Thursday, March 21, 2013

Behind Closed Doors Case #9: SPECIAL EDITION, #AmandaTrujillo, MSN, RN @NURSEINTERUPTED #nurseup #nursefriendly #casestudy #malpractice

Behind Closed Doors Case #9: SPECIAL EDITION

March 20, 2013 By

Information: The Estate of L. Bayless versus ?? (no current litigation exists)

Summary: Healthcare worker self identifying as a “Nurse” refuses to administer CPR citing “employer/facility policy”—resident dies

Disclaimer: Due to the overly sensitive and backward nature of the state I reside in, my nurse attorney Teressa Sanzio has asked me to clarify that I am not practicing law on my blog, rather, targeting these articles toward educational activities that empower good, safe nursing practice. Thank You.

     You’ve spent the better part of a year trying to find a job as a new nurse. Compounding your efforts is the fact you are early into your first pregnancy. Exasperated, you decide to start applying out of state in hopes of broadening your prospects and are thrilled when a beautifully updated independent living facility offers you a job. Your husband, an electrical engineer who graduated from the local state university with you a year ago has been having a tough time finding a job as well— so he is more than happy to help pack up the apartment and hit the road. It seems that brighter days are ahead for both of you. Surely he will find a job in California. For now, you will be the breadwinner and will be able set aside some money in anticipation of the baby that is due in another six months.

     The first week in California is a whirlwind of activity. There are numerous orientation classes to attend at the facility, tours to take, management figures to meet, business at the State Board of Nursing to take care of (to ensure your license is secured in the new state you are living in), finding a new OBGYN, and of course setting up house in the small apartment you and your husband are relieved to have found on such short notice. It’s an old, tiny, run down studio…the perk? It’s located a little over half a block away from the beach. Your husband, an avid runner, has already declared the mornings as “his time” to run alongside the water.

     Your new nursing career officially begins the second week in California and the first day at the independent living facility is anything but exciting— in fact, it’s horrendously stressful. You feel absolutely clueless. The nurses are not helpful here other than to make it clear that YOU are in THEIR way. Every question is dumb. Every move or sound you make is a nuisance. Clearly you are on your own to figure out where your place is as part of the nursing staff of The Cliffside Coves. At 1700 hours you’re feeling kind of lightheaded and dizzy so you head over to the “always open” gourmet dining hall to get a snack. You are optimistic because in one more hour your first nursing shift will be complete and a peaceful, barefoot walk on the beach with your husband lies ahead.

    Savory aromas are swirling all around you as residents come and go from the dining hall. As you browse through the take away cart counting calories, a call for help sounds out. A female resident has gone down and her male friend is pleading for help. You rush over, kneel down, and check for any sign of breathing or pulses—of which there are none. Making eye contact with the wait staff, you request that 911 be called immediately.  Performing a head tilt chin lift maneuver you prepare to administer CPR when a male hand reaches over to stop you. It’s one of the nursing managers on staff—he is advising you that CPR is not performed at this facility and it is their policy to do nothing more than call 911 and wait for help to arrive. The male friend informs you his partner has made it clear she wants CPR should she ever require it and is begging you to begin CPR….but your manager’s hand remains on top of yours…..as yours rest on top of the pulseless and apneic female resident’s chest. In just a matter of seconds you have to make the choice of a lifetime….a decision that will not only affect the life and future of a stranger… but yours, your husband’s, and your unborn baby’s as well.

The Real Thing

On February 26, 2013 at 1100 hours 87 year old Lorraine Bayless collapsed in the dining hall of Glenwood Gardens, a multilevel nursing care facility located in Bakersfield, California—she had been a resident of the independent living area of the campus. The fire department was summoned at 1107 hours and arrived at the facility at 1113. Members of the fire department were given paperwork for Bayless in which no DNR was found. They immediately began CPR and transported her to Mercy Southwest Hospital. She died shortly after arrival from what has now been identified as a massive stroke (per her death record). These basic facts are similar to those you would expect to unearth on just about any death that occurs at a nursing care facility or an independent living facility, but they aren’t what the eyes of the nation have been focused on these past couple of weeks—the concerns revolve around all the unknown variables in the mix and the 911 tape heard around the country…the contents of which have ignited a firestorm of questions healthcare consumers, bloggers, journalists, and the healthcare community at large are currently debating the answers to. A woman identifying herself as a nurse is heard repeatedly telling the dispatcher she cannot, per her employer’s policy—administer CPR to Ms. Bayless. The same woman refused to summon any passersby who were not on staff to render aid when the dispatcher begged her to do so.

 Lorraine Bayless

      So…. who is right? Who is wrong? Well that depends on you, your beliefs, and whether you are a healthcare consumer or a healthcare provider. Embedded within the few minutes of the 911 tape is a complex and multifaceted set of issues that must be addressed in order to: A.) Restore some trust between healthcare consumers and healthcare providers who work at these kinds of facilities, B.) Ensure that the rights and wishes of every human being are preserved, and  C.) Remind both nurses and other healthcare providers of why  knowledge of basic ethical principles and their application to everyday practice is so very crucial to providing best care to every human, every time, no matter WHERE they require our help.

QUESTIONS FOR CONSIDERATION: Would you have administered CPR? Why or Why Not?

As a nurse do you think it is okay to accept a job in which you know you will not be allowed to render aid in similar circumstances?  Why or why not?

Would you as a nurse have tried to protect your job before acting on behalf of your patient in a similar circumstance? Why or why not?

How would your personal values and beliefs impact your actions in similar circumstances?

Apply basic ethical principles to the case discussed above—do you believe the application of ethics was missing? If so, give examples of how.

Provide some examples of how the case above conflicts with the oath we take as nurses, the Code of Ethics for Nurses, the American Nurses Association Standard of Nursing Care or your own state’s Nurse Practice Act

Before looking it up–What does moral courage mean to you? How would you display moral courage and under what circumstances?

Is moral courage required to be a good nurse? Why or why not?

Discussion

 I have no doubt that there exists hundreds upon hundreds of media responses to the Glenwood Gardens incident in the form of  opinions, discussions, debates, columns, blogs, articles, and interviews. It raises many concerns, –and rightfully so. I’m going to take a hypothetical approach and say that it was indeed a Registered Nurse who refused to render aid. Now, recall the oath we take upon graduation and that we are bound to behave according to the Code of Ethics for Nurses while engaged in the business of caring. This case should cause one to pause and query whether the world of academia has prepared today’s nurses aggressively and effectively enough to understand, practice, and apply basic ethical precepts to everyday work. Moreover, do nurses understand that acting in an ethically sound manner is not a casual choice, rather, an expectation? Lastly, are the glossy buzzwords  “moral courage” simply things to be tossed about in articles, textbooks, and blogs or do nurses truly not “get” (beyond the walls of academia) that we are obligated to act in such a way that places the interests of another human being ahead of our own well- being?

 No CPR Woman Dies

    Nurses go to school for years, some stacking up as many years of training as doctors do.  We make sacrifices. We dream of that seemingly elusive “last care plan” or “last clinical rotation” signaling that graduation is around the corner. Our families make huge concessions so that we can finish our nursing programs. Our own health, at times, takes some pretty big hits on the journey toward achieving the RN credentials after our names. Compounding the challenges of newly minted nurses are the recent hiring trends that seem to shut out inexperienced RN’s from the industry by only considering “experienced nurses” for employment opportunities. No doubt, the real world comes calling quick just moments after a nursing student walks down that long aisle to receive his/her diploma. After all, bills still need to be paid… and before long the feds come calling for financial aid loan payments. Any nursing job opportunity becomes a highly sought after commodity in the eyes of new nurses, and for this reason I’d like to implore readers to stop and think twice before snatching the first opportunity that comes along. Ask yourself—is it okay to take a job in which you know you will not be allowed to do the very things a nurse practice act says you can do, that are within your licensure to do, and that are mandated of you by oath and by the Code of Ethics for Nurses?

     The Glenwood Gardens incident highlights some very important reasons why nurses seeking employment in the healthcare industry should research any potential place of employment and ensure that “it” is a good fit for the “nurse,” and not the other way around. Dr. Phil has a saying that I find rings true in many areas of life and I think it fits well with nurses and the healthcare industry: “We teach the world how to treat us.” Applied to nurses—we teach both the industry and coworkers how to treat us or value us, what we will tolerate and accept in the workplace, and how serious we are about the oath we take and abiding by strong moral and ethical standards in the day to day care of patients. Simply put: when we “settle” for “what we can get” for the sake of getting employment as a nurse, we may be sending a dangerous message to the healthcare industry that says “you can redefine my profession as you wish, you can decide whether my work environment will be safe or not, you can decide whether I have the resources I need to do my job or not, you can decide whether my oath or code of ethics means anything within your organization.”  If we start at the beginning—one new nurse at a time, change can happen and organizations will begin to see that we as a profession mean business when it comes to upholding our oath and standards in the workplace.

     There are two more concerns that resonate within me when I listen to the 911 tape (listen to it here): First, the woman who identified herself as a nurse, and second – the voice of “management” in the background instructing the supposed nurse to standby and wait for paramedics to arrive despite the pleas of the dispatcher to find a passerby who could administer CPR to Ms. Bayless. They represent two opportunities for nursing, as a profession, to act. (Recall that this incident quickly made headlines on the Today Show and Good Morning America) We are often touted as among the most trusted individuals in the healthcare industry. When someone intentionally deceives others by identifying him/herself as a nursing professional in a very public situation like this I believe we have a duty to thoroughly investigate and ensure appropriate legal action is taken in whatever state the deception occurs. This unfortunate incident has the potential to undermine the public’s trust in Nursing as a profession because the individual identifying themselves as a nurse is on record as refusing to render lifesaving CPR to someone who needs it because her employer said not to.

 No CPR Woman Dies

     Now, a word or two on what nurses can be doing at both the state and federal levels to ensure that our practice is not further infringed upon by private or corporate entities and that healthcare consumers can trust we do view their rights and best interests as a priority..Yes, I’m about to say the “P Word”:  Politics.  It isn’t easy—it can be exhilarating, frustrating, time consuming, disappointing and rewarding all at once….it takes time, passion, and a certain kind of dedication to keep moving forward with efforts to make changes that benefit your fellow man. Who else better to do it than nurses? In my state of Arizona there is not a single nurse currently serving in the state legislature. I wonder whether any facility would dare set forth a policy that does not allow a Registered Nurse to render life- saving aid to a nursing facility resident if there was a Registered Nurse serving in their respective state’s legislature….

     As a profession we have no business bitching and whining about how Nursing looks when a tragedy like Glenwood occurs – social media arm chair quarterbacking behind anonymous postings, critiquing or arguing with others, appearing appalled while asking how facilities could “dare” to set forth policies prohibiting “US” from adhering to “OUR” oath and code when members of our profession aren’t out there at the highest level of politics (The White House and Congress) putting their foot down saying “this isn’t how it’s going to be – not now, not ever, because I’m here representing nurses and patients to tell you how it “is going to be.”  Right now, we as a profession allow it all to happen because people are too afraid to speak out and rise together for change. God forbid one of us stands up, raises his/her voice, and loses carefully constructed personas, reputations, and looks bad to everyone else. Well, here’s a question– 20 years from now if you are still a nurse what will be the most important thing you will have done to leave the profession of Nursing a better place for the next generation…. The play it safe strategy?  Your silence?  Your fear?  Your popularity at work? This incident should make us all stop and ask ourselves what we can be doing better — not just as individual practitioners but as a whole. 

 

When something like the Glenwood incident happens again — and rest assured it will —  be content to be part of the problem or get to work creating solutions that ensure not one more healthcare facility will be allowed to silently and passively enforce a policy telling its employees (and that includes its nurses) that the “rules” come before what is “right.”

Think about it…..Hindsight’s 20/20, we know not who all was standing by watching Lorraine Bayless slip away that day….

“Non- Scholarly” Sources:

http://www.bakersfieldcalifornian.com/local/x738926924/Police-probe-Glenwood-Gardens-death

http://www.bakersfieldcalifornian.com/health/x837006603/Document-Do-not-resuscitate-order-was-not-on-hand-for-Glenwood-Gardens-resident

http://www.bakersfieldcalifornian.com/local/x738926892/Glenwood-Gardens-visitors-withhold-judgment-on-nurses-refusal-to-provide-CPR

http://www.bakersfieldcalifornian.com/health/x837006530/911-recording-details-dispatchers-struggle-to-get-aid-for-elderly-woman

http://www.bakersfieldcalifornian.com/archive/x921547996/file?nodisp=1

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