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(Bakersfield Californian)   While internet rages over a "nurse" failing to perform CPR at a "nursing home", family of the 87 year old woman is OK with it   (bakersfieldcalifornian.com) divider line 380
    More: Followup, rage, CPR, home, California Attorney General, Kern County, legal recourse, elder abuse, nurses  
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9256 clicks; posted to Main » on 06 Mar 2013 at 1:46 AM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-03-06 08:55:28 PM

lohphat: This is not about this instance of denial of care. Even if the family wanted it, the protocol was broken and dysfunction was exposed. They are legally obligated to provide care -- it's not about this grandma, it's abut the next one who needs care and is denied it because a nurse violated her and the facility's legal duty to provide state mandated care as stipulated by their license to operate as a healthcare facility.


No, no and no again.  They were NOT legally obligated to provide care and were, in fact, prevented from providing lifesaving measures by their insurance.  This was NOT a healthcare facility...it was NOT a nursing home.  This was a retirement community where residents live on their own, in their own apartments, independently.

We have been through this...read the thread.
 
2013-03-06 09:17:57 PM

SarcasticFark: They were NOT legally obligated to provide care and were, in fact, prevented from providing lifesaving measures by their insurance.


Wrong again. Facility insurance does NOT trump the state's licencing laws that the nurse and facility are REQUIRED to provide care UNLESS there's a physician present or a DNR on file.

Their insurance polity does NOT negate state law.
 
2013-03-06 09:20:47 PM

The more you eat the more you fart: hardinparamedic:


I respect what you said, and I too, hope for more...constructive...dialog with you from now on.

For the record, to earn an MSN, it takes the normal 128 credit hours of classes, PLUS 500 hours of hands-on training...then an additional 18 hours of physiology/pathophysiology and 21 hours of chemistry and additional biology courses, and 18 hours of Nurse Educator classes.

To earn Trauma Nurse status/licenses, the path goes like this:

BSN ->TNCC (trauma nursing core course) while working in an ER ->CEN (certified emergency nurse) certification -> work for at LEAST two years in an emergency medicine setting -> earn your MSN.

This adds up to more than 10 full years of education, 90% of being hand-on, and even a brand-new trauma nurse will have more than 2,000 hours of actual hands-on experience.

The debate at hand...whether this nurse acted ethically or morally, is NOT what I was arguing, NOR was I stating what *I* would do in that situation.  Personally speaking, I'd say "fark you" to the facility director and do whatever I thought was RIGHT....fark everyone else.

A LOT of my job consists of knowing the rules and knowing when to play "by the book" and knowing when to say "fark the rules....this needs to be done to save this person."

In addition to an area of specialization, MSN nurses are also allowed to suture, perform certain minor surgical procedures, prescribe most medications, prescribe courses of treatment, make a diagnosis, etc.

I am sure you are a very good paramedic.  The education aspect I was only arguing because I think a lot of people underestimate the skill that someone who is a nurse possesses.  As an MSN trauma nurse, otherwise known as an ENP in my state, I hold many certifications (including psych)....as do all of the other ENP's where I work, however, I am the only MALE enp that works in my hospital.

Do I PERSONALLY have a problem with what this woman did?  Yes.  Professionally?  Not from what I've read thusfar.   ...


Oh, I know how much is involved in becoming a trauma nurse. I work with several. Our team composition is Medic-RN(Advanced Credential)-RRT. Never meant to insinuate it wasn't difficult.

TNCC is a great class, too. It's similar to PHTLS and ITLS, but focuses on beyond golden hour care. What I'd really like to get is ATLS, but it's cost prohibitive, the closest one is 1800 bucks. Still, I have the textbook in my personal library, and it's an awesome read.

That said, Tennessee considers RN and EMT-P to be equivilant levels of care in terms of provider level when providing direct patient care. You're considered to be equals, not a lower level like RN to LPN is. The only thing an EMT-P cannot do is charge on a ward or unit, but they can work in the same scope and role as a nurse - with a few limitations like no chemotherapy, and special training requires for invasive procedures like central line access and ventilators/critical care equipment monitoring.

One thing I'm glad I can't do, and don't want any part of, is Transport ECMO as the primary care tech. ECMO and Bypass scare the living crap out of me.

At our team, we work as equals. We discuss care plans, and we have a three to go, one to say no policy when it comes to high risk procedures and transports.

I know it's a lot different outside of our specialty care and flight teams when it comes to RNs and Paramedics. Our Paramedics are expected to know and be able to step into the Nurse Role, and the Nurses are expected to step into the RRT role, and vice versa. Even when I was an EMT-IV, we were expected to train and know at that level, and it was hell on earth to step off a 911 rural truck and into what I could only describe as a daily feeling of feeling like an idiot.

However, there is an increased educational role and burden to do this, as like I said before, our education focuses on specialization versus generalization of roles.

Personally, I'd LOVE to see Paramedic education become the same standard as nurses have nationwide. If you haven't read it, the National Standards for Paramedics for 2012 are an exceptional white paper for the direction of our profession in that manner.

Paramedic Practitioners and advanced level practice are coming, thanks to the ACA. And I welcome it.

As for scenes, I'd be happy if you rolled up to help me, offer advice and direction, and be an extra set of hands. Once I knew you were who you said you were, I'd be happy to delegate care tasks and split the load, so to speak, on a critical patient. What i meant by that statement, and again apologizing for the rudeness, is my state is very specific about who and what I can take orders from. As a bystander, off duty, you place yourself at legal and civil liability risks. 1200-12-01 of TCA specifies the specific steps I have to take to get orders from a Physician On scene, and still does not recognize a NP or APN to give those orders. The actual steps are time and labor intensive, and basically require the medical provider on scene to either ride in with the patient and sign the actual care chart and orders he gives, or step aside and allow the EMS care team to render care.

If you're ever in Memphis, please let me know. I'd love to get together and have a drink and swap war stories.
 
2013-03-06 09:24:21 PM

SarcasticFark: No, no and no again.  They were NOT legally obligated to provide care and were, in fact, prevented from providing lifesaving measures by their insurance.  This was NOT a healthcare facility...it was NOT a nursing home.  This was a retirement community where residents live on their own, in their own apartments, independently.

We have been through this...read the thread.


Depending on the State, that's not true. My position, despite being far too emotionally involved last night, comes from the fact that Tennessee requires medically trained staff who are able to perform CPR be available at assisted living facilities, even if it's just a CNA working as Residential Aide. Assisted Living facilities also have to be licensed by the State to operate.
 
2013-03-06 09:31:34 PM

lohphat: This is not about this instance of denial of care. Even if the family wanted it, the protocol was broken and dysfunction was exposed. They are legally obligated to provide care -- it's not about this grandma, it's abut the next one who needs care and is denied it because a nurse violated her and the facility's legal duty to provide state mandated care as stipulated by their license to operate as a healthcare facility.


Except this place is not a healthcare facility and is needs no license.  It's an apartment complex that offers non-medical services such as cooking, cleaning, shuttle buses to shopping, community activities, and so on.
 
2013-03-06 09:35:51 PM

hardinparamedic: SarcasticFark: No, no and no again.  They were NOT legally obligated to provide care and were, in fact, prevented from providing lifesaving measures by their insurance.  This was NOT a healthcare facility...it was NOT a nursing home.  This was a retirement community where residents live on their own, in their own apartments, independently.

We have been through this...read the thread.

Depending on the State, that's not true. My position, despite being far too emotionally involved last night, comes from the fact that Tennessee requires medically trained staff who are able to perform CPR be available at assisted living facilities, even if it's just a CNA working as Residential Aide. Assisted Living facilities also have to be licensed by the State to operate.


We have 49 States too many for Fark.
 
2013-03-06 09:38:12 PM

BarkingUnicorn: We have 49 States too many for Fark.


Actually, I'd support a unified, Federal standard for all healthcare workers, Physicians down, and a national standard for healthcare facilities OTHER than the CMS rules. (CMS is a headache, period, and doesn't reflect the realities some situations deal with.) It would solve A LOT of problems in the Nation with reciprocity.

The fact someone trained in Louisiana cannot go to New York and work in their respective level is silly. Using Canada as an example, someone trained in Manitoba can go to Ontario and work. I personally like the way the EU countries do it.
 
2013-03-06 09:47:35 PM

hardinparamedic: BarkingUnicorn: We have 49 States too many for Fark.

Actually, I'd support a unified, Federal standard for all healthcare workers, Physicians down, and a national standard for healthcare facilities OTHER than the CMS rules. (CMS is a headache, period, and doesn't reflect the realities some situations deal with.) It would solve A LOT of problems in the Nation with reciprocity.

The fact someone trained in Louisiana cannot go to New York and work in their respective level is silly. Using Canada as an example, someone trained in Manitoba can go to Ontario and work. I personally like the way the EU countries do it.


Another step towards fascism, many would say.  Interestingly, they're the same people who made Howard Johnson's and McDonald's so successful; they value consistency and having their expectations met everywhere they go.
 
2013-03-06 10:03:07 PM

BarkingUnicorn: hardinparamedic: BarkingUnicorn: We have 49 States too many for Fark.

Actually, I'd support a unified, Federal standard for all healthcare workers, Physicians down, and a national standard for healthcare facilities OTHER than the CMS rules. (CMS is a headache, period, and doesn't reflect the realities some situations deal with.) It would solve A LOT of problems in the Nation with reciprocity.

The fact someone trained in Louisiana cannot go to New York and work in their respective level is silly. Using Canada as an example, someone trained in Manitoba can go to Ontario and work. I personally like the way the EU countries do it.

Another step towards fascism, many would say.  Interestingly, they're the same people who made Howard Johnson's and McDonald's so successful; they value consistency and having their expectations met everywhere they go.


Which is ironic because nursing already has pseudo-national licensure in the form of nursing compacts between the states, and national standardization would actually increase the freedom of work and professional scope that many healthcare professions have.
 
2013-03-06 10:56:10 PM

hardinparamedic: BarkingUnicorn: hardinparamedic: BarkingUnicorn: We have 49 States too many for Fark.

Actually, I'd support a unified, Federal standard for all healthcare workers, Physicians down, and a national standard for healthcare facilities OTHER than the CMS rules. (CMS is a headache, period, and doesn't reflect the realities some situations deal with.) It would solve A LOT of problems in the Nation with reciprocity.

The fact someone trained in Louisiana cannot go to New York and work in their respective level is silly. Using Canada as an example, someone trained in Manitoba can go to Ontario and work. I personally like the way the EU countries do it.

Another step towards fascism, many would say.  Interestingly, they're the same people who made Howard Johnson's and McDonald's so successful; they value consistency and having their expectations met everywhere they go.

Which is ironic because nursing already has pseudo-national licensure in the form of nursing compacts between the states, and national standardization would actually increase the freedom of work and professional scope that many healthcare professions have.


Don't forget the Uniform Commercial Code, which is enacted by States independently but is crafted by a non-governmental body.
 
2013-03-07 02:29:01 AM

GardenWeasel: * Must have CPR certification <------- WHY??????


Probably because the law requires it for an ALF to have a certain number of staff with one.  That's a guess, but it would make sense.  I imagine there's the same requirement for kindergartens.

Hell, I work in an office and the law requires the business to have a certain percentage of staff with First Aid certification.  We have literally never had a Serious Harm incident ever, in the history of the business.  Not one heart attack, not one CPR requirement.  No broken bones, no squirting arteries.  Ever.  But every two years off we go to our recertification courses, praying we never actually ever need to use the 'skills' we're taught because the law.
 
2013-03-07 02:48:50 AM

if_i_really_have_to: Hell, I work in an office and the law requires the business to have a certain percentage of staff with First Aid certification.  We have literally never had a Serious Harm incident ever, in the history of the business.  Not one heart attack, not one CPR requirement.  No broken bones, no squirting arteries.  Ever.  But every two years off we go to our recertification courses, praying we never actually ever need to use the 'skills' we're taught because the law.


To be fair, though, you have a lot of legal protection for using those skills if you are a "layperson", i.e. someone with first aid/CPR training who is not required by their job or virtue of their licensure to use those skills.  Good Samaritan Laws apply there as well, unless you're a member of an in-house medical rescue team, like a Plant Emergency Operations team. Even if that is the event, your employer is required to maintain medical malpractice coverage on you.

Survival to discharge with good neurological function for an adult victim of sudden cardiac arrest, who receives immediate bystander CPR and AED use, and who receives early advanced care ranges from 30 to 60% depending on what city you live in. Since 2005 and the 2010 guidelines and the advent of advanced post-cardiac arrest therapies and early advanced care emphasis. The numbers that have been touted in this thread about CPR only working "3%" of the time come from statistics which incorporate all-cause factors for cardiac arrest. They lump unwitnessed arrests with witnessed arrests, arrests where bystander CPR is performed with arrests where no one touches the body for five to ten minutes, and arrests from sudden cardiac arrest causes with those from irreversible traumatic injuries like aortic sheer.
 
2013-03-07 07:30:08 AM

log_jammin: cretinbob: No log_jammin. She doesn't have a legal duty to act, nurse or not.

you said a nurse can only practice under a physician license and the only reason I can see you making that point is if you were trying to say she couldn't legally preform CPR since she wasn't under a physicians license at the time. is that what you were trying to say? if not please explain why you brought that up.


Because she only had a LEGAL responsibility to act if she if she were a nurse and working in such a capacity. If she wasn't then she doesn't.

Anyway, I had to make the same call last night. I'll tell you, it's never an easy one, even when there is no possibility of successful resuscitation due to major trauma and blood loss. But one has to look at the bigger picture of public safety. Do I risk the lives of my crew and the people on the street as we tear down the interstate at 100mph with someone who is dead and is going to stay dead because no amount of surgery can repair them?
Sadly many other EMTs are of the mindset that, yeah you do just that because "protocols" and the inability to think critically. I've seen medics let patients slip through their fingers on scene because they wasted time doing shiat there instead of in the back of the ambulance on the way to the hospital. Would it have changed the outcome? Maybe, maybe not.
And nurses, don't get me started on those assholes. I left nursing because there are too many stupid ones who think they have all the answers but lack even 1 mg of compassion.

ANd I see that Securitywyrm  gets it. I've seen a lot of people call themseleves nurses because they think it elevates them in some way, even though they have zero training. CNAs are notorious for it.

But again, the point that everyone is missing here is that the family is OK and they believe that the patient is OK. It doesn't matter two farks what the rest of you think.
 
2013-03-07 07:58:54 AM

audioguy16: As a paramedic, I encounter this predicament once in a while. The problem with this situation is that as a nurse, she has a duty to act .  If the person does not have a DNR, resuscitative efforts are given. As medical professionals,we are always trained to err on the side of the patient. That duty to act  supersedes the facility she works for. She opened herself for that liability.  I won't be surprised if she loses her license.


What is the difference between a "Medic" and a "Paramedic"? One is a licensed and regulated title, and the other is a position that can be assigned to anyone with a first aid kit.
What then, is the difference between "Nurse" and "Registered nurse/Licensed Nurse Practitioner"? Same thing. This individual was called 'nurse' but she is not a medical practitioner. Thus there was no legal obligation.

The facility has NO TRAINED MEDICAL STAFF. This was not a 'nursing home.' This was an 'independent living facility.' It's basically an apartment complex where they have meals provided and there's someone available to help you around your apartment. That's it.
 
2013-03-07 08:02:24 AM

lohphat: This is not about this instance of denial of care. Even if the family wanted it, the protocol was broken and dysfunction was exposed. They are legally obligated to provide care -- it's not about this grandma, it's abut the next one who needs care and is denied it because a nurse violated her and the facility's legal duty to provide state mandated care as stipulated by their license to operate as a healthcare facility.


Please read article. This was an independent living facility, not a nursing home. An independent living facility is not a healthcare facility. It's an apartment complex that has people available to help you around your apartment and provides meals. That's it.
 
2013-03-07 08:07:44 AM

Securitywyrm: What is the difference between a "Medic" and a "Paramedic"? One is a licensed and regulated title, and the other is a position that can be assigned to anyone with a first aid kit.


Erm, not really.

Paramedic is an official, legal term, 'Medic is slang derived from the military, and can also refer to a physician depending on what area of the world you're in. Most paramedics will call themselves a 'Medic.

However, both are considered "protected' titles corresponding to holding a license which grants that title in your state. You cannot claim to be a Paramedic without actually having a Paramedic card - i.e. an EMT-Basic who says he's a Paramedic can actually face a charge of practicing outside of his license, and misrepresentation. Impersonation of a Paramedic is, at least in Tennessee, a Felony.

Nurse is the same way. The only people who can call themselves "Nurses" are licensed nursing personel, LVN/LPNs and Registered Nurses, and Advanced Practice Nurses. One of the first things you learn in a CNA class is not to call yourself a nurse, you're a nurse aide.

 One of the reasons you're taught to verify the licensure of a person claiming to be a nurse or a medic on scene, in the field, with their wallet cards is because many people will falsely claim to be one in order to help, or because they want to be involved. I've had everything from nursing students, to some guy who had actually lost his nursing license for violation of the prescribed acts tell me they were a nrurse.
 
2013-03-07 08:31:26 AM
end of story

Now you can go back to beating off to global warming threads
 
2013-03-07 08:33:12 AM

hardinparamedic: Securitywyrm: What is the difference between a "Medic" and a "Paramedic"? One is a licensed and regulated title, and the other is a position that can be assigned to anyone with a first aid kit.

Erm, not really.

Paramedic is an official, legal term, 'Medic is slang derived from the military, and can also refer to a physician depending on what area of the world you're in. Most paramedics will call themselves a 'Medic.

However, both are considered "protected' titles corresponding to holding a license which grants that title in your state. You cannot claim to be a Paramedic without actually having a Paramedic card - i.e. an EMT-Basic who says he's a Paramedic can actually face a charge of practicing outside of his license, and misrepresentation. Impersonation of a Paramedic is, at least in Tennessee, a Felony.

Nurse is the same way. The only people who can call themselves "Nurses" are licensed nursing personel, LVN/LPNs and Registered Nurses, and Advanced Practice Nurses. One of the first things you learn in a CNA class is not to call yourself a nurse, you're a nurse aide.

 One of the reasons you're taught to verify the licensure of a person claiming to be a nurse or a medic on scene, in the field, with their wallet cards is because many people will falsely claim to be one in order to help, or because they want to be involved. I've had everything from nursing students, to some guy who had actually lost his nursing license for violation of the prescribed acts tell me they were a nrurse.


So far the criminal probe has found no evidence of wrongdoing. That's not 'we haven't decided to charge' but rather 'there is no evidence they did anything wrong.'

Here's a problem. The 911 operator says that "The facility can't be sued we take responsibility." However... will the dispatcher take responsibility for the job of the person on the phone for breaking facility policy?
You're a licensed paramedic, but let's say that you take a job waiting tables at a restaurant, and there's a wreck across the street. As you say, you're legally obligated to provide assistance. An hour later when you get back, you're fired from the job because you walked off to do your own thing.
Under what you're arguing, anyone who is a licensed nurse or paramedic can't hold a job doing anything else because they'll be legally obligated to play superhero and rush to the scene where they can provide help, regardless of what they're supposed to be doing on the clock.
 
2013-03-07 08:46:38 AM

Securitywyrm: So far the criminal probe has found no evidence of wrongdoing. That's not 'we haven't decided to charge' but rather 'there is no evidence they did anything wrong.'


Because the either the California Board of Nursing or the DA's office would have to prove that she tried to act in the capacity of a nurse after representing herself as such. It's far harder to get someone on misrepresentation without an act behind it.

Securitywyrm: You're a licensed paramedic, but let's say that you take a job waiting tables at a restaurant, and there's a wreck across the street. As you say, you're legally obligated to provide assistance. An hour later when you get back, you're fired from the job because you walked off to do your own thing.


Depends on the State as to whether you could be compelled to do so or not. Until 2009, in Alabama - for example, EMS personnel had a duty to act regardless if they were on duty of off duty if they were certified or licensed in that state as such, by the State Law. If you failed to do so, you could be reported to the state board for negligence and failure to act and lose your license. Infamously, they went after a Tennessee paramedic who was not even licensed in that state after she drove by a wreck and called 911 rather than stop to render aid. Tennessee board refused to pursue it. However, Alabama also had state laws in place which did not allow an employer to fire a person for doing so if they were not employed as an EMT.

Some states, as well, have specific protections written in for healthcare workers who choose to act while off duty to render aid to prevent termination or litigation.

Securitywyrm: Under what you're arguing, anyone who is a licensed nurse or paramedic can't hold a job doing anything else because they'll be legally obligated to play superhero and rush to the scene where they can provide help, regardless of what they're supposed to be doing on the clock.


Actually, you might want to read the comments I've posted. They all include the phrase "If she was a licensed nurse and employed to provide care in ANY capacity".  Also see the example for Alabama.

If you are not employed or acting in the capacity of a volunteer, that's not what I'm saying at all. However, you have an ethical and moral duty to act based on your profession's oath and ethical guidelines.
 
2013-03-07 09:18:26 AM

SarcasticFark: Melvin Lovecraft: What an awesome thread!  I learned a lot.  As soon as I saw nurses arguing, my (mostly controllable) nurse fetish set me all aquiver, but the more I read, the more I realized that most of said arguing was being done by male nurses, and that kind of made me sad and somewhat ashamed.  I have a very quick csb to relate:

Early 90's:  I had rudimentary (at best) training in CPR and just happened to be the first aid "go to" guy at a soft drink factory, where I worked nights.  One morning, about 9 or so, after I'd been home for a while and had a few drinks, somebody furiously pounded on my door, startling the shiat out of me.  I opened the door, and it was an old guy (like 70) hollering something about calling an ambulance.  I didn't understand him, and said I hadn't called for one, and he said, "No, I need you to call for one!  My buddy's down!"  I looked out the door, and sure enough, there was a guy laying in the middle of the street.  I lived in a mobile home park, so there was no traffic, and it was about 2 degrees outside; snow piled up 4'.  Michigan in January.  So I dial 911, tell the ambulance where to come, grab my little CPR kit, and run out to save the day.  I took one look at the guy, and I'm just a layman, but I knew right then and there, that that guy was dead.  When the paramedics arrived, they stripped off his clothes and worked him for 40 minutes to no avail.  Even if they were to revive him, he would have probably died right away again from frostbite.  Point is, that guy was dead, and there was nothing ANYONE was going to do to save him.

/just one picture of an angry nurse in lingerie would have been nice in this thread

[highlatencylife.files.wordpress.com image 200x306]


Why does a nurse need a feather duster?
 
2013-03-07 09:49:26 AM

TabASlotB: .

/just one picture of an angry nurse in lingerie would have been nice in this thread

[highlatencylife.files.wordpress.com image 200x306]

Why does a nurse need a feather duster?


Because apparently we're just glorified maid/waitresses.  I want to see Brony/Hardin in that outfit.

/on second thought...
 
2013-03-07 09:51:57 AM

hardinparamedic: If you are not employed or acting in the capacity of a volunteer, that's not what I'm saying at all. However, you have an ethical and moral duty to act based on your profession's oath and ethical guidelines.


Ah okay, so long as it's just ethics and morals we're talking about, I can see your point.
However, ethics and morals don't pay the bills. If you want to direct moral and ethical outrage at the company for their policy of not providing medical care, okay. However with all the people unemployed in this country, and the number of people acting as parasites to the system, I'll never fault someone for doing what it takes (within the law) to keep their job.
 
2013-03-07 10:03:03 AM

lyanna96: I want to see Brony/Hardin in that outfit.


2.bp.blogspot.com
 
2013-03-07 10:45:38 AM

Securitywyrm: lohphat: This is not about this instance of denial of care. Even if the family wanted it, the protocol was broken and dysfunction was exposed. They are legally obligated to provide care -- it's not about this grandma, it's abut the next one who needs care and is denied it because a nurse violated her and the facility's legal duty to provide state mandated care as stipulated by their license to operate as a healthcare facility.

Please read article. This was an independent living facility, not a nursing home. An independent living facility is not a healthcare facility. It's an apartment complex that has people available to help you around your apartment and provides meals. That's it.


A Licensed nurse was present. She was obligated to provide care under the terms of her license to be a nurse.

Not being in a healthcare facility does not exempt you from state licensing laws.
 
2013-03-07 10:59:18 AM

lohphat: A Licensed nurse was present. She was obligated to provide care under the terms of her license to be a nurse.


Unfortunately, according to the wording of California State law, he's correct. California does not license assisted living facilities as other states do, and allow them to operate without medically trained or employed staff present.

While it's a pretty dick move, the information coming out is that the woman was not employed by the facility for the purpose of providing medical care, and the person at the patient's side was not a trained attendant.

Even though we can argue the nurse had a moral and ethical obligation to respond, thanks to the way the state law is worded she will get off without even a letter of reprimand from the board.

I suspect, given the outcry and the industry wording on the matter, that this loophole might soon be closed.
 
2013-03-07 07:55:01 PM

hardinparamedic: lohphat: A Licensed nurse was present. She was obligated to provide care under the terms of her license to be a nurse.

Unfortunately, according to the wording of California State law, he's correct. California does not license assisted living facilities as other states do, and allow them to operate without medically trained or employed staff present.

While it's a pretty dick move, the information coming out is that the woman was not employed by the facility for the purpose of providing medical care, and the person at the patient's side was not a trained attendant.

Even though we can argue the nurse had a moral and ethical obligation to respond, thanks to the way the state law is worded she will get off without even a letter of reprimand from the board.

I suspect, given the outcry and the industry wording on the matter, that this loophole might soon be closed.


I'm moving to Denmark.

Thanks for the clarification but what concerns me more is my original point: a nurse elected to not give care without an MD or DNR. Who speaks for the next patient who wants to be revived in that scenario?
 
2013-03-07 09:42:47 PM
The more you eat the more you fart:

I have a master's +30 in my field, and am licensed by my state as a "Trauma Nurse, MSN, Level 2-A" which means I out-rank you in skill, knowledge, and practical application by an order of magnitude.

I just turned 36

There's a typo in here somewhere...
 
2013-03-07 09:56:02 PM

Pontious Pilates: log_jammin: evil saltine: The facility's policy takes precedence over what the 911 dispatcher says.

Then why call 911 in the first place?

That's my question in this whole thing. What was the "nurse" doing calling 911 if she wasn't going to do anything?


The situation changed during the call.
At the time the call began, it was a simple collapse and unresponsiveness, cause unknown.  For this, you call the ambulance, no doubt.  As stated above, you do NOT do CPR on a person that is unconscious but is breathing and has a pulse.

Halfway through the call, the patient went into total respiratory arrest.

And THAT'S where things went straight to shiat...
 
2013-03-07 11:27:56 PM

Ishidan: As stated above, you do NOT do CPR on a person that is unconscious but is breathing and has a pulse.


As of the 2010 guidelines, this is not correct. Laypeople are no longer taught to look for a pulse, as research has shown a >50% false detection rate in studies. In addition, rescue breathing is not performed if there are signs of poor circulation or gasping respirations, they are taught to go directly to CPR.

Coincidentally, CPR - including compressions - are provided to neonates, infants and pediatrics who have a pulse below 60 all the time as part of the Pediatric/Infant BLS and PALS ALS protocols. They've actually shown, in research, that CPR will not stop an adult heart if performed, but it will be painful as hell and run the risk of injuring the liver, pancreas, diaphragm or stomach from the xiphoid process.

Ishidan: Halfway through the call, the patient went into total respiratory arrest.


Incorrect. The Priority Dispatch system that the dispatcher uses identified what the caller told them as ineffective breathing and questionable life status, which pulls the ProQA system into the Pre-arrival instruction mode and instructs the dispatcher to provide CPR instruction.

Had the caller told the dispatcher simply that the facility had documentation on the patient's wishes to not be resuscitated, and that she did not want CPR, it would have ended the debacle right there. That's why having the paperwork is so important. That facility policy is useless to the EMS crew responding, and to the hospital which recieves that patient, and there is a chance of getting a vegetable back in that event.

 circ.ahajournals.org
 
2013-03-08 04:48:50 PM

Ishidan: The more you eat the more you fart:

I have a master's +30 in my field, and am licensed by my state as a "Trauma Nurse, MSN, Level 2-A" which means I out-rank you in skill, knowledge, and practical application by an order of magnitude.

I just turned 36

There's a typo in here somewhere...


I've been suspicious of tmyetmyf throughout this entire thread. His/her posts have been characterized by a lot of yelling, a lot of abuse, a few (very) unusual anecdotes . . . but not a lot of actual, cited information.

I'm guessing the "just turned 36" was a forgetful moment of honesty.
 
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