Termination of employment for failure to initiate CPR

[NRSKarenRN, BSN, RN]

See original thread (posting here with permission):

https://allnurses.com/forums/showthread.php?s=&threadid=19627

I was recently terminated because I failed to initiate CPR on a patient who had been expired for about 40 minutes. Administration informed me it was "policy" or protocol even though there was not chance of reviving the patient.

Has anyone experienced this type of situation before? The incident was reported to my State Board and I am waiting to hear.

Others thoughts would be appreciated.

Follow-up Info:

The patient was found by the nurse assigned to her, an LPN who

reported this to the RN. The death was not expected.

The RN involved was a new clinical supervisor to the facility.

In answer to "why a facility has this policy", I was informed if a RN fails to initiate CPR/code blue, then the RN is acting as a physician by determining that death has actually occured and this act is not in the scope of a nurse's practice.

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. He did not want the facility to terminate me when he was informed that would happen.

Also, when I checked the patient, she was what we call "stone cold dead."

Am posting this here as a discussion springboard.

How many nurses are aware of their facilities/employers position on initiating CPR on a patient found "stone cold dead"/ stiff?

What would you have done in this situation?

Are you legally allowed to pronounce death in your state, and if so, under what circumstances?

---------------

In the hospitals I've worked, in PA, expectation is to CODE ALL PATIENTS unless explicit code status ordered.

Under home care, same expectation. I DID come across patient dead 30 min after arrived in home(cared first for spouse). Patient stiff; death not anticipated. Immediately called PCP who told me not to call 911 but notify coroner (outcome long story already posted on here).

RN's are allowed in PA to pronounce death when death expected/anticipated.

Some interesting PA statues:

21.13. Resuscitation and respiration.

External cardiac resuscitation and artificial respiration, mouth-to-mouth, are procedures regulated by this section, and these functions may not be performed unless both of the following provisions are met:

(1) External cardiac resuscitation and artificial respiration, mouth-to-mouth, shall only be performed by a nurse on an individual when respiration or pulse, or both, cease unexpectedly.

(2) A nurse may not perform external cardiac resuscitation and artificial respiration, mouth-to-mouth, unless the nurse has had instruction and supervised practice in performing the procedures.

[SKM-NURSIEPOOH, BSN, RN]

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

[micro, RN]

if someone is a "fullcode", then cpr is started automatically.........and code is called.........

even if all "hope" is gone.....

if patient is a DNR and expires.....the doc has to officially give the order to pronounce, but a t.o. is sufficient.....it is up to doc choice if doc comes in to talk to family.........

in a fullcode situation.....a doc has to pronouce and ..........

what I find ??? interesting.....is "chain of command" or not.....

we are all trained in cpr, right.......

if patient'resident is found "down"............the first person on the scene should initiate the code, start cpr and then when the charge or supervisor is brought into the situation, they can call 911, etc.....

sounds like too much buck being passed and not enough common sense policies.......

I wouldn't want to be charge in a situation like that.....

like what is the time frame between biological to clinical death......

if resuscitation is possible..........

and of course, we have all seen situations that we know are not, but you have to

CYA, CYA, CYA..........

sad to say....

it is a legal world where we work.........

in the community.....I am just me.....

if I find a person down, i have a choice to start cpr or not.....

and the good samaritan law is there to cover me

but this doesn't apply in the health care setting.........

advance directives along with doctors are essential.................

[Sleepyeyes]

Frankly, I couldn't think of a stupider policy. Please look at the ACLS guidelines. If a person has been down >5 minutes, they're toast. I might even try after 10 if it was a young person. But 40????

Why resuscitate a vegetable?

[bestblondRN]

Don't you think at some point it becomes abuse? We have recently had a few codes in my unit involving 90+ year old folks who didn't have advance directives/living wills, and 2 of which had state-appointed guardians. When they have guardians, the process for obtaining a DNR is exhaustive and cumbersome, and it never seems to happen before the patient crumps and they're on multiple pressors, vented, etc., etc.....The point I was trying to make is that it is abusive to keep pouring fluids and pressors into them. Then, when they finally code, we beat on their chests, pour them full of medication and zap them with 360 joules to try to jumpstart them again. They don't usually survive long, and there is absolutely NO quality of life. If the person expresses the wish for all of this, then fine, but if they don't, then I feel we cross a line when we continue to resuscitate a person who has never said that it's OK to do this. Same applies when you find a patient who has obviously been dead for some time. EMS brought a SIDS baby to us once.....cold, stiff and...well....you get the picture. I was the sup on that night, and responded to the call. I said to the doctor, who was frantically trying to resuscitate this kid, "We need to stop now.....this baby has been dead for a long time, and there is nothing we can do except help the family." She asked me if we were legally obligated to perform a minimum amount of CPR, and I asked her if, by her assessment, she thought the baby could be resuscitated, and if the clinical signs (i.e.--rigor, lividity, ice-cold body temp) were enough to justify calling the baby a DOA. She stopped, wrote a note in the chart, and we went to talk with the mom.

I agree with everyone here that we need to address the whole when/when not to resuscitate people. Until then, we should all be proactive in finding out what patients want and encouraging people to make those wishes known through advance directives/living wills.