Can’t a nurse be fired?

[Barbara Fouch Lentz]

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

[adventure_rn, MSN, NP]

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.)

[Guest219794]

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?

[caliotter3]

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]

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]

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]

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

[hppygr8ful, ASN, RN, EMT-I]

I will not debate that some nursing homes give terrible negligent care. But some like the one I worked in are pretty good. Still when a patient either falls or develops a pressure ulcer the term decubs hasn't been used in years it is usually seen as a sign of neglect though pressure wounds are not always the result of neglect but rather a product of protein catabolism

[ArmyRntoMD, BSN, RN]

I don’t know we regularly use the word decubitus here. The NH I my grandma was at was adequate, but we also checked on her almost daily. There are 3 I can think of right off that are god awful. Anytime a patient says they’re from there I wince a little. I’ve also had poor experience with LTAC. Like I said earlier the one I worked at went bankrupt, and the other ones in the area seem pretty similar.

One reason I work hard in life, if I have to go to a nursing home, I want to be able to afford a good one.

[Just me.]

11 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

I thought the same thing, I was thinking back to BLS? somewhere about choosing not to initiate cpr when rigor mortis had set in. I was thinking it was suspension for not discovering the situation sooner, because rounds were not done.

[hppygr8ful, ASN, RN, EMT-I]

On 1/9/2020 at 12:04 PM, ArmyRntoMD said:

I don’t know we regularly use the word decubitus here. The NH I my grandma was at was adequate, but we also checked on her almost daily. There are 3 I can think of right off that are god awful. Anytime a patient says they’re from there I wince a little. I’ve also had poor experience with LTAC. Like I said earlier the one I worked at went bankrupt, and the other ones in the area seem pretty similar.

One reason I work hard in life, if I have to go to a nursing home, I want to be able to afford a good one.

So very true - Many people believe that Medicare will cover the cost of their care in a nursing home - but Medicare does not pay for custodial care. My mother's care in a very good specialty facility for dementia patients ran between 9 and 10K a month. She had a trust that paid for most of it - but still

Hppy

[ArmyRntoMD, BSN, RN]

My grandma worked at a credit union, but my family members are financially smart. She paid for her stay for 2 years, 9500 a month until she passed at the ripe age of 92. And still left myself and other descendants a handsome inheritance. Probably helped that she worked until she was 90.

Never did get why people look forward to retiring. I never plan to retire, what would I do with myself?

[MunoRN, RN]

13 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

That's a bit absurd.

The stage of rigor mortis described by the OP, neck stiffness, is the initial stage of rigor mortis and is present as soon as 2 hours after death. There is no reasonable expectation that nursing home residents be rounded that frequently, that's a stretch even for hospitalized patients on a regular floor.

Particularly since that frequency of rounding would be unlikely to alter the outcome in this particular scenario. Anoxic brain injury begins about 3 minutes after the loss of a pulse, and by 10-15 minutes the most tragic thing that could happen would be to get a pulse back.