How often do you do CPR in a skilled nursing facility?

dcoffee · Nov 4, 2006

I started last November as a new grad Lvn...Charge Nurse. I had 4 weeks of orientation at night, then went to days, and was very often the only nurse in the building with 45 patients. Amazing! I work in a private facility and I guess I would have thought that would make the owner nervous, like these families may be more likely to sue for negligence or whatever. I have seen 5 or more people die or come near to death, and most of our patients are "full code" for some reason I have been very lucky that the residents that have gone into cardiac arrest or stopped breathing have been "no CPR" or have been put into Hospice care. Knock on wood! I cannot imagine calling 911 and performing CPR on someone you know damn well is dead!!!!! I'm curious how your first few weeks of work go!! Hey I'm still at my same job, love the residents, love most of the people I work with and yes, still close the door to the med room and just cry!

Dana

Bala Shark · Nov 4, 2006

I started last November as a new grad Lvn...Charge Nurse. I had 4 weeks of orientation at night, then went to days, and was very often the only nurse in the building with 45 patients. Amazing! I work in a private facility and I guess I would have thought that would make the owner nervous, like these families may be more likely to sue for negligence or whatever. I have seen 5 or more people die or come near to death, and most of our patients are "full code" for some reason I have been very lucky that the residents that have gone into cardiac arrest or stopped breathing have been "no CPR" or have been put into Hospice care. Knock on wood! I cannot imagine calling 911 and performing CPR on someone you know damn well is dead!!!!! I'm curious how your first few weeks of work go!! Hey I'm still at my same job, love the residents, love most of the people I work with and yes, still close the door to the med room and just cry!
Dana

Well, I know it will happen that someone will die in my shift..It is natural and I am concerned that I might get sued..

dcoffee · Nov 4, 2006

It would have to be proven that you were negligent. Believe me, I worry also about being sued, I document like I'm writing a novel. Are you afraid that you will do CPR incorrectly or that you do it and they die anyway?

Daytonite, BSN, RN · Nov 4, 2006

it is very typical to be alone and in charge of 49 patients in a nursing home. i recommend that during your orientation you go through the charts of your 49 patients and make a list of those who do not have dnr or no code orders so if those patients do go systole or have an apneic episode you will know exactly who you will have to start cpr on and call 911. review the facility policy for this as well. my experience has been that we usually knew when a patient was getting bad and we had time to contact the doctor and get the patient transferred to the hospital before they coded. patients who were most often at risk of coding were those who had just been transferred in from the acute hospital. make sure you assess them and keep a close eye on new admits for that reason. we didn't do that many codes in ltc. keep in mind that in ltc changes in patient's condition are supposed to be charted and acted upon asap. a facility and it's nurses are more likely to get into trouble with the state for the nurses failing to recognize and do something about a change in a patient's condition than they are for getting sued for failing to start cpr on someone, believe me. codes were, in fact, a rare occurrance. most, but not all, of the patients were dnrs.

you are going to find that ltc facilities are very regulated by the state department of health and by medicare. i'm sure many of the rules and regulations will be pointed out to you during your orientation.

jamangel · Nov 4, 2006

where are ya'll living with 49 patients and 1 nurse? that's ridiculous. Now where i live LTC facilities have 2 or more wings each wing with roughly 44 patients. Each wing will have one licensed person and 2-3 nursing assistance (nights) and some even have a night supervisor as well (RN mostly but some have an experienced LPN)). So we're talking 3-4 licensed and and roughly 6-8 NA's in the entire building. At the LTC I used to work at, if one wing had a code all the nurse's responded and the CNA's stayed on the floor.

Daytonite gave you some good advice about noting who your codes are. I always kept a list of my full codes on my clipboard.

I had an incidence once with a patient that coded on Christmas Day (also his birthday). He was perfectly fine and then mid-shift the CNA found him in distress. He was a full code of course and we coded until the EMT's arrived but to no avail. He was dead before they got there. It was unforeseen, he was about 59 and not a new admit. Just one of those things.

Katnip, RN · Nov 4, 2006

May I make a suggestion? I worked in ER and we were always running codes and we sent code teams to the floors. One day our code team arrived to a room to find that not one of the staff had initiated basic CPR. The charge was standing there in a panic. The patient died.

The main reason the staff panicked is because you take CPR once every two years, and on most floors you just don't get the practice.

My suggestion is that you and the staff get together regularly and just review the steps of basic CPR. and the variety of roles that are involved. I assume that all aides are required to have CPR, not just the nurse.

The roles:

The first person to find the patient down-assesses the person, calls for help and initiates CPR.

Second person to arrive-may call 911 and joins in CPR or gets the AED if you have them.

Other people can stand by to help relieve in administering compressions. Compressions can be hard work and emotions will be running high, which makes it even harder. Offer relief every 5-10 minutes if possible.

During all this the nurse in charge should be getting medical records ready for EMS when they arrive. Medication and history are the most important part of those records.

You can have little mini practice drills just to famliarize everyone with where equipment you need-masks, AEDs, etc. You know that you can pass an AED hanging on a wall a million times a day and never see it, then when you need it waste precious time looking for it.

If you do talk throughs, and possible mini-drills, so much of it will become automatic enough that it will be easier to get on top of that scarey feeling that you can accomplish what you need.

Don't forget, afterward, give a verbal pat on the back whether the patient survives or not. Acknowledge that it was a frightening event and that everyone did their best.

CHATSDALE · Nov 4, 2006

good advise from kat

if you practice with cnas you will have confidence in what you and everyone else should be doing

make sure that they are doing their rounds to recognize a pt in distress before they reach the code stage

TheCommuter, BSN, RN · Nov 4, 2006

I have been working at the same SNF/LTC for the past 8 months and have been involved in two codes. Many residents have DNR orders, so you will not ever need to do CPR on those people.

mel1213 · Nov 5, 2006

I have been working in a SNF for over a year now and is my first job as a nurse. I am just wondering if you are comfortble enough to be put in charge and have all that responsibility of a charge nurse. Not that I am saying you cannot do it but as a new nurse myself, I still have yet to do charge. And we have 2 LPNs on a wing, sometimes an LPN in charge if the Rn is off. I hope they just dont throw you to the wolves. I have done the basic duties of a charge nurse if we are short but I would definitly get the feel of everything else before doing charge. As far as doing CPR, I have yet to perform it. Most of the residents are a DNR.

Daytonite, BSN, RN · Nov 5, 2006

hi, mel1213! you're kind of new on the forums. bala shark has been around and posting for a bit. i think i can say with some confidence that despite any trepidation we might get from his posts, that he is going to be an awesome force to be reckoned with as a charge nurse. i always get a sense of great confidence on his part from his posts. i'm willing to bet that even as i write this that he has been busy researching exactly what his role as a charge nurse is going to be. and, anything that he's not sure about he has been asking about. i have no doubt that he will perform his new duties with great care and diligence. i have worked in nursing homes off and on throughout my 30-year career. i started out as a charge nurse in ltc in charge of 50 patients on the day shift. was is tough? you bet. did i learn a bunch of stuff? you bet. could my learning have been done differently? probably. but, nothing anywhere is perfect. what doesn't break you only makes you stronger. bala shark is a pretty smart cookie--at least from what i've been able to figure out from his posts. i hope he makes his list of non-dnr patients to ease his own mind on this issue. i'm waiting to hear how he does with this new job and ready to help and support him at it. wishing you well, bala shark!!! :w00t:

mel1213 · Nov 6, 2006

Hello Daytonite! Yes I am new on these forums, I was just kind of surfing the web and found this site to be really interesting! Anyway, I do not doubt that anyone can do their job if they put there mind and confidence to it. I was simply just giving some advice being a first year nurse myself. I just see that the charge nurse takes the brunt of it all. And yes it will seem very overwhelming at first Bela but once you get your routine down you will be fine. So please dont take my post as trying to say you are incompetant because that is not what I meant at all. I wish you luck with your job. Need any advice on something i may be able to help you with feel free to ask!! I dont know it all but from some of my experiences in the short time I have been a nurse may help!! good luck