Will I lose my license?

bluescoop, BSN, RN · Mar 15

Meh, sounds like he would have died anyways. Nobody can force him to do anything. I personally would ask to send someone to the hospital if I could not get there O2 above like 87% and I know the doctor would approve if I ask. I don't know about your license but most likely you will be alright. They may not even report you to the BON as the nurse in charge when he died. I worked in SNFs for years and had several patients die on my watch. No one ever questioned if it was my fault. Sometimes patients just code unexpectedly.

JKL33 · Mar 15

I know this is not helpful for you at this time, OP, but I'm writing it anyway because yours is a cautionary tale and a lesson for anyone who doesn't know already:

When management makes stupid rules that, by the stated parameters of the rule, violate basic nursing principles, that rule can go right in one ear and out the other. In this case, that is the rule about getting permission for what you're going to do about a patient deterioration in condition. The correct answer is ALWAYS to inform the responsible provider, in addition to whatever nursing assessments and interventions are being done. Informing the DON, house supervisor, charge nurse or any other non-provider entity does not meet a nurse's legal obligation to that patient, and any rule specifying that as a sole or initial course of action is invalid in my book. Your example, unfortunately, is why I have always been a stickler about this exact particular nonsense rule--because whomever you're supposed to tell instead of informing the provider then has the option of doing exactly what they want to do with that information, including nothing. Including misrepresenting the situation in order to get a certain outcome that they/administration wants. Etc. etc.

If I'm going to get suspended or terminated for something, I'd much rather have it be insubordination or not following indefensible rules, rather than "patient died" (or didn't receive appropriate care in someone's eyes).

I've heard a lot of reasons for why floor nurses have to inform Someone In Charge so that person can handle things. I could not care less what the reasons are and I have never complied. And also never been terminated or suspended....or even talked to about it.

JKL33 · Mar 15

I will add that OP did notify MD - was this through messaging? This is a scenario that calls for re-paging or messaging or calling q30 until response received and making sure you have the opportunity to present your own findings and consult on further steps. Unfortunately it is not a situation where we can assume nothing further is going to happen because we haven't heard back. We stay on it until there is a clear plan. With that mindset you would have been more likely to see message from MD.

Although appropriate parties were notified (though what about any NOK?) this extra element of DON involvement gives a false sense that other people would be doing something if something more needs to be done.

Also, patients don't "refuse" things with an (accurate) SpO2 of 80% and in distress—they are considered obtunded. And his wishes were for at least some degree of intervention as he was later coded.

People do die no matter what we do sometimes, obviously. But we can always review and see if there's anything that could have gone differently either in caring for and advocating for our patient, or in protecting ourself when others want to point fingers after the fact. They did know what was happening with this patient and IF there is blame here it is not all on OP.

NurseMH · Mar 15

Unfortunately, it has already happened. Have you received notice that your license was referred? It's unlikely that you'll loose your license but you would likely have stipulations for a designated time.
Always remember that in LTC you have to make independent decisions. As a DON you do get a lot of pressure surrounding RTAs. My guidance was that I triaged all NON-emergency situations. But it it affected the ABCs and they are in distress then your first call better be EMS. Then you notify me afterwards and we can review for anything that may have been missed later.

Barbara B. · Mar 15

I always relied on my assessment of the patient and did what I thought needed to be done. If you are at the bedside of your patient you have the most accurate assessment of what action needs to take place. I'm sorry that you were put in this position. I doubt that there will be any action taken against you.

abbnurse · Mar 17

JKL33 said:

When management makes stupid rules that, by the stated parameters of the rule, violate basic nursing principles, that rule can go right in one ear and out the other. In this case, that is the rule about getting permission for what you're going to do about a patient deterioration in condition. .

If I'm going to get suspended or terminated for something, I'd much rather have it be insubordination or not following indefensible rules, rather than "patient died" (or didn't receive appropriate care in someone's eyes).

I've heard a lot of reasons for why floor nurses have to inform Someone In Charge so that person can handle things. I could not care less what the reasons are and I have never complied. And also never been terminated or suspended....or even talked to about it.

Agree 100% I worked at a facility many years ago that had that stupid rule, too. I also never complied with it, and was never even talked to about it.

Good luck, Princess97. I don't see why any action should be taken against you.

rentalnurse, RN · Mar 20

Ck code status, DNR/dni call md and make comfortable, full send and ask questions later! Had to send one out last night AMS, we use I pad call md call service she was questioning decision to send out and I was printing papers to send. Supervisor LPN, me RN , was going to send anyway. When in doubt ship em out ! Yrs ago had chf pt, anxious, low o2, couldn't get in touch with family, Md said try what you have and if no improvement send. Did and questioned why I did and told them, they said "he likes to go to hospital" really. Heard he passed a week later. Not on my watch.

Barbara B. · Mar 20

You can't go wrong if you do what is in the patient's best interest.

Hannahbanana, BSN, MSN · Mar 20

I volunteered for my state BON for a few years. They get many, many complaints from families, pts, physicians, and others. Short answer: unless you are practicing impaired (drugs, alcohol, etc.), committing a felony (stealing, diverting drugs, abuse of a vulnerable person, assault, etc.), or such, these complaints generally go right into the circular file. Falsifying licensure credentials, that can get you in real trouble. Falsifying documentation or HIPAA violations may get you a suspended license while you get retrained about your legal obligations in that regard but rarely if ever rise to the level of license revocation. Alcoholism or addiction might land you in a supervised program with satisfactory completion and follow up as a condition of licensure. Making your staffing office annoyed by refusing overtime, pffft. Reporting unsafe conditions, pffft. Being rude, dress code violations, or having poor personal hygiene may get you in trouble with your employer but the BON has much bigger fish to fry.
Hope that helps.

Lynker, LPN · Mar 28

I have been in similar situations. One that sticks out in my mind was also 7p-7a many years ago. She was helped to the toilet, went white and couldn't get up. BP was 60/30 (IIRC) and I couldn't even get a temp on her it was so low. I paid no mind to tell ANYONE management-wise--I WAS the supervisor. I called the HCP (Since they were a DNT) and got permission to send her out via 911.

Never got spoken to about that night. I quite literally saved her life.

Think about it in a more basic way. Could they have been saved if you called 911? Then CALL. Who cares what management says. A patient's or anyone's LIFE is worth more than a stupid manager's say, who isn't even there.

You did nothing wrong. You were following orders. But just keep this in mind next time. Human life is more important than management's say in ANYTHING (Especially if they're a full code!!). 🙂