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Nurses refuses to give CPR to dying woman b/c it's against facility policy Options · View
lafayettemister
Posted: Tuesday, March 05, 2013 9:01:46 AM

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An 87 year old woman died after collapsing in her Assisted Living Facility. Not a nursing home, these residents are still partly able to care for themselves. It's like an apartment complex for the elderly, they do receive aid but are still mostly self sufficient.

After the woman collapsed, a call to 911 was made. A nurse got on the phone and refused to give CPR even as the emergency operator implored her too. Absolving her and the facility of any responsibility if the lady died anyway. Btw, the elderly lady did NOT have a DNR on file. For over seven minutes, the nurse stayed with the dying woman but would not do anything to help.

The 911 operator pleaded for help from someone who didn't work at the facility...

"I understand if your boss is telling you, you can't do it," the dispatcher said. "But ... as a human being ... you know, is there anybody that's willing to help this lady and not let her die?"

"Not at this time," the nurse answered.

"Is there a gardener? Any staff, anyone who doesn't work for you? Anywhere? Can we flag someone down in the street and get them to help this lady? Can we flag a stranger down? I bet a stranger would help her."

"I understand if your facility is not willing to do that. Give the phone to a passer-by. This woman is not breathing enough. She is going to die if we don't get this started, do you understand?"

So far, there has been no response from the woman's family.

Should the nurse be charged with a crime? The facility?





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Guest
Posted: Tuesday, March 05, 2013 11:23:35 AM

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I saw the recording of the call on TV and was and still am horrified. I think if someone can pinpoint who originally wrote that policy that person AND the owners of the facility should be charged. When did it become acceptable to stand there, and let a person in front of you die, when something as simple as CPR might have saved her?

As for the nurse's refusal to give CPR, I couldn't have done the same thing.... my instincts would have been to try and save her..... I can totally understand she and other people out there are afraid to lose their jobs, but I'll bet there is not a Law Court in the world that would not have ruled"unfair dismissal" if she had been fired for giving CPR to a dying person.
Guest
Posted: Tuesday, March 05, 2013 11:30:00 AM

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Pretty chilling! I don't know that she should be charged with anything, but I wouldn't call her a nurse. Weird that she should worry about losing her job for trying to save a life, surely it should be the other way around!!
Naughty_Nurse
Posted: Tuesday, March 05, 2013 11:38:21 AM

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That must be a devillish 'nurse'.
Was it really a nurse?? What a shame.
I am a nurse myself and I wouln't even THINK of my job or whatever.
She was simply reluctant that she didn't even try to help her by trying to find another person.
I hope she will be fired for not helping a human being in serious need.
She can be charged I guess, as a nurse it is your job to help....

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MrLosAngeles
Posted: Tuesday, March 05, 2013 11:42:37 AM

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First, according to my limited knowledge: A nurse is not a doctor nor an EM. Second: I believe I read the woman had a DNR in place. Do not resusitate, I think, is quite clear.
"A DNR (Do Not Resuscitate) Form (actual title: “Emergency Medical Services Prehospital Do Not Resuscitate (DNR) Form) is an official State document developed by the California EMS Authority and the California Medical Association which, when completed correctly, allows a patient with a life threatening illness or injury to forgo specific resuscitative measures that may keep them alive. These measures include: chest compressions (CPR), assisted ventilation (breathing), endotracheal intubation, defibrillation, and cardiotonic drugs (drugs which stimulate the heart). The form does not affect the provision of other emergency medical care, including treatment for pain (also known as “comfort measures”), difficulty breathing, major bleeding, or other medical conditions. Many patients make their DNR wishes officially known because they do not want to be placed on life-assisting equipment in the event that their heart or breathing ceases. "
Guest
Posted: Tuesday, March 05, 2013 11:43:29 AM

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It was the facility's policy so the nurse really can't be charged with anything. Without knowing what caused the woman's death, we can't say if receiving CPR would have saved her.

I do think the facility should have had face masks handy for situations like that if it doesn't want it's personnel performing CPR on people.

Reports did say that the woman's daughter was "satisfied" with the level of care that her mother received at the facility.
lafayettemister
Posted: Tuesday, March 05, 2013 11:44:48 AM

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MrLosAngeles wrote:
First, according to my limited knowledge: A nurse is not a doctor nor an EM. Second: I believe I read the woman had a DNR in place. Do not resusitate, I think, is quite clear.
"A DNR (Do Not Resuscitate) Form (actual title: “Emergency Medical Services Prehospital Do Not Resuscitate (DNR) Form) is an official State document developed by the California EMS Authority and the California Medical Association which, when completed correctly, allows a patient with a life threatening illness or injury to forgo specific resuscitative measures that may keep them alive. These measures include: chest compressions (CPR), assisted ventilation (breathing), endotracheal intubation, defibrillation, and cardiotonic drugs (drugs which stimulate the heart). The form does not affect the provision of other emergency medical care, including treatment for pain (also known as “comfort measures”), difficulty breathing, major bleeding, or other medical conditions. Many patients make their DNR wishes officially known because they do not want to be placed on life-assisting equipment in the event that their heart or breathing ceases. "


Read it again. She did NOT have a DNR... at least not according to the article I linked above...

Staff members are "required to perform and provide CPR" unless there's a do-not-resuscitate order, said Greg Crist, a senior vice president at the American Health Care Association.

Bayless did not have such an order on file at the facility, said Battalion Chief Anthony Galagaza of the Bakersfield Fire Department, which was the first on the scene. That's when firefighters immediately began CPR, continuing until she reached the hospital.







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MrLosAngeles
Posted: Tuesday, March 05, 2013 11:47:11 AM

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lafayettemister wrote:


Read it again. She did NOT have a DNR... at least not according to the article I linked above...

Staff members are "required to perform and provide CPR" unless there's a do-not-resuscitate order, said Greg Crist, a senior vice president at the American Health Care Association.

Bayless did not have such an order on file at the facility, said Battalion Chief Anthony Galagaza of the Bakersfield Fire Department, which was the first on the scene. That's when firefighters immediately began CPR, continuing until she reached the hospital.


Okay, thanks for that information. If there was no DNR generally known and on file, the nurse was negligent. Manslaughter?
LadyX
Posted: Tuesday, March 05, 2013 11:52:11 AM

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If that's the policy, and the nurse risks termination for not following policy, then there's really nothing more that can be said about that part. If the patients and their families/guardians are notified of this no-CPR policy upon admission, especially if the family/patients signed it, then I really don't see how a legal pursuit of the facility would be anything short of frivolous, either. I agree it's shitty, but if I was informed or given paperwork that spells out what the nurses will and will not do for my loved one, and I chose to disregard or ignore the information, then I can't blame them when something like this happens. And like OWA, I also heard that the family had no issue. In which case, what's left to say?

I do agree that it's an odd policy though.
overmykneenow
Posted: Tuesday, March 05, 2013 11:53:20 AM

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The controversy of "Do not resuscitate" aka "allow natural death" can seem very chilling when applied to the elderly and very ill.

The sad truth is that CPR is designed to get healthy hearts working again, not to get more life out of a dying body. In the slim possibility of it actually working the quality of any remaining life would be negligible.

In the UK, asking relatives if they wish their loved one to be resuscitated is more of courtesy than a stipulation. A doctor will decide whether or not resuscitation is viable or not irrespective of the wishes of the patient or their family.

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lafayettemister
Posted: Tuesday, March 05, 2013 12:03:42 PM

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LadyX wrote:
If that's the policy, and the nurse risks termination for not following policy, then there's really nothing more that can be said about that part. If the patients and their families/guardians are notified of this no-CPR policy upon admission, especially if the family/patients signed it, then I really don't see how a legal pursuit of the facility would be anything short of frivolous, either. I agree it's shitty, but if I was informed or given paperwork that spells out what the nurses will and will not do for my loved one, and I chose to disregard or ignore the information, then I can't blame them when something like this happens. And like OWA, I also heard that the family had no issue. In which case, what's left to say?

I do agree that it's an odd policy though.


In theory, I agree. If they knew about the policy, then the nurse may be safe. Unless she violates some sort of Nurse's code. But in her shoes, I'd have risked my job for the lady's health. Also, I wonder if the no-CPR clause is part of some lengthy contract that no one really reads. Not that it's an excuse, but very few people actually read all of the fine print.

And I wonder of the legality of that policy, and I think authorities are investigating it.





When the debate is lost, slander becomes the tool of the loser. Socrates
jillinjulie
Posted: Tuesday, March 05, 2013 12:09:03 PM

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Who called 911 anyhow?

& how does that (so-called) nurse sleep at night?
keoloke
Posted: Tuesday, March 05, 2013 12:47:44 PM

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I did say in another post that as humans we have lost it. We get engulfed in our overly created paper work (as with the privacy laws)and loose the character that made us, such as compassion, mercy and became robots.

A nurse is a person the tend, cares for someone. Call Emergency personnel than immediately start to help. Not what she did.. than again a "nurse" would do that.

Anyway no DNR makes them both responsible in my opinion.


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Naughty_Nurse
Posted: Tuesday, March 05, 2013 1:08:16 PM

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Oh, if she had a DNR it makes it a different story....

MrLosAngeles wrote:
First, according to my limited knowledge: A nurse is not a doctor nor an EM. Second: I believe I read the woman had a DNR in place. Do not resusitate, I think, is quite clear.
"A DNR (Do Not Resuscitate) Form (actual title: “Emergency Medical Services Prehospital Do Not Resuscitate (DNR) Form) is an official State document developed by the California EMS Authority and the California Medical Association which, when completed correctly, allows a patient with a life threatening illness or injury to forgo specific resuscitative measures that may keep them alive. These measures include: chest compressions (CPR), assisted ventilation (breathing), endotracheal intubation, defibrillation, and cardiotonic drugs (drugs which stimulate the heart). The form does not affect the provision of other emergency medical care, including treatment for pain (also known as “comfort measures”), difficulty breathing, major bleeding, or other medical conditions. Many patients make their DNR wishes officially known because they do not want to be placed on life-assisting equipment in the event that their heart or breathing ceases. "


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Dancing_Doll
Posted: Tuesday, March 05, 2013 1:14:12 PM

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I have mixed feelings on this one.

I heard that the patients and family understand and are made aware of the facilities policies about CPR before being admitted.

It sounds horrible to allow natural death to occur without intervening but this could be for a myriad of reasons such as compounding issues that can occur with advancing age such as brittle bones and frailty. Yes, she could have been on her way to dying and then someone performs manual CPR and breaks her ribs and they pierce her lungs and then she's on the way to the hospital and yay she's alive! But then she gets to spend the next six months suffering in the hospital with other injuries sustained during manual compressions, and healing when you're that old ain't an easy thing.

It's not a totally black and white situation. She may not have had a DNR on her file but may have been ok with forgoing manual CPR because of the host of complications that can occur when doing this with a frail senior citizen.

If she (the patient) understood the no-CPR clause and was ok with it, and her family said they are satisfied with the level of care she received, I don't get why this is getting blown up. It's tragic that she passed away, but she's 87 yrs old. To be honest - at that age, depending on my health and quality of life, I might also prefer that kind of clause. It still allows for resuscitation but only in certain circumstances as a way to try to safeguard against causing potential additional injuries that may affect remaining quality of life.


chileanbean
Posted: Tuesday, March 05, 2013 2:54:41 PM

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Mmm this kind of reminds me of Immanuel Kant's philosophy. You follow your duty because it's more important than your happiness... Although it's true the nurse followed her duty as a member of that facility, she failed in acting as a normal human being. There's certain universal values that people follow and one was broken here. I'm not sure whether she should be charged... i'm in fact undecided, but this policy certainly needs to be revised. What a chilling and sad story.
I'm often amazed at how people obviously don't think about whether they'll find themselves in a similar situation and as a result do nothing but sit and watch.
MissPegLegg
Posted: Tuesday, March 05, 2013 3:02:41 PM

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I am a Care Assistant and each resident at my home has it detailed in their care plan whether or not they have a DNR. Having a blanket policy like that is surely institutional abuse as it doesn't allow each resident to have a decision over whether or not they would like to receive CPR. The whole home should be charged, not just the nurse.

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AngelHeart01
Posted: Tuesday, March 05, 2013 3:14:16 PM

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I would get my loved ones out of there. I would let anyone and everyone know. You don't even have to give mouth to mouth anymore for CPR. If there wasn't one person willingly to try and save this woman, that is disgusting. I don't care if my job was on the line or not. I'm not going to willing watch someone die, without attempting to help. That facility says they are able to assist in emergencies. I guess there is some fine print there.
Their policy (so I heard), was to call for help and wait .... Sign me up!!
It makes me sad and ill.
Dancing_Doll
Posted: Tuesday, March 05, 2013 4:12:30 PM

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Here are a few excerpts from an interesting article on the subject. Just food for thought...

News Link wrote:


In another story, CPR was dutifully performed, without regard for whether it might do more harm than good, followed by urgent races to the ER where holes were cut in throats to accommodate tubes, arteries were probed and accessed to provide antibiotics, fluids and perhaps opiates, and ventilators were cranked up to deliver to elderly humans what they no longer were capable of accessing on their own: the breath of life.

Except for a lucky few – roughly, one in five – these patients will not resume life as before. They will not eat for themselves, drink for themselves, clean themselves, or possibly ever feel another thing except maybe when their dressing is changed or feeding tube suctioned, when they’ll grimace or moan. Maybe the heart will stop and CPR will be performed again. This will go on for days, weeks, maybe months.

But isn’t something wrong with the assumption that performing CPR and rushing a dying elder to the ER is always the good and compassionate act?

In the Journal of the American Medical Association in March 2012, physicians Craig Blinderman of Columbia University Medical Center and Eric Krakauer of Massachusetts General Hospital, with social scientist/bioethicist Mildred Solomon of the Hastings Center, suggested that CPR should no longer be the default option for dying patients:

“Whenever there is a reasonable chance that the benefits of CPR might outweigh its harms, CPR should be the default option. However, in imminently dying patients, a default status of full resuscitation is not justifiable. Not only is CPR in this situation likely to harm patients without compensatory benefit, the default framework likely influences patients and surrogates to request that full resuscitation is attempted even when the physician believes doing so may be inappropriate.”

Investigation may find that CPR would have been appropriate for Lorraine Bayless, and that the nurse was as unfeeling as her recorded voice and the corporation (not to say, the person) that employed her. And yet, with CPR on an 87-year-old, if you don’t crack a rib, you’re not really trying. A nurse knows this.

It’s worth noting that, according to a television reporter, Bayless’ daughter “was satisfied with the care her mother received”. And that Bayless’ daughter is a nurse.




lafayettemister
Posted: Tuesday, March 05, 2013 4:18:23 PM

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Dancing_Doll wrote:
Here are a few excerpts from an interesting article on the subject. Just food for thought...



Satisfied with the treatment her mother received, as in general at that facility? Or specifically in relation to when her mother collapsed? I know CPR rarely works, and it may not be worth it on the elderly. But if she didn't have a DNR, even at her advanced age, that she intended to live as long as possible and wanted life saving attempts to be made.

More may come out on this later. Will be interesting to see.





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Dancing_Doll
Posted: Tuesday, March 05, 2013 4:29:07 PM

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lafayettemister wrote:


Satisfied with the treatment her mother received, as in general at that facility? Or specifically in relation to when her mother collapsed? I know CPR rarely works, and it may not be worth it on the elderly. But if she didn't have a DNR, even at her advanced age, that she intended to live as long as possible and wanted life saving attempts to be made.

More may come out on this later. Will be interesting to see.


I assume the question was asked of the woman's daughter by the media and that was her response, so it obviously takes into account the way in which she passed away. I agree the formal DNR wasn't in place, but if the policies of care were provided up front to both the patient and her caregivers, I assume they understood what would happen should manual CPR come into play. It could have been that life-saving measures were to have been up to the discretion of the daughter, but that both had decided it should only be performed by certain medical personnel and not by nurse-caregivers or passerbys.

I'm sure there's much more to this case, but I don't see it as a black and white case. It would be interesting to know if the nurse would have refused to administer CPR if it had been the able-bodied daughter that went into cardiac arrest while at the facility visiting her mother one random day. To me - that would be a much more clearcut case of negligence.


Guest
Posted: Tuesday, March 05, 2013 5:02:07 PM

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a nurse dr. etc are like a commissioned police officer they are Never off duty and have an ethical duty to perform if the situation calls for it, doesn't matter if the facility didn't approve she could have her license yanked for carrying out a procedure that could save a life.
Kitanica
Posted: Tuesday, March 05, 2013 5:23:13 PM

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From what I know it's pretty much standard procedure at alot of facilities like that to not perform CPR.

Just another notch in a broken healthcare system as far as I'm concerned.

I'd like to see the nurse in jail for murder IMO, she made a deliberate choice that directly lead to the death of another human-
but I know that won't happen so ..yeah

Had this been a case where CPR wouldn't have done anything or done more harm than good and it would be more humane to let her pass naturally I'd understand, but if it was the nurse wouldn't have called 911, she knew she could have saved her but she didn't, she knew if someone got their quick they could have saved her and that's the difference, if it would have ruined the persons quality of life and left her unable to enjoy life the nurse should have left the room to read a magazine and let her go quietly. Instead she stood there saying hey, I "can't" so you need to hurry up.

Murder, negligent homicide at the least.
Guest
Posted: Tuesday, March 05, 2013 5:32:47 PM

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Unless I missed an article where it was verified that the woman was a nurse, the majority of those I read said that the woman identified herself as a nurse but it wasn't verified.

Quote:
State officials did not know Monday whether the woman who talked to the 911 dispatcher actually was a nurse, or just identified herself as one during the call


What if the woman wasn't sure how to perform CPR? What if she didn't know how? What if she knew she had a disease that she could have given the patient? Or what if she knew the patient had a disease she could give her?

A few places have the no-CPR rule to keep themselves from being sued. It's a sad statement about the current mindset of people, but if something had gone wrong during the CPR administration, the place could have been sued.

Without knowing all the facts, we can't say that the woman who made the call was in the wrong.
Kitanica
Posted: Tuesday, March 05, 2013 5:42:48 PM

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one_winged_angel wrote:
Unless I missed an article where it was verified that the woman was a nurse, the majority of those I read said that the woman identified herself as a nurse but it wasn't verified.

What if the woman wasn't sure how to perform CPR? What if she didn't know how? What if she knew she had a disease that she could have given the patient? Or what if she knew the patient had a disease she could give her?

A few places have the no-CPR rule to keep themselves from being sued. It's a sad statement about the current mindset of people, but if something had gone wrong during the CPR administration, the place could have been sued.

Without knowing all the facts, we can't say that the woman who made the call was in the wrong.


I Listened to the phone call they played it on CNN a few times she knew how to perform CPR, she said she didn't need to be walked through CPR because I'm not allowed to give it, and I'm afraid I can't do that (CPR), when will the fire department arrive? The 911 dispatcher asked anyone else on staff was willing and she said were not allowed, she asked to give the phone to another patient and she would walk them through CPR and she said were not allowed to let patients perform CPR, and the dispatcher cursed at her and said go outside and find a stranger that could be willing to help and she said no again when will the fire department arrive? The dispatcher said their coming as fast as they can and then talked to someone in the background saying yeah they're gonna let her die they won't perform cpr. The nurse knew what to do she just kept saying "I'm not allowed" like her boss was standing there. The dispatcher was pretty much pleading with this lady and she just nonchalantly says no.
Guest
Posted: Tuesday, March 05, 2013 5:46:45 PM

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Kitanica wrote:


I Listened to the phone call they played it on CNN a few times she knew how to perform CPR, she said she didn't need to be walked through CPR because I'm not allowed to give it, and I'm afraid I can't do that (CPR), when will the fire department arrive? The 911 dispatcher asked anyone else on staff was willing and she said were not allowed, she asked to give the phone to another patient and she would walk them through CPR and she said were not allowed to let patients perform CPR, and the dispatcher cursed at her and said go outside and find a stranger that could be willing to help and she said no again when will the fire department arrive? The dispatcher said their coming as fast as they can and then talked to someone in the background saying yeah they're gonna let her die they won't perform cpr. The nurse knew what to do she just kept saying "I'm not allowed" like her boss was standing there. The dispatcher was pretty much pleading with this lady and she just nonchalantly says no.


She said she wasn't allowed, that doesn't mean she knew how and didn't want to.
Dancing_Doll
Posted: Tuesday, March 05, 2013 6:00:03 PM

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Kitanica wrote:

Had this been a case where CPR wouldn't have done anything or done more harm than good and it would be more humane to let her pass naturally I'd understand, but if it was the nurse wouldn't have called 911, she knew she could have saved her but she didn't, she knew if someone got their quick they could have saved her and that's the difference, if it would have ruined the persons quality of life and left her unable to enjoy life the nurse should have left the room to read a magazine and let her go quietly. Instead she stood there saying hey, I "can't" so you need to hurry up.


Actually they are mandated to call 911, even in cases where there is a DNR. The care delivered by medics may strictly be palliative (eg. oxygen, morphine etc.) in those cases however, until the person passes.


Kitanica
Posted: Tuesday, March 05, 2013 6:12:44 PM

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one_winged_angel wrote:


She said she wasn't allowed, that doesn't mean she knew how and didn't want to.


So your saying shes impersonating a medical professional? She sates she is a nurse.

I've never met a real nurse that didn't know cpr...

http://www.youtube.com/watch?v=yS_dPYk6beI

The director claims they can't because they're are no nurses on staff but there was a nurse calling 911? so is she lying to the dispatcher?
Guest
Posted: Tuesday, March 05, 2013 6:18:20 PM

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Kitanica wrote:


So your saying shes impersonating a medical professional? She sates she is a nurse.

I've never met a real nurse that didn't know cpr...

http://www.youtube.com/watch?v=yS_dPYk6beI

The director claims they can't because they're are no nurses on staff but there was a nurse calling 911? so is she lying to the dispatcher?


I'm saying that we don't know all the facts. She might have been lying, she might not been.

Just because she said she's a nurse doesn't mean that she was, I haven't seen any info to prove that yet.

I know medical assistants, med students and nursing students that say they're nurses when calling places just because it's easier to say. And depending on where they are in their education, they might have not completed the BLS course yet.

There's also the matter of whoever was in the background calling the shots.
Kitanica
Posted: Tuesday, March 05, 2013 6:21:04 PM

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Dancing_Doll wrote:


Actually they are mandated to call 911, even in cases where there is a DNR. The care delivered by medics may strictly be palliative (eg. oxygen, morphine etc.) in those cases however, until the person passes.


Yes I know
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