Refusing to do CPR

catlady, BSN, RN · Jun 7, 2002

Wow, lots of issues here. What is your role; are you the day supervisor?

Where is the night supervisor in all this, or was the night nurse you mention also supervising? It's pretty scary that you have three nurses (the day nurse, the new nurse, and the night nurse), none of whom apparently has a clue what to do in an emergency. Sounds like some serious failure to educate staff, although anyone who says you don't do CPR on people who've stopped breathing needs to be sent back to the first day of nursing school, IMNSHO!

I'm not sure why the night nurse was singled out, seeing as the event seems to have occurred at change of shift. They were all at fault for standing around boo-hooing and doing nothing. Someone needed to be in charge and start delegating tasks, including getting the frightened residents out of the way and calmed down. Nurses had better figure out that even in LTC, people encounter medical emergencies. They may not have caused the problem, but they need to know what to do when a problem occurs. Call the doc, call 911, do basic emergency care. You don't have to be an ICU nurse to know that. I hope your facility learns from this and reassesses how it orients its nurses and maintains their competencies.

jmcclellanprofrn · Jun 7, 2002

Nursegoodguy,

I think you lost me in that long scenerio, but I got the jist of it. The nurse that was on duty when this man initially fell is responsible. Despite his code status or prognosis, that nurse is responsible for the safety of his/her residents. A head injury is a definite ambulance ride. I am an ED nurse, we are overwhelmed, with more than falls, but the patient should have been evaluated either by a NP or doctor. The EMS just might have prevented this from happening.

As for refusing to perform CPR? What the heck is this?!!! I'm not sure what state you practice in, but I would contact my State Board. Protect yourself and your license, your facility won't! Refusing to perform CPR does not fall under the nurses' morality rights, such as refusing to assist in a D/C & E. Look to your Board and a trust collegue(s) for assistance. Good Luck and keep on nursing.

ktwlpn, LPN · Jun 7, 2002

IMHO-I believe that the night nurse was doing exactly what she was supposed to be doing-she assessed the resident and was calling the doc.She never should have been fired-I hope she gets a lawyer...The day shift nurse that walked into the room to find a resident with a full code status and did not start CPR-looks to me as though she should be loosing her license.A head injury does not automatically mean an ambulance ride in my experience...I have assessed many a head injury per policy at whatever institution I was working in-some really looked ugly-but no change in VS-no sign of ICP....No telling what really caused this fella to die when he did-was an autopsy done? Shame that he was a full code given his diagnosis-perhaps that day shift nurse could have worked with social services and the residents family to explain what was going on with him and help them accept his terminal dx....This may have been avoided....

hapeewendy · Jun 7, 2002

you did the right thing

when a person is a full code you do CPR end of story, its really simple

it seems like the day nurse showed gross neglect for her patient and needs to be reported.

if she has trouble dealing with code vs no code situations that is a safety and practice issue and needs to be adresse

its too bad that the night nurse took the fall for

both the day nurses.

I Hope the night nurse fights this

and that the truth gets out before this day nurse can refuse to do cpr on another patient

you acted as a patient advocate good guy, and were the only one to do so!!

keep it up

lisamcrn · Jun 7, 2002

My opinion is if the noc nurse was charge nurse and IF monitoring the pt. per basic neuro and physical assessments set up for head injury pts., if she had documented appropriately and notified the dr. when she realized that her resident did have a change of status she should not be in trouble. The twit who refused CPR should be fired and reported to your state board. The orientee should be involved in a discussion about correct policies and procedures and promoting teamwork/unity for pt/res. care and that this is not typical calamity. Social Services and the Care Plan Nurse should be talked to regarding a change needed in DNR since this is one of their areas of meeting needs for the changes he probably would have had from the CA. His care plans would have dramtically changed future focus with the effects of the brain CA.

I've had probably 100 falls in LTC in 4 years and probably only sent out 5 related to hitting their head....for lacerations. I have never had one with change in LOC or ICP>>YET.

Good Luck surviving this mess.

colleen10 · Jun 7, 2002

Not a Nurse yet, have no experience but I have to say that just from Common Sense......

1) I can't believe she didn't do CPR and didn't call 911, a nursing home in my area was just written up by the state for not dialing 9-1-1 when they had a patient they were giving CPR to.

2) Very un-professional to go around crying and pointing fingers and making a scene

3) Sounds to me like the "Boo Hoo" nurse knew that she, herself, had done something wrong and that's why she was so quick to point out to others that it was the night nurses fault.

4) If you can't give basic CPR get out of the kitchen.

Definately speak up. If you hadn't come in when you did would they have EVER performed CPR and called 911?

Huganurse · Jun 7, 2002

Sounds like the patient picked a lousy time to go bad, right at shift change. What did she think she was doing when whe was practicing on the dummies??? I've heard of lay people refusing for fear of HIV but never a nurse. CPR seems such a fundamental part of nursing. I would like to think that when I teach CPR that the people I'm instructing would use it when it was needed. I think I'll start asking the class if they plan on it or are just in the class for entertainment.

Teshiee · Jun 7, 2002

Drama Queen on days should have gotten written up! I have worked in LTC and their crash carts are nothing short but a suction and ambu bag. Nothing like the acute care facilities. It was a bad situation that could have had a less stress moment if the family, social workers, and other individuals got a no code going. People fall in LTC everyday and the first thing we do is assess them. If it was a head injury assess them often including their neuro. I think the night nurse did all she could of what she had to work with. Good job on your part. I hope that night nurse get some lega advice.

Ted · Jun 7, 2002

Originally posted by Huganurse
Sounds like the patient picked a lousy time to go bad, right at shift change.

That's when it usually happen. At least it seems that way.

Hope the night nurse gets a lawyer.

I'd be afraid to work with that day nurse in my small rural hospital.

Ted

jevans · Jun 7, 2002

I agree with Ted

How can anyone feel safe working with that nurse.

What about patients feeling safe

jacky

micro, RN · Jun 7, 2002

it is a sad state of affairs that we find ourselves dealing with some days.........

nursegoodguy.........more power too you.........

to refuse to do what a nurse is supposed to do and rather to just b & m about it while a person lies dying.....or already gone.....and let us remember the family that was not called, etc.......

incompetence 101

NURSEGOODGUY.........you rock!!!!!!!!! and to all of you that work in LTC, you rock also.......

I have worked in LTC and will probably again someday in my nursing career.......

but the demands and the stressors are at times in a whole 'nuther realm'

I am so thankful as a human and as a nurse that the majority of nurses in LTC as well as anywhere are caring, professional and knowing simply what to do in a given situation.........

and why do I say this.....not to hear myself think or talk or to get accolades.....but because someday i hope not to, but may find myself a patient and at the worst case scenario.......a little, but tall lady residing in a nursing home all alone.....

please care about me nurses, no matter what your working conditions are.....my conditions are far worse.....let me guarantee to you..........

micro and out:o