Legal responsibility to perform CPR?

nurseprnRN, BSN, RN · May 7, 2015

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?

The answer is that people can sue anyone for anything, assuming they can find an atty willing to take the case. In such a case as you describe, that's unlikely. If 1) CPR was done to standard taught to the Good Samaritan who responded, 2) there was no money changing hands, 3) and especially if there were no damages (which there weren't-- the patient recovered), no suit would be brought. The cost to bring it would not be covered by any judgment...because there wouldn't be one. That's a lousy business model for any atty hoping to make a living. :)

RNsRWe, ASN, RN · May 7, 2015

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?

Well....BLS certified IS CPR certified, they aren't two different things. If you have a BLS card, you have been taught (successfully) to perform CPR.

However, as already mentioned, you are running to get a nurse because you might just be starting CPR on someone you should NOT be starting CPR on. You have BLS training so that in the event a code IS to be called, you are able to assist. Once it's established (and it's established QUICKLY) that a code is to be enacted, you will be instructed by whoever is running it what to do.

Your training is there so you can follow the directions as given, and be a competent member of the code team, whether it be compressions or bagging. There is always plenty of work at a time like that to share :)

allnurses Guide · May 7, 2015

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

What you don't know about this story is that the 87 year old woman had a POLST that clearly stated she did not want extraordinary measures performed in the event of an emergency. That is why the family did not sue the facility. Although that did not mean that she wanted to choke to death on the dining room floor the nurse in question thought she was following the patient's wishes to not go to extraordinary measures as her code status was DNR. I don't work there but have followed the case closely as I work in LTC where such issues arise.

MegGusta · May 7, 2015

I am honestly a little sketched out by that policy, as I am a CNA. I know that help should definitely be alerted before compressions begin, but to leave the dying patient laying their to seek out a specific individual? No way, Jose! The DNR notices should really be posted within plain sight in order to eliminate any confusion. What if someone from another wing waltzes by and sees a patient in cardiac arrest with no visible DNR and activates a response? Not their fault at all. I see an ethical and moral obligation to act when someone needs CPR, so boo to that policy.

However, I would seek out a reason from your supervisor just to gain an understanding. I doubt they have that great of a reason, but it would behoove you to try and understand.

BuckyBadgerRN, ASN, RN · May 7, 2015

That story makes me so mad---in every story they did on it, it was said that a NURSE REFUSED to do CPR on this resident and they died. It wasn't a flipping nurse who refused to do CPR!!!

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

RNsRWe, ASN, RN · May 7, 2015

I am honestly a little sketched out by that policy, as I am a CNA. I know that help should definitely be alerted before compressions begin, but to leave the dying patient laying their to seek out a specific individual? No way, Jose! The DNR notices should really be posted within plain sight in order to eliminate any confusion. What if someone from another wing waltzes by and sees a patient in cardiac arrest with no visible DNR and activates a response? Not their fault at all. I see an ethical and moral obligation to act when someone needs CPR, so boo to that policy.
However, I would seek out a reason from your supervisor just to gain an understanding. I doubt they have that great of a reason, but it would behoove you to try and understand.

I've had CNAs hit the Code Blue button on the wall near the patient to get us there pronto, no one had to leave anyone. Same with someone "waltzing by" (lol at the imagery!): they can do the same thing.

It's happened all of two times during my shift; once the patient was a DNR, the other not (perfect example for this!) but even though there were rolled eyes when the code team arrived to find out that there would BE no code, I told the CNA it was the right thing to do. She didn't know, and didn't want to waste any time (it was night shift, tended to be pretty scarcely staffed). And I let the ones rolling their eyes know the same thing. Better to stay on the safe side of things.

VANurse2010 · May 7, 2015

I've had CNAs hit the Code Blue button on the wall near the patient to get us there pronto, no one had to leave anyone. Same with someone "waltzing by" (lol at the imagery!): they can do the same thing.
It's happened all of two times during my shift; once the patient was a DNR, the other not (perfect example for this!) but even though there were rolled eyes when the code team arrived to find out that there would BE no code, I told the CNA it was the right thing to do. She didn't know, and didn't want to waste any time (it was night shift, tended to be pretty scarcely staffed). And I let the ones rolling their eyes know the same thing. Better to stay on the safe side of things.

The eye rollers ought to know that code status isn't necessarily slapped on every patient, and that delaying calling a code to look it up in the chart would be negligent. I swear some of these people just need to spend 5 minutes at the bedside - they wouldn't last!

RNsRWe, ASN, RN · May 7, 2015

The eye rollers ought to know that code status isn't necessarily slapped on every patient, and that delaying calling a code to look it up in the chart would be negligent. I swear some of these people just need to spend 5 minutes at the bedside - they wouldn't last!

Unfortunate thing the Eye Rollers were people who really should have known better, but the one from the ED felt he was "too busy" to be taken away from watching his one patient (there were staff to cover). And the one respiratory therapist (who had been pulled away from NOTHING urgent) also felt too important to "waste" his time on something like that. As if his JOB didn't involve doing exactly this....? Oh well.

I tell newbies all the time that I would personally MUCH rather run to a code that doesn't happen than NOT be called to one that SHOULD have been! No eye rolling here

_zoubisoubisou_ · May 7, 2015

Nowhere did I say that this woman died because CPR wasn't performed. So before those of you who were there or like to think you were there shout your opinions about how this is old news or the patient had a DNR or the family refused - whatever the case, it is similar to the OPs post. Whether it's the hospital/LTC facility policy to perform CPR or not, is per each facility. I would never want to put myself in that position to have to make a decision like that. Now if the patient has a DNR, that is a completely different story and I can agree with you 100%. As far as a facility not allowing CPR to be performed by anyone who is certified to do so, is a sticky situation. Maybe they have their reasons but who knows..all I know is I wouldn't want to be involved.

MunoRN, RN · May 7, 2015

What you don't know about this story is that the 87 year old woman had a POLST that clearly stated she did not want extraordinary measures performed in the event of an emergency. That is why the family did not sue the facility. Although that did not mean that she wanted to choke to death on the dining room floor the nurse in question thought she was following the patient's wishes to not go to extraordinary measures as her code status was DNR. I don't work there but have followed the case closely as I work in LTC where such issues arise.

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.

She did not have a POLST or other DNR, that was more of an alternate reality created in the discussion of it here on AN. The facility had not made it clear they didn't do CPR and admitted that was a misunderstanding of their policy by staff, they clarified their policy to include that staff is allowed to perform CPR when appropriate. They don't provide acute medical and nursing services, which wasn't meant to mean their residents where more likely to receive BLS when needed if they eat at the Applebee's down the street instead of in their cafeteria.

This all seems based on the daughter's initial reported statements which were apparently taken out of context with all sorts of incorrect assumptions made. The daughter's response when asked if she was satisfied with the care she received (that CPR was not done):

"I never said I was fine with that," daughter Pamela Bayless told CNN Monday before hanging up the phone. "That was completely taken out of context, and I have no further comment."

Glycerine82, LPN · May 8, 2015

When I worked LTC we weren't required to be certified for CPR and were to yell for help or get the nurse if/when we encountered something like this.

At the hospital we were all BLS certified and absolutely expected to act if we came across the above situation.

I'm sorry, but if someone is choking I am giving them the abdominal thrust (or whatever they're calling it now-a-days). CPR is a different story in LTC because I'd need to know the code status which i was never privy to in that setting.

MegGusta · May 8, 2015

I appreciate that train of thought. Thanks for supporting the CNA! I was specifically speaking to the directive to notify the charge nurse, in the OP's case. That might not be the greatest policy, and I think it is a unique situation. Nonetheless, glad to know I wouldn't get eviscerated for trying to pull a Code Blue on a dying patient.