BLS and RQI - Can't do it

[Brae30, BSN]

I'm just finishing my second year in nursing. I just took an ACLS class through my hospital and was recertified. I completed the online BLS portion but had to use the hospital RQI mannequin to complete the BLS. I fought for an hour trying to get my compressions deep enough to complete even just the CPR portion. I failed every single time and hurt myself in the process. 75% is the passing. I only made 43% at the maximum. I was literally in tears and shaking when I had to admit defeat. I had to go out and do an outside course in order to complete my BLS. However, I've been told that in the near future that my hospital is going to be only using these horrific mannequins and RQI in order to complete BLS. I don't know if the mannequin was faulty or I have just a very weak upper body strength (which I do) but I fear the future. I fear that I will be suspended and not be able to work as a nurse because of the stupid BLS recertification mannequin. Has anyone else experience this? What was your solution? I went through too much with nursing school and I'm in so much debt from nursing school. I can't lose my job because of this RQI nonsense. Any advice would be greatly appreciated. Thank you. 

[JKL33]

It sounds like you'll need to ask for some kind of accommodation if it comes to that. Talk to your supervisor.

As a side note, the concept of having real-time feedback about the quality of the compressions is not nonsense. The more silly thing was the way prior training was done, with one incapable instructor strolling around chatting while 60 or so people pressed on a piece of rubber on a Spring for a minute or two. Real CPR is its own experience--but it does indeed require a LOT more energy (to do it right) than what the old mannequins required to depress the sternum. Those mannequins might have been helpful for teaching hand placement, rhythm, speed, etc, but they were a joke with regard to actual force needed.

[chare]

@Brae30, have you heard of  the American Heart Association's (AHA) Advisor: Basic Life Support (BLS) program?  The AHA implemented this in 2020 for those that passed the cognitive portion of the BLS course, but were unable to "independently perform the physical skills of CPR [verbiage from AHA website]." 

Best wishes.

[adventure_rn, MSN, NP]

Friend, if it makes you feel any better, those RQI mannequins are The Worst. I just had to wrestle with a broken one last week for both the compressions and breaths, and it had me in a sweat.

A couple of thoughts:

First, it helps to use a step-stool, that way you can put your full body weight into the compressions (this is very helpful in real compressions, too).

Second, I think it's literally impossible to compress too hard on the RQI mannequins (vs. the older regular CPR mannequins). Don't fool around trying to make the compressions 'deep enough' without being 'too deep,' just push as hard as you can each time (this is different from the breathes). This is a little counterintuitive, since with a lot of the non-RQI ones, you actually have to go to the correct depth.

Third, I'm not sure if your facility has a bunch of them (my hospital probably has at least 30+ scattered around the various units and buildings), but try to find one on a very solid surface. Mine last week was on a wobbly table, and every time I tried to compress the mannequin slid around, so I had to work twice as hard. Also, try to pick one with a screen that can be positioned directly in front of you while you compress so you don't have to look over your shoulder to see the depth/rate (since that will make your compressions less effective, which is also true in a real code).

Fourth, if you're tired, give yourself a break before you try again later. There's a reason we don't compress in real life for an hour straight. If you're already worn out, the chances that you'll be successful are even smaller. Get started on your RQI renewals early so you aren't in a time crunch to get it done on a specific date. If you have several mannequins to choose from and one isn't working for you (wobbly table, defective airway), try a different one next time.

Fifth, if it's still giving you trouble, ask your educator for help. They probably have some tips and tricks for when the dummies aren't working well. (This is perhaps most important for their airways, which are truly the devil's work--point their chins toward the sky...)

May the odds be ever in your favor. You can do this.

[JBMmom, MSN, NP]

Ours are always broken. One time I had to fashion a hygienic "mouth to mouth" for the baby because the mask contraption was broken and it was the end of the quarter. I think that they do have some benefit with the real time feedback because many people don't have the rhythm intuitively.

And my hospital is one that has gone to quarterly RQI and no longer accepts outside BLS certifications. It's in our education system and the mannequins are online. 

OP, I'd bring your educator with you next time to make sure you've got the best set-up for you. Good luck!

[Nurse Beth, MSN]

It can be frustrating. Sometimes it seems the prompts contradict themselves- do they want it faster or do they want it deeper?

But I finally got the hang of it by getting in a zone (relaxing) and watching the performance monitor. I guarantee you can get this with practice.

[brandy1017, ASN, RN]

Also when it says do you want to keep going don't!  It doesn't help and it only tires you out!  Just start over.  But as others said quit and take a break if you are tired out.  So many of us had problems with the mannequins our educator told us to use each other to help pass ie if we couldn't do it have our coworker essentially do it for us.  I don't know if that is kosher where you work.  But that is what it came down to for some of us to get the robot to pass us!

[inthepink07]

We had one that the settings were off and no matter what you did you failed. When it's working it's great and shouldn't be to hard to complete. A step stool does help and luckily there is one provided. 

[beyer_corpuz]

I failed the computer guided practical exam. I am a Lpn. For one, I work in psychiatry and a patient had just damaged my hand. Second they started an hour late. There was no guidance.

 

I am due to retire in 12/31/23 and my BLS expires 10/31!23. If I can't pass I get suspended. 

What's  worse is that I am already out on workers compensation.

So during the practical I only made it through first phase. Then for 30 compressions and 2 breaths I kept failing albeit with sore hand.

HR will give no exceptions. Nursing says I can only take exam there on computer and mannequin on table.

If a doctor allows me to go back to work next week I could still fail.

Help! Any ideas? So far this information has been very helpful. I don't want to be suspended even though on workers compensation.

I know this is a lot of information at once but I am really stuck on what to do.

Also, I hope I am posting in the right place.

 

 

[brandy1017, ASN, RN]

beyer_corpuz said:

I failed the computer guided practical exam. I am a Lpn. For one, I work in psychiatry and a patient had just damaged my hand. Second they started an hour late. There was no guidance.

 

I am due to retire in 12/31/23 and my BLS expires 10/31!23. If I can't pass I get suspended. 

What's  worse is that I am already out on workers compensation.

So during the practical I only made it through first phase. Then for 30 compressions and 2 breaths I kept failing albeit with sore hand.

HR will give no exceptions. Nursing says I can only take exam there on computer and mannequin on table.

If a doctor allows me to go back to work next week I could still fail.

Help! Any ideas? So far this information has been very helpful. I don't want to be suspended even though on workers compensation.

I know this is a lot of information at once but I am really stuck on what to do.

Also, I hope I am posting in the right place.

 

 

This whole BS makes me think management could use the damn CPR robot as a way to get rid of people, especially older nurses!  It sounds like they are targeting you in retaliation to your filing workers comp.   I would recommend getting a workers comp attorney as your inability to pass CPR is directly related to the work injury. 

Sadly, some places are known to play dirty when someone files a WC claim and just try to get rid of them.  My aunt had to get an attorney to get her WC injury taken care of correctly at the hospital she worked for and it was a slip and fall from housekeeping leaving a wet floor. 

Really sad they would do this to you when you plan on leaving in a couple months anyway.  Do they know you are retiring soon?  Also an attorney would help make sure any issues down the road surgery etc would be paid via WC.  They get paid a percentage of a settlement or or lawsuit win at the end.  That's my best suggestion.

But who in "Nursing" is refusing to let you do the CPR elsewhere or use the mannequin on the floor?  It seems unreasonable.  Plus if you are on workers comp and not light duty should  you even be going into work to do anything?  I don't think so.  They are literally threatening you and intimidating you to do something, CPR, that could further injure your hand already injured from a work related incident!  I would really recommend talking with an attorney.  I would imagine they would tell you to stay away from work till you are given the green light!

You could ask your Dr to file an accommodation, but if HR is being this hostile chances are they won't cooperate anyway.  The disability accommodation is voluntary per management, so they can always refuse and dismiss a person. 

But again since this comes back to a work injury the only true way to protect yourself is to invoke WC and probably get a lawyer to fight for your rights. You could send an email for written documentation to your manager and HR that this is a WC issue and that you are ready to get an attorney if need be if they don't accommodate you, but again if you need CPR to work they would have to put you in a different job. 

There is a type of CPR license you can get where you don't have to physically perform, just do the written test, Advisor, BLS per the OP above,  "have you heard of  the American Heart Association's (AHA) Advisor: Basic Life Support (BLS) program?  The AHA implemented this in 2020 for those that passed the cognitive portion of the BLS course, but were unable to "independently perform the physical skills of CPR [verbiage from AHA website]."  mentioned by Chare.

Otherwise if you don't want to fight, then I would just take early retirement and enjoy having your weekends and holidays free!  Start checking out social security and medicare now if you haven't already. 

When I decided to take early retirement due to unsafe working conditions I gave myself Christmas off.  It was first time I'd had Christmas Eve and Day off in many, many years!  Is it really worth it to you to fight to work thru Christmas, especially for these ungrateful people?  It wasn't to me!

Good luck to you!

[beyer_corpuz]

Thank you! I will get on this right away.

 

beyer_corpuz

[FiremedicMike, BSN, RN, EMT-P]

I'm going to come from a different perspective.

The major focus for the last several years from the AHA is that high quality CPR with minimal interruptions is THE single deciding factor for patient outcome.  qCPR mannequins and their internal sensors are designed to mimic typical resistances found and measure rate, depth, and recoil. 
 

For years we had no real way to evaluate this and folks were being given CPR cards despite weak compressions, poor rates, and long pauses.  Now these folks have a standard they're being measured against and many are failing.  On top of that, the human factor of a "nice" CPR instructor just trying to help some fiends out is over and you have a cold, emotionless computer that will ensure the student understands what high quality CPR feels like.