Nurse refused to give CPR - page 47
"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
- 0Mar 21, '13 by CrunchRNQuote from chrysdamianThank you for explaining and clarifying further the restrictions a nurse works under in an ALF.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.
- 0Mar 21, '13 by leslie :-DQuote from Joliejolie, do me a favor and spare me the snark.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.
my point was that at the time of the call, it would seem this resident director did not know this lady's wishes.
and while there are no legal ramifications to declining cpr, the ethical action would be to try and save a life.
same goes for your example of a person falling and taking a header.
to sit by and do nothing... it escapes me.
but if that is your main concern (the legalities), then yes, this director did nothing wrong.
- 1Mar 21, '13 by LadyFree28Quote from jrsmrs^I can agree with THIS...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.
- 2Mar 21, '13 by MunoRNQuote from JolieI don't think anyone would argue that CPR should not be performed on someone who has made it known they do not want CPR, and highly encourage everyone to make that known, but I think you've misunderstood the story here. The staff were not refusing CPR because this person did not want CPR, there were many opportunities to point that out during the call but no such point was made, and the statement that they were calling 911 for resuscitative purposes contradicts your claim that there was any knowledge she had chosen to forgoe CPR at the time. In POLST states such as California, it's not uncommon for assisted living facilities to maintain a file of POLSTS for residents, which would explain why EMS stated this particular person had no such directive "on file", rather than just saying there was no way of knowing. The claim that she didn't want CPR anyway was made after the fact, this was clearly not the premise the ALF staff were basing their actions on.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.
The issue is also not with whether or not she chose not provide CPR as a personal choice, but that there was supposedly a policy in place that prevented early CPR regardless of the providers choice to perform CPR or not, even though their policy was also to initiate EMS services which will begin ALCS in the absence of a POLST. This is effectively a policy that only delays CPR, yet you seem to support such a policy, yet don't advocate delaying CPR, which is all the policy does, which is confusing. Do you oppose such a policy?
- 0Mar 21, '13 by leslie :-DQuote from MunoRNTHANK YOU, muno.I don't think anyone would argue that CPR should not be performed on someone who has made it known they do not want CPR, and highly encourage everyone to make that known, but I think you've misunderstood the story here. The staff were not refusing CPR because this person did not want CPR, there were many opportunities to point that out during the call but no such point was made, and the statement that they were calling 911 for resuscitative purposes contradicts your claim that there was any knowledge she had chosen to forgoe CPR at the time. In POLST states such as California, it's not uncommon for assisted living facilities to maintain a file of POLSTS for residents, which would explain why EMS stated this particular person had no such directive "on file", rather than just saying there was no way of knowing. The claim that she didn't want CPR anyway was made after the fact, this was clearly not the premise the ALF staff were basing their actions on.
my thoughts exactly, except rather than respond as you did, i sit here shaking my head...
wondering if i have lost my mind.
to me, your post expressed to a tee, what this issue is about.
yet i've been questioning myself, wondering if i missed something in translation.
so...yes, yes, yes.
if this resident director had simply relayed this pt's wishes (dnr) to the 911 operator, none of this hoopla would have occurred.
all of this talk about her not wanting to be rescusitated, is definitely irrelevant to this issue and therefore, a moot point.
phew....thanks for affirming my thoughts all along.
it shouldn't have to be this dramatic.
- 0Mar 26, '13 by MunoRNQuote from MunoRNJust to clarify, I wasn't trying to being sarcastic or rhetorical, I really am curious.This is effectively a policy that only delays CPR, yet you seem to support such a policy, yet don't advocate delaying CPR, which is all the policy does, which is confusing. Do you oppose such a policy?
- 0Mar 26, '13 by SuzieVNThis issue will be determined by the CA BON (if she's an RN, I never did find out her credentials), in the end. Yes, you need to follow policy at work, but underlying is the nurse practice act, and Good Samaritan laws. What I have yet to see mentioned, even by lawyers that speak of following 'advance directives', that include such things as 'Do not resuscitate', is: I have never myself seen a directive that states 'if I am choking, or otherwise in distress, do not help me'. I have seen "DNR if I you find me dead", do not intubate to resuscitate me, and on and on...But- in this case advance directives do not seem to apply, and the policy of calling 911 is not going to protect that nurse, my opinion. She stood by, and let her die a terrible death. Her claim of following policy won't save her license, my guess. Interesting case to follow up on, for sure.
- 0Oct 19, '13 by praterrThis so called "nurse" violated her nursing oath of "do no harm", she stood there arguing with the 911 dispatcher and refused to help. I remember hearing this all of the news when the story first broke and I was sickened and disgusted that facility had no contingency plan to provide CPR. Their policy is to sit and wait, pretty sure all state licensed facilities need to have CPR trained employees and have proper DNRs on files. I reread the article that was listed in the in the discussion above and the residents family was happy with her care??? Im at a loss for words.....
- 4Oct 19, '13 by Ruby VeeOh great! Bump the six month old, contentious thread!
If the facilities policy on CPR was known to the patient and family and they agreed, what business do the rest of us have second guessing? As an ACLS instructor and the daughter of a parent in a nursing home, I know very well that not every patient benefits from CPR. death is, after all, a part of life.
- 0Nov 1, '13 by kcochraneQuote from woohSince she did not have a DNR order, it would be assumed that she wanted everything done. Whether or not we think it will be successfull or whether or not it would have caused damage is not our call. I may not agree with every DNR or full code decision that is made, but I will abide by it, if it's the person's wish. It was not anyone's elses call except for the person in question or the Dr. who feels it is futile.So you'd rather have on your conscience that you beat the crap out of a little old lady so you wouldn't have to feel like you "let her die." Sounds selfish to me.
Sure it's DONE. Is it EFFECTIVE? On 87 year old people?
This wasn't a healthcare facility. Would y'all be up in arms if my landlord didn't do CPR on me?