I'm 66 and on Occupational Health Nurse Manager at a Fortune 500 company. In November one morning I woke up unable to stand on my right leg. Subsequently I was hospitalized, had a MRI then a CAT and given an spinal epidural of steroids whereupon I recovered over the next two months. I have severe bilateral neuroforaminal stenosis. This was quite to my surprise as I work out regularly in the gym (aggressively which may have caused the issue) and my lumbar radiograph is none to pretty.
I returned to work half days and my doc said: "What do you want for restrictions?" I answered: "Stand no more than one minute; Walk no more than 5 minutes and No lift/push/pull greater then 7 lbs. Well, I was at work for about two hours and someone came running into my clinic: "Come quick, someone is having a heart attack."
Indeed, that appeared to be the case. I said to one of our first responder team: "I can't do compressions, you do compressions, I'll bag." We did exactly that. The person giving compressions did an excellent job, we ventilated him, I shaved, slapped on the pads, analyzed and shocked. I thought we might save the fellow because of "shock advised," but it wasn't to be. It was great teamwork and I'm proud.
However, my CPR card just expired and now I must get a AH CPR card but I should not do compressions. Since CPR is an essential function of the job, I could be terminated because of this. So I wonder, am I covered under ADA?
I'd argue yes, as I would never be doing CPR one on one and there would always be another first responder to do compressions.
Any thoughts? Anyone face this sort of issue before?
I broke my wrist several years ago. I was not able to return to work until they cleared me to return without restrictions, partially because of CPR, and all nurses being required to be able to perform CPR. As I result, I was out of work over 4 months.
The restrictions look a bit of extreme to me. No more than 1 min standing and 5 min walking? That's less than walking from the parking lot and getting into elevator.
Honestly, I think that it depends. In acute, we have several people (me including) who are known to be much more useful as drug pushers/runners/baggers during the code, and they are designated accordingly within the code team. But in acute care it is hardly imaginable to have only two people being available for a code. If the OP is working in a place where two rescuers have to keep things going till more help arrives, then accomodations may not be possible.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I don't know your situation or how often you are called upon to do CPR. I do know that following my knee replacement, I was unable to kneel. Not just advised that the joint will last longer if I don't kneel, but in excruciating pain if I tried to, even on a mattress. I tried once, to reach across to make the bed and was instantly rolling around on the bed in pain. I cannot put weight on my knees. When I recertified for CPR, the instructors were kind enough to let me do it on a table, and I was able to do very good compressions and even have the strip to prove it.
In reality, when our ICU patients code they are almost always in bed. If they're on the floor -- well there are almost always several co-workers around in their 20s who CAN kneel on the floor to do CPR. My manager knows and understands this. She's making an informal accommodation. I have wonderful coworkers -- the one time someone DID require CPR on the floor, they beat me to it.
Your best course is, as recommended above, to discuss this with your employer. If CPR is indeed one of the things you absolutely have to do for your job, they will be unable to make an accommodation. You'd be advised to seek other employment where CPR was not a condition of employment -- case management, telephone triage, administration -- others will know more than I. If your employer agrees that it isn't a big deal because there is always another first responder around, then perhaps you're OK.
On the other hand, at 66 perhaps you'd like to travel and see the world, write that novel you've had outlined in your head or live on a sailboat and sail the seven seas.
If your employer agrees that it isn't a big deal because there is always another first responder around, then perhaps you're OK.
I wish the OP no ill, but just have to say that, if I were going to be the "another first responder around," I would not be happy about having to work with someone who couldn't do her/his fair share in a code, just as I would not be happy about being expected to pick up the slack for a co-worker who couldn't do any other part of the basic responsibilities of the job.
I worked with a 1 armed nurse who could code, 1 ARMED NURSE!
I have also worked with nurses who were disabled in one fashion or another, a couple being paras and one being a quad. There are tasks that can be done where you can still be useful and vital as a nurse BUT your employer has to know and accommodations have to be made.
So initially you said, "You start compressions, I'll bag." Fair enough.
Now it's 1 minute and 45 seconds into delivering high-quality compressions. Rescuer #2 says "I'm getting fatigued. We need to switch after this cycle."
What do you do? We both know 2 minutes in, EMS is not there yet. You must either take over compressions per BLS protocol, or you allow the fatigued rescuer to continue knowing full well that high-quality compressions are becoming medical-drama-quality compressions. That doesn't sound reasonable in a position were you're looked to as the medical person.
There may come a time where you may actually be by yourself and expected to perform compression's. What will you do then? Best of luck to you! Don't loose your license over this because you can get another job.
Many seem to think that I was hiding something. Someone wrote: I take it you have not officially notified your employer? It is not only a professional requirement that you immediately notify your employer but it is the ethical thing to do.
Fact is: Employer has been notified both by restrictions, verbally and in writing asking for what this nurse should do. My medical director knows, HR knows. What will become of this is not yet known.
The fact is.. YOU asked for the the restriction.YOU can get it removed. You are able to perform compressions. It could just possibly exacerbate your condition.
Were you an employee that I cared for, even if you managed to get your restrictions removed, (and I had read the medical notes) I'd override the removal and my Medical Director and HR would back me up. There is a difference between possibly and almost surely were I to attempt to do compressions it is almost certain that overwhelming pain would soon stop me. Originally lifting a fairly light object while bending put me in hospital for 5 days and unable to walk for weeks. Respectfully, so much for the fact is
Martymoose's question: Dumb question- can you retire and then find a per diem job that's more bookwork?
I could, but I'd rather not, I quite enjoy working and my student loan won't be paid off till I'm 75. Actually about 60% is "bookwork" (Workers' Comp) with about 20% teaching, about 15% safety admin, and about 5% direct patient care. Doing a bit of math, over ten years (20,800 hours) about 100 hours has been emergency response and one hour has been CPR. That is 0.005% emergency response and 0.00005 CPR. However I don't mean to minimize, clearly I've saved some lives over the years. If I worked where there was a likelihood of being alone during a code I'd be the first to say I am no longer sufficient, but that is never the case.
Horseshoe asks: Just curious, are you able to exercise anymore? Swimming, water aerobics, etc.?
I am, within limits and am working diligently w/ a PT and progressing nicely. I'm told that the sort of forcible bending will come much later in PT. I'm hopefully expecting to be able to pass an AH CPR practicum within 6 months or a Red Cross CPR practicum in May. I'd so much love to be able to use a pool, as you know the absolute best thing for lumbar issues. I do use an exercise bike and miss my rower but the PT people say no on that for now. It's the bending that is the issue.
Blondie wrote: And really, you can tell someone else to do CPR, but in reality, if you want high quality compressions, you need to switch compressors frequently. It sounds like you're more of an administrator. How often does CPR really done up?
Agreed and I'm proud to say that my two workers (EMT's arrived within 8 minutes) performed perfectly, excellent pacing excellent depth. While working in hospital I'd participate in one or two codes each year. Since then, as Occ Health RN, one CPR in about ten years.
Princess Bride wrote: Can't stand for more than a minute? No CPR? Can't walk for more than five? Time to look for another job. Those accommodations are unrealistic for a staff nurse and unfair to your coworkers.
Thank you, for a hospital nurse I'd be the first to agree. Actually this job is uniquely suited since I can spend most of my time sitting and can get anyplace I want in the facility with five minutes walking. Perhaps Princess you are assuming that my co-workers are other RN's who will need to pick up the slack? I'm sole RN here, and have my own Occ Health clinic. Nobody picks up the slack except in emergency response and in that case there are at least half a dozen who respond on each of the two shifts.
Mr Nurse(X2) wrote: Telephonic case manager?
Actually that is what I do a great deal of. About two hundred of my potential patients are Class A truck drivers who are out on the road. That group accounts for about 80% of the injuries that I deal with. Much of that is done telephonically. I do enjoy the other 20% which adds quite a lot of variety.
Elkpark wrote: I wish the OP no ill, but just have to say that, if I were going to be the "another first responder around," I would not be happy about having to work with someone who couldn't do her/his fair share in a code, just as I would not be happy about being expected to pick up the slack for a co-worker who couldn't do any other part of the basic responsibilities of the job.
Elkpark you might want to look over my OP again. Within hours of my return to work I successfully worked as part of a CPR team. While others switched doing compressions I shaved, attached pads and administered a shock, as well as performed bag valve respirations.
Here.I.Stand wrote: What do you do? We both know 2 minutes in, EMS is not there yet. You must either take over compressions per BLS protocol, or you allow the fatigued rescuer to continue knowing full well that high-quality compressions are becoming medical-drama-quality compressions. That doesn't sound reasonable in a position where you're looked to as the medical person.
Actually I could have done compressions after a few minutes. The victims ribs broke and was essentially left with at least a partial flail chest. That medical-drama-quality compressions did make me laugh though, so true.
It would be an interesting case for ADA. While most appear to believe that ADA would not over-ride any essential function, I'm not so sure that'd be the case. Look at the data based upon ten years of this job:
Workers' Comp Admin 60%
Teaching and Wellness admin: 20%
Safety Admin: 15%
Direct patient care: 4.9%
CPR: 0.00005% (one hour in ten years)
I think that ADA, in this case, with a first responder team always available, ADA would protect the position, though of course, I'm not sure.
I'll update the thread when my bosses decide just what to do with me. Thank you all again.
blondy2061h, MSN, RN
1 Article; 4,094 Posts
I broke my wrist several years ago. I was not able to return to work until they cleared me to return without restrictions, partially because of CPR, and all nurses being required to be able to perform CPR. As I result, I was out of work over 4 months.