Woman Dies, Nurse Refuses to Give CPR

[Keleynal]

Take a look at this article: Nurse Refuses to Give CPR to Dying Woman

I'm not posting the article to avoid copyright infringement.

Basically, a nurse at a retirement facility encountered an elderly woman who was not breathing. Following company policy, she called 911 for assistance, but refused to perform CPR despite the begging of the 911 operator. The woman eventually died at the hospital.

I came across this article because I am researching Do Not Resuscitate (DNR), euthanasia, and physician-assisted suicide issues for a college paper. I thought it would be interesting to get some reactions from the community here.

My wife, who is a LPN, has worked at several nursing and assisted living facilities. She had some great feedback:

This was a nurse in a no-win situation obeying policies set in place by bad management decisions. If she ignored company policy and performed CPR the lady had a greater than 80% likelihood of not resuscitating and even if she did survive that, the injuries associated with correctly performed CPR are almost impossible to survive. So then she is wide open for a lawsuit for causing harm and suffering to the patient as well as losing her job and possibly her license for not following the clearly stated policies of her facility.

Deciding not to perform CPR, was an easier decision in the short term since it ensured that she would keep her job. Since she worked in a position it is quite likely that she was either not currently certified for CPR or had never performed it in a real-world setting. As a nurse performing CPR she would be held to a higher legal standard than the average person off of the street. Since CPR guidelines have changed dramatically in recent years, odds of her performing it correctly if she hadn't had a recent update in her training were unlikely. In that case, she is wide open to a lawsuit for medical malpractice and loss of licensure.

The other aspect of this story that is not often noted is that the women was not in a nursing home. She was in an independent living facility. This means that she was living in an apartment that did not provide nursing care. So this nurse was probably not even working at this facility but rather at the next-door nursing home or assisted care facilities. So this nurse had no previous relationship with this women who was not her patient. Also I looked at the facility website and all residents are encouraged to have DNR orders upon admission. So this nurse was faced with a stranger requiring CPR who most likely was DNR, the nurse would not have had access to this women's medical records. She was not allowed to do anything for this women other than to call 911 and she was being paid to care for an entirely different set of patients who she was having to ignore while dealing with this women who was not her patient and also very likely to cause her to lose her job of she intervened.

My 2 cents is that the nurse was not paid enough (no matter her wage) to work at a facility that would put her in such a position and she should have never accepted such a job in the first place.

I'd especially like to hear from Crake and any others in the medical field.

 

[Crake]

That is just an absurd policy - anyone working with the elderly should be allowed to not only certify in CPR but perform it as well. There are plenty of laws in place to protect people and businesses in the event that CPR is required and I can't possibly conceive why they would not allow it. I personally would never work in an organization that had a policy like that. While I agree that odds are it would have not saved the woman's life (In my 4 years of EMS I have never saved a person with CPR alone), I do find it pretty awful that all she was allowed to do was stand there. Given my background I probably wouldn't be considering policy in a situation like that; it's second nature for me to at least begin compressions when someone arrests.

I'd like to find out a bit more information before I condemn the nurse; my initial instinct is not to blame her personally in any way. I agree with almost everything your wife said. However, DNRs are never assumed, and in the event that a situation occurs and there is no paperwork on hand you are to assume the person is not a DNR.

Also, fear of lawsuit is almost a non issue in regards to CPR:

In the United States people may try to file a lawsuit when they think that one person has harmed another. It is important for lay rescuers to know that they do not have to fear a lawsuit if they give CPR. No lay rescuer has ever been successfully sued for performing CPR because lay rescuers are “Good Samaritans” and are protected by “Good Samaritan” laws. All 50 states have Good Samaritan laws or regulations. These laws and regulations grant limited immunity to anyone who tries to give CPR in an honest, “good faith” effort to save a life.

A person is considered a Good Samaritan if
• The person is trying to help.
•The rescuer’s actions are reasonable (you can’t engage in gross misconduct—for example, doing something that no reasonable person would do).
• The rescuer does not receive specific compensation for performing CPR.

Under most Good Samaritan laws, lay people are protected if they give CPR even if they have had no formal training.
Is giving CPR part of your job duties? If it’s part of your job, you have a duty to give CPR to a victim of cardiac arrest. If it’s not part of your job, you have no legal duty to give CPR. But some people think you have an ethical duty to give CPR.

Source: http://www.life1st.com/files/CPR-Legal_and_Ethical.pdf

Although they use the term "lay person" you are not excluded from the laws because you are licensed; if anything you have a greater duty to act. If she is clocked in at an institution that forbids CPR she technically must follow their guidelines, though I'm sure had she acted and been reprimanded there would have been quite an outcry from the community. Again, we don't have enough information to really tell.

 

[Curtech]

From a non-medical viewpoint, I can't personally blame the nurse, for reasons that Keleynal's wife and Crake have said. It's a situation nobody should have been put in, and probably doesn't have a good outcome.

 

[Keleynal]

That is just an absurd policy - anyone working with the elderly should be allowed to not only certify in CPR but perform it as well. There are plenty of laws in place to protect people and businesses in the event that CPR is required and I can't possibly conceive why they would not allow it. I personally would never work in an organization that had a policy like that. While I agree that odds are it would have not saved the woman's life (In my 4 years of EMS I have never saved a person with CPR alone), I do find it pretty awful that all she was allowed to do was stand there. Given my background I probably wouldn't be considering policy in a situation like that; it's second nature for me to at least begin compressions when someone arrests.

I'd like to find out a bit more information before I condemn the nurse; my initial instinct is not to blame her personally in any way. I agree with almost everything your wife said. However, DNRs are never assumed, and in the event that a situation occurs and there is no paperwork on hand you are to assume the person is not a DNR.

Also, fear of lawsuit is almost a non issue in regards to CPR:




Source: http://www.life1st.com/files/CPR-Legal_and_Ethical.pdf

Although they use the term "lay person" you are not excluded from the laws because you are licensed; if anything you have a greater duty to act. If she is clocked in at an institution that forbids CPR she technically must follow their guidelines, though I'm sure had she acted and been reprimanded there would have been quite an outcry from the community. Again, we don't have enough information to really tell.

I think the nurse could be tripped up by that "no compensation" caveat, since she is a paid employee. Also, that's no protection on her job since the company could fire her for violating policy.

From previous conversations with my wife, I know that emergency workers almost always break ribs and cause other damage when giving CPR to an elderly person, which is why so many have DNR orders in place. My grandma has that in place. I'd be very upset if a nurse or random passerby decided to "help" her and cause her even more pain. I wouldn't sue them unless there was negligence or other inappropriate conduct involved, but I'd definitely complain, which could certainly result in the nurse's termination.

It'd be interesting to search through court decisions and see if this issue has resulted in successful lawsuits.

 

[Crake]

I think the nurse could be tripped up by that "no compensation" caveat, since she is a paid employee. Also, that's no protection on her job since the company could fire her for violating policy.

From previous conversations with my wife, I know that emergency workers almost always break ribs and cause other damage when giving CPR to an elderly person, which is why so many have DNR orders in place. My grandma has that in place. I'd be very upset if a nurse or random passerby decided to "help" her and cause her even more pain. I wouldn't sue them unless there was negligence or other inappropriate conduct involved, but I'd definitely complain, which could certainly result in the nurse's termination.

It'd be interesting to search through court decisions and see if this issue has resulted in successful lawsuits.

Trust me the fall out from thinking there is a DNR and doing nothing is much greater then the fallout from not having a DNR and initiating CPR then finding out there was one. Compensation imo refers to something beyond what she is already getting to do her job. The loss of job would be the only risk I could realistically see.

I agree that DNRs need to be respected; I can't count how many times I've broken ribs, especially in the ICU where patients are particularly frail.

 

[Euchale]

I can't count how many times I've broken ribs, especially in the ICU where patients are particularly frail.

In first aid we learned that we will most likely break some ribs. But also that death is not as bad as some broken ribs, so you should also take that into consideration.

Actually the First Aid course I had to visit because of my job was pretty good. It teached everything you needed to know, from treating simple wounds, over how to handle chemical burns to psychology.

 

[Crake]

In first aid we learned that we will most likely break some ribs. But also that death is not as bad as some broken ribs, so you should also take that into consideration.

Actually the First Aid course I had to visit because of my job was pretty good. It teached everything you needed to know, from treating simple wounds, over how to handle chemical burns to psychology.

If anything the ribs are just slowing you down. It's much easier to perform good compressions after they are broken (assuming they don't immediately cause a pneumothorax).