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?
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
15 minutes ago, Gillyboo said:
No. You are twisting it all around as usual. Someone used the example of their mom having a DNR and having metastatic breast cancer who had difficulty breathing, and their entire mentality is apparently that her asking her family to call for rescue is somehow a means of justifying negating the DNR order.
I wasn’t using that example of my mom as a means to justify negating a DNR order. At all. I’m not sure how you came to that conclusion. I was using it in regards to your snarky comment that someone with a DNR shouldn’t have an ambulance called because they don’t “want or need it.”
I wasn’t using that example of my mom as a means to justify negating a DNR order. At all. I’m not sure how you came to that conclusion. I was using it in regards to your snarky comment that someone with a DNR shouldn’t have an ambulance called because they don’t “want or need it.”
I have made two examples on calling an ambulance, for someone with a DNR. Again, you are completely missing the entire point LOL but lets go ahead and go over this AGAIN. .
If someone has DIED (unconscious, with no pulse, no breathing) and has a DNR, then you shouldnt be providing them with BLS, regardless of how YOU feel about their age and health, and regardless of whether YOU agree with their decision to refuse care once they are dead. So, dead person with a DNR, portable or otherwise- JUST DO NOT RESUSCITATE. Very simple.
Now the cancer patient. Shes alive, shes alert and oriented. Shes not dead. She has some sort of breathing problem. The person that described this did not say she was in respiratory distress. Just that she was having a breathing problem.
Her needing an ambulance ALSO has NOTHING to do with her DNRO becsuse SHE ISN'T ACTUALLY DEAD. Shes also actively asking for rescue.
Her DNRO has ZERO bearing on that, since YOU KNOW SHE WANTS RESCUE.
Obviously a DNRO can be rescinded immediately, even if only temporarily.
I think one would ask her if she still would NOT want chest compressions, and rescue breaths or if shes just looking for maybe oxygen support or albuterol and a nebulizer. I mean if shes talking, and asking for rescue, you cant also just assume that its a call for BLS just by wanting rescue. She may STILL not want BLS.
Im sure thats gonna have yall doing some serious mental gymnastics but it is what it is.
If a person is communicating wanting medical assistance, it doesnt mean they want to have heroic measures taken. It could just mean they are not liking the process of dying and just want it to go a little easier.
She wasnt in respiratory distress. If she was, the nurse who wrote about it would have said as much.
Having a DNR is not the equivalent to not wanting medical care. People don't sign a DNR with a death wish, quitting their blood pressure meds and Trelegy treatments. Thats not how it works.
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
6 minutes ago, Gillyboo said:
I have made two examples on calling an ambulance, for someone with a DNR. Again, you are completely missing the entire point LOL but lets go ahead and go over this AGAIN. .
If someone has DIED (unconscious, with no pulse, no breathing) and has a DNR, then you shouldnt be providing them with BLS, regardless of how YOU feel about their age and health, and regardless of whether YOU agree with their decision to refuse care once they are dead. So, dead person with a DNR, portable or otherwise- JUST DO NOT RESUSCITATE. Very simple.
Now the cancer patient. Shes alive, shes alert and oriented. Shes not dead. She has some sort of breathing problem. The person that described this did not say she was in respiratory distress. Just that she was having a breathing problem.
Her needing an ambulance ALSO has NOTHING to do with her DNRO becsuse SHE ISN'T ACTUALLY DEAD. Shes also actively asking for rescue.
Her DNRO has ZERO bearing on that, since YOU KNOW SHE WANTS RESCUE.
Obviously a DNRO can be rescinded immediately, even if only temporarily.
I think one would ask her if she still would NOT want chest compressions, and rescue breaths or if shes just looking for maybe oxygen support or albuterol and a nebulizer. I mean if shes talking, and asking for rescue, you cant also just assume that its a call for BLS just by wanting rescue. She may STILL not want BLS.
Im sure thats gonna have yall doing some serious mental gymnastics but it is what it is.
If a person is communicating wanting medical assistance, it doesnt mean they want to have heroic measures taken. It could just mean they are not liking the process of dying and just want it to go a little easier.
She wasnt in respiratory distress. If she was, the nurse who wrote about it would have said as much.
Having a DNR is not the equivalent to not wanting medical care. People don't sign a DNR with a death wish, quitting their blood pressure meds and Trelegy treatments. Thats not how it works.
I’m not sure why you’re trying to school me on what a DNR is and means when I’ve been very directly vocal that I support DNRs in every scenario. And again not one single person on this thread has said that DNR equals not wanting medical care, so I don’t understand why you’re jumping to that conclusion as if posters have said that.
Your unnecessary condescending tone is very hard to look past but I will try.
I was the nurse who posted about the cancer patient who was my mom. I stated she felt like she was suffocating, which sounds like respiratory distress to me but that’s irrelevant. The sole point of my example was because YOU ignorantly made a snarky comment saying that someone who was DNR shouldn’t have an ambulance called because they don’t need it. YOU said that, those were YOUR words. I was providing an example as to why someone with a DNR may have an ambulance called, because YOU made a statement that said otherwise.
Her DNRO has ZERO bearing on that, since YOU KNOW SHE WANTS RESCUE.
Obviously a DNRO can be rescinded immediately, even if only temporarily.
I think one would ask her if she still would NOT want chest compressions, and rescue breaths or if shes just looking for maybe oxygen support or albuterol and a nebulizer. I mean if shes talking, and asking for rescue, you cant also just assume that its a call for BLS just by wanting rescue. She may STILL not want BLS.
Im sure thats gonna have yall doing some serious mental gymnastics but it is what it is.
If a person is communicating wanting medical assistance, it doesnt mean they want to have heroic measures taken. It could just mean they are not liking the process of dying and just want it to go a little easier.
She wasnt in respiratory distress. If she was, the nurse who wrote about it would have said as much.
I appreciate that you realize an ambulance may be called for other problems that attenutation of DNR related wishes.
AND YOU DON'T KNOW she was in the process of dying.
Try to get over your fear oF CPR, bones breaking and death. PLEASE
OK so lets just recap here, and skip the red herrings.
The opening post is in reference to whether nurses will respect someones DNR.
All that has been said, by those who clearly don't have an active DNR, regarding a fellow nurse dying at work have been the following, some paraphrasing, of course:
"Get a medical proxy"
"I cant be expected to check your lanyard for a DNRO"
"Posting a DNR by the time clock (where most hands on health care facility BLS workers clock in and everyone can see it- sic) is not going to work"
"How do I know it (the one the fellow nurse is actively wearing as she died) is a current DNR?"
"Funeral planning is important"
"Younger people with NO terminal illness should get a mental health evaluation, for even wanting a DNRO"
"Its none of my business"
"I am just going to react, without consideration and therefore all of your official and clearly publicized advance directive wishes are simply not my problem."
"Oh, the language in this section says "may honor" and it doesnt mean anything that the law states that the DNRO is REQUIRED to be honored. So lets discuss this MAY word shall we, since it really works for ME."
"Even if you and your doctor have signed a DNR, and you are actively wearing it, and posting it for all to see, and telling everyone thats what you want, if your surrogate or proxy says otherwise, we will simply ignore your DNRO."
"In the absence of a health care surrogate or proxy, with power of attorney, if nobody is around to speak for you, I don't care if you are HOLDING A SIGNED DNR or taping it to your chest. I will force my will upon you and initiate BLS."
Obviously all of these folks are repeatedly saying "Oh I respect a dnr for someone who is inpatient," etc but this thread just isn't ABOUT ADMITTED PATIENTS.
And your answers, are obviously, a resounding No.
Keep trying to backpedal.
WHATEVER!! WHAT A JOKE. don't CALL YOURSELVES RESPECTFUL NURSES IF YOU CANT HANDLE RESPECTING A DNR FOR A COWORKER.
Sometimes people are dying and are wanting pain meds or a breathing treatment only, to prolong life. What they do NOT want is HEROIC MEASURES.
IDK why this is so doggone difficult.
So, OK. You have stage 4 lung cancer. You are on oxygen. You have shortness of breath and need some added care. You have a DNR. Asking for care from a medical professional is NOT the equivalent to rescinding a DNR.
When in doubt, ASK THE PERSON WHO HAS THE DNR IF THEY ARE RESCINDING IT. They are the ones who are still alive and its their wishes you are trying to respect.
I appreciate that you realize an ambulance may be called for other problems that attenutation of DNR related wishes.
AND YOU DON'T KNOW she was in the process of dying.
Try to get over your fear oF CPR, bones breaking and death. PLEASE
Holy crap once again here we go. It's not UP TO YOU to determine whether someone else has rescinded their DNR.
The object of the post is to determine if you would respect someones DNR.
And yes someone with metastatic breast cancer is indeed dying. LOL give me a BREAK. We are all dying actually. Some people just get the misfortune of learning about how it will actually happen.
And don't TELL ME TO JUST GET OVER IT.
I will have a DNR no matter what you think of ME and my so called "fear of broken bones and death" lmao
I don't want CPR because it is INEFFECTIVE at keeping people going. Who wants to spend an added day or two in a bed, alone and suffering? No thanks!
Some of us have suffered enough LOL and thats why we actually have compassion for other people who are suffering, or in this case, are dead and want to be left alone, so as they don't have to continue or begin suffering in their last days. And it is their last days, because it doesnt even WORK between 70 and 90% of the time. Out of those small percentages of "lucky ones" only 10.6% are ever discharged alive.
And you thought I was crazy. Laughing my head off. Please respect my rational decusion making skills and JUST KEEP YOUR HANDS OFF. THANKS.
Again. (Ad nauseum) please read this site. And the site for your state.
Please LEARN about this. People are trying to help YOU learn that YES YOU ARE REQUIRED TO HONOR THAT FORM.
The place where it says that some facilities may have their own forms, just means that they have an additional form. Thats administrative. They simply MAY have their own internal form..
I realize this sites wording is a little non specific.
But since you are trying to claim that this page is some kind of written in stone verbatim law, then how can you explain that when 911 is called that "hemmorhage control, oxygen administration and pain management WILL be used?"
Maybe it will maybe it won't. I doubt that their word usage of the words WILL BE USED and MAY are being taken as literally as you want to think they are.
Or "EMS and Hospitals are not obligated to honor a form if it is completed on white paper" I mean, they arent actually talking about the bricks that surround the doctors and nurses, when they say Hospitals, lady.
This is the reasonable person standard just being WHOLLY MISSED.
Reasonably, if I have a portable DNR, on my lanyard, you have a DUTY to protect my right to choose even when I am dead, no matter where I am, within the state of Florida.
And yes it says EMS are required. Now, just knock it off, and have some respect for people who JUST don't WANT TO BE RESUSCITATED. My God, we just want to die when its our time. Preferably in our sleep, and without pain, LOL isn't that what everyone wants?
In any event. Now you know. No more exuses and deleting stuff I (we) already got in my (our) gmail boxes. LOL
My apologies for that. As I opt not to receive notification when my posts are quoted or responded to, I was unaware that you would receive a copy of the post.
1 hour ago, Gillyboo said:
[...]
Again. (Ad nauseum) please read this site. And the site for your state.
Please LEARN about this. People are trying to help YOU learn that YES YOU ARE REQUIRED TO HONOR THAT FORM.
[...]
Assuming your use "this site" refers to the information you referenced regarding the FL DNR, I have. As I stated in my posts, I don't think that that section discussing EMS means what you think it does. If I were practicing as a paramedic in FL, I would ensure that I was fully aware of what the intent was, and where it was valid. And, as I have stated previously, unless my protocols or medical control directed otherwise, I would have no problem honoring your DNR if I was aware you had one.
1 hour ago, Gillyboo said:
[...]
In any event. Now you know. No more exuses and deletingstuff I (we) already got in my (our) gmail boxes. LOL
Im just... I shouldnt have toBEG.
This is the reason I deleted my post. You are so personally involved in this that, in my opinion, you are unable to discuss this logically and civilly.
I sincerely wish you the best.
ETA: Strikes colors and withdraws from field of battle.
JadedCPN, BSN, RN
1,476 Posts
I wasn’t using that example of my mom as a means to justify negating a DNR order. At all. I’m not sure how you came to that conclusion. I was using it in regards to your snarky comment that someone with a DNR shouldn’t have an ambulance called because they don’t “want or need it.”