Opinion of nurses

Nurses General Nursing

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This is a rant so if you don't want to read it I completely understand, I just need to get this off my chest to people who understand where I'm coming from or can honestly tell me I'm being silly and to get over it! Thanx!

It's 2013 and there are people who still don't understand what nurses do! I had someone say to me today "a nurses job is to save lives" now it was the context it was used in that upset me. This was said because this person thinks nurses and doctors want to use extreme measures to extend people's lives no matter how horrific it is to the person regardless of if they want it or not because our job is to "save lives." Somewhere along the line this person was told that withdrawing life support is illegal?!? I'm sad as well because this information was passed on to them as fact and continues to be passed as fact. I will be the first to admit that a hospital is a business and the more they do the more they can bill. But nurses and doctors have taken an oath. Yes our job is to "save lives" but it's also to provide holistic and patient centered care and see patients as people with lives and a family! I could go on forever about this issue! I just can't believe there are people who actually believe my job is to "torture" people until they die under the ruse of "saving lives."

Specializes in ICU.

Re: elkparks's info on NC- maybe that was a facility-specific thing, or something that has since changed, but that is no longer true- NOK always has the right to make EOL decisions. Usually families seem to be nudged more towards w/d of care than not (when the situation warrants).

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I live in NC...

I had a patient come in from a nursing home who was very confused, oriented only to person (sometimes). After a couple days, he came out of it...turns out he was still kind of crazy (aside from any medical condition) but he was with it enough to be able to make his own health care decisions.

Anyway, when he was still so confused, his sister came to visit and immediately asked how to make him a DNR. I wasn't there for that shift, but apparently there were orders signed and a DNR was placed on the patient. A couple days later, he woke up and asked me what that bracelet was for. I told him, he asked me why it was on him. I told him why and he responded with, "That *****, it figures," then told me to take that bracelet off him. Then we got rid of his DNR orders.

I'm new, and I don't have a clue how legal that was but it happened!

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Well I hope to God that some heroic friend of mine doesn't try to extend my life when it's pass overdue. It's the nurse's and the doctor's role to give a realistic picture on the quality of life, and the reality of the situation. There are worst things than death.

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Specializes in Hospice.

I think one of the big factors concerning families not wanting a DNR status is that they are not educated on what it means. In my experience, some people believe DNR means DO NOTHING. How many times have we started the conversation and the family states, "Well we want everything done but we don't want them to be on a breathing machine." This is our opportunity to educate people on what is included during an attempt to revive their loved one, also to educate DNR does not mean we just stand back and let that person die, explain to them we can make that person comfortable with pain medication, diuretics, supplemental oxygen, etc...

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Specializes in ICU.
I think one of the big factors concerning families not wanting a DNR status is that they are not educated on what it means. In my experience some people believe DNR means DO NOTHING. How many times have we started the conversation and the family states, "Well we want everything done but we don't want them to be on a breathing machine." This is our opportunity to educate people on what is included during an attempt to revive their loved one, also to educate DNR does not mean we just stand back and let that person die, explain to them we can make that person comfortable with pain medication, diuretics, supplemental oxygen, etc...[/quote']

Although in my experience, 9 times out of 10, the medical team ends up treating a DNR as if they are comfort care only. :/. Pretty messed up.

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Specializes in LTC Rehab Med/Surg.
I'm not surprised people actually believe this in our death-defying, death-denying society.

Rather than present more realistic options to the family of the comatose 99-year-old with terminal illness, the weak-spinned attending physician often caters to the wishes of the relatives to "have everything possible done to save my great grandma."

And it's almost always the nursing staff who carries out the orders to keeppatients artificially alive when they are terminally ill. Much of the nursing care is painful and torturous. It can create moral distress and feelings of dread in even the best of us.

The public's perceptions arise out of the death-defying, death-denying culture in which we are immersed. In addition, doctors and nurses are not doing more to educate the public about other options for dignified care.

There. I said my piece. . .

I'm on board with the family insisting on life saving measures for hopeless situations. I don't agree, but that's not my decision to make.

On the other hand, nothing exhausts me more than anticipating a code on a terminally ill patient. Pushing pain meds or Ativan on an end stage COPDer who's a full code, and their pressure is 80/40. Trying to balance the unreasonable expectations of a family in denial.

"Moral distress and feelings of dread" is an excellent description.

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Specializes in Cardiac step-down, PICC/Midline insertion.
Although in my experience, 9 times out of 10, the medical team ends up treating a DNR as if they are comfort care only. :/. Pretty messed up.

This has been more of my experience as well. I once was on a unit where a patient came in with a GI bleed and the ED doc basically didn't do anything for the patient because there was a DNR order. It wasn't my patient so I don't know the extent of the medical history or quality of life. They placed an NGT, the wallsuction canister was FULL of blood, no transfusion---ED doc said it was an "old" bleed. yeah right! Pt died. Family definitely was not prepared for that. I personally think it's best to just have an advanced directive stating your wishes in the event you became incapacitated and let your NOK know that you want a DNR only in the event that death is imminent or there is absolutely no hope for a high quality of life if you survive.

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Specializes in Hospice.
Although in my experience, 9 times out of 10, the medical team ends up treating a DNR as if they are comfort care only. :/. Pretty messed up.
Maybe my experience is different because I work on a Progressive Care Unit, I agree with you, if you treat a DNR as comfort care only that is messed up. We use a lot of anti-arrhythmia gtts to try to convert someone's heart even if they are a DNR. We use diuretics for those who are DNR and are filling up with fluid. We use Bi-Pap to help keep oxygen saturations up, heck, last week we put a PPM in an 80 something y/o man who came in with diagnosis of CVA who was a DNR.

I wonder if it is cultural or regional?

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Specializes in Critical Care.

also the difference between DNR vs comfort care. and how does the family define " life support" exactly? dialysis, peg tube feedings, vent support, ecmo, lvads etc.... when does it cross the line? its not just jumping up and down on someone's chest.

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Specializes in Critical Care.

I have to say the majority of our docs and critical care NP s are good about the distinction that "DNR" does not mean " do not treat". thank God.

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