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?
This is obviously a lost cause. I mean, short of a home bound or nursing home bound patient having someone throw a paper in your face, you don't *want* to encounter a DNR.
[...]
I presume, as you've quoted me in this response, that this is directed to me. As a paramedic, if I responded to a facility in which a DNR order could be in place I always asked if the patient had a DNR order in place, and if so obviously honored it. However, if I responded to a location where a DNR might not be expected, this is a different situation, and can vary widely from state to state. If the patient's family was aware of the patient's wishes and made these wishes known, and all family members were in agreement, thisbwas an easy decision; I would not initiate a resuscitation. However, and this in my experience was the norm, if the patient's wishes were not known or the family wasn't in agreement, my options were limited. I would contact medical control while initiating the resuscitation.
1 hour ago, Gillyboo said:
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Once again, you failed to read the full page. There is a portable DNR. You just choose to not be informed of this, despite all the educationalmaterials being at your fingertips.
[...]
No, actually I did. However, I think thebterm "portable" is being used in two different ways. As I read the FAQ document you referenced, I take this to mean that the form itself is portable in that the patient can carry it with them from one health care facility to another, where it obviously will be recognized as a valid physician order.
Portable, as used with the North Carolina medical order for scope of treatment (MOST) form, means just that: It is a legal document documenting the patients wishes anywhere in the state of North Carolina, in any setting.
1 hour ago, Gillyboo said:
[...]
I mean, and why would a DNR patient even have an ambulance called in the first place? They clearly don't need or want a paramedic. But okay. Say someone called 911 for someone else, despite the patients family, "all agreeing" to it (which again, if they did agree, they obviously wouldnt call an ambulance, and also, its the patients decision, and a DNR tells you that much, which should be enough, considering that its legally enough!!) But yeah lets say someone called for a medic anyways.. WHOOPS!! No they didn't [emphasis added].
[...]
This is where it becomes muddy. In another post you mentioned the "reasonable person standard." If someone calls EMS the expectation is that the person calling did so knowing the patient's wishes, however this isn't always the case. As I understand your form the patient, or their durable power of attorney, can revoke the DNR at any time. If the family is in disagreement, this become most important as the patient's wishes become less clear.
1 hour ago, Gillyboo said:
[...]
Imcalling BS across the board on this one. Jeez.
This is why I am so disappointed in this thread.
Please don't misread my post. It is not my intent to be argumentative. Rather, I'm trying to ask questions and provide some clarity on this topic, as it is an important issue. And, bear in mind none of my experience with this is in Florida.
Including my time as a paramedic I have nearly 35 years in healthcare. As during this time I have seen patients, and participated in their resuscitation that, in my opinion, where either unwanted or not in the patient's best interest I agree with you, and have said for years in the states that I have practiced in that there has to be a better way to ensure that the patient's wishes are both known and honored.
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?
I mean they are your coworkers, not your patients. I don't care to know my coworkers' code status. Their health and code status are private. I have enough to worry about without adding some more to my plate.
Just write down a will and pick a medical proxy if you're that worried.
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
On 4/8/2021 at 8:32 PM, Gillyboo said:
...Thats AFTER having to suffer for an extra two days in pain because some moron couldnt respect the laminated signed legal DNR form that me and my doctor signed together, that I intentionally hang daily from my ID lanyard...
Logistically I think this is where it may be hard. If a staff member goes down in the middle of the shift, it’s going to be a chaotic scene of course and I’m not sure if people are going to be checking for DNRs on a lanyard (or near the time clock like someone else weirdly mentioned). I say this from the perspective as a float nurse who doesn’t have those deep connections with floor staff since I’m only on a unit every now and again - maybe these are normal conversations that floor staff have with each other so they’d know if Gillyboo drops in the middle of the shift that Gillyboo is DNR. But as an “outsider” I don’t know this, so I’m going to do the prudent thing that I’m legally obligated to do and initiate resuscitation efforts.
That being said - I’m in my 30s and am a DNR myself. I don’t think someone’s age should have any determining factor on why they would be DNR. I started my career in PICU and over my years have unfortunately seen and participated in my resuscitation efforts that should have never happened which is eventually what led to me deciding to choose DNR for myself. But I wouldn’t hold it against any coworkers who didn’t know I was a DNR if they initiated CPR on me.
because some moron couldnt respect the laminated signed legal DNR form that me and my doctor signed together, that I intentionally hang daily from my ID lanyard.
First off, I wouldn't call people "moron", it's not appropriate; you put a DNR on a lanyard and expect people to check it, it' s unrealistic. Pick a medical proxy and just make sure that your DNR status is reported officially, not on a lanyard.
You can also pay for your own funeral in advance, they have programs for that and cremation is pretty cheap compared to a regular funeral. The same can be done for your bills (if you're that worried about the electric bill). You can set money aside for that. Consult an attorney for a will.
The sticking point of this post is what would happen if the OP (or any other coworker) were to experience such a traumatic episode while on duty. I doubt I'd be looking for some necklace lanyard. Or some bracelet.
You just don't expect a coworker to go down while on duty.
I'd just kick into gear and all the emerg protocols would fall into place. NO delay or second thoughts.
Back to the original topic, I can tell you as a paramedic for 18 years and as an ER nurse for 11+, we resuscitate until we learn that we shouldn't. We received plenty of coding patients from a particular nearby facility who never seemed to have that DNR order at hand until later. But what is done can be undone, lifesaving measures can be withdrawn and terminated, and if the patient goes, they go. If they survive, they were probably meant to. Anyone found down that arrives as a Jane/John Doe is going to get the full measure of our efforts.
SilverBells , you can have a living will put into place with specific directives. You can make your family aware, and it will be up to them to ensure your wishes are followed. Your own personal "code status" has zero bearing where you are not a patient.
The tricky thing about coding a patient is that it's relatively easy to flog a heart back into beating a short time after cardiac arrest, but long after any meaningful neurologic function is salvageable. This makes it frequently possible to put someone into a potentially tortuous limbo which doesn't just resolve itself if treatments are then withheld, so once that's done, how are you saying it "can be undone"?
Statutes regarding DNR requirements vary by state, typically non-Providers can only act on a DNR when the actual order is present if there is no legally-designated decision maker available to communicate that, but if the Provider is aware there is a DNR order on file at the nursing home I'm having a hard time imagining why they would be justified in not pursuing that information.
I mean they are your coworkers, not your patients. I don't care to know my coworkers' code status. Their health and code status are private. I have enough to worry about without adding some more to my plate.
Just write down a will and pick a medical proxy if you're that worried.
Not saying anything should be added to anyone's plate or that we should all know all of each others' code statuses. However, I would think that if one person was a DNR/DNI and was adamant about being so, there would be ways of ensuring those wishes are respected should the need come to be.
First off, I wouldn't call people "moron", it's not appropriate; you put a DNR on a lanyard and expect people to check it, it' s unrealistic. Pick a medical proxy and just make sure that your DNR status is reported officially, not on a lanyard.
You can also pay for your own funeral in advance, they have programs for that and cremation is pretty cheap compared to a regular funeral. The same can be done for your bills (if you're that worried about the electric bill). You can set money aside for that. Consult an attorney for a will.
That's actually a good idea to pre-plan/pre-pay for your funeral. Wondering if there is a good way to communicate those wishes to coworkers as well? For example, in the event SilverBells unexpectedly passes away, please contact AGoodLife Funeral Home? And, before anyone says this completely nuts, there are actually some internet websites that encourage funeral planning in one's 20's and 30's.
First off, I wouldn't call people "moron", it's not appropriate; you put a DNR on a lanyard and expect people to check it, it' s unrealistic. Pick a medical proxy and just make sure that your DNR status is reported officially, not on a lanyard.
You can also pay for your own funeral in advance, they have programs for that and cremation is pretty cheap compared to a regular funeral. The same can be done for your bills (if you're that worried about the electric bill). You can set money aside for that. Consult an attorney for a will.
I would assume "lanyard" refers to a necklace? If so that's a common way to communicate that you are DNR, either a necklace or a bracelet, if there are 50 different cards with various things on them attached to the lanyard then no, you aren't going to through them looking for a DNR notification, but if it's plainly visible than that is a commonly accepted way of making it "reported officially".
State statutes vary on how the DNR must appear, where it's valid, and who it's valid to, but it's not useless either.
That's actually a good idea to pre-plan/pre-pay for your funeral. Wondering if there is a good way to communicate those wishes to coworkers as well? For example, in the event SilverBells unexpectedly passes away, please contact AGoodLife Funeral Home? And, before anyone says this completely nuts, there are actually some internet websites that encourage funeral planning in one's 20's and 30's.
This information should be given to the family members, not coworkers. I go to work to work, not to take care of my coworker's end of life wishes while he/she is on the job. Stick the person in a bed with a pt ID bracelet and then I will be interested.
I gave the information to the poster, I am not discouraging the planning of funerals.
Wow thank you for this thread. I've never told anyone at with my wishes, I've only told them if I fall out at work, y'all better make sure my butt gets transported straight to Grady Memorial even if you have to drive me yourself.
The sticking point of this post is what would happen if the OP (or any other coworker) were to experience such a traumatic episode while on duty. I doubt I'd be looking for some necklace lanyard. Or some bracelet.
You just don't expect a coworker to go down while on duty.
I'd just kick into gear and all the emerg protocols would fall into place. NO delay or second thoughts.
The sticking part of the post is that there was a reasonable expectation of their coworkers respecting their right to refuse, via a legal and binding signed official DNR hanging from their lanyard which you would be touching anyways to move out of the way. If this person fell and was without pulse and breath, IT isn't GOING TO MATTER IN THE SLIGHTEST BIT TO THEM THAT YOU FLIPPED THE LANYARD OVER WHILE YOU WERE MOVING IT, TO CHECK FOR A DNR FORM.
I mean, OMG. It takes LESS THAN A SECOND to glance at someones lanyard.
If I am A DEAD DNR, you should NOT have survivors guilt for not being the HERO.
Thats called having a hero complex. It's your way or the highway, and looking at the back of an ID that would likely have to be removed or moved anyways, is NOT asking you for anything other than recognizing that in this case, offering care at death is absolutely refused and is completely LEGAL and perfectly ACCEPTABLE for you to RESPECT that wish.
Its about RESPECT. NOT YOU. NOT YOU NOT YOU NOT YOU.
chare
4,376 Posts
I presume, as you've quoted me in this response, that this is directed to me. As a paramedic, if I responded to a facility in which a DNR order could be in place I always asked if the patient had a DNR order in place, and if so obviously honored it. However, if I responded to a location where a DNR might not be expected, this is a different situation, and can vary widely from state to state. If the patient's family was aware of the patient's wishes and made these wishes known, and all family members were in agreement, thisbwas an easy decision; I would not initiate a resuscitation. However, and this in my experience was the norm, if the patient's wishes were not known or the family wasn't in agreement, my options were limited. I would contact medical control while initiating the resuscitation.
No, actually I did. However, I think thebterm "portable" is being used in two different ways. As I read the FAQ document you referenced, I take this to mean that the form itself is portable in that the patient can carry it with them from one health care facility to another, where it obviously will be recognized as a valid physician order.
Portable, as used with the North Carolina medical order for scope of treatment (MOST) form, means just that: It is a legal document documenting the patients wishes anywhere in the state of North Carolina, in any setting.
This is where it becomes muddy. In another post you mentioned the "reasonable person standard." If someone calls EMS the expectation is that the person calling did so knowing the patient's wishes, however this isn't always the case. As I understand your form the patient, or their durable power of attorney, can revoke the DNR at any time. If the family is in disagreement, this become most important as the patient's wishes become less clear.
Please don't misread my post. It is not my intent to be argumentative. Rather, I'm trying to ask questions and provide some clarity on this topic, as it is an important issue. And, bear in mind none of my experience with this is in Florida.
Including my time as a paramedic I have nearly 35 years in healthcare. As during this time I have seen patients, and participated in their resuscitation that, in my opinion, where either unwanted or not in the patient's best interest I agree with you, and have said for years in the states that I have practiced in that there has to be a better way to ensure that the patient's wishes are both known and honored.
Best wishes.