The Slow Code - page 12

by TheCommuter Senior Moderator | 27,283 Views | 148 Comments

I have been a nurse for only seven years; however, certain events and situations will remain embedded in my memory for the rest of my life. One of these events took place during my first year of nursing practice when I was... Read More


  1. 0
    Quote from PMFB-RN
    *** What behavior do you find disterbing and unethical?
    To quote the article "This clinically dead man was a full code, yet the multiple people in the room were moving with a disturbingly unhurried pace.", "A nurse with more than 20 years of experience glanced at me with a smile and sternly said, “Give it up! Don’t waste your energy! Wait until EMS gets here, then act as if you’re doing something in front of them!” She ended her statement with a quiet giggle as the house supervisor stood over me, grinned, and nodded in agreement."

    And finally, most disturbing of all, "
    Approximately 30 seconds before EMS staff entered the room, my coworkers began putting on the show and pretended to exert an all-out effort to save the patient (a.k.a. the ‘show code‘ or ‘Hollywood code‘).''

    Those things I found particularly disturbing, and unethical. To stand by while someone who is a full code and do nothing, then encourage someone who is trying to help the patient in duress is in my mind cause for professional misconduct. Then, to behave after the notified EMS staff arrives as if you have been contributing to the care of the patient in duress is frankly alarming and highly disturbing in my opinion.

    You don't find that disturbing?
  2. 0
    Quote from JoyfulNurseLPN
    You don't find that disturbing?
    You're going to receive a mixture of opinions on this issue. Based on the content of the 100+ responses, apparently not everyone is disturbed by slow codes.
  3. 0
    Quote from JoyfulNurseLPN
    To quote the article "This clinically dead man was a full code, yet the multiple people in the room were moving with a disturbingly unhurried pace.", "A nurse with more than 20 years of experience glanced at me with a smile and sternly said, “Give it up! Don’t waste your energy! Wait until EMS gets here, then act as if you’re doing something in front of them!” She ended her statement with a quiet giggle as the house supervisor stood over me, grinned, and nodded in agreement."

    And finally, most disturbing of all, "
    Approximately 30 seconds before EMS staff entered the room, my coworkers began putting on the show and pretended to exert an all-out effort to save the patient (a.k.a. the ‘show code‘ or ‘Hollywood code‘).''

    Those things I found particularly disturbing, and unethical. To stand by while someone who is a full code and do nothing, then encourage someone who is trying to help the patient in duress is in my mind cause for professional misconduct. Then, to behave after the notified EMS staff arrives as if you have been contributing to the care of the patient in duress is frankly alarming and highly disturbing in my opinion.

    You don't find that disturbing?
    *** There has been a lot of discussion in this topic and I didn't realize you were refering to the OP. Standing by and doing nothing when a person is full code may or may not be disterbing and unethical depending on the circumstances. For example I will not go aginst a patients informed decision to be DNR just cause the out of town adult child, or estranged wife changed the code status after the patient could no longer speak for themselves.
    Misleading EMS I do find disturbing, not coding a person who made an informed decision to be full code I also find disterbing and unethical.
  4. 0
    Quote from AnonRNC
    This is a very interesting topic and a fabulous discussion. I have a couple of things to add.

    In 14 years of NICU/Peds nursing (plus 4 as a CNA), I have never seen a "slow code."
    *** Neither have I seen a slow code on a peds patient in 18 years of nursing.
  5. 2
    Quote from PMFB-RN
    *** Neither have I seen a slow code on a peds patient in 18 years of nursing.


    me either, and it's a rare pedi code that isn't followed by a weeping staff, too. Whether they weep together, or go off into a bathroom to weep, lotta staff weeps when we lose a child.
    AnonRNC and PMFB-RN like this.
  6. 0
    Oh, I absolutely agree with you Commuter. Some people think it's a dignity
    issue to allow someone to die peacefully where death is obviously imminent, I
    agree to an extent but I don't agree with standing around and putting on a big
    charade and then pretending that you've been doing something the whole time
    when other staff arrives to tend to the patient. I think that's redonculous.

    I agree also that it's kind of a grey area, and I sometimes would be hesitant
    to perform CPR on a frail little elderly person who has obviously passed but
    has a standing full code order - but I've also heard of people getting into
    really big trouble for not helping the patient if they are a full code.
  7. 0
    Quote from PMFB-RN
    *** There has been a lot of discussion in this topic and I didn't realize you were refering to the OP. Standing by and doing nothing when a person is full code may or may not be disterbing and unethical depending on the circumstances. For example I will not go aginst a patients informed decision to be DNR just cause the out of town adult child, or estranged wife changed the code status after the patient could no longer speak for themselves.
    Misleading EMS I do find disturbing, not coding a person who made an informed decision to be full code I also find disterbing and unethical.
    heh, I jumped in really late as I've just discovered this message board, so I responded really late to the OP.

    I also agree, an informed decision made by a patient to be a DNR should never be gone against especially if a family decides later it's in their best interest to be a full code, I would think that sounds
    like there is some other motive to keep the patient alive at that point.
  8. 0
    Quote from JoyfulNurseLPN
    I've also heard of people getting into really big trouble for not helping the patient if they are a full code.
    Yep. I know of an LPN who had her nursing license recently referred to the state board of nursing for failing to initiate CPR on a hospice patient. Yes, the hospice patient was still a full code. Yes, the LPN felt that coding a terminally ill patient on hospice would have been an exercise in futility.

    I really hope the BON does not come down too hard on this nurse.
  9. 1
    Quote from TheCommuter
    Yep. I know of an LPN who had her nursing license recently referred to the state board of nursing for failing to initiate CPR on a hospice patient. Yes, the hospice patient was still a full code. Yes, the LPN felt that coding a terminally ill patient on hospice would have been an exercise in futility.

    I really hope the BON does not come down too hard on this nurse.
    I find it ridiculous to have a hospice patient that is not a DNR. It might just be what I was taught in our local hospice though..the patient had to be a DNR, all family had to agree to this, if the pt had a PACER or a defib they even had to be deactivated, etc. Even if they were there for RESPITE care, is what we were told.
    monkeybug likes this.
  10. 0
    We lost my grandfather several years ago, and I still get angry when I think about it. NOT angry at the healthcare professionals, but angry at the "friends" of the family. My grandfather had a brain stem stroke while hospitalized for salmonella. Rapid response team arrived within minutes, and he got excellent care. He had TEN kids, so getting them all to agree on something is a feat. But all 10 agreed to try TPA. He went to ICU, and we all held vigil waiting for him to die. At one point, one of my aunts came flying into the waiting room, "He's awake! He's awake!" We went in two-by-two (we followed the rules!) and I got to hear my grandfather tell me he loved me again, something I never thought would happen. He did amazingly well, very little cognitive impairment, truly, a miracle, we all thought. He went to Rehab, and then had a bleed secondary to the TPA. Once again, all 10 kids finally came to the conclusion to make him a DNR and move him to hospice (and I always found it fascinating that the sons were the holdouts, but they both had unfinished issues with their dad. The daughters came to the conclusion pretty quickly). At hospice, visitors poured in. He was truly a remarkable, wonderful, man. He was treated as such at the hospice (a group of nurses and a facility I will always be grateful to). I got to listen to the whispers by "friends" at hospice. "They are starving him." "They are just letting him die." My own father in law said it to my face. Every time a comment was made, my uncles would go through turmoil again, rethinking their decision. It's hard to let someone go when you love them. Or when you owe them money, or when you didn't tell them often enough that you loved them, or any other loose ends. It's even harder when the community at large judges you for your decisions.

    A bit off topic from slow codes, but just my experience as a nurse and a grandchild.


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