Full Code

[VtMaleNurse]

I recently found myself in a difficult situation in my nursing home job. I'm an LPN with about 8 months under my belt. My job is that of a staff nurse at a nursing home working third shift. I have about 45 residents to manage with the help of two aides. Last week in the process of my morning med pass (5AM-7AM) I came upon a resident who was dead. The death was unexpected, although the woman had multiple serious co-morbidities, and was currently being treated for multiple infections. After doing an appropriate assessment, it was clear that from the condition of her body that she had been dead for 30-60 minutes, and was beyond resuscitation. Consequently I did not begin CPR or call 911, despite her chart showing her to be a full code. I followed all other protocols required.

I now find myself suspended from my job, with my job and probably my licence in jeopardy. I knew that a full code patient had to have all efforts at resuscitation made if they went into cardiac or respiratory arrest. But where its clear they have been dead for a period, and are beyond resuscitation, apparently we are required to start CPR and call 911 anyway. Even if full rigor mortis has set in and they are attracting flies, we still have to attempt cpr.

I am heartbroken over all this. Has anyone been in a similar situation, and can tell me what the outcome was?

[traumaRUs, MSN, APRN]

I do pre-hospital nursing and if we come upon a full arrest where death is obvious (as it sounds in this case), we do nothing.

It would be futile to do CPR on a corpse.

[RN_stucky621]

Sorry to hear about you suspension...but it was your job to do "all things necessary" because that patient was a full code. It is not in the nursing scope of practice to determine if someone is dead and decide not to do anything because you believe they are beyond resuscitation.

[bill4745, RN]

In most states, RNs and LPNs cannot pronounce death (which is what you did). It does not matter how cold and stiff the patient is. You must call a code and do CPR until a doc pronounces them.

[highlandlass1592, BSN, RN]

That's actually not true. the OP needs to read the practice act for their state. I've worked in many states where a nurse could pronounce a patient.

[highlandlass1592, BSN, RN]

I recently found myself in a difficult situation in my nursing home job. I'm an LPN with about 8 months under my belt. My job is that of a staff nurse at a nursing home working third shift. I have about 45 residents to manage with the help of two aides. Last week in the process of my morning med pass (5AM-7AM) I came upon a resident who was dead. The death was unexpected, although the woman had multiple serious co-morbidities, and was currently being treated for multiple infections. After doing an appropriate assessment, it was clear that from the condition of her body that she had been dead for 30-60 minutes, and was beyond resuscitation. Consequently I did not begin CPR or call 911, despite her chart showing her to be a full code. I followed all other protocols required.

I now find myself suspended from my job, with my job and probably my licence in jeopardy. I knew that a full code patient had to have all efforts at resuscitation made if they went into cardiac or respiratory arrest. But where its clear they have been dead for a period, and are beyond resuscitation, apparently we are required to start CPR and call 911 anyway. Even if full rigor mortis has set in and they are attracting flies, we still have to attempt cpr.

I am heartbroken over all this. Has anyone been in a similar situation, and can tell me what the outcome was?

You need to check the policy manual and state BON for guidance. They are your guidelines, utilize them. And it may not hurt to retain an attorney who represents people in front of the BON. Good luck to you.

[mamamerlee, LPN]

You should have had someone call 911, and her doctor, and begun CPR as per your facility's protocol. Unless your state allows LPNs to pronounce, you must proceed.

I don't think your license should be in jeopardy, but you were certainly taught that it was not your place to decide there was nothing to be done, even if you are certain that there was nothing to be done.

[Inquisitive one]

In Massachusetts LTC'S a RN can pronounce death and CPR can be withheld in a person who is a full code provided certain criteria are met: decapitation, decomposition, rigor mortis, dependent lividity. There must be a very specific assessment done and documented. Here's the link from the Mass BON- http://www.mass.gov/?pageID=eohhs2modulechunk&L=5&L0=Home&L1=Provider&L2=Certification%2C+Licensure%2C+and+Registration&L3=Occupational+and+Professional&L4=Nursing+Home+Administrators&sid=Eeohhs2&b=terminalcontent&f=dph_quality_boards_nursing_p_long_term_care_ruling&csid=Eeohhs2

[dishes, BSN, RN]

It is a stressful way to learn and yes there are other nurses who did not perform CPR in circumstances similar to yours, they went through a hearing, followed the recommendations and resumed working, hopefully it will work out this way for you.

regards

dishes

[VtMaleNurse]

Ouch! Guys I've already been scolded all I need. I appreciate the knowledge you all have to share, and I hope you are right that this will all come out okay. A very stressfull way to learn. BTW, RN's can pronounce in my state, but not LPNs.

[NurseLoveJoy88, ASN, RN]

OP Im truly sorry this has happened. A Nurse responded the same as you did at my job and Im sorry to say that she did get fired due to the incident. I know you learned your lesson and so did she. best wishes to you, hang in there!

[dishes, BSN, RN]

I agree you do not need anyone telling you should have known better, it is not going to help your situation. FYI, I remember reading a study that showed approximately 30% of the nurses did not know they were obligated to perform CPR in a futile situation, so you were definitely not alone in your thinking. Keep your chin up, things are difficult now but you will be ok.

regards

dishes