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?
What state are you in? Because thats the only way anyone can help you learn how to let your coworkers know what to do and what counts and doesnt count.
Oregon law is different from Florida law. I will say that since researching Oregon law for another nurse, I have yet to find any portable DNR provisions, but the long and the short of that is probably going to be posting an official DNRO at your work station while keeping a copy on your person, and letting co workers know your wishes.
Connecticut requires a DNR bracelet, even outside of hospitals, which is by law.
Florida has a portable yellow DNRO card which simply allows us to clip it to the name tag holder on our scrub uniforms/ lab coats etc.
Just tell me what state you are in and I will see if theres anything you havent done that will help your coworkers to know your health care choice as a DNR status.
Im literally about to make a website dedicated to DNRO orders and state to state requirements.
I mean, this is just ridiculous. Most of these people really just don't know how to do their duty of checking, and then theres a few that obviously are ambivolent to heeding anyones wishes that arent family or a close personal friend.
But alas. Your health care choices DESERVE respect.
Every one of them. So name a state you need DNRO info on and I will be glad to help.
You can pm me, if thats even a thing on here. LOL
Xo much love and respect to you.
Without going into more details regarding my location, I've done some looking and, with my luck, it turns out I live in a state with "stricter" requirements. Hence, it will be challenging to make my wishes known, let alone have them respected. Not sure why something like this has to be this difficult.
Specializes in Psych (25 years), Medical (15 years).
1 minute ago, SilverBells said:
??
As a kid, my parents would take us once year to the St. Louis Zoo. On one particular trip, we passed a humongous graveyard. My Dad asked us kids, "Do you know how many dead people there are in that graveyard?"
OP - playing Devil's Advocate, do you know any of your co-workers' code status???
If one of them keels over, what will YOU do???
This is what I'm asking with roles reversed.
Well, I mean, I really think this is a good question, and it really is the meat and potatoes of this entire post.
A lot of people believe that only people who are actively dying will have a DNR, and therefore, they won't have to worry about their coworkers who are working and not expected to code. These same coworkers are expected to be totally on board with being a full code, but thats obviously just not the case.
So, look. Now, really. Are you aware that Silver Bells is a DNR? Yes you are.
If this was your coworker, then chances are, *you* would know SB is a DNR.
The question led to a lot of open and honest discussion about how different states have different guidance on DNROs. Alabama calls them DNARs (Do not attempt resuscitation) and any competent adult person can get one. Doctors can also issue DNARs to incompetent patients under certain circumstances.
Theres just not a lot on the actual DNAR issue there, AND they only apply or offer DNARs when the Natural Death Act comes into play, where a person becomes terminally ill or death is imminent. So its similar to how a lot of people here think of DNRs.
But competent people of any age can still GET a DNAR, even in Alabama. It's a means of protecting yourself and your family and even courts, from having to make decisions for you is all, if you become partially brain dead and are unable to eat, or you die or whatever. Some of us just don't want to be zombies.
Please see the Terri Schiavo case, for more info. Poor thing was kept alive on a feeding tube for what felt like EONS. 1998 to 2005. She was PVS.
But I digress. The language for Alabama's Natural Death Act may lead to confusion. Thats going to need to get fixed.
So anyways this is what all the confusion is about.
And thats why we have to be familiar of our states laws.
So for Silver Bells the issue is what state is she in and whats their guidance. If statutory guidance is limited, then an identifying bracelet is a big help, and carrying the form in a pocket also helps. This allows rescuers to know that they are looking for a DNR to honor her final wishes.
And talking about it is never a bad idea either. ?
The criteria is pretty strict, SilverBells. And sadly, I'm not sure if you meet any of them:
1. Old
2. Sick
3. In your right mind
1. Old--"old" is subjective. To a 5 year old, someone my age would be considered "old."
2. Sick--does sick and tired count for this one? LOL
3. In your right mind--says who? LOL. It must be said that making decisions that others don't agree with doesn't necessarily mean someone isn't in their right mind. To each their own, though.
Well, I mean, I really think this is a good question, and it really is the meat and potatoes of this entire post.
A lot of people believe that only people who are actively dying will have a DNR, and therefore, they won't have to worry about their coworkers who are working and not expected to code. These same coworkers are expected to be totally on board with being a full code, but thats obviously just not the case.
So, look. Now, really. Are you aware that Silver Bells is a DNR? Yes you are.
If this was your coworker, then chances are, *you* would know SB is a DNR.
The question led to a lot of open and honest discussion about how different states have different guidance on DNROs. Alabama calls them DNARs (Do not attempt resuscitation) and any competent adult person can get one. Doctors can also issue DNARs to incompetent patients under certain circumstances.
Theres just not a lot on the actual DNAR issue there, AND they only apply or offer DNARs when the Natural Death Act comes into play, where a person becomes terminally ill or death is imminent. So its similar to how a lot of people here think of DNRs.
But competent people of any age can still GET a DNAR, even in Alabama. It's a means of protecting yourself and your family and even courts, from having to make decisions for you is all, if you become partially brain dead and are unable to eat, or you die or whatever. Some of us just don't want to be zombies.
Please see the Terri Schiavo case, for more info. Poor thing was kept alive on a feeding tube for what felt like EONS. 1998 to 2005. She was PVS.
But I digress. The language for Alabama's Natural Death Act may lead to confusion. Thats going to need to get fixed.
So anyways this is what all the confusion is about.
And thats why we have to be familiar of our states laws.
So for Silver Bells the issue is what state is she in and whats their guidance. If statutory guidance is limited, then an identifying bracelet is a big help, and carrying the form in a pocket also helps. This allows rescuers to know that they are looking for a DNR to honor her final wishes.
And talking about it is never a bad idea either. ?
In my state, a bracelet can be worn, but I better make sure the document is actually on me. And actually obtaining the exact orders in my state is tough too. I like the idea of the POLST, but it seems to be restricted to only people who are seriously ill. A healthy person can get an advanced directive but it is pages long which would be a hindrance in any emergency and also requires two witnesses as well.
However, at my work place we take verbal orders all the time...
Perhaps a verbal order from me will suffice? No CPR at any time? ?
SilverBells, BSN
1,108 Posts
Without going into more details regarding my location, I've done some looking and, with my luck, it turns out I live in a state with "stricter" requirements. Hence, it will be challenging to make my wishes known, let alone have them respected. Not sure why something like this has to be this difficult.