Can’t a nurse be fired?

Nurses General Nursing

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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

Specializes in Critical Care.

2 hours is a stretch? We do hourly rounding at my hospital. And the chances that they died immediately after your last rounding and you didn’t notice anything off is slim.

Between nurses and ancillaries I don’t see why it needs to be that long between rounding checks. I personally try to check in on my patients every hour, but if I’m unable, I know they’re still getting seen about that often.

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Specializes in Critical Care.
On 1/9/2020 at 5:05 PM, ArmyRntoMD said:

2 hours is a stretch? We do hourly rounding at my hospital. And the chances that they died immediately after your last rounding and you didn’t notice anything off is slim.

Between nurses and ancillaries I don’t see why it needs to be that long between rounding checks. I personally try to check in on my patients every hour, but if I’m unable, I know they’re still getting seen about that often.

Yes, it's a stretch. Nursing home ratios are typically 1 nurse and 1 aid for 30-40 or more patients. They may be able to round that often if that is absolutely all they are doing, but that's not the case.

And yes, even on a 'regular' floor in a hospital there will frequently be times where neither the nurse nor ancillary staff is able to routinely assess a patient as often as every 2 hours. Every hospital I've worked at "does hourly rounding", the number of hospitals where the workloads allow that to consistently occur is zero.

That's great that hourly rounding is a potentially achievable goal with your 2 to 3 patients, but you might be a bit out-of-touch if you think that's consistently achievable with 5 to 8 busy patients.

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24 minutes ago, MunoRN said:

Yes, it's a stretch. Nursing home ratios are typically 1 nurse and 1 aid for 30-40 or more patients. They may be able to round that often if that is absolutely all they are doing, but that's not the case.

And yes, even on a 'regular' floor in a hospital there will frequently be times where neither the nurse nor ancillary staff is able to routinely assess a patient as often as every 2 hours. Every hospital I've worked at "does hourly rounding", the number of hospitals where the workloads allow that to consistently occur is zero.

That's great that hourly rounding is a potentially achievable goal with your 2 to 3 patients, but you might be a bit out-of-touch if you think that's consistently achievable with 5 to 8 busy patients.

Unfortunately it may not always be achieved, but does not mean it is not expected by management. As a nursing home nurse, I had a clip board for turning and positioning that I was expected to fill out every 2 hours. 1 nurse to 42 patients. Hourly rounding is the expectation at the hospital I work at.

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Specializes in Psych, Addictions, SOL (Student of Life).
On 1/9/2020 at 5:05 PM, ArmyRntoMD said:

2 hours is a stretch? We do hourly rounding at my hospital. And the chances that they died immediately after your last rounding and you didn’t notice anything off is slim.

Between nurses and ancillaries I don’t see why it needs to be that long between rounding checks. I personally try to check in on my patients every hour, but if I’m unable, I know they’re still getting seen about that often.

Well in California with 6:1 ratio in acute you can do hourly rounding. In the nursing home some nurse have 40 or more patients.

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Specializes in Critical Care.
2 minutes ago, Just me. said:

Unfortunately it may not always be achieved, but does not mean it is not expected by management. As a nursing home nurse, I had a clip board for turning and positioning that I was expected to fill out every 2 hours. 1 nurse to 42 patients. Hourly rounding is the expectation at the hospital I work at.

It's been management's expectation at every hospital I've worked at, and consistently achievable at zero of them.

The claim this was in response to was that if a nursing home patient had not been rounded on in less than 2 hours (the time it takes for a stiff neck to appear after death) then that would be sufficient basis for firing nurses, which is a bit silly.

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Specializes in Critical Care.

It’s usually achievable where I work. I can’t say there’s never been a time I haven’t, but it’s pretty much the norm. Some of my patients are so needy I do 30 min rounding on them. Especially my quad vents that can’t call. I promise them I’ll round often just Incase, usually ends up being 45 min -1 hour max.

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Specializes in Critical Care.
15 minutes ago, ArmyRntoMD said:

It’s usually achievable where I work. I can’t say there’s never been a time I haven’t, but it’s pretty much the norm. Some of my patients are so needy I do 30 min rounding on them. Especially my quad vents that can’t call. I promise them I’ll round often just Incase, usually ends up being 45 min -1 hour max.

You work in a nursing home?

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Specializes in Critical Care.

God no. That’s probably the most task oriented nursing job there is. “Alright let’s pull these pills for 60 people.”

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Specializes in OR, Nursing Professional Development.
5 minutes ago, ArmyRntoMD said:

God no. That’s probably the most task oriented nursing job there is. “Alright let’s pull these pills for 60 people.”

Great way to insult a decent percentage of nurses. This is the type of division nursing doesn't need.

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Specializes in Critical Care.

To clarify, this was the statement in question, that it would seem likely that in a nursing home, not seeing each patient more frequently than every two hours would be sufficiently negligent and outside of any norms to justify termination.

On 1/9/2020 at 2:44 AM, 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

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On 1/9/2020 at 6:42 PM, MunoRN said:

To clarify, this was the statement in question, that it would seem likely that in a nursing home, not seeing each patient more frequently than every two hours would be sufficiently negligent and outside of any norms to justify termination.

In fairness, just because the care provided may have been reasonable/the norm doesn't necessarily mean that the nurses in question weren't fired for it anyway.

Without more information, I have no real idea what happened. But speculatively, it seems pretty plausible that the SNF higher-ups settled on a strategy of sorts: admit error where there is none, publicly blame and flog the underlings for the supposed 'error,' hope that satisfies everyone enough that lawsuits go away and the media focuses elsewhere.

Of course, that's not even considering the very real possibility that the administrators in question have no clinical skills or judgement to speak of and genuinely believe either that the patient was dead for a day and a half or that CPR should have been performed "just in case." It's not like every single health care administrator out there actually knows anything about medicine...

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Specializes in Critical Care.
31 minutes ago, Rose_Queen said:

Great way to insult a decent percentage of nurses. This is the type of division nursing doesn't need.

It’s not an insult. It definitely takes skill- time management. That was one thing working LTAC gave me aswell. It’s just not the kind of work I enjoy. Nothing wrong with it. Just a lot of running like a chicken with your head cut off, and more responsibility than you have reasonable time to ensure. Hats off to them, you have to be passionate to work in a nursing home. I LOVE my geriatric patients (especially combat vets) but it’s still not for me. I’ll take care of them in the hospital.

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