When Is It Time To DNR
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When Is It Time To DNR Your Employee?
When is it time to just let go?
When should you try to rescuitate their career?
What are the warning signs of an imminent code situation?
Standing protocols for codes(local and fed regs)
Steps for D/Cing the code
How to triage your problems
Defib the employee--or jump starting their career
Teaching First Aid to The Employee
Turfing the employee
Glasgow Coma Scale-when you have that glazed over look
Hazmat- When the staff does something you are going to have to document
Flat liners-dead beat staff and how to get rid of them
Personal Protective Equipment- how to protect yourself
It happened on the way to the hospital-dealing with excuses
The Brotherhood of EMS-working with family
Radio chatter-phone duty
EMS or Emergency Medical Service (you know the people that get to drive
the cool trucks really fast and run stoplights) is a lot like a business office,
the problems you see in an office are the same or similar to the ones that an
EMS crew often only have seconds to a make a decision on. Having worked
as a manager in a variety of positions and having been involved in EMS for
many years, I’ve found the same principals that worked as a Paramedic also
work for me as an office manager. I’ve tried to come up with some of the
things that have helped me. As a Paramedic I had a lot of good times, but I
also had a lot of dangers to face, much like an office-it’s amazing how many
stabbings can occur at work, even if they are just in the back. Hope my
When is it time to just let go?
There comes that time in every manager’s life when they must decide if it is
time to let a person go. One of the hardest decisions in EMS is deciding
whether or not to resuscitate a person. We have clear guidelines for
terminating a code, but it can still be a difficult decision, especially if it is a
child. The first time you have to let a person go it is always the hardest,
either by terminating their employment or a code, at lot of emotions can be
involved. Just as you should have clear cut guidelines in discontinuing a
code, you need to have clear cut guidelines in terminating employment.
Sometimes you have to overcome your personal feelings and be the
professional that I know that you can be.
How do you know when it is time to stop trying to save the person? That is a
difficult question, each situation is different. When you know that no matter
what you do the person’s life is never going to be viable its time to make
some difficult choices. If a patient has been down to long (without any
oxygen) no matter what you do to save their life it isn’t going to make a
difference. With employees it can be the same thing.
You have worked and worked to turn this person around, but nothing seems
to sink in, you have a problem. Several years ago, I had an employee that
after four months of almost daily training, she could not take vitals or
document correctly in the chart. Amazingly, we went through the
progressive action steps and when I finally did terminate her, she was
surprised. She had no idea that it was coming, according to her. I asked her
if when we went through all of the training then the verbal warning for not
taking vitals on a cardiac patient, then the written and even days off for not
taking vitals and documentation and my telling her that if she did not take
vitals and document that she would be let go, if that was not a sign to her
that just maybe she needed to take vitals and document in the charts. She
stated that she did not think she could be let go for not doing her job.
I really did not do her any favors, by keeping her on so long. After that
incident we started a new training program. The new employee received
training from other employees and myself. After each new skill the
employee was checked off on the skill and given a copy of the log sheet, the
original goes in their file. The only down fall is that you have to make sure
that the employee that is showing the new person how to do something, is
performing the skill correctly themselves. If not you can have really big
retraining issues later on, not for just one employee, but at least two now.
Trust me; it is no fun to try to retrain everyone, when they should have been
trained correctly the first time.
I have found that progressive disciplinary steps give the employee the
chance to take corrective action to maintain their employment. Some of the
employees will take the necessary actions and others will not. It is
interesting how sometimes you can hear a person complaining to another
employee that they had received a waring for their actions and the other
employee will inform them that they had at one time received an action, but
that they had been “smart” enough to change their ways. Often these will
turn out to be the best employees.
The steps that I have taken are 1. Verbal-it is written out for them to read
later on and does go into their file.2. Written-I require them to sign off on
these forms and remind them that it is going into their file. With all steps I
give a timeframe for improvement, action that needs corrected, how it needs
corrected, and what will happen if it is not corrected. 3. Suspension with or
without pay. I like this step, because it gives a cooling off time, also if I need
to investigate the incident further, this allows time to do so. 4. Time to go.
We have gone through all other steps and come to this or maybe the action
was serious enough that we jumped straight to this. If the person has
wantoningly destroyed records or equipment, become violent and I do not
see any changes possible or I have to be concerned for other employees or
records, I will let the person go before all the usual steps are taken. In all
cases documentation is extremely important, but more so in these cases.
When you document one suggestion is to write it out on scratch paper, get
out everything. Then rewrite the paper describing in detail who, when, how,
why but without any emotion. Next make absolutely sure that you destroy
the first draft. You wouldn’t want that to find its way into a courtroom
The main thing in whichever style you choose that it is constant, each and
every time that you handle issues the same way. You might be tempted,
because the employee cried or you feel sorry for her/him, but do not fall into
the trap of handling problems differently for each person. That is the