[boulergirl]

Last night at work, when 3-11 shift gave me shift report, they told me one of the residents was being put on hospice and in the process of getting a DNR order. Then they told me to do something that did NOT sit right with me. If this resident stops breathing during the night, we were supposed to PRETEND to do CPR and then tell the EMT's that we did CPR. Umm, WHAT?!? We were told not to mention this to a lot of people. (Uh-oh!)
Thank God she did NOT stop breathing during the night. I had prayed for God not to let that happen. I would have done the CPR anyway and let the boss fire me if she had to. Since when is it okay to "fake" CPR and then lie to the EMT's???

[z's playa]

Seems to me that goes against a few codes of ethics. I'm not judging but I could never do what what imposed on you. I would have walked out the door if it came to that.

[missmercy]

Until there is a code status document on file -- that constitutes a full code status here -- we would definately do CPR, defibrilation etc. until there was an order to do otherwise! To be told to "fake it" and then lie about it -- NO WAY!!! That sounds pretty unethical to me! I sure wouldn't be able to play that game!!! Glad to hear it didn't sit well with you and that you weren't put in a position where it would have come to making that choice -- wold encourage you to talk to someone about addressing code status on the patient ASAP.

[heart queen]

through my 10 yr. career, I've hear everything from this to a "slow code". what I do is talk to the patient and have the papers signed if they are able. If not, call the attending and next of kin (health care proxy if there is one), and clarify. There are policies to ensure that verbal DNR orders can remain in place for X amount of hrs. until the attending signs the order.

If I cannot make this happen, within reasonable efforts, than the patient remains a full code, despite my personal and own moral feelings twords the situation.

People may say as they wish. The law as well as facility policies dictate what must be done. There is no gray area here. Several times I've said "oh hell no, I'm not coding him", only to have to do so that very shift, until the MD calls it, the EMT's arrive, or family says stop.

Problems with this situation arrise, when nurses believe there is a choice here to do as "they" feel would be best. The choice does not exist. Accept this as the patient or family wishes, and try to work through your own ethics after the legal and "right" thing has been done.

You can't controll what other nurses say and do, only how you act and react.

[wam79]

I had a rotten experience years ago. I had a patient that was well knon to the staff. Woman in her 30's. fighting a losing batle with leukemia developed an untreatable infection in her sinuses. Her nose and face was turning black and she was facing a rather horrible death. On the evening she and her husband decided she should be DNR so she could go with as much peace as possible she coded. They wanted to tell the attending MD in the AM for the DNR. We did the "right thing" and she died a truly horrible death. I have been a strong advocate for teaching patients about theire DNR rights. If anyone ever expresses intrest in DNR I call the resident to see them even at night. Some residents get ******, but so what I'm there for the patients . I owe it to them to not let anyone I care for not get what they want for their last wish.

[fergus51]

This is NOT ok. Until there is a DNR, you have to code them. I don't understand why people wait to get a DNR anyways.

[RN4NICU]

Originally Posted by fergus51

This is NOT ok. Until there is a DNR, you have to code them. I don't understand why people wait to get a DNR anyways.

Me either. I also don't understand why their families will fight them when they want to be made DNR. H-E-L-L-O selfish people! Not your life, not your death - stay out of it! Some hospitals/LTC facilities pressure the MDs not to sign the DNR unless the family agrees ('scuse me, but they don't get a vote!). Where I have worked, it was acceptable for 2 nurses to take a telephone order from an MD for a DNR that would be valid until it was signed within 12 hours (2 nurses - so the doc can't change his/her mind after the fact - which is never a bad idea where phone orders are concerned, IMO). This was also appropriate for obtaining family consent - 2 nurses over the phone documenting family member's name, consent by phone, time and date, then both nurses sign.

However, until DNR is signed, witnessed, and on the chart - NO FAKING - call the code and do it properly.
No "walking slow", no "Baywatch" compressions, no lying about medical care provided, no forgetting the phone number for 9-1-1, no closing the door so you won't know if she codes, none of that business. I've heard of all of the above being done when the DNR isn't in place yet, but although it is a difficult situation, it is just not ethical. Don't do it.

[jemb]

Originally Posted by boulergirl

Last night at work, when 3-11 shift gave me shift report, they told me one of the residents was being put on hospice and in the process of getting a DNR order. Then they told me to do something that did NOT sit right with me. If this resident stops breathing during the night, we were supposed to PRETEND to do CPR and then tell the EMT's that we did CPR. Umm, WHAT?!? We were told not to mention this to a lot of people. (Uh-oh!)

After asking the people giving me report if they had obtained a written order for that, I would have ignored the 'instructions'. While I certainly empathize with the dilemma the situation presented you, until there is an official DNR order, you would be endangering your own license if you did not do what you know was legal.

Incidently, hospice does not automatically mean DNR.

[boulergirl]

Thanks everyone. I feel more confident about my decision now. Until I know the DNR is in her file, I'm doing CPR on this resident if she stops breathing. Although I'm a nurse's aide with no license to worry about, I still have to answer to my conscience.

By the way, I talked to the shift supervisor for the next shift about the "instructions" I was given, and she told me two girls got fired at her last job for faking CPR.

[PHTLS]

I had a former coworker who once told me to fake it too.