Legal responsibility to perform CPR?

Nurses General Nursing

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So I just got hired on as a CNA at a nursing and rehab center. I am BLS certified, and even CPR certified through the Red Cross. During orientation, the supervisor told us orientees that we are NOT to perform CPR or even the Heimlich maneuver on choking residents. She said that if we were to walk in on a resident who needs CPR, or is choking, to go get their charge nurse. She said even if we're certified to do those duties, she doesn't know which CNAs have CPR certificates or not (it's not a requirement)-and therefore we shouldn't do it.

Is this normal? I feel like if I were to run into a situation where a resident needed CPR or was choking, and I was to walk away from them to get a charge nurse, that it would be looked at as negligence. What are your thoughts?

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There's a fine line I think. I personally would never take a job that would require me to be in that situation. Check out this news story on a very similar situation.

911 Call Audio: Retirement-Home Nurse Refuses Woman, 87, CPR, Despite 911 Operators' Pleas Video - ABC News

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Wow that video was interesting to watch...I decided a couple days ago that I'm not going to even finish orientation at this place. So many red flags, this was just one of them. CNAs don't even have access to care plans there to get more information on their residents. I just can't see myself going to find a nurse to do something that's potentially life saving-when I'm capable of also doing it.

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Not only negligence, but personal morals ya know? Maybe others will have a different opinion, but personally I think you made a good choice.

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Do you as CNAs know who is a Full Code and who is a DNR? That may be why they say to get a nurse. Or, in any situation you need to call for help or alert EMTs and get an AED unless another person is with you. This would be the same in a nursing facility, if you walk into a patient's room and find that they're unresponsive and not breathing the next step is to call for help before starting CPR.

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Specializes in Pedi.

I've never worked anywhere where CNAs code patients. That's left to nurses, MDs, respiratory therapists, etc.

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Specializes in SICU, trauma, neuro.

I agree that that's a difficult position to be put in. Some years back, there was this PSA on the radio station I listened to, advising lay people to do compressions only if they witness someone arrest and have no pulse. "Put your hands on the center of their chest, and push hard and fast. It's called hands-only CPR, and it's approved by the AHA." The rationale is that early and un-/minimally interrupted chest compressions are so vital. And choking? Three minutes and the anoxia will be causing brain damage...I imagine it could easily take >3 minutes to find the charge nurse.

I used to work as an RN at this LTACH; I don't know what the requirements for the CNAs were exactly, but RNs were not even allowed in the units without current BLS. I mean new hires couldn't even shadow with the HUC, because that would require us to be bodily in the unit.

I'd think that given the nature of LTC and subacute rehab, with the relatively high CNA-to-pt ratio and low RN/LPN-to-pt ratio, it would behoove them to make ALL pt care staff be certified. That way in the event of a cardiac or airway emergency, BLS can be initiated by whoever finds that patient.

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Look at it this way, you as the CNA are expected to inform your nurse if there is a change in condition, abnormal VS, ect... You can't get a bigger change of condition then cardiac arrest and the nurse must be notified immediately!! I get irritated when the CNAs fail to tell me about a resident with a fever, I'd be livid if one of them was doing CPR on a resident and I had no idea what was going on!

As for not having access to residents' care plans.. Do you mean their kardex or ADLs care plan that says how each resident transfers, whether or not they're continent, ect ect? A CNA should not have access to a resident's full careplan. Per HIPAA guidelines a facility staff member should only know the info that's pertinent to their job, having access to anymore than that would be a privacy violation. When you have a question regarding a patient or their care the person you should be going to is their nurse!

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Do you as CNAs know who is a Full Code and who is a DNR? That may be why they say to get a nurse. Or, in any situation you need to call for help or alert EMTs and get an AED unless another person is with you. This would be the same in a nursing facility, if you walk into a patient's room and find that they're unresponsive and not breathing the next step is to call for help before starting CPR.

I am a hospital RN,working ER and don't know much about LTC. But, when I walk through the hospital, I could encounter a cardiac arrest, in which case I would yell for help, and start compressions using the exact same technique CNAs are taught. I would have no idea of code status, unless it was prominently posted. How would this be different if I was a CNA?

As far as the heimlich? Why on earth would a CNA not do that? How is a nurse more qualified?

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There's a fine line I think. I personally would never take a job that would require me to be in that situation. Check out this news story on a very similar situation.

911 Call Audio: Retirement-Home Nurse Refuses Woman, 87, CPR, Despite 911 Operators' Pleas Video - ABC News

OLD news. That woman and her family chose this facility precisely because they did NOT want her resuscitated. The facility made it very clear that they did NOT have a code team, did NOT require CPR training, and did NOT do CPR. That was exactly what this family wanted. But somebody in the facility panicked, made that call, and unleashed an unhappy chain of events.

That is NOT what the OP is describing. In her case, if I read it right, she has BLS training but since not all the CNAs do, fr some dumb reason the administration doesn't want ANY of them to use it.

I agree, go work somewhere else if you can't get anybody to see the foolishness of this position. Are they worried about somebody who isn't trained doing it wrong, or doing it on someone who's DNR? Make a policy that you can't do CPR without a valid current card. Make a policy that everyone has to have one. Make a policy that DNR patients wear purple wristbands. Make a policy that nobody gets CPR in this facility. Any of the above would make better sense than the one the OP describes. OP, are you sure you understood her clearly?

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I don't know where you're from hherrn so I can't speak for your state or the hospital in which you work. Why the hospital not have it clearly posted if a patient was or was not a DNR?! When I worked in the hospital each patient's code status was posted on the front of their chart (chart was located right by the door to their room. Our county also had DNR bracelets for anyone who had elected to be DNR. For a nurse to call a code on a DNR patient would be a huge no-no! Furthermore, in the hospital each room had a "code blue" button, hit the button and an alert goes out over the intercom system alerting all available staff in the area to respond.

The area I live in now does not have a county wide DNR bracelet program, the county uses POLSTs, but every DNR patient admitted to either hospital has a DNR bracelet put on along with their hospital one. In LTC things are run differently, these nursing homes are these people's homes. Their rooms are not equipped with a "code blue" button, you initiate CPR before calling for help and you may be stuck doing CPR on that patient all alone until someone happens to walk into the room! And something like their code status may not be posted out in the open, all facilities do things differently obviously. The facility I work at used to print out the census every night, all Full Code resident's names were highlighted and a copy was placed by each of our crash carts. We stopped doing that and now each Full Code resident has a green circle after their name on the outside of their door. The last place I worked at didn't have it posted anywhere who was a full code, a heart was drawn by their names on the 24 hour report sheet by the noc shift nurse.

As for the heimlich, I never said a nurse is more qualified to perform it then a CNA. But my guess is that in a licensed facility that may fall into the category of requiring a "nursing assessment". Or it may be that because that facility doesn't require their CNAs to be CPR certified, their policy is that no CNA is to perform the heimlich. CNAs at my facility are not certified, and a licensed nurse (with a CPR cert.) is assigned to the dining room at meal times.

Every facility is going to be different but if a facility does not require the CNAs to be CPR certified and therefore is their policy that CNAs are not to initiate either CPR or the heimlich, well then that's what needs to be adhered to. I started out as a CNA in the hospital, I could remove IVs and inding catheters but that doesn't mean I was allowed to do either at my next job in a nursing home.

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I'm curious- What if you are CPR certified, you and your family are out to dinner and someone in the restaurant faints and is unresponsive with no pulse and needs CPR, while doing said CPR a few ribs are broken in the process and punctures a lung, person goes to hospital and recovers but the family is upset about the broken ribs/lung. The family decides to hire a lawyer to sue you for extra medical expenses and whatever else they can get. My question is... would you think twice before doing CPR again on someone outside of your job?

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