I am a nurse, darn it!

JustBeachyNurse, LPN · Aug 7, 2014

I think it depends on the patient. I have one that I go in the pool with for school. I loathe it. Kiddo loves it so much I suffer. PT or OT does half the session. We play the other half. Lifeguard in the pool and on deck.

Another I am poolside but with the child's emergency kit if needed. The pool staff is in the water. (Nurse in the water in that case was optional. I chose not)

brattygrl · Aug 7, 2014

Seems like a liability issue to be a nurse without CPR training.

JustBeachyNurse, LPN · Aug 7, 2014

Text from patient at 8pm = bring bathing suit and change of clothes because I am bringing X to pool and I need you in the pool to help.
A) I have no lifeguard training or CPR training for lifeguards (which is a different animal).
B) I am an RN, not a physical therapist?!
I just said I will accompany, but I am not going in the pool. Am I wrong here? Isn't that a liability issue? I mean this client can't even attempt to swim. If they get water in their lungs they are toast.

FYI CPR training for lifeguards is the same as BLS. Lifeguards take ARC "CPR for the professional rescuer which is CPR for adult/ infant/child , AED, BVM, and O2 administration ". It's the equivalent of AHA CPR/BLS for healthcare providers. The only difference is AHA touches on health issues like recognizing signs of heart attack and stroke.

If you have an AHA BLS for healthcare professionals you have the same CPR as a lifeguard with higher training.

ceebeejay · Aug 7, 2014

If it were part of the plan of care, I would have turned the assignment down at the outset. It's not part of the plan of care. Even the physical therapist (who wants to do it) can't because she won't get approved for it because it's not part of the plan for them.

If an RN does this outside the plan of care and something goes wrong, the RN would be liable. Am I correct?

ceebeejay · Aug 7, 2014

The BLS instructor explained the process is different for lifeguards. CPR is the same, but there are different protocols for breathes (knowing when not to give them) for drowning and some positioning.

SycamoreGuy · Aug 7, 2014

I've taken both AHA BLS and ARC CPR/AED for the professional rescuer. I couldn't tell a difference. I've worked places where they would accept either.

JustBeachyNurse, LPN · Aug 7, 2014

I've taken both AHA BLS and ARC CPR/AED for the professional rescuer. I couldn't tell a difference. I've worked places where they would accept either.

Same here. I've been an instructor for both. The only difference is AHA does some background on CVA & MI. The protocol is the same there is no delineation for rescue breaths/ventilation respiratory arrest due to drowning vs aspiration of a foreign body. The ratios are the same for AHA, ARC, and NSC (national safety council) for at least the past 15 years if not longer.

As far as plan of care, pool time is social/play not therapeutic. My patient that has PT in the pool has the pool therapy as part of his PT plan of care for school and at times a pool therapy outpatient with specific goals. The nurse in pool is for safety due to respiratory and seizure precautions. The pool time is socialization and play not therapeutic. It's no different than playing in the playground. We are not permitted to take a child in the pool without parental permission and there must be 2 lifeguards poolside. In school one guard is in the pool and one is on deck. In the special needs swim at the Y there is two guards on deck and one in the pool. The special needs swim at the Y is just recreational water play.

My agency policy is nurse on duty goes in the water with child or in certain circumstances is pool side. Two families a parent is a WSI/lifeguard so we can sit poolside. This was clarified with risk management.

I checked with my malpractice carrier and accompanying a client for recreational pool time with lifeguards on deck is considered within scope/coverage. I'm not doing anything more than gentle range of motion

SDALPN · Aug 7, 2014

Everyone is going way overboard with this. Not everything will be in the care plan. Not every activity will be mentioned. These are kids living in their own home and doing activities that most kids do and that includes swimming. We are there to be a nurse first. But there is nothing wrong with getting in the pool with the kid. We aren't there to be a lifeguard any more than we are there to be a babysitter, tutor, or maid. But we go where the pt goes, wherever that may be. I've been to the water park with trach kids. I've held trach kids in the pool in their apartment complex. We are there so the kid can live their life. These kids could have the same risks in a tub taking a bath. Its really ok. Relax, have fun!

ceebeejay · Aug 7, 2014

Agency says I did the right thing. They need a waiver from the parents for any trips away from the home and if I am uncomfortable with it, I am not required. Pool time is not fun time for everyone. Being text'd at 8pm the night before is not advanced warning. I am not stopping the parents from doing anything. I understand their position and if it means they need a different RN, then that's fine too.

I trust that the information about the lifeguard is similar/same, but two people specifically asked about during my recert and they were told that they would have to take the cert for lifeguards in addition according the our state. Is he wrong; is he right; don't know and I am not arguing that point.

Thank you for your knowledge!

SDALPN · Aug 7, 2014

A waiver for any trips away from the home? That's odd. With all the dr appts some kids have and the trips to the mall or park out just for a walk outside? That's just strange. We are there to allow the kids to have a semi normal life. Without us they would be in the hospital or a facility. Medicare/medicaid requires us to be wherever the kid is. And what about kids that go to school? Something is off about that. What's next? A waiver for them to swing or go down a slide at the neighborhood park?

eeffoc_emmig · Aug 7, 2014

I always refused any shift that required me accompanying my patient on outings on one particular case because Dad was a horrible driver. If they announced we were going somewhere after I arrived, I called the agency and then went home.

I also would not agree to go to a pool with a patient of they were wanting me to go in the water.

Edited to add: I work nights so I wouldn't have to go to MD appts/school with patients. Just not my cup of tea.