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Can’t a nurse be fired?

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Can’t a nurse be fired if she didn’t initiate CPR on a full code that looked to have been dead for awhile

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

Why would one initiate CPR on someone who has been dead for a while?

Three nurses were suspended because they didn’t start CPR on a woman who was found unresponsive slumped over her chair. She was gray bloated no pulse no respiration’s her neck was stiff and she was cold

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

If by "stiff" you mean rigor mortis was present, then no, CPR is not indicated per ACLS protocol. If anything, termination should be considered if a nurse does CPR on a corpse with rigor-mortis since that could technically be considered a crime.

Quote

Criteria for Not Starting CPR

Scientific evaluation has shown that there are no clear criteria to predict the futility of CPR accurately. Therefore, it is recommended that all patients in cardiac arrest receive resuscitation unless

The patient has a valid DNAR order.

The patient has signs of irreversible death: rigor mortis, decapitation, or dependent lividity.

No physiological benefit can be expected because the vital functions have deteriorated despite maximal therapy for such conditions as progressive septic or cardiogenic shock.

Withholding attempts to resuscitate in the delivery room is appropriate for newly born infants with —Confirmed gestation <23 weeks or birthweight <400 g —Anencephaly —Confirmed trisomy 13 or 18

Source link: https://ahajournals.org/doi/full/10.1161/circ.102.suppl_1.i-12

Her head wouldn’t lay straight when she was put on the bed. Rigor Mortis set in because she died in her chair and her head was slumped over

Pepper The Cat, BSN, RN

Specializes in Gerontology. Has 35 years experience.

Maybe they were fired because of patient negligence? They did not find the woman until she had been dead for hours?

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

38 minutes ago, Barbara Fouch Lentz said:

Her head wouldn’t lay straight when she was put on the bed. Rigor Mortis set in because she died in her chair and her head was slumped over

Rigor Mortis is unrelated to patient positioning, it's due to an extended period of myocyte anoxia which results in the inability to produce ATP which results in the inability to break the actin-myosin bridges that causes a muscle to contract.

CPR isn't contraindicated because of the rigor-mortis itself, it's contraindicated due to the duration of death that the presences of rigor-mortis indicates, which is far longer than the duration that any meaningful brain functioning can remain viable.

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

1 hour ago, MunoRN said:

If by "stiff" you mean rigor mortis was present, then no, CPR is not indicated per ACLS protocol. If anything, termination should be considered if a nurse does CPR on a corpse with rigor-mortis since that could technically be considered a crime.

I was thinking that too... breaking ribs seems like desecration of a corpse.

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

Yeah CPR WASN’T appropriate. There is no question.

On 1/8/2020 at 9:18 PM, Barbara Fouch Lentz said:

Three nurses were suspended because they didn’t start CPR on a woman who was found unresponsive slumped over her chair. She was gray bloated no pulse no respiration’s her neck was stiff and she was cold

ArmyRntoMD, BSN, RN

Specializes in Critical Care. Has 7 years experience.

Lol. I’m laughing out loud.

“WhY ThEy No CPR a CoRpSe?!”

🤦🏻‍♂️

Delia37, MSN

Specializes in Critical Care. Has 15 years experience.

It takes a while for rigor mortis to set in, which in itself tell me no one was checking on that poor soul (...nursing home??); I would bet that was the real reason for the nursing staff to be fired

adventure_rn, BSN

Specializes in NICU, PICU.

5 hours ago, Pepper The Cat said:

Maybe they were fired because of patient negligence? They did not find the woman until she had been dead for hours?.

2 hours ago, Delia37 said:

It takes a while for rigor mortis to set in, which in itself tell me no one was checking on that poor soul (...nursing home??); I would bet that was the real reason for the nursing staff to be fired

According to Dr. Google, it starts within a couple of hours but peaks at 12 hours. In a nursing home, or even on a med-surg floor without continuous tele monitoring, it wouldn't be outside the realm of possibility. For instance, if your policy was to do assessments q shift and visual checks q hour, I could see this being missed in a patient who appeared to be sleeping soundly in bed. (I once worked with an RT who morbidly joke that that's why so many med-surg codes are called at 0630.)

I feel like the bigger issue is that she was in a chair. If she were asleep in bed overnight, you could honestly do hourly visual checks and just think that the patient is comfortably sleeping. However, if you've got a patient up in the chair, I'd hope people are checking a little more diligently since the patient is at risk for a fall. It also seems like the symptoms would be a bit more obvious in a patient seated in a chair (vs. asleep in bed).

Even if the nurses in question were following policy, I could totally see the facility suspending the nurses in an attempt to cover their own butts and lay blame on the team for not catching the early signs of deterioration and initiating a code.

6 hours ago, JKL33 said:

Withholding attempts to resuscitate in the delivery room is appropriate for newly born infants with —Confirmed gestation <23 weeks or birthweight <400 g —Anencephaly —Confirmed trisomy 13 or 18

Source link: https://ahajournals.org/doi/full/10.1161/circ.102.suppl_1.i-12

Sidebar, is it terrible that I've seen kids resuscitated despite literally all of these things? (Spoiler alert, do not go to the NICU forum, we are having a pretty salty debate about this precise topic.)

Edited by adventure_rn

I am not sure what the question is.

Did the nurses involved do anything wrong by not beating the crap out of a corpse?

No, they did the right thing.

Can they be fired for doing the right thing?

Absolutely. It's not all that unusual.

What are your thoughts on what they should have done and how management should have reacted?

7 hours ago, Delia37 said:

It takes a while for rigor mortis to set in, which in itself tell me no one was checking on that poor soul (...nursing home??); I would bet that was the real reason for the nursing staff to be fired

This post sounds like the head of the nail that has been hit straight on.

ArmyRntoMD, BSN, RN

Specializes in Critical Care. Has 7 years experience.

What negligence.. sickening. We see terrible stuff from nursing homes. We send them out, no decubitus. They come back months later, stage 4.

if you have family in a NH, you better he checking on them, because they most likely won’t be.

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, SOL (Student of Life). Has 19 years experience.

31 minutes ago, ArmyRntoMD said:

What negligence.. sickening. We see terrible stuff from nursing homes. We send them out, no decubitus. They come back months later, stage 4.

if you have family in a NH, you better he checking on them, because they most likely won’t be.

We used to get patients from acute hospital's and ICUs all the time with advanced Hospital Acquired pressure ulcers - the hospital's shoved them out to nursing homes immediately as Medicare/CMS stops payment for the care of any acute patient who develops a PU. The nursing home then had the job to heal that wound for which we did get paid.

https://www.todayshospitalist.com/The-pressure-is-on-to-treat-pressure-ulcers/

ArmyRntoMD, BSN, RN

Specializes in Critical Care. Has 7 years experience.

I don’t know how that is. Where I work each floor has accountability. If I get a patient from another floor with DU and there’s no documentation, I’m going to be documenting and it shows that it originated on them.

We have several nursing homes here known for how poor they treat the patients. One of my frequent fliers will purposely get himself sent back to us when he’s at the nursing home. He went to a rehab and was there for awhile. You can tell which facilities are god awful, the patients don’t stay there any time before being sent back