Nurses and Defibrillation

[bobnurse]

It was not long ago when defibrillation was limited to physicians only. One day, nurses said, "why cant we defibrillate, instead of waiting for the doc's to arrive" The docs said are you crazy...Then not long after, they decided to let the medics perform defibrillation out of hospital, and it worked...Patients lives were saved prehospital....Nurses said, "why cant we defibrillate, instead of waiting for the code team to arrive" The docs said are you crazy!! Now the janitors and normal lay people are providing defibrillation prehospital (AED's and PADs System). Floor nurses are saying,"why cant we defibrillate". The docs said are you crazy????

This is a story we tell in regards to defibrillation in the hospital. It amazes me that we allow lay people to defibrillate in the community, but not the hospital trained (ACLS) nurses to provide the same care (floor nurses).

For every minute that passes, you lose a 10% chance of survival in regards to V-fib/V-Tach arrest. This gives you around 10 minutes to restore circulation before death has occurred. So my question is: Why cant floor nurses defibrillate before the physicain/code team arrives? Your looking at realistically a 2-4 minutes response time, after the patient is found. This gives the patient optimally an 80-60% chance of survival if the code is called at the onset of arrest. If the floor nurse could defibrillate, your looking at an 80-90% chance of survival........If you think about it, you have a better chance of survival in some instances going into arrest in front of Dillards at the mall than on the rehab floor of your local hospital.

All Defibs sold today come with an AED mode? So why arent floor nurses allowed to perform BLS? Many of you thought i was going to say ACLS, but remember defibrillation is a BLS function.

I just wanted to get your thoughts and opinions. Also, what if a family member went into cardiac arrest, and defibrillation didnt occur for say 7 minutes post arrest due to 1. Waiting for a code team, then 2. Code team came and reassessed, then defib 7 minutes into it. Now the patient has expired. what is the hospital liability?

Thanks for your replies

[OC_An Khe]

Actually this exemplifiem1es that the main problem in Nursing is that we as Nurses are not in control of our own professional standards for patient care.

[Thunderwolf, MSN, RN]

Yes, this is very frustrating.

I worked at one hospital for many years...and you were the initial code team...providing initial defib and CPR, until the house doc arrived.

At another hospital, hands off.

It depends where you work.

I agree with you. Nurses should be utilized more here in this area.

[TiffyRN, BSN, PhD]

I guess it depends hospital to hospital. All the cardiac floors I ever worked the RN could use "quick look" on the paddles and defib if v-fib noted on the monitor. I know one hospital I worked at all RNs were specifically trained to recognize v-fib if no other rhythm and then defib, didn't matter if you worked ICU or rehab floor. I actually got to do it one time before the team arrived and felt I was giving the patient a chance she might not have had (she survived that code anyway).

Now I work Neo-ICU and one does not routinely defib in codes so I wouldn't dare without a neonatologist or NNP at the bedside.

[snowfreeze, BSN, RN]

I have worked in a number of facilities, most of them in critical care so I was part of the code team and/or expected to initiate the ACLS code. Now that I am in another type of facility, I am still the code team most of the time but the code team only has an AED, O2 tank, BVM and 911. LTC/sub-acute is different than an acute hospital unit. Units in hospitals that don't have cardiac monitoring is probably where this question comes from. Yes all nurses should be able to at least apply the pads for a defibrilator that has an AED mode on a patient. Address this issue if your facility doesn't have a policy to cover your decision to apply the AED pads and maybe suggest that the facility needs this policy. The nurses would like to be able to make a difference in all situations pertaining to what is in the best interest of their patients. Address this to the Medical Director and the DON as well as the Board of Directors and your unit manager.

[UM Review RN, ASN, RN]

We can.

[tiredfeetED]

Never knew that some RNs are not allowed to defib...Wow! I guess working a ED its expected...its very rare to see a ER doc Defib..maybe for unstable cardioversion.

[bobnurse]

It is very common.......Im talking outside the ER and ICU......Ive seen PCCU's where the nurses could only provide BAsic life support.....No defib.......My wife works on a step down where they take drips and vents and so forth......But no defib.....Only airway and cpr.........Here in oklahoma, many floors (med surg, neuro, renal, etc....) are like that.....

[saskrn]

I've travelled to many different facilities, not only were we allowed to defibrillate, but it was expected! With alot of the nurses, it seemed to depend on what their comfort level was with that procedure.

[begalli]

It's expected of us as well.

As the doc sat in a chair a few feet away saying...okay, who's never done this, I said me! So the first time I used the paddles was not for v-fib/tach, it was for a cardioversion for an unstable svt. I'd never do this on my own, but have had to defib many many times over the years. It's just part of what we do in the ICU.

All ACLS certified nurses defib in our facility including on the floors. Doesn't mean all do or even could, but the majority will begin a code and use the defibrillator if needed.

[Roy Fokker, BSN, RN]

Never knew that some RNs are not allowed to defib...Wow!

Me neither! Tjough I'm not a urse yet, it doesn't make sense.

De-fib is a part of BLS. You can't be a nurse if you don't know BLS (we can't join nursing school without a BLS cert.)

Again, it makes no sense to me :stone So according to the OP:

If I'm a nurse, I can't do nothin (pretty much) but if I'm Off-duty and walking the street, I can do de-fib as part of BLS on a stranger having trouble?

[PA-C in Texas]

This is the most assinine thing I have ever heard in my life! I never knew floor nurses couldn't defibrillate. Even if you have older monitors around, I bet that most nurses can recognize v-fib when they see it. If not, its not hard to teach. I could probably teach a monkey to recognize v-fib and light someone up, but we aren't letting nurses do it? Is the problem with the nursing managers or the medical directors of the units?

I really hate it when turf wars interfere with providing the best possible patient care.