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?
is it policy for the hospital to suspend until they've performed an investigation? I think that's a difficult one - how are you determining that the patient (it would be hard to prove, is my point...) had expired 30-60 minutes prior to finding her?
Not faulting you for your judgment, since you were there, but I'd have called 911 and initiated CPR when you found no pulse... then had EMS deal with it... but that's just my two cents. What's your facility's policy?
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.
well, actually, you can declare a patient dead who is absent of a pulse, no breath sounds, pupils fixed and dilated....
The policy at the nursing home where I previously worked stated CPR would be started in the event of a witnessed arrest of a resident who was a full code. I thought it was a wise policy for a long term care setting.
I'm so sorry to hear about your situation. I don't like that people judge so harshly on this site. I posted asking for help and I was judged really harshly too, and sometimes you just need support from your peers. Nurses have such a high accountability and minor mistakes can go a long way... when its not happening to you its so easy in hindsight to judge when reality is we are still humans and mistakes happen. I hope you all the best and I'm sorry you had to go through this and learn the hard way. Good luck to you.
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?
At my nursing home we ONLY do CPR on WITNESSED cardiac arrests.
well, actually, you can declare a patient dead who is absent of a pulse, no breath sounds, pupils fixed and dilated....
In most states, LPNs can't. RNs could at the LTC facility I used to work at...they can't at the hospital I work at.
To the OP...it was a hard lesson learned and I'm sorry you had to learn it. What you did was indeed declare someone dead. The only reason I knew better as a LPN was because I was a EMT and they were very specific about this in my training. But I don't remember them actually teaching this in orientation when I was a LPN. I did ask in my new facility where I am now a RN...... And as stated above, RNs cannot declare death in my hospital.
How did you determine the patient had been dead for 30-60 minutes? Only the doctor can pronounce a patient or two RNs (check your facility policy). You have to perform CPR on a patient who's fullcode regardless of the circumstances until a doctor (or a qualified personel) says stop CPR and pronounces them dead.
I hope this is a learning experience for you. And I hope it end well for you.
If you are undecided about whether you should hire a lawyer to represent you at the hearing, the articles may help you with your decision. In case you are wondering, the nurses that I mentioned in my previous post (the ones who resumed working), hired a lawyer to represent them at the disciplinary hearing.
Some have asked how I determined the patient had been dead for some time. I immediately did an assessment that showed lack of a radial or apical pulse, and no chest movement or breaths. Her face was ashen and lips purple. Her expremeties were cold and slightly stiff. Stimulation of her palms and soles of feet brought no reaction, reflexive or otherwise.
I any case, it seems the consensus here is that my handing of the situation made sense..but the rules of the game do not allow for making sense here. The rules always must prevail... and I'll concede, maybe for good reason. Whatever happens, I've learned my lesson here.
JulieCVICURN, BSN, RN
443 Posts
I suppose the lesson learned here is, when in doubt, do CPR. If nothing else, it would have been good practice.
I feel for you, really, because I'm not sure I wouldn't have done the same thing.