Can a nurse refuse to participate in a code?

[wooh]

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...

[nurseprnRN, BSN, RN]

*** What will your defence be if you are arrested for battery for coding a patient who did not want to be coded? Do you think "well the doctor, or well the family member told me to" will prevent you from being convicted?

I don't honestly know. I DO know one RN (and some other staff) who was arrested by police and charged with battery for coding a patient who had been clear he did not want CPR or intubation. (he was terrable and constant pain). Despite this the family changed his code status after he could no longer make his needs known.

There's a very famous case in the law and medicine arena. Mrs. Candura in NJ was an elderly diabetic with a gangrenous leg. She refused surgery. She completely understood that if she didn't have it off she would die from it, and said she was ready to die. Her physicians agreed not to amputate because that was her wish. After a time she began to fail (die), and was not longer alert and oriented. At that time her daughter went to court to compel her mother's physician to amputate the leg to save her mother's life. The court refused to so order, saying, in effect, it would be unconscionable to know what her wishes were and then wait until she could no longer defend herself against unwanted medical intervention, in this case, amputation.

[CodeteamB]

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

.

I work with a JW nurse and while she refuses blood for herself she has cheerfully helped me hang blood. Is it against their religion to give blood? I'll have to ask her. (Or if anyone here knows, I am curious, I had never thought of it).

[PMFB-RN, RN]

Interesting question, but we're obligated to help in a code. If there's adequate staff, you could step aside, but if the person is a full code, even if you think it unethical for them to be so, it would be deemed failure to rescue if you didn't, well, in a word, rescue. It's something we encounter in the ICU, and we do our best to have the MD initiate that discussion before it comes to that, a code, but sometimes the right, or ethical, decisions don't get made by families, and there's not much we can do about it other than consult ethics, palliative care, and hope that many people talking to them help them see the futility of it all.

*** If I was a patient and was coded after I made it clear I wanted to be DNR (like say if my family insisted) the staff better hope I don't make it. If I do I would hire a lawyer and go after the license of everybody involved. In addition I would call the police and try to have the staff arrested and charged with battery and of course a civil suit would be filed.

Personally I am shocked that so many nurses would be willing to code a patient even if the patient didn't want it.

[RNsRWe, ASN, RN]

I work with a JW nurse and while she refuses blood for herself she has cheerfully helped me hang blood. Is it against their religion to give blood? I'll have to ask her. (Or if anyone here knows, I am curious, I had never thought of it).

Used to work with a JW nurse who would refuse to hang blood, although she would monitor the patient and remove the empty bag/tubing. I asked her directly why she could not give the blood to the patient who WANTED it (and had no religious objections to receiving it). She said that she believed doing this would endanger that patient's soul, and she wanted no part of anyone's "downfall".

So, she didn't want it herself and wouldn't give it to someone else, either. She could monitor the patient's vitals because it was doing nothing more than ensuring the patient was safe at that moment, regardless of what was going on. And she'd gladly remove it, because, well....she was taking it away.

Still, whenever humanly possible, we'd just give her a different patient, or if not possible, she'd pick up the slack caused by someone else's additional workload. Not a big deal, really.

[Horseshoe, BSN, RN]

Absolutely nobody, should have the authority to override a living will that was executed by the patient.

I totally agree. But apparently this is legal?! Makes me sick. As said above, what is the purpose of Advance Directives if one's family can say "I don't care what she wanted, it's what I want which is important"? This just makes my blood boil.

[MunoRN, RN]

I totally agree. But apparently this is legal?! Makes me sick. As said above, what is the purpose of Advance Directives if one's family can say "I don't care what she wanted, it's what I want which is important"? This just makes my blood boil.

It's not really legal, although it happens often as it's usually seen as easier. All states require that the POA/NOK/Proxy follow and make sure that others follow the patient's "clearly stated" wishes. DNR orders are a bit different and aren't subject to various interpretations of "clearly stated" and really shouldn't be overturned by POA's based on the spirit of medical decision making laws.

There are many barriers to enforcing the spirit of these laws; dead patients dont' sue, families do, so it's seen as safer to side with the families (even though legal precedent overwhelmingly favors denying families the ability to override a patient's DNR wishes), and it can be a huge hassle to actually override a POA/family even though it's the right thing to do.

Because of this some states have actually gone through the trouble to remove any ambiguity and specifically define in law that POA/family cannot override a DNR order.

[sharpeimom]

I am a DNR and all the paperwork has been filled out, my husband and both of our families know that my angry spirit will haunt anyone who participates in any way in keeping me alive or bringing me back after I've crashed throughout eternity!

When my grandmother was in a nursing home because of very advanced Parkinson's Disease, her roommate was very fragile medically

and had two daughters who could have not felt more differently about her ultimate care. One wanted only comfort measures to be given and the other wanted kept alive and resuscitated, no matter at what cost, no matter what all the treatment and lifesaving measures did to their mother's body and soul.

That poor sweet little 102 year-old old lady's poor little scrawny wrinkled baby bird-like body was almost uniformly purple or black plus whatever was in between simply from normal gentle nursing care plus the frequent resuscitation attempts. She was barely conscious but moaned most of the time.

If someone had ordered me to code her or be fired, I could not have ethically participated as a part of the code team. I would have felt immoral.

A child is in a special category as are the very old and we must not forget that ever!

[MunoRN, RN]

Nurses don't enjoy the same scope that allows Physicians to refuse to code a patient, so in that sense I agree that in many situations Nurses have much less ability to refuse. So in that sense I agree, but I disagree with many of the rationales presented.

The first problem is that we've overgeneralized the question. The general question involves a few different sub-categories that are very different:

• A Nurse who refuses to take part in a code because it goes against the clearly expressed wishes of the patient (when a POA/NOK attempts to override the patient's wishes).
  
• When a code has been deemed medically futile by an MD.
  
• And finally, when a Nurse refuses because they would not want to be coded themselves, even though it's not medically futile and is consistent with the patient's wishes.
  

I'd argue that only the third scenario is unethical. Like the JH who refuses to hang blood or Nurse who refuses to assist in abortion, it's very different to substitute your choices for the patients regardless of what the patient wants or what can be provided by those interventions.

In the second scenario, when a patient wants to be resuscitated but where a Code won't achieve resuscitation, withholding CPR is not unethical. We need to honor a patient's wish to be resuscitated, but we're not obliged to provide interventions that have no hope of achieving that any more than we're ethically obligated to perform open heart on a patient who wants it done to cure their seasonal allergies.

The first scenario should be pretty straightforward. Our obligation is primarily to the patient. When patient's and their family disagree, the patient wins.

[Horseshoe, BSN, RN]

Note that the OP asked if a nurse could be fired for refusing to participate in a code. The answer to that is a resounding yes. The nurse may decide to take that risk, but a risk it certainly is.

[MunoRN, RN]

Note that the OP asked if a nurse could be fired for refusing to participate in a code. The answer to that is a resounding yes. The nurse may decide to take that risk, but a risk it certainly is.

I don't think it's that simple. As a rapid response I've been called to many situations where the RN has called a code, but the patient is DNR so I don't code them (even though the patient's Nurse might be in the midst of CPR), it's unlikely I can be fired for that.

[PMFB-RN, RN]

In the second scenario, when a patient wants to be resuscitated but where a Code won't achieve resuscitation, withholding CPR is not unethical. We need to honor a patient's wish to be resuscitated, but we're not obliged to provide interventions that have no hope of achieving that any more than we're ethically obligated to perform open heart on a patient who wants it done to cure their seasonal allergies.

*** This! Thank you for saying it better than I could have.

[Horseshoe, BSN, RN]

I don't think it's that simple. As a rapid response I've been called to many situations where the RN has called a code, but the patient is DNR so I don't code them (even though the patient's Nurse might be in the midst of CPR), it's unlikely I can be fired for that.

In the scenario given in the OP, she states specifically that the patient is NOT a DNR, but the nurse has a personal opinion that running a code would be "torture." I maintain that if a patient is NOT a DNR, and the nurse takes it upon herself to decide that it is inappropriate, she may very well be fired. That's a world away from what you just described.