Can a nurse refuse to participate in a code?

Sun0408, ASN, RN · May 30, 2013

This is a post I want to be able to come back to so I'm putting my name in. As far as the question at hand, I really have no clue. This is something I have thought about numerous times working in the ICU.

Sun0408, ASN, RN · May 30, 2013

Welcome to Medceu Found this as I was researching. I know this pertains to PCP but it is helpful to know :) Back to researching I go..

Sun0408, ASN, RN · May 30, 2013

Sorry, that didn't work right..I will try again

Welcome to Medceu

MunoRN, RN · May 30, 2013

Physicians are not required to provide care they deem futile. So when an MD makes a patient a medically futile DNR, nurses are fairly safe in following that order. Physicians may deem a patient a medically futile DNR because that is within their scope, and while I might argue otherwise, I have a feeling most BON's would consider that a Nurse determining a patient to be a medically futile code to be out of their scope, even though questioning the appropriateness of a full code order is within our scope.

(I'd argue that the determination of medically futile is well enough defined that an MD doesn't have to confirm that, but anyway). If the MD has not declared a patient to be a medically futile code, then the assumption is that they are not (though often this is just because the MD hasn't made that official for a variety of reasons).

I have refused to code someone before (the patient was well known to us and had firmly established they were DNR, including on this admission, after the patient developed a decreased LOC the family made them full code, which the MD obliged). I'm quite sure my license and job were in jeopardy and I don't really think I could have put up much of a defense if I lost either of those. Luckily we now have much stronger policies about enforcing DNRs and the restrictions on NOK/POA decision making.

MedChica · May 30, 2013

This is a post I want to be able to come back to so I'm putting my name in. As far as the question at hand, I really have no clue. This is something I have thought about numerous times working in the ICU.

I know. I agree. I don't work ICU. I'm LTC psych but many of our residents who should be DNR...actually are, thank God. We have some elders and I can tell by looking at them that, if they were 'full-codes', could be injured by the compressions. The recovery would be hell.

There's just no way.

However, during my clinicals in the ICU, we had a pt who desired to not be brought back...and the ICU nurses called code when the pt started to crash because the family pushed the issue.

Of course, I wasn't participating but it made ME very uncomfortable. I never much thought about the matter before then but the exp in that part of nursing made me consider the situation...often.

So, I absolutely believe that a person has a 'right' to die, I guess you could say. I think having the right to die entails being allowed to meet your end with dignity.

I wonder if you can refuse to participate like the OP but it seems like that would open you up to a lot of litigation.

Guests · May 30, 2013

I think one could safely 'defer' in a code... that is, step aside and let other nurses perform the functions.

However, if stepping aside were to delay care at all, I think the nurse could face sanctions.

Even if it the deferral made no difference, it could certainly lead to termination for an at-will nurse and perhaps even for-cause as a refusal to perform assigned duties.

xoemmylouox, ASN, RN · May 30, 2013

Interesting question. I'm sure you could step aside as long as there was adequate staff to participate in the code. You might lose your job or face punishment from your BON if someone wanted to make a stink about it.

blondy2061h, MSN, RN · May 31, 2013

I would think the better route would be to bring it up with the ethic's committee (if the attending physician route got you no where) before they actually coded. Obviously this isn't always possible.

umcRN, BSN, RN · May 31, 2013

I don't think so...I did have a patient once though who I was very close to, he was basically comfort care at that point but without the technicality of the DNR, his parents just couldn't agree to it yet though they knew there was no chance of him surviving. The morning we knew he was going to die my charge nurse came to me and told me that when he coded to call him (the charge RN) and he would come do compression's so I didn't have to, he knew how hard that would be for me (we have some great charge nurses). Luckily it didn't come to that and the parents agreed to withhold escalating treatment and the baby died peacefully in his parents arms while remaining maxed out on medical support...although since they were unable to withdraw anything it was a little unnerving to have a vent breathing into a dead body but certainly better than coding that poor child.

Horseshoe, BSN, RN · May 31, 2013

Can we similarly refuse to participate in a code?
ETA: Without getting fired/violating our nurse practice act/getting in some sort of trouble...

I believe most facilities would fire a nurse who refused to participate in a code on a patient who was not DNR.

You could always be the recorder or the timer without doing compressions or pushing drugs. But I don't think you'd have a leg to stand on if you made an on the spot decision to not participate if there were not enough willing/competent participants at hand when the arrest took place. It's not in our scope to override the lack of DNR just because WE believe it's "torture." You could be sued and I bet you could lose your license if it could be proven that you did not act and the patient died as a result. PARTICULARLY if the patient did NOT want to be DNR, you would be in a heap of trouble for your refusal to honor their wishes. And families do not react well when they state they want their loved one coded in the event of an arrest and you refuse to act.

Now, in advance of an actual arrest/code, you are within your rights to approach the ethics committee with a situation which you believe is unethical. But to just decide on the spot that you know better and will not participate? No hospital is going to back you in the face of family and/or legal action as a result of your refusal.

ThePrincessBride, MSN, RN, NP · May 31, 2013

Be prepared to lose your job.

Honestly, I don't see the point of entering a profession or accepting a job if you (general "you") aren't willing to perform the tasks at hand. For example, I don't think pro-life/pro-abstinence nurses have any business working at a place like Planned Parenthood.

You may not feel that a code is ethical, but if the PATIENT states in his/her advanced directives that he or she wants to resuscitated, who are you to say otherwise, even if it goes against your personal beliefs? If you are a Jehovah's Witness who is against blood transfusions, why would you take a job knowing that you will most likely encounter a patient who may need blood? I think it would be unprofessional for that JW to refuse to give blood transfusions to a patients who desperately need them and are NOT against receiving the procedure themselves. It is not as though the JW nurse is being tied down and forced to receive another's blood.

As a patient, I would fire a nurse if I knew he or she was not willing to give me the blood transfusion or refused to participate in my coding. We have so many unemployed nurses out there who would take the job and do what needs to be done and they would leave their judgments / beliefs at the door...where it belongs.