to intervene or not to intervene

applesxoranges, BSN, RN · Dec 19, 2015

You know I thought of posting a similar scenario but feared AN hatred for even having the thought. I was recently visiting my Grandfather, who is in a rehab/nursing home facility right now to recover from surgery. A [u']patient[/u] (a rather young one) had an unexpected respiratory and subsequent cardiac arrest in the hallway. Being an ICU nurse I Jumped right in to help with the situation, bagging and performing chest compressions. When I suggested further ACLS interventions I was told "We can't give/do that without Dr.'s orders." This was kind of shocking to me as the patient was dead. It was also kind of shocking the profound unpreparedness the nurses displayed in the situation. At that point I questioned whether I should crack the otherwise unused crash cart and give the damned meds myself. And then I thought... "S***, can I actually be doing this at all?"

Well, this is a tricky situation. First, you are not employed by that facility. I can't jump on any ambulance and say "I'm a paramedic! Let me crack open the drug box!" I have to be on the drug license.

Two, they are probably not ACLS trained. They have some stranger who claims to be an RN who is ACLS trained. How do they know that you are who you say you are? They do not have policies in place for ACLS medication. They do not have your ACLS card on file. They do not have your nursing license on file. They may not even have ACLS medications for a code. Most rehab facilities I have seen are not ACLS facilities. Heck, a lot of hospitals hire floor nurses and do not require them to be ACLS trained. They have an AED and call 911. Technically if you administer that epi you are probably acting outside your scope of practice. In the hospital, we have protocol orders that say follow ACLS. In the field, we have protocol orders.

Nope, not substandard. The word that came to mind for me was actually selfish. How selfish of her/him to not take 10-15 minutes out of their day to render help to someone laying on the ground unresponsive as they walk right by. Those were that posters words, she/he is not worried about being sued, simply just doesn't want to get involved. So I do find that selfish, ESPECIALLY when you have the skills/training to help that person in some way. Elkparks exact words were she/he doesn't feel any obligation to respond to a random stranger in a public place "when I'm on my own time, living my own life". Yuck, people like that make me sick

How often do those scenarios really happen though? I don't hang out in nursing homes or hospitals on my day off. So the risk is pretty slim. Yes someone may choke. Yes someone may die from cardiac arrest. It's possible but it's slim to happen. It happens. Hopefully they would call 911 but that's really all we can ask them to do.

Sometimes people make it worse when they try to help. "Hey! I'm a nurse! I want to take over this trauma!" Except that nurse has zero experience dealing with traumas. When it comes to EMS, I let them do their thing.

MunoRN, RN · Dec 19, 2015

No, of course not, but, outside of work, we determine individually whether or not and how much we are obligated in any specific situation, and different people have different views about that. There's no one global, "right" position.

Opinions do vary from person to person and there's nothing wrong with that, but I can't help but wonder if the facts you're basing those opinions on are accurate.

Whether not a patient gets CPR during those first few minutes of CPR is primarily what determines the difference between a patient who could recover and return to a normal life, and a patient with significant anoxic encephalopathy which is a fate arguably worse than death. So by deciding you've got better ways to spend those few minutes until help actually arrives, you're essentially choosing to guarantee the patient is doomed for the tortuous state of permanent anoxic injury, which seems unlikely you're knowingly choosing that, I hope.

HopefulRN7 · Dec 21, 2015

Opinions do vary from person to person and there's nothing wrong with that, but I can't help but wonder if the facts you're basing those opinions on are accurate.
Whether not a patient gets CPR during those first few minutes of CPR is primarily what determines the difference between a patient who could recover and return to a normal life, and a patient with significant anoxic encephalopathy which is a fate arguably worse than death. So by deciding you've got better ways to spend those few minutes until help actually arrives, you're essentially choosing to guarantee the patient is doomed for the tortuous state of permanent anoxic injury, which seems unlikely you're knowingly choosing that, I hope.

Makes you wonder why people became nurses in the first place...

It's not for the money unless there's a money train steaming down the halls that I keep missing