has been discipline enough !!!

    Again, your replies have been much appreciated.

    DanielMark
  11. by   CATHYW
    Chin up, DanielMark, and do it now! Do not beat yourself up any further! You have nothing to be be regretful for, except that some people do not recognize dead when they see it. Even if this man was not a DNR, a 40 minute down time and a stone cold body should be evidence enough to even the most ignorant layperson that this is not a reversible situation. I think your State Board will see this clearly. While you sare sitting around thinking, think of other times that you did recognize something critical that something could be done about, and what you did about it. These are situations that you can relate in interviews when the current situation is related. I think there are plenty of "exterminating" (LOL!) circumstances here that need to be looked at. In the hospitals where I worked, EVERYONE, (including Housekeeping) was responsible for CPR. Upon finding an unresponsive person, a Code Blue alarm was sounded, and then CPR was inititated until the Code Team arrived. There was not all of this chain-of-command crap that put you into the situation you are in right now.
    Take it easy on yourself! When things cool down a little this evening, go for a walk. Watch the sun set, or find a patch of grass and lay down on your back and watch the clouds float by. Fix yourself something good for supper, and have a good long hot shower or bath. Maybe a glass of wine after that will get you in good shape. Just don't do TOO MUCH alcohol. BTW, if you don't drink, don't say that "this nurse on the boards told me to start drinking, and everything would be okay," okay? LOL!
  12. by   live4today
    DanielMark.........I second what Cathy is saying to you. Be encouraged, and know that justice will prevail in the end. :kiss
  13. by   oldgirl
    At our place, we code everyone unless there is a DNR. Even the 100 year olds that are so contracted their knees touch their chins. Of course the doc can call it whenever he deems appropriate, but the whole production has to be initiated no matter what. I had a friend who got in trouble as a EMS member for refusing to start CPR on a call for someone that they thought had been dead 3-4 DAYS when they got there. These are the kinds of things that keep ME up at night. I hope this will resolve in your favor, because you certainly made the compassionate decision. Still can't see the blessings in putting a body through that kind of trauma for no results.
  14. by   NRSKarenRN
    Daniel,

    Sending a {{{hug from PA}}} too. Can only imagine how must be a difficult time...glad you reached out to vent here.

    Tried to find Missouri statue re who can pronounce death but unable to locate on search tonight.

    While the events are fresh in your mind now, review and write down WHy you took the actions you did. Do you have an orientation manual that you can refer to that would have hospital CPR guidelines in it?? Gather as much info togher as you can. PLEASE seek guidance from an attorney---will certainly need one to go before the SBON to defend youself in this situation.

    Since you were not the patients nurse, what actions were taken against him/her for not calling a code?? OR does policy state RN must initiate a code?

    Wish I could offer more guidance. Please keep us updated. Praying to send you faith and guidance in the weeks ahead.
    Last edit by NRSKarenRN on Jul 23, '02

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