Termination of employment

Home Health Columnist / Guide · Jul 24, 2002

Daniel,

Sending a {{{hug from PA}}} too. Can only imagine how must be a difficult time...glad you reached out to vent here.

Tried to find Missouri statue re who can pronounce death but unable to locate on search tonight.

While the events are fresh in your mind now, review and write down WHy you took the actions you did. Do you have an orientation manual that you can refer to that would have hospital CPR guidelines in it?? Gather as much info togher as you can. PLEASE seek guidance from an attorney---will certainly need one to go before the SBON to defend youself in this situation.

Since you were not the patients nurse, what actions were taken against him/her for not calling a code?? OR does policy state RN must initiate a code?

Wish I could offer more guidance. Please keep us updated. Praying to send you faith and guidance in the weeks ahead.

lynniepooh · Jul 24, 2002

A very similar situation occured in a LTC facility where I was employed last year. We did not have an MD in facility, but the nurse called our house MD at home on finding what seemed to her to be a patient dead for hours. (90 yo male) House MD did not raise any fuss, nor did the family, but she was fired by the facility and reported to MO state board of nursing. MO publishes all discipliary action in their newsletter, and I have watched for her name and have not seen it. Best of luck to you! You did what seemed right at the time, and that's all any of us can do.:kiss

kids · Jul 25, 2002

I would suggest obtaining documentation from the Red Cross and the (I think) American Lung Assoc. on their current CONTRA-indications for initiating CPR. (as I recall it includes things like cooling, line of demarcation, rigor, pupils fixed).

Then I would file for unemployment...citing the reason for termination and attaching the documentation.

DanielMark · Jul 25, 2002

Response from "lynniepooh" was encouraging in that the SBON apparently did not pursue any disciplinary action against the nurse. Why this nurse was fired also is a mystery to me too.

Hopefully my outcome will be similar.

kids-r-fun reply was informative in that I had thought I did not qualify for any unemployment since my employer stated that the termination was due to a "fault of my own making." According to MO unemployment dept. persons are not entitled to benefits if that is the case. However, I may again pursue this avenue after reading your reply.

THanks to you both for your responses. Very helpful.

Danie

**SKM-NURSIEPOOH, BSN, RN** · Jul 26, 2002

...it's their lost!!! i hope that your state board of nursing agrees & don't decide to discipline you because your employer might make it out to be worst than what actually happened...i hope you covered your a$$ with documentation...i'll say a prayer for you tonight...anyway.

i had posted the following from another thread that was brought-up because of what's happened to you here....

why just two weeks ago, my friend, who is a lpn in albany, ny, told me something similar had occurred in her facility!!!

in her situation, a resident (ltc facility) was found sometime overnight by one of the cnas who also notified the nurse on duty. this resident was 90 something, confused/disoriented when awake, had g/tube placement due to not remembering how to swallow, but was a full-code!!! so the nursing staff called a code & began cpr on this poor man...they worked on him for at least 20 minutes before the shift supervisor (who was in another building - she didn't even know that she was the supervisor because the regular supervisor called-out & the 3-11pm shift supervisor never told her...but that's another topic by itself) was made aware of the code. by the time she came over & called for an ambulance....this poor man's chest was all bruise & some of his ribs were cracked!!! the ambulance came approximately 20 minutes after the supervisor called them...& they're only located down the street...something like 5 minutes away!!! this facility doesn't even have the defibulator on their crash cart. my girlfriend was quite upset as she was involved in the resuscitation efforts...she said it was horrible & wishes that she never get involve in another code like that one again.

my concern is...why are some residents or patients that will obviously not make it through a code be listed as full code? don't get me wrong...i believe that if the quality of life is good where the person knows what's going on, can physically get about with or without assistance, & they don't have a obvious deadly diagnosis...yea it would make sense to be full code. but when people are at death's door...especially when they're in their mid to upper 90's, & they're not in control mentally & physically...why put them in full code status when they're going to die naturally....why put them through the stress & pain of a code only to have them die minutes, hours, or days after the code??? i hope i'm relaying my question correctly...i don't want to sound like i'm coming off as being uncaring about the elderly population because i do care about them...a lot!!! are these poor souls being made full code so that the hospitals or nursing homes could continue to profit off of them just so long as their insurance companies or medicare/medicaid pays for it??? do we all need jobs so badly that we'd keep folks artificially alive knowing that they have no quality of life....& some are unfortunately abuse or neglected by staff

just was wondering...moe

in reading all of the other previous post here, i realize that each sbon maybe different in regards to cpr protocols. again, i'm soooo sorry that you have to go through this distasteful ordeal!!! - moe

micro, RN · Jul 26, 2002

tough spot DanielMark......

if patient/resident was not a DNR, legally you start a code......and I don't know.....don't get the chain of command........

the first one that noticed the patient down....should have called the code,started cpr, etc.

if outside of the hospital.........911 called and patient/resident out of there.....

it is a cya world.........

now DNR is a totally different story..........

but heck........Daniel Mark.....this too shall pass......

you made a judgement call.........do not beat yourself up about it........you knew person wasn't gonna be resuscitated, but you have to go by the legal parameters.....

go through the review of your state board......

this too shall pass.........

you are better off without that job anyway.....

there are always opportunities.........

and you will not have to leave health care or nursing......

just state your case simply and truthfully.........

keep on keepin on'

micro

preciousnurse · Sep 22, 2002

In my state I believe the policy just changed and that if a patient is already a DNR the nurse can pronounce the patient and the time of death.

DanielMark · Sep 22, 2002

UPDATE: Hey, nurses. This matter is all in God's wonderful hands now. I was finally able to turn it over to Him completely. All your comments were extremely helpful and thought-provoking. What a tremendous support group you have been.

Currently, my nurse/attorney is handling this case and will be with me at the SBON hearing, which may take another year to materialize. In the meantime, I am actively seeking employment elsewhere. All the fears and self-doubt have vanished and I now feel I can get on with my life and nursing career. Many have held me up in prayer and their thoughts. It was definitely felt by me.

So, I will continue to keep you all posted. This is a wonderful web- site for nurses. It helped me tremendously during a very dark period in my life.

Daniel Mark

Youda · Sep 22, 2002

Originally posted by DanielMark
This unplanned time off is providing lots of time to think and re-group but at the same time can be harmful since I have yet to start applying for other positions as I would definintely have to tell any future employers of this incident.
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Most states do not require that you to tell a potential employer that there is a complaint pending against your license. As soon as you can, call your state BON to make certain about what your state requires. Some applications, though, from various companies do ask. If a potential employer asks, tell the truth, but I wouldn't go into the nitty gritty details with them. Unless your state requires you to do it, don't tell a new employer!

Violating a facility POLICY is a different thing from violating your state's nurse practice act. Couldn't say for sure, but you may be OK because you used your best judgment and training and determined there was no chance of survival. But, get yourself an attorney, just to be sure you aren't out on a limb and to protect yourself. As you noted, the person who discovered the pt. should have called the code. You aren't the only one who is involved, probably just the only one with a RN!

I know this kind of thing is so upsetting. But, hang in there.

:kiss

renerian, BSN, RN · Sep 22, 2002

I hope if I die like that nurses will be around me like you and let me be......

renerian

jnette, ASN, EMT-I · Sep 22, 2002

Know that you CAN appeal to the labor board for unemployment compensation ! And reverse the decision of "mistake of your own making", and collect.

I have done this one time in the past (not nursing related) when I KNEW I was right and my judgement call was based on the facility's own Federal Register Guidelines.

I won the appeal and the facility had to offer me my position back.. needless to say, after the treatment I received by them, I was no longer interested.

If you do as suggested above with the Red Cross/AHA guidelines, etc., you stand a good chance at your appeal to the Labor Board and can at least collect unemployment and keep your head above water !

Hope all turns out in your favor...keep the faith.. in Him AND in yourself ! :kiss

BBFRN, BSN, PhD · Oct 19, 2002

Originally posted by DanielMark
I

Replying to the other question of "how did I know the patient had been expired for 40 minutes", the resident guessed this to be the case and even informed my manager that there was no chance of reviving the patient.

If the resident knew this, then why didn't he pronounce it? It seems to me, that if a Dr. is present, then the situation would be in his/her hands. Was the resident reprimanded for not pronouncing the death?