Job Suspension

klone, MSN, RN · Jun 2, 2011

Was the pt's primary nurse also reprimanded?

I don't work with that patient population (in OB, pretty much all patients are full code except non-viable infants), but isn't it standard to assume they ARE full code unless they have a sign posted at the bed or something on the armband designating DNR? (with the exception of hospice patients, of course)

Esme12, ASN, BSN, RN · Jun 2, 2011

Ive been working prn at a ltc/snf for 6 months as a new nurse. This week I went in to assist an aide who said she needed help. (this was not my assigned hallway) The pt was unresponsive, but still breathing & had a pulse. I left the pt with the aide to get the VS machine & his nurse. Later, I leave the room several times to get things his nurse asks for. The last return, was during the transfer of the pt out of the bathroom & to his bed. He passed while doing so. His nurse tells the aides to prepare the body & I leave the room to begin my morning med pass. Later, the nurse says to me the pt was a full code.FULL CODE! I trusted her & her judgement & I was a fool. Now, I have been suspended, pending an investigation. I just got my license & I feel like its about to be snatched out of my hands. Please offer any advice.

Let me if I hear you correctly. Somehing doesn't make sense.....

A nurses aide asked you to help her, you found a patient non responsive but with a pulse on the floor to the bathroom. You left the patients side leaving the aide with the non responsive patient to get the vitals machine and the patients nurse. (I probably would have sent the aide for these things and the nurse and I would have stayed with the patient) but when his nurse arrived she gave no indication that this was a drastic change for the alert patient and gave no indication that he was a full code. Then... Somewhere along the line it was decided to move the patient from the floor to his bed (always better than coding on the floor) when his vital signs ceased and the patient died. You return to the room and you were informed the patient has "passed" and no one seemed alarmed or disturbed and it's business as usual.

The nurse in charge of the patient tells the aides to "prepare the body" and you go back to your duties thinking all is as it should be. Now the nurse in charge of that patient wants to blame you for her ineptness and throw you under the bus by saying you didn't call a code when it was clearly her fault for not calling one upon her first encounter with the patient on the floor and yet again when the patient "passed" on his journey to the bed. It's curious that NO ONE during this exchange asked....Is this patient a full code?

So....now she's saying that the patient died because you didn't call a code? Has she been suspended too? Do you have malpractice insurance? If you do call them and ask them what you should do. You should have some legal resources. If you don't have malpractice when this is over.... get some. You may never need it again but it's worht having for when the what if....happends... Write down everything right now what you remember exactly as you remember it occured. You may need it later..

If all this information is accurate then the nurse is at fault.......upon arriving in the room with her ALERT patient non responsive on the floor......a sense of urgency should have taken over this nurse, and in her attempts to care for this full code there for therapy patient, she should have called a code or ambulance for this man. When what she did do....decide he's dead already and blame someone else........

I'd talk to a lawyer......just to protect yourself.

charmayn05 · Jun 2, 2011

the pt's nurse isnt blaming me. i was only told of my own suspension. i would assume she has been suspended as well.

NewTexasRN · Jun 2, 2011

Well here's the question of the day. Do you have Liability Insurance? If not please get it. You should NEVER practice without it.

klone, MSN, RN · Jun 2, 2011

the pt's nurse isnt blaming me. i was only told of my own suspension. i would assume she has been suspended as well.

If you've both been suspended, then I'm not sure that I necessarily think it's unfair. If you both are RNs, and you both failed to attempt resuscitation on someone who went into cardiac arrest and is a full code, then IMO you are both negligent. I would contact an attorney if I were in your situation.

klone, MSN, RN · Jun 2, 2011

Well here's the question of the day. Do you have liability insurance? If not please get it. You should NEVER practice without it.

The ship's kind of already sailed on that one, don't you think?

Will you please insure me? By the way, I've recently been reprimanded in a patient death...

Esme12, ASN, BSN, RN · Jun 2, 2011

the pt's nurse isnt blaming me. i was only told of my own suspension. i would assume she has been suspended as well.

This may well be the mandatory suspension fact finding mission to try to sort out what the heck happened and how this could have been prevented. I would still write everything down and contact a lawyer (just in case) but write everything down while it's fresh in your memory. You have no way of knowing what may come down the road. I don't think you were at fault....the patients primary nurse is at fault for not calling the code herself and for not letting everyone in on the secret that this patient was a full code.

But I also blame the facility. There should be some standard as how to identify who's a code and who is not. Some places have "comfort care" designation as legally indicated by families and the patients MD. In my state a "comfort care' is also recognized by EMS services for the paients do not code status. Yes there is a special arm band to identify the patients.

http://www.mass.gov/?pageID=eohhs2subtopic&L=5&L0=Home&L1=Provider&L2=Guidelines+and+Resources&L3=Guidelines+for+Clinical+Treatment&L4=Comfort+Care+-+Do+Not+Resuscitate+(DNR)+Order+Verification+Program&sid=Eeohhs2

I have also seen color coded wrist bands for code indicators, fall risks, ect which are extremely useful. After this is said and done, maybe suggest a colored wrist band for DNR patients so this is less likely to occur again...

I wish you the best..:redpinkhe

Esme12, ASN, BSN, RN · Jun 2, 2011

The ship's kind of already sailed on that one, don't you think?
Will you please insure me? By the way, I've recently been reprimanded in a patient death...

Better late than never.......

Esme12, ASN, BSN, RN · Jun 2, 2011

If you've both been suspended, then I'm not sure that I necessarily think it's unfair. If you both are RNs, and you both failed to attempt resuscitation on someone who went into cardiac arrest and is a full code, then IMO you are both negligent. I would contact an attorney if I were in your situation.

In the LTC setoing there are more NO CODES than codes. To code a no code is assault and battery as well as malpractice and abuse. It depends on what your setting is.......I am positive that there are very few DNR's on Labor and Delivery and most L&D's aren't located in a nursing home.......

klone, MSN, RN · Jun 2, 2011

In the LTC setoing there are more NO CODES than codes. To code a no code is assault and battery as well as malpractice and abuse. It depends on what your setting is.......I am positive that there are very few DNR's on Labor and Delivery and most L&D's aren't located in a nursing home.......

Yes, I already indicated that I'm not entirely familiar with how it works.

But it seems to me...from an outsider's viewpoint...that unless you know that they are DNR, you have an obligation to attempt resuscitation. I'm looking at it solely from a litigation standpoint - what is worse - to start CPR on a DNR, or to fail to do CPR on a full code and have them die?

Assault and battery vs. manslaughter.

Hmmm...

NewTexasRN · Jun 2, 2011

The ship's kind of already sailed on that one, don't you think?
Will you please insure me? By the way, I've recently been reprimanded in a patient death...

Come on, can we be mature about this. That's not what I meant. What's point after the fact? I was simply curious and wanted show why's important to have it.

gettingbsn2msn, MSN, RN · Jun 2, 2011

This is exactly why I am thinking I do not want to work in ANY facility anymore.