Nurse refused to give CPR - page 46

by flexiseal 68,540 Views | 489 Comments

"Nurse refused to give CPR to elderly woman who later died" Have you guys seen this? It's quickly making national news. What would you do in this situation? Also, in your experience is it common for assisted living... Read More


  1. 5
    Oh for the love of Pete. The employee on the phone was a nurse of some kind people, WAS, as in past tense, employed as one at some time in her life and according to the California BON, apparently still licensed. No longer working as one, for reasons we have not been made privy. Jeebus. Not hard to grasp, yet there are 45 pages of confusion on this point.

    The 911 operator is a loon and probably ought to be reassigned to a file clerk position in the office versus actually answering the calls, she sounded unglued. The employee should have said "send ambulance please for transport to a medical facility for evaluation and treatment, as this is a cafeteria, thank you." and hung up. The +/- 7 minutes of discussion on CPR was ridiculous and she should never have entertained that conversation. That was her biggest mistake, IMO. I don't blame her for not performing CPR on an 87 y/o, it is rarely appropriate.

    And lastly, what amuses me the most is the OUTRAGE that the 87 year old didn't get CPR despite the hundreds of thousands of dollars of follow up care that would have been required had the CPR been even marginally successful (I see we have already covered the exceptionally low statistical likelihood she would have lived 30 days) to keep her alive for 14-60 days coming from people (not necessarily posters here, but the public in general). Yet, many of those same people would simultaneously insist that she is not entitled to any sort of health care, "because health care is not a human right." We cannot have it both ways. Human beings are either entitled to care or they are not. Or is the argument that we should do a wallet biopsy first, and if she has 250k in the bank and can afford to pay for her ICU stay, then she gets CPR? We will start calling codes as soon as the credit reports are in...
    elkpark, Jolie, llg, and 2 others like this.
  2. 2
    Quote from Jolie

    This place is not a healthcare facility. It is essentially an apartment complex or room and board house. I find it partially amusing and partially embarrassing that there are numerous posters on this thread (presumably nurses) who are criticizing the facility for failing to follow "standards of care," since there are no such things for residential facilities, and railing against the staff for not knowing, or not having the woman's DNR status "on file". Does your landlord have your DNR on file?

    I find it equally frustrating that many of those same posters are apoplectic that the individual on the phone called 911 despite no intention to perform CPR. What would you expect a LAY person to do when an elderly lady keels over in front of her? Whether or not CPR was to be performed, a call to 911 was completely appropriate, since the floor of a dining room is not a suitable place for anyone to pass away, especially when there are other options. Regardless of the provision of emergency care (or not), transport to a care facility was appropriate for comfort measures. (We all understand hospice, right?) Would you deny this woman an opportunity to pass from this world in a dignified, private setting, on a stretcher with clean sheets and a warm blanket, rather than the cold linoleum dining room floor, with gawkers looking on? Or as another poster asked, should the maintenance guy just have waited for the lady to stop breathing altogether, then toss her body in the back of his pick-up to drive to the morgue?

    For the love of all that is good and holy, how in the world can we expect the lay public to understand this story when we have supposed healthcare professionals decrying lack of standards of care in an apartment house, and expecting knowledge of EMS protocol from lay people on the phone. To compare the "Resident Director" to a nurse is laughable, and that she declared herself as such is what we should be outraged about. Not that the elderly lady's wishes for a peaceful death were followed.

    This whole story would be more understandable if we inserted the following (more accurate) information: Instead of care facility, let's call this an apartment complex. Instead of resident director, let's call her a leasing agent.

    Now can we get past the silly notion that there was a standard of care, a duty to act, or any medical knowledge at all on the part of the staff?
    I work in an assisted living facility as an ADON with an Alzheimer's unit and there is also a separate independent living side. As a nurse I am limited by company policy and state guidelines as to what nursing skills I am allowed to perform. I don't agree with all of these policies but I am obligated to follow BON guidelines. For example; if someone gets a modest size skin tear I can only put a band aide on it, no gauze or dressing of any kind. I can put 30 band aides if I need to. Ridiculous, I know but it is what it is. We are not licensed to perform "complex" nursing procedures. We can act as an advisor to residents and coordinate care. It is very frustrating to be told I cannot provide the nursing care I have learned. The truth is though, I have absolutely done dressings for skin tears that were bleeding profusely. It would be irresponsible for me to let some one bleed until the home care nurse can come to dress the wound. and not to mention infection control issues.
    We are basically an apartment complex with CNA/CMA's and 2 nurses on staff. We cannot provide skilled care. We don't scam people out of their money. If an elderly person has substantial financial assets they have to basically burn through their money before Medicare will pay for nursing care, either in our facility or skilled nursing facility. Or if they are lucky enough to have LTC insurance to pay for it.
    We do our best to stay within the guidelines but we do sometimes walk the line, we do what we can for our residents.
    Assisted living facilities are licensed differently than skilled care facilities.
    We do not require our staff to be CPR certified, which I personally don't agree with, and we are a no CPR facility. If we unknowingly perform CPR on a DNR resident we are screwed. I honestly don't know what I would do if I were in a situation where one of my residents needed CPR, I cringe at the thought of doing chest compressions on a 90lb 90 year old! But I don't think I could not help either.
    Spidey's mom and elkpark like this.
  3. 1
    Quote from BlueDevil,DNP
    Oh for the love of Pete. The employee on the phone was a nurse of some kind people, WAS, as in past tense, employed as one at some time in her life and according to the California BON, apparently still licensed. No longer working as one, for reasons we have not been made privy. Jeebus. Not hard to grasp, yet there are 45 pages of confusion on this point.

    The 911 operator is a loon and probably ought to be reassigned to a file clerk position in the office versus actually answering the calls, she sounded unglued. The employee should have said "send ambulance please for transport to a medical facility for evaluation and treatment, as this is a cafeteria, thank you." and hung up. The +/- 7 minutes of discussion on CPR was ridiculous and she should never have entertained that conversation. That was her biggest mistake, IMO. I don't blame her for not performing CPR on an 87 y/o, it is rarely appropriate.

    And lastly, what amuses me the most is the OUTRAGE that the 87 year old didn't get CPR despite the hundreds of thousands of dollars of follow up care that would have been required had the CPR been even marginally successful (I see we have already covered the exceptionally low statistical likelihood she would have lived 30 days) to keep her alive for 14-60 days coming from people (not necessarily posters here, but the public in general). Yet, many of those same people would simultaneously insist that she is not entitled to any sort of health care, "because health care is not a human right." We cannot have it both ways. Human beings are either entitled to care or they are not. Or is the argument that we should do a wallet biopsy first, and if she has 250k in the bank and can afford to pay for her ICU stay, then she gets CPR? We will start calling codes as soon as the credit reports are in...
    The intact survival rate for an out-of-hospital arrest for 87 year old isn't merely low - it approaches 0.
    Jolie likes this.
  4. 1
    Quote from BlueDevil,DNP
    Oh for the love of Pete. The employee on the phone was a nurse of some kind people, WAS, as in past tense, employed as one at some time in her life and according to the California BON, apparently still licensed. No longer working as one, for reasons we have not been made privy. Jeebus. Not hard to grasp, yet there are 45 pages of confusion on this point.

    The 911 operator is a loon and probably ought to be reassigned to a file clerk position in the office versus actually answering the calls, she sounded unglued. The employee should have said "send ambulance please for transport to a medical facility for evaluation and treatment, as this is a cafeteria, thank you." and hung up. The +/- 7 minutes of discussion on CPR was ridiculous and she should never have entertained that conversation. That was her biggest mistake, IMO. I don't blame her for not performing CPR on an 87 y/o, it is rarely appropriate.

    And lastly, what amuses me the most is the OUTRAGE that the 87 year old didn't get CPR despite the hundreds of thousands of dollars of follow up care that would have been required had the CPR been even marginally successful (I see we have already covered the exceptionally low statistical likelihood she would have lived 30 days) to keep her alive for 14-60 days coming from people (not necessarily posters here, but the public in general). Yet, many of those same people would simultaneously insist that she is not entitled to any sort of health care, "because health care is not a human right." We cannot have it both ways. Human beings are either entitled to care or they are not. Or is the argument that we should do a wallet biopsy first, and if she has 250k in the bank and can afford to pay for her ICU stay, then she gets CPR? We will start calling codes as soon as the credit reports are in...
    Excellent points! The employee apparently was not clear on how to handle the call and policy and procedures. The 911 dispatcher was in dissarray and did not handle the call well. Many of us, me included, may not have been clear with our understanding of what happened or should have happened. My oh my, what a mess! Well it was interesting to see the debate go this far.
    Jolie likes this.
  5. 1
    Quote from subee
    The intact survival rate for an out-of-hospital arrest for 87 year old isn't merely low - it approaches 0.
    Yes, I agree, but I saw there was some debate on that and didn't wish to get into the mire, lol.
    Jolie likes this.
  6. 0
    Quote from BlueDevil,DNP
    Oh for the love of Pete. The employee on the phone was a nurse of some kind people, WAS, as in past tense, employed as one at some time in her life and according to the California BON, apparently still licensed. No longer working as one, for reasons we have not been made privy. Jeebus. Not hard to grasp, yet there are 45 pages of confusion on this point.

    The 911 operator is a loon and probably ought to be reassigned to a file clerk position in the office versus actually answering the calls, she sounded unglued. The employee should have said "send ambulance please for transport to a medical facility for evaluation and treatment, as this is a cafeteria, thank you." and hung up. The +/- 7 minutes of discussion on CPR was ridiculous and she should never have entertained that conversation. That was her biggest mistake, IMO. I don't blame her for not performing CPR on an 87 y/o, it is rarely appropriate.

    And lastly, what amuses me the most is the OUTRAGE that the 87 year old didn't get CPR despite the hundreds of thousands of dollars of follow up care that would have been required had the CPR been even marginally successful (I see we have already covered the exceptionally low statistical likelihood she would have lived 30 days) to keep her alive for 14-60 days coming from people (not necessarily posters here, but the public in general). Yet, many of those same people would simultaneously insist that she is not entitled to any sort of health care, "because health care is not a human right." We cannot have it both ways. Human beings are either entitled to care or they are not. Or is the argument that we should do a wallet biopsy first, and if she has 250k in the bank and can afford to pay for her ICU stay, then she gets CPR? We will start calling codes as soon as the credit reports are in...
    As an ICU Nurse I certainly agree that we could use less CPR on 87 year olds, avoiding situations where 87 year olds are alive but sentenced to live out their remaining days in a state of anoxic encephalopathy should be our priority. But I disagree with your theory on how to achieve that.

    Due to very different oxygen storing abilities as well as different tolerances to anoxia, it's much easier to obtain cardiac functioning after some time down that it is neurological functioning. 5 minutes of no CPR followed by ACLS can often get a heart going again, although the chances of a good neurologic recovery are extremely poor given the same down time.

    If cardiac death occurred just as easily as anoxic brain injury, I'd go along with your suggestion to just delay CPR, but that's not the case. If someone is 5 minutes away from getting ACLS, withholding CPR reduces the potential for cardiac/respiratory resuscitation far less than it reduces the potential for a good neurologic recovery, so if your goal is to avoid causing situations where someone is alive, but with poor neurological functioning, delaying CPR for someone who will get it anyway is arguably the worst way work towards that goal. If your goal is create more "alive" but miserably encephelopathic patients, that's about the best way of doing it.
  7. 3
    Oh for Pete's sake, Muno, no one is advocating delaying CPR. We are advocating following the victim's stated wishes not to do it at all.

    Focus on to those who desire resuscitation, rather than torturing those who don't.
    Spidey's mom, elkpark, and wooh like this.
  8. 1
    Purely my opinion, but I think it's completely irrelevant if this person was or wasn't a nurse, whether she was or wasn't operating in a medical capacity, or whether or not CPR was appropriate or likely to have been successful on this person.
    The bottom line, for me, is that with this facility's policy in place, I would have to imagine that there was some kind of contract signed when the woman moved in, with clauses to this effect. Essentially, if this woman signed a contract stating she would receive no medical care whatsoever, and that employees would call EMS in case of an emergency and absolutely nothing more, that is as good as a DNR in my books. I can't sign a contract with my bank and then complain if I don't get a lower interest rate. My signature is my affirmation that the terms of the contract are agreeable to me.
    That this employee wasn't "allowed" to do CPR because of policy is irrelevant. (Presumably) this woman signed a contract stating she did not expect CPR, as did every resident of this facility. I can see the moral dilemma, in that there is a question of whether this resident really wished to be a DNR, or if she was just settling for the terms of the contract when she signed it, but really, if you expect the people around you to do CPR, you'd better make sure they are ready, willing, able, and qualified to do so. And certainly don't sign anything that instructs them not to do it.
    Jolie likes this.
  9. 0
    Quote from Jolie
    We are advocating following the victim's stated wishes not to do it at all.
    ok, i obviously missed this critical piece of information.
    please tell me where/when the victim stated her wishes.
    because at the time of the call, her wishes were unknown.
    it doesn't matter what the facility's policy was,esp citing we (nurses) should not base our responses on assumptions.
    so yes, please...do tell.

    leslie
  10. 4
    Quote from leslie :-D
    ok, i obviously missed....

    leslie
    Yes, apparently you did. It's all been covered leslie, but if you don't wish to re-read, here goes.....

    This elderly lady lived in a residential home, not a healthcare institution. Her daughter has revealed in interiews that this choice was consciously made because the woman did NOT want resuscitative measures in the event of her impending death.

    The "resident director" did not have a nurse-patient relationship with the deceased so her choice not to proide CPR is no more heinous than any of us choosing not to provide CPR when the elderly person in the next booth at Denny's falls headlong into her pancakes.

    To simplify the matter for those sidetracked by irrelevant information, substitute the terms, "apartment complex" and "leasing agent" for "residential care facility" and "resident director." Unless you believe that your landlord (nurse or not) is somehow responsible for providing CPR should you collapse while signing your lease, you've got the concept.

    Now, I've got better things to do while you all continue to beat this dead horse, which is exactly what the elderly lady and her family did not want. Good call.
    Altra, Spidey's mom, wooh, and 1 other like this.


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