Can a nurse refuse to participate in a code?

Jory, MSN, APRN, CNM · Jun 1, 2013

I don't know if hospice is inpatient or out patient, but it is in our consent forms for home hospice that we do not perform CPR. So if their was an 11 th hour decision change and the nurse is in that home we are not obligated to do CPR.

I honestly, don't see how your hospice gets around this because written consents for anything can be verbally withdrawn at any time.

I would seriously doubt that, "but you signed the form" would hold up in court, should a family change their mind.

Jory, MSN, APRN, CNM · Jun 1, 2013

But times have changes, parents do not have to leave when their child is coding, it is their right to stay there. Sometimes this is better because we have has parents see this and then decide enough is enough. It is just a sad and difficult time all around.

I agree. In my experience, when our unit started allowing parents to stay, they understood very quickly how many people were involved in saving a baby's life and if we brought them back, they found out very quickly how that baby gets all available resources immediately.

They also see, if it doesn't work, the efforts that were given.

Esme12, ASN, BSN, RN · Jun 1, 2013

But times have changes, parents do not have to leave when their child is coding, it is their right to stay there. Sometimes this is better because we have has parents see this and then decide enough is enough. It is just a sad and difficult time all around.

Absolutely and I think that it has helped in these situation with these siclk little ones.....even traumas when the parents will tearfully and quietly ask the team to stop...there is a comfort that everything has been done.

It forces MD's to have these honest conversations with families and frankly many are just no good at it.......PMFB....and ♪♫ in my ♥.....I couldn't agree more.

BrandonLPN, LPN · Jun 1, 2013

I'm sure many of us have had patients that we felt it was just torture to code the person, but for whatever reason, the patient wasn't DNR.
We can refuse to hang blood for religious reasons.
We can refuse to participate in an abortion for ethical/religious reasons.
Can we similarly refuse to participate in a code?
ETA: Without getting fired/violating our nurse practice act/getting in some sort of trouble...

Nurses can refuse to hang blood based on their own religious beliefs? Really?

And why would a nurse who has religious issues with abortion work in a clinic that performs them? Abortions are only (legally) performed in very specific facilities. It's not something that's going to just pop up one day on the med surg floor.

Blood transfusions are medically indicated procedures the pt needs. Abortions are legal operations the pt has elected to have. I don't really see how a nurse would have the right to refuse to participate based on religious scruples.

I guess you could say the same applies to pts who choose to be full code..... but the key here is that I believe doctors/nurses have the right to refuse to participate if the code would be clearly futile. We wouldn't perform a transfusion on a pt with a raging fever because it's a contraindication. Likewise, futility could be seen as a contraindication to a code.

wooh, BSN, RN · Jun 1, 2013

Yep, JWs can refuse to hang blood. In the facilities I've been at, they do end up having to monitor the patient if there's no way to switch the assignment though.

And this is the second person that has intimated abortions NEVER happen due to necessity. Tell that to Savita Halappanavar

http://www.nytimes.com/2013/04/20/world/europe/jury-cites-poor-medical-care-in-death-of-indian-woman-in-ireland.html?_r=0

But that's not closely relevant to my original question.

I think the previous posters that have talked about the difference between being against ALL of a certain procedure and those being against only some getting a procedure have made a good point. It does somewhat lead to a slippery slope.

MomRN0913 · Jun 1, 2013

I honestly, don't see how your hospice gets around this because written consents for anything can be verbally withdrawn at any time.
I would seriously doubt that, "but you signed the form" would hold up in court, should a family change their mind.

They can call 911. They can go to the hospital. But it states we as hospice nurses do not perform CPR. It's there.

jayjaybsnrn, MSN, APRN · Jun 1, 2013

yes you can refuse to a code. even though you have training in CPR but if yo think that you can't do a proper compression to a patient don't push yourself or else you're just putting the life of the patient in danger.

Horseshoe, BSN, RN · Jun 2, 2013

Most all the advanced directives I see are useless. They use useless terms like "persistent vegetative state". As WE all know a heck of a lot of terrible things can happen to you, like multiple organ failure, that will earn you a long, slow and painful lingering death in ICU without any part of your advanced directive kicking in.

Hmm, food for thought. I would love to have a copy of your advanced directive so I could make sure I didn't leave out anything important. :shy:

Horseshoe, BSN, RN · Jun 2, 2013

yes you can refuse to a code. even though u have training in CPR but if u think that u can't do a proper compression to a patient don't push yourself or else you're just putting the life of the patient in danger.

Someone who needs CPR is already in danger of losing their life! If no CPR is done, they die. "I'm certified but not competent" so I refuse to do CPR is not going to cut it. FIRED.

I've heard some good reasons why some nurses might consider refusing to give CPR, but "I don't want to put someone's life at risk with improper compressions, so I'll refuse to help" is not one of them.

KelRN215, BSN, RN · Jun 2, 2013

*** And me.
*** I will buy one of the first copies! However I know from the times I have told hospital stories to non hospital / EMS types that Americans are not ready to hear your stories.
*** If it's a "bad" code I try to get the family as close to the bedside as possible in the hopes they will yell "ENOUGH!". In a "good" code I try to get them far away so I can concentrate on my work.
My personal advanced directive is highly detailed and currently runs to 14+ pages. I have it on a Word template somebody gave me. Not unusual that after a tough shift I will sit down and add to it, print, sign and shred the old one. My best insurance against a slow lingering death in the ICU is my wife. She is my POA for health care and is the beneficiary of a TON of life insurance. She won't hesitate to pull the plug on me (just kidding).
Most all the advanced directives I see are useless. They use useless terms like "persistent vegetative state". As WE all know a heck of a lot of terrible things can happen to you, like multiple organ failure, that will earn you a long, slow and painful lingering death in ICU without any part of your advanced directive kicking in.
My experience is that, despite the face that I am an atheist, a great chaplain is the best asset to have available in these situations.

This reminds me of a patient I encountered during nursing school. He was a young-ish man (40s or 50s) with end-stage multiple myeloma in multi-organ system failure. He was in the MICU, intubated, sedated, vented with tubes coming out of every orifice in his body... foley, rectal tube, NG tube. He was a full code. In his chart was a living will which specifically stated "I do not want CPR, I do not want a feeding tube, I do not want a breathing tube, I do not want a ventilator, I do not want to be kept alive by artificial means." (I forget the exact wording but basically everything they were doing to him, his living will specifically said he didn't want.) His siblings were his next-of-kin (he was a lifelong bachelor) and they believed-despite this living will in writing stating he did not want these things- that he "would want everything done." Horrible. That's a patient I would refuse to code and if I was caring for him when the MD ordered the NG tube to be placed, I'd have refused to do that too.

Horseshoe, BSN, RN · Jun 2, 2013

KelRN215, that's just despicable. The siblings can't read? :mad: Why did the MDs go against the patient's living will? Did they try to communicate to the sibs that his living will was very specific? I don't see how there could have been any confusion there. It's just horrible.

Esme12, ASN, BSN, RN · Jun 2, 2013

KelRN215, that's just despicable. The siblings can't read? Why did the MDs go against the patient's living will? Did they try to communicate to the sibs that his living will was very specific? I don't see how there could have been any confusion there. It's just horrible.

Not all states acknowledge living wills....they are not legally binding....where I live ...Massachusetts....they use them as indicators of the patients wishes when the family is in conflict...however the family can override them at any time.

The docs here believe it's the living who sue you.