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

Specializes in Geriatrics, Dialysis.

Where I work we are required to initiate CPR on a full code resident regardless of how obviously dead they might be. The thinking behind this is since we as nurses are not allowed by our scope of practice to declare death we have to behave as if the patient is not until that death is confirmed by somebody with the legal ability to officially proclaim that person as dead.

We've only tun into this situation a couple of times and I wasn't there for either one thank goodness. All staff responding to the so called code felt a little...no a lot silly going through the motions for something so obviously not needed. The first responders that arrived to the stat 911 call just to confirm that yes, the person is indeed dead must have thought we were either an incompetent bunch of boobs or hopefully realized we have no choice but to proceed with CPR no matter how obviously futile.

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Specializes in Med Surg, Tele, Geriatrics, home infusion.
On 1/14/2020 at 12:18 PM, kbrn2002 said:

Where I work we are required to initiate CPR on a full code resident regardless of how obviously dead they might be. The thinking behind this is since we as nurses are not allowed by our scope of practice to declare death we have to behave as if the patient is not until that death is confirmed by somebody with the legal ability to officially proclaim that person as dead.

We've only tun into this situation a couple of times and I wasn't there for either one thank goodness. All staff responding to the so called code felt a little...no a lot silly going through the motions for something so obviously not needed. The first responders that arrived to the stat 911 call just to confirm that yes, the person is indeed dead must have thought we were either an incompetent bunch of boobs or hopefully realized we have no choice but to proceed with CPR no matter how obviously futile.

Wow that's a brutal (? unethical) policy to be operating under. If they don't consider their nurses skilled enough to assess irreversible signs of death... or more likely the policy stems from a CYA perspective that's been badly misinformed. It sounds worth gathering literature to make an argument for the futility of, and the harm such a policy could cause.

I have found patients dead in bed 2 times in 10 years of working at nursing homes on the night shift. They had no complaints on the first half of the night, these patients happened to be able to independently position themself, appeared to be sleeping peacefully, and they were not acutely ill. They just literally unexpectedly died in their sleep. One was a DNR...one was not. Starting CPR regardless of irreversible signs of death was fortunately not a written policy, and when criticized by the DON we had to remind her it's well within our scope to do RN pronouncements as physicians are rarely present for deaths. Therefore, frequently it is us RNs who assess the patient for irreversible death, call the next of kin and arrange for the funeral home to come collect the deceased.

I don't miss that 45:1 ratio. My 6:1 med surg one is highly preferable.

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Specializes in Geriatrics, Dialysis.
4 hours ago, scribblz said:

Wow that's a brutal (? unethical) policy to be operating under. If they don't consider their nurses skilled enough to assess irreversible signs of death... or more likely the policy stems from a CYA perspective that's been badly misinformed. It sounds worth gathering literature to make an argument for the futility of, and the harm such a policy could cause.

I have found patients dead in bed 2 times in 10 years of working at nursing homes on the night shift. They had no complaints on the first half of the night, these patients happened to be able to independently position themself, appeared to be sleeping peacefully, and they were not acutely ill. They just literally unexpectedly died in their sleep. One was a DNR...one was not. Starting CPR regardless of irreversible signs of death was fortunately not a written policy, and when criticized by the DON we had to remind her it's well within our scope to do RN pronouncements as physicians are rarely present for deaths. Therefore, frequently it is us RNs who assess the patient for irreversible death, call the next of kin and arrange for the funeral home to come collect the deceased.

I don't miss that 45:1 ratio. My 6:1 med surg one is highly preferable.

I agree it's a ridiculous policy. I might be wrong but I get the feeling it started when some family in one of the facilities my employer owns sued when CPR wasn't initiated when it should have been so now everybody has to start it no matter what. Another case of everybody paying for one person's mistake.

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Specializes in Med Surg, Tele, Geriatrics, home infusion.
3 minutes ago, kbrn2002 said:

I agree it's a ridiculous policy. I might be wrong but I get the feeling it started when some family in one of the facilities my employer owns sued when CPR wasn't initiated when it should have been so now everybody has to start it no matter what. Another case of everybody paying for one person's mistake.

Sounds about right for how most ridiculous policies start ?

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Specializes in Dialysis.
On 1/10/2020 at 10:07 PM, nursebert said:

I actually thought that you were a VA nurse when you mentioned combat vets. VA provides excellent medical and nursing care.

As a veteran, I choose not to use the care anymore. What I have seen firsthand as a patient prior, and have dealt with in care coordination currently, is pathetic...There may be good VA facilities around, but they are far and few in between

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On 1/9/2020 at 8:48 PM, Barbara Fouch Lentz said:

yes it was in a nursing home. The nurses that were suspended just started their shift. The day shift nurses didn't get suspended

On 1/9/2020 at 8:52 PM, JKL33 said:

It is unclear why anyone was suspended at this point.

What is the allegation?

The issue comes from the State. Because of the abuse laws that have been enacted, this is most likely considered a Self-Reportable Incident. If substantiated, the Nursing Home can receive an Immediate Jeopardy (IJ) State or Federal tag in Professional Standards, Quality of Care, or in any of the other numerous areas facilities can be tagged in. I have seen cases of facilities being tagged on an IJ for not initiating CPR, and a facility almost receive a tag for having non-CPR certified staff initiate CPR when it WAS appropriate.

It was stated that this occurred at change of shift. One of the questions that matters is "How long was it between the last round of the off-going shift and the first round of the on-coming shift?" It doesn't matter what discipline you work in, you do first rounds upon taking the assignment, unless there is another critical incident that requires your attention. When was that first round done, and when was the patient last seen "at baseline".

It is typical to suspend pending investigation, and then that staff member maybe, or may not be fired upon the outcome. When it comes down to it, most normal Nursing Management isn't looking to fire anybody. Staff works hard enough by working short, long hours, or expansive OT. Why would they want to make it worse?

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Specializes in NICU.

How embarrassing for the institution,how did they explain this patient being unobserved for so long.

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Specializes in ICU.

Like someone else said, they wouldnt be fired for not doing CPR, they would be fired if the issues was they didnt find a patient for 5 hrs and they were stone cold dead. You would not do CPR on someone who is dead dead, with rigor mortis

Or as others mentioned, because technically our scope of practice on a full code patient is we cant delcare death? And need the ambulance maybe in this situation to confirm that yes, we are calling it. Im not actually sure on this issue

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On 1/8/2020 at 11:27 PM, 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?

This is what I was thinking. How is a patient found dead in a chair to the point OP described? Were they not checking on this patient? The other patients? Doesn't sound like the patients were safe in their care.

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