Resuscitation in Long Term care

[Old Gal]

Hi,

The health region in which I work defines 3 levels of care, number 1 being comfort measures only to number 3 being the most intensive care level where resuscitation (CPR) and other measures are to be given. Families and the residents (if they are competent) decide on the care levels upon admission to our Long Term care facility. We are located in a wing of a hospital, but do not have our own crash cart, etc. I honestly have gotten several different answers both from management and other RN's about what they would actually DO in the event of either an unwitnessed or witnessed collapse of a resident. Yes, we can start CPR, but often are on our own way down the long hall and if we ring for help we would be waiting a long time on this busy unit as call bells are rarely answered immediately due to staffing levels, etc. Another answer I was given is to load the resident on a stretcher and get them over to emergency, which would take much longer than 4-6 minutes by the time you find help to load them on a stretcher, that is after locating the stretcher, etc.

How do other nurses on similar units deal with this situation? I am a returning nurse after 16 years away and am finding this the most stressful thing to deal with, in the anticipation of such an event. Like the old saying goes, Wal-Mart greeting is looking mighty good. I hate to give up nursing after all the work I went to in refreshing my RN., but staffing levels, policies that are not backed up with practical instruction, miscommunication, etc. are driving me crazy.

(My fire orientation consisted of the maintenance man pointing out the exits to me as I finished a bleary-eyed night shift, this on the instruction of my manager!)

Any thing you can say to cheer me up would be most welcome!

Thanks in advance.

[Fiona59]

Most of my seniors were DNR. We were only required to start CPR if the incident was witnessed.

My only suggestion is pull the call bell out of the wall, send your NA off to get help and commence CPR (if it is required by the care plan).

I have memories of a family that had finally decided to have a DNR order for their parent. We had all the comfort/palliative care plans in order. The minute he was really going downhill, the daughter called 911 and had him shipped off to ER. The paramedics were p*ssed at us, the family was ticked because we weren't "doing enough to save him", and acute was miffed because he wound up in their beds...

Welcome back (and I do mean it). Patients are no longer patients but health care consumers and the family is always right....