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Coworkers Respecting Each Others' Advance Directives and Code Statuses

Posted

Specializes in Rehab/Nurse Manager. Has 6 years experience.

Note: This might seem like a strange topic, but seeing as how that is nothing new coming from the source, I'll go ahead anyway.  

As nurses, we are trained to do everything we can to save someone until it's no longer feasible or unless doing so would go against a patient's wishes, such as performing CPR for a patient with a a DNR/DNI.  

However, theoretically, anyone of us could "code" at anytime--and this includes at work. 

For those who are full codes, this wouldn't create any ethical issues.  You would simply perform CPR on your coworker as you would anyone else.  

However, for those who have DNR/DNIs, issues could come up if coworkers are unaware such orders exist.  How do we ensure that these coworkers have their wishes respected should the need come up? 

For example, I am legally a Full Code but am wanting to pursue a DNR/DNI.   Based on my age and no apparent health issues, I have a feeling most of my coworkers would automatically assume I am a Full Code should circumstances arise, however.  

What is the best way to inform my coworkers that under no circumstances should anyone provide CPR to me? 

For the rest of you, how do you ensure your coworkers' wishes for CPR or no CPR are ensured? Have you ever experienced such an ethical dilemma at work? 

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

1 hour ago, SilverBells said:

I am legally a Full Code but am wanting to pursue a DNR/DNI.   Based on my age and no apparent health issues, I have a feeling most of my coworkers would automatically assume I am a Full Code should circumstances arise, however.  

 SilverBells  SilverBells  SilverBells  SilverBells SilverBells SilverBells.

I am a DNR/DNI, have no apparent health issues, and my colleagues I worked with knew this. However, it's like my work wife Eleanor asked, "But if you code on us you still want life saving measures, right?"

Of course I told her I did. The DNR/DNI has specific guidelines that state if my status is one where I cannot make my own decisions, and I have a terminal diagnosis, I want only comfort measures.

My medical nurse wife Belinda is well aware that when I have no quality of life, then she is to pull the plug.

You silly girl you. You keep things interesting.

Okay. Time for the popcorn!

 

568493815_popcorndd.gif.20507f805cd63efa84c5198bcd70aa87.gif

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

59 minutes ago, SilverBells said:

for those who have DNR/DNIs, issues could come up if coworkers are unaware such orders exist.  How do we ensure that these coworkers have their wishes respected should the need come up? 

Perhaps we could follow this fellow's example:

 

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SilverBells, BSN

Specializes in Rehab/Nurse Manager. Has 6 years experience.

1 hour ago, Davey Do said:

 SilverBells  SilverBells  SilverBells  SilverBells SilverBells SilverBells.

I am a DNR/DNI, have no apparent health issues, and my colleagues I worked with knew this. However, it's like my work wife Eleanor asked, "But if you code on us you still want life saving measures, right?"

Of course I told her I did. The DNR/DNI has specific guidelines that state if my status is one where I cannot make my own decisions, and I have a terminal diagnosis, I want only comfort measures.

My medical nurse wife Belinda is well aware that when I have no quality of life, then she is to pull the plug.

You silly girl you. You keep things interesting.

Okay. Time for the popcorn!

 

568493815_popcorndd.gif.20507f805cd63efa84c5198bcd70aa87.gif

OK, so I'd have to look into the specific stipulations of any DNR/DNI I would have signed to ensure that it states that under no circumstance, regardless of my previous health status, should CPR be performed.  Maybe it would also be helpful to keep a copy of my code status at work to ensure that no CPR at all would ever be attempted.   Of course, the first step is actually completing a form (hopefully one that does not require any witnesses) and obtaining a physician's signature.  It is too bad that one cannot fill out a form and make it legal without witnesses/doctor's signatures.  But anyway, once I'm successful, the next step will be informing my coworkers. 

Otherwise, my coworkers have made it pretty clear that they are all Full Codes so that makes things easier on my end.  

dream'n, BSN, RN

Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych. Has 28 years experience.

I have no idea what my coworkers DNR status is and I find it a rather private decision I wouldn't want to discuss with them. Certainly some people may be comfortable sharing this with coworkers and that's fine.  But if you were my coworker, it wouldn't matter what you SAID, you're not my patient and I don't have your DNR paperwork (and even if I did which is strange, I wouldn't know that it was the most current), therefore resuscitation would begin. I find it strange to worry (especially as your healthy) that you'll code at work and your coworkers would initiate BLS.

 

SilverBells, BSN

Specializes in Rehab/Nurse Manager. Has 6 years experience.

55 minutes ago, dream'n said:

I have no idea what my coworkers DNR status is and I find it a rather private decision I wouldn't want to discuss with them. Certainly some people may be comfortable sharing this with coworkers and that's fine.  But if you were my coworker, it wouldn't matter what you SAID, you're not my patient and I don't have your DNR paperwork (and even if I did which is strange, I wouldn't know that it was the most current), therefore resuscitation would begin. I find it strange to worry (especially as your healthy) that you'll code at work and your coworkers would initiate BLS.

 

Certainly, nobody has to participate in code status discussions if they do not wish, and it’s not something I would just ask anyone.  
 
However, people can and do code anywhere.  It’s actually happened at my workplace, so it’s possible a person’s code status wishes could come into play at the workplace.

As for myself, I don’t have any apparent health issues, as I’ve stated.  But, with the 12-15 caffeinated Pepsi’s I drink a day, who knows when an event may be triggered?  And if it does, I would hope someone would respect my right to be gone. 

Anyway, just something I was thinking of, as we did have an event just recently, so...

sideshowstarlet, BSN, RN

Specializes in Med-Surg, Developmental Disorders. Has 8 years experience.

Wouldn't it make more sense to get some type of medic-alert bracelet that says DNR? Seems inefficient to verbally tell your coworkers and expect them to remember, not to mention either having this conversation with everyone or expecting veteran staff members to pass on this information to the newbies. 

Examples of medic-alert DNR bracelets in my state: https://www.stickyj.com/product/new-hampshire-do-not-resuscitate-bracelet-7-9-in-cr5280c?child=cr5282&source=googleps&gclid=CjwKCAjwx6WDBhBQEiwA_dP8rXMmvaRZClqWNIg0DnrYodkFStWJCw4k0fsX8AHaO842pnFpQbBt1xoCTrYQAvD_BwE

sideshowstarlet, BSN, RN

Specializes in Med-Surg, Developmental Disorders. Has 8 years experience.

4 hours ago, SilverBells said:

As for myself, I don’t have any apparent health issues, as I’ve stated.  But, with the 12-15 caffeinated Pepsi’s I drink a day, who knows when an event may be triggered?  And if it does, I would hope someone would respect my right to be gone. 

I know codes can happen anywhere and to anyone, but you cited heavy caffeine use as a possible factor in your hypothetical emergency. How do you feel about taking steps to prevent a health emergency? 

CharleeFoxtrot, BSN, RN

Has 10 years experience.

56 minutes ago, sideshowstarlet said:

Wouldn't it make more sense to get some type of medic-alert bracelet that says DNR? Seems inefficient to verbally tell your coworkers and expect them to remember, not to mention either having this conversation with everyone or expecting veteran staff members to pass on this information to the newbies. 

Examples of medic-alert DNR bracelets in my state: https://www.stickyj.com/product/new-hampshire-do-not-resuscitate-bracelet-7-9-in-cr5280c?child=cr5282&source=googleps&gclid=CjwKCAjwx6WDBhBQEiwA_dP8rXMmvaRZClqWNIg0DnrYodkFStWJCw4k0fsX8AHaO842pnFpQbBt1xoCTrYQAvD_BwE

Sadly, those are not valid in my state. The only "enforceable" DNR (outside of a facility) is the hardcopy paper the doctor signed.  I do have a drawing for a nifty tattoo that reads "DNR" no matter how you look at it that I plan to have inked on my sternum when that time f life approaches 😉

Seriously doubt you’ll find an ethical physician who will sign DNR papers for a perfectly healthy young person who experiences a sudden and unexpected medical crisis or trauma. This post is disturbing in a “suicide by cop” kind of way. What a horrible position to put your co-workers in. 
 

Please get help.

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

14 hours ago, Davey Do said:

You silly girl you. You keep things interesting.

SilverBells is the National Enquirer of allnurses.

21 minutes ago, Wuzzie said:

What a horrible position to put your co-workers in. 
 

Please get help.

Another avid reader satisfied.

macawake, MSN

Has 13 years experience.

On 4/3/2021 at 11:32 PM, SilverBells said:

Note: This might seem like a strange topic

Yes.

On 4/3/2021 at 11:32 PM, SilverBells said:

For example, I am legally a Full Code but am wanting to pursue a DNR/DNI.   Based on my age and no apparent health issues, I have a feeling most of my coworkers would automatically assume I am a Full Code should circumstances arise, however.  

What is the best way to inform my coworkers that under no circumstances should anyone provide CPR to me? 

On 4/4/2021 at 6:21 AM, SilverBells said:

As for myself, I don’t have any apparent health issues, as I’ve stated.  But, with the 12-15 caffeinated Pepsi’s I drink a day, who knows when an event may be triggered?  And if it does, I would hope someone would respect my right to be gone.

You are correct, this is a strange topic. Your posts are worded in a way that are likely to elicit a strong emotional response in people who are empathetic. This is a forum for nurses and the chance that you’ll receive multiple replies on the theme of ”please get help”, ”you’re young and healthy and it’s sad to see that you want to be DNR” or ”you sound like you might be dealing with anxiety and depression” etc is very high. It’s probably one of the better forums to make posts like this if you’re looking for strong reactions. 

If any, or all, of the thoughts you’ve described in numerous posts are feelings and thoughts that you actually have, then seek help. In real life. 

 

Emergent, RN

Specializes in ER. Has 28 years experience.

I don't know why people have to tell others to get psychiatric help because they post a creative thread on allnurses.com.

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

9 hours ago, dream'n said:

 I find it strange to worry (especially as your healthy) that you'll code at work and your coworkers would initiate BLS.

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SilverBells is an artist who manipulates her media in order to achieve a desired response, as she "explores alternatives to conventional notions".

SilverBells is also a sacramental lamb in that she doesn't generically refer to an individual or situation, but is specific that she is the individual and this is the situation. She presents a specific controversial subject in which she is the main character. SilverBells  vulnerates herself and is open to be attacked.

8 hours ago, SilverBells said:

Certainly, nobody has to participate in code status discussions if they do not wish, and it’s not something I would just ask anyone.  
 
However, people can and do code anywhere.  It’s actually happened at my workplace, so it’s possible a person’s code status wishes could come into play at the workplace.

 

As I've noted in other threads regarding SilverBells' modus operandi, after being attacked, she reinforces the attacker's premise, then introduces a conjunction to negate the premise.

SilverBells, you have my respect and admiration.

Would you please consider changing your username to "SensationalisticBells"?

4 minutes ago, macawake said:

You’re posts are worded in a way that are likely to elicit a strong emotional response in people who are empathetic.

I know! 

Isn't she good?!

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

3 minutes ago, Emergent said:

I don't know why people have to tell others to get psychiatric help because they post a creative thread on allnurses.com.

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macawake, MSN

Has 13 years experience.

6 minutes ago, Emergent said:

I don't know why people have to tell others to get psychiatric help because they post a creative thread on allnurses.com.

Don’t you think that’s what empaths or any medical professional really, will likely do if they fear that a person might be actively harming themselves? I think it’s to be expected that many posters here would respond that way. 

Emergent, RN

Specializes in ER. Has 28 years experience.

Just now, macawake said:

Don’t you think that’s what empaths or any medical professional really, will likely do if they fear that a person might be actively harming themselves? I think it’s to be expected that many posters here would respond that way. 

I think it is condescending and disrespectful to the creator of the thread. 

My opinion is, if you don't like a thread go to a different one. Some of the sanctimonious posters here need psychiatric help in my opinion, with their intolerance of creativity.

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

8 minutes ago, Emergent said:

I don't know why people have to tell others to get psychiatric help because they post a creative thread on allnurses.com.

We all need to feel as though we have power and are in control of our environment. Therefore, if another presents a notion alternative to our own consensual and conventional notion, we feel as though we must squash it. 

When we publicly display our integrity, we are in essence saying, "Hey everybody I'm okay"!