Nurse not assisting with a Code

[hhurley]

Hey Y'all, would love to get some input on this. I'm still new to nursing (licensed LPN for 2 years) so I'm not sure if I'm over reacting or not...I work in LTC 3rd shift with 50+ residents to care for with 2 CNAs to assist. On the other side of the building we have the same grouping, at 5am yesterday my RCS discovered a resident cold and unresponsive, I went in to check for a pulse and found nothing, checked the chart and found the resident was a full code, I immediatly grabbed the crash cart called a code blue and went down the hall. One RCS followed me into the room the other was sent to get the nurse from the opposite side. I began chest compressions and my RCS starting bagging until the other nurse would have arrived. Ideally what was supposed to happen was the other nurse takes over breathing and we swap out just like your taught in CPR class while one CNA calls 911 and tells them we have a code in progress and CPR has been started and the other CNA goes the the front doors to guide EMS upon arrival. What acutally happened was my CNA (who is not CPR trained, our facility doesn't require it) bagged for me until EMS arrived 45 mins later and I did compressions the entire time ALONE! The other nurse was sitting at my desk waiting for EMS and never even told them we started CPR she only stated we had a possible death. She didn't call the facility MD or DON. She just freakin' sat there. When EMS arrived they we're shocked even telling me "why is that nurse sitting at the desk" and "why didn't she tell us you were doing CPR"... Is this not neglect or something similar? I would never dream of not assisting even if 10 nurses were in the room I'd still offer. Any similar situations out there? Any advice on how to deal with her, I can't even speak to her I'm so angry. Other nurses in our building keep coming to me and apologizing for her behavior which leads me to believe that something is seriously wrong with this. Also she has been a nurse for 10+ years so I know it's not lack of knowledge on her part.

Thanks for letting me vent

Heather

[iluvivt, BSN, RN]

In the situation you decribed I would say that indeed she was negligent. Negligence is a breach of duty or injury. What would a reasonable and prudent nurse do in this circumstance or what should they do in this circumstance based on the current standard of care? A reasonable and prudent nurse would initiate CPR and follow the CPR guidelines from that point on until EMS arrived or you can no longer continue d/t physical exhaustion. Doing compressions and CPR for 45 min can be physically exhausting..I would have send for the nurse and told her you need a compression break...... if any harm should come to the patient..including death b/c she failed to act..the only way she would be able to get out of it would be if she was not in any assigned to the patient. If she was not but you you needed CPR relief..called her and then she failed to come..she would be liable IMO in that situation. they really need to send the aides to CPR IMO. I would report her to managment for failing to assist you..even from an ethical standpoint she abandoned the patient and her coworkers b/c she was a lazy A##.

[hhurley]

I talked to the DON and ADON that morning and they informed me that CNAs are not allowed to do CPR in our facility that is why there are two nurses on staff at all times, and the age old "something will be done about this" comment was made. Don't get me wrong I like my supervisors but they are so busy with "management" type stuff that they don't handle the day to day issues on the floor, also we were not able to get the resident back and EMS/MD called the code

[morte, LPN, LVN]

I talked to the DON and ADON that morning and they informed me that CNAs are not allowed to do CPR in our facility that is why there are two nurses on staff at all times, and the age old "something will be done about this" comment was made. Don't get me wrong I like my supervisors but they are so busy with "management" type stuff that they don't handle the day to day issues on the floor, also we were not able to get the resident back and EMS/MD called the code

If the patient was cold, the patient was dead....no CPR was going to work. Was the other nurse a RN? If so, and you are in a state that allows it, and you had a doc order, she could have pronounced. And maybe that is why she didn't get involved...

[hhurley]

No, she's an LPN and we could have gotten orders from the MD to stop the code, but she was not trying to do that either

[jadelpn, LPN, EMT-B]

What a horrible experience to have to go through. If the resident was a full code, you did the right thing. If there are only 2 nurses on, then the "code team" should be talked about every shift if there's residents who are full codes. Code 1 starts compressions, etc, code 2 breaks you on compressions, and the CNA can call 911. If it was apparent that when putting the patient on the monitor that you were not getting any sort of viable rythym, the perhaps then the #2 LPN could call the MD to stop the code.

It is a shame that the CNA's are not CPR certified. And as one of only 2 nurses on, I would want to be ACLS as well. If a code situation is unusual for your facility, perhaps the other LPN was not sure what to do. There are some nurses (10 years of experience or not) that get a bit "frozen" when a code is called. You should take the lead, see if you can organize some sort of education surrounding codes, get your CNA's CPR certified, get a list of all residents who are full codes, and be clear on what the roles of each of the 2 people on are in a code situation. That may be just compressions and rescue breaths and EMS is to be called each time for a more advanced level of care. And most importantly, work on changing the belief that just because someone is elderly, or elderly and ill, that the resident and the family don't have their own reasons for the resident to be a full code. And it is a nurse's duty to act in those instances. I am not suggesting this was the thought process of the other nurse on with you, but it could have been. But I have seen the most seasoned nurses freeze at the thought of a code as well. So education moving forward, learn from this to make changes.

[CrunchRN, ADN, RN]

You must have been exhausted. She should have been in that room with you.

[morte, LPN, LVN]

Playing devils advocate....who was supposed to be responsible for the rest of the patients?

[CrunchRN, ADN, RN]

I would think the CNA's would cover and if another emergency apparent they would come tell the nurses and the nurses would prioritize.

[morte, LPN, LVN]

Hopefully this would happen, but remember, this is a place were the aides are not required to know CPR!

I would think the CNA's would cover and if another emergency apparent they would come tell the nurses and the nurses would prioritize.

[CrunchRN, ADN, RN]

Yeah, sucks!

[xoemmylouox, ASN, RN]

That's horrible. She should have came in and helped. If a patient is a full code you run the code until you get an order to stop or EMS arrives. You don't stop just because you don't think that there is hope. Give me a break. Are there no RNs in your facility? I would def. use this as an example of why your CNAs need to be CPR certified. If that was my parent I would be so greatful that you continued to try despite everything that was going against you.