medical theftFor most nurses, their duty to save lives doesn’t end when their nursing shift ends. On December 30, 2013, two nurses aboard United Flight 1637 rendered life-saving aid to their pilot who was experiencing a heart attack. Linda Alweiss and Amy Sorenson established an IV and used the defibrillator to treat the pilot.

In a similar incident in 2011, registered nurse Jahn Herrick saved a fellow passenger’s life on an American Airlines flight from Las Vegas to Dallas. In addition to performing CPR, Herrick established an IV, used the defibrillator, and administered epinephrine.

As dramatic as these stories are, a 2008 Nursing Times survey asked 3,500 nurses in the United Kingdom whether they would use their clinical skills in a public emergency. Astonishingly, almost two-thirds (65%) reported they had already used their clinical skills to help someone experiencing an emergency in public.

A Duty to Help

Nurses have consistently been named the most trusted profession and naturally want to help. Many nurses feel a moral duty to preserve life and provide care according to the level of their professional training. Ethically, nurses may feel the duty to provide care.

The survey reported 90% of the nurses were prepared to intervene and 89% of those responding said they would feel uncomfortable if they did not offer care to those in need. Almost all respondents believed the public expects nurses to provide aid outside work, regardless of any legal risks. In fact, I was required to divulge I was a nurse when I purchased airline tickets in the past.

Nurses do worry about the professional liability and potential financial repercussions, however. The fear of being sued is a major cause for nurses deciding not to intervene.  Three-quarters of the nurses in the survey worried about the risk of litigation. More than two-thirds were not sure if they would be covered by malpractice insurance

I have experienced the wrenching dilemma of whether to stop and render aid to a mangled motorist. As nurses, we must be prepared to face the haunting consequences of our decisions. 

Are you prepared to render aid in situations outside your nursing shift? The following observations are based on applying the nursing process before, during, and after such events.

Before an Emergency: Assess

In any emergency, consider if the scene is safe. Assess whether the environment or situation is safe to intervene.  Alweiss and Sorenson focused on the pilot while flight attendants recruited another passenger, a retired Air Force pilot, to assist the co-pilot.

  • Assess your current state of being.

    As a fellow passenger on a plane, nurses may need to determine if it is safe for them to offer assistance. They may have enjoyed in-flight alcoholic refreshments or may have taken a sedative to calm their fear of flying.

    It’s also important to remember that not all passengers on a flight are on vacation. Nurses may be fatigued or emotionally exhausted when traveling to attend a funeral or to be at the bedside of a sick family member.

  • Assess available resources.

    Know what equipment is available such as the defibrillator, emergency supplies, and personal protective equipment. 

  • Assess your skill level.

    The critical care nurses who found themselves in the above in-flight scenarios were able to calmly intervene because they practice these life-saving skills. That’s why it’s important to keep your competencies up to date. Especially since much of emergency care in these situations will be basic life support and first aid.

    I have been a nurse for 28 years and have sat through countless, seemingly endless required competency classes. As a result, I was able to immediately offer life-saving measures for my toddler with an obstructed airway because of the skills I practiced.

    It also helps to develop a plan of action for emergencies. Participate in mock codes, mock disasters, etc. Captain Chesley B. "Sully" Sullenberger credits his success of his January 15, 2009 emergency landing of US Airways Flight 1549 on the Hudson River to the many hours of simulation training. You will render care to the level you have practiced the skill.

  • Assess your scope of practice.

    Know your state laws and nurse practice acts. Nurses who act in good faith within their scope of practice are protected by Good Samaritan Laws. Good Samaritan legislation only protects volunteer rescuers who act in a reasonable, prudent manner within their scope of practice.

    Some states include language to protect nurses who are licensed in other states. The nurses in the above scenarios were not necessarily practicing in the state they are licensed to practice nursing. Should you decide to render emergency aid, you will have a duty to remain until the victim is stable or another provider with equivalent or higher training provides relief. Otherwise, there could be a charge of abandonment.

    Additionally, some states such as Minnesota and Vermont have enacted a duty to rescue law. These require healthcare workers to stop and help the injured. According to the American Nurses Association (ANA) Code of Ethics for Nurses (2001), nurses are responsible not only for their nursing judgment and actions, but also to the public. 

  • Assess your level of protection.

    Determine what, if any, coverage your malpractice insurance provides in such situations outside your nursing shift. 

  • Lastly and more importantly, assess the patient for injuries.

To read part 2 of this article, click here.