general question needing guidance

Nurses Safety

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Hello, I was recently terminated from my employer for an incident at work. I was the residents nurse and had a clinical manager to assist. The resident had been I'll for a little while now and on that day she was under my care. She passed away. My clinical manager and I both said she is a DNR. So we open up her chart to do notifications and we see she is a full code. I froze and just stood there and the clinical manager did the same. I got terminated to make an example. No discipline to the manager. I have done CPR on another resident before. My concern is, what should I expect from the board of nursing? How should I handle this? My director of nursing and administrator both said they would hire me back and be a reference but I'm worried about what the board is doing to say. Thanks for any advice that will help.

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It is YOUR responsibility to know what your patients code status is. Period. What do you mean you and your clinical manager both said the patient was DNR? Did you take the time to look in the patient's chart to find out what the code status was when you assumed care? Because it quite frankly doesn't matter what you both "said", it matters what the patient and their family wanted.

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Yes, when I was done assessing her and realized she has passed, we looked in the chart. I do know who and/or what the code status are. When she padded we looked in the chart to make notifications and realized she was a full code. So, since we did not follow plan of care one of us had to go. In my opinion it should have been both of us, considering she is my manager. I don't deny what I did wing but if one is going to be disciplined then both should be. Now I have to worry about my license. Which, sucks. I'm not that kind of nurse who neglects the residents, I'm always there for them and there families.

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Yes, when I was done assessing her and realized she has passed, we looked in the chart. I do know who and/or what the code status are.

The main problem you have is that you didn't know what the patient's code status was when you assumed care of the patient. You looked it up after the fact, as you said, when you were attempting to make notifications.

You were the nurse that assumed care of the patient so you should have been fired, not your clinical manager unless s/he was directly involved with the patient's care at that time. If I were you I wouldn't dwell on whether or not the other person should have been fired, that is the least of your worries at this point.

Look, I realize that we're all human and that as humans we sometimes make mistakes. I don't know what will happen with respect to your license. I'm sure a full inquiry will take place. I mean, was it a systems issue whereby it's just too busy, not enough staff, etc...? Who knows...

For me, this is a very basic, fundamental aspect when assuming care of a patient that you should have known. It's the same as knowing the patient's name and what, if any, allergies they have. You can't claim ignorance because the patient's code status was listed somewhere, albeit maybe not in the most accessible place.

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I completely understand. I'm not dwelling over the manager. Worried about my license is the main concern. My D.O.N said with pay cases that she had found the nurse kept there license to practice. Just wondered if anyone had advice pertaining to that. I know i screwed, I'm not denying that, just worried about my future.

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I'm really sorry this happened to you, that is like living through one of the top ten nurse's nightmare :(

When I took my first hospital job, I was struck by how VIGILANT the nursing staff were about a patient's code status. I mean really vigilant!

I also know how it feels to be quite 'sure' of something and then find out I am wrong after all. It's a human thing to do, and especially if you are 'sure' and your own manager stands next to you and agrees with you . . . and the patient is clearly dead, only a certain train of thought will go through your mind, you know?

At least once a week, usually twice, we'd hear the overhead call for a code blue and then a few minutes later, an overhead to cancel the call. We 'joked' to each other that the patient was actually a DNR and someone panicked. Yeah, you can joke about that, but not about what happened to you :(

I'm guessing the only way that the BON will be involved is if your conduct is reported to them. In your shoes I'd be assertively trying to find out if there is an investigation going on. Something like this must be a sentinel event, right? Reportable, in other words, the facility must report it to CMS. Don't stick your head in the sand (I'd sure want to :( ) but stay on top of it and present yourself as thoroughly aggrieved and responsible (avoid fingerpointing to the manager, clearly she was THERE). This manager is in just as hot of water as you are in, if that helps.

And quickly seek new employment, just in case :( Anyone can make such a mistake, and you don't need a lecture. If anything you'll be the posterchild for checking the code status of every patient you ever take care of again. Take care :)

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Since you were terminated for misconduct, the employer is obligated to report to the BON. Contact a lawyer who is familiar with nursing licensing to discuss the situation. The lawyer will advise you not to discuss details in public. Search your BON website for disciplinary hearings regarding failure to initiate CPR. Where I am, there have been a few of these types of hearings, the results were; suspension of license for 4 months, provide proof of CPR and meet with the licensing body's nursing practice advisor to discuss the standards of practice on resuscitation.

The nurses who failed to initiate CPR were terminated from their emplyer but my understanding, from reading the disciplinary report, is they are working with new employers who are aware of their past disciplinary action.

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Specializes in Pediatrics, Emergency, Trauma.
Since you were terminated for misconduct, the employer is obligated to report to the BON. Contact a lawyer who is familiar with nursing licensing to discuss the situation. The lawyer will advise you not to discuss details in public. Search your BON website for disciplinary hearings regarding failure to initiate CPR. Where I am, there have been a few of these types of hearings, the results were; suspension of license for 4 months, provide proof of CPR and meet with the licensing body's nursing practice advisor to discuss the standards of practice on resuscitation.

The nurses who failed to initiate CPR were terminated from their emplyer but my understanding, from reading the disciplinary report, is they are working with new employers who are aware of their past disciplinary action.

This.

Do you have ???

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One more piece of advice, if you can be identified by your user name, suggest you change it to something more anonymous.

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Thanks for all the advice.

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