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?
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.
Yeah I am hearing you on the difficulty factor 100%.
I wonder if, and hear me out.. because IDK how well this could work, but as long as you have a DNRO and its official, and most of your coworkers are aware, if you could wear a reminder pin on your chest, that says, "My DNRO is in my pocket. Thank you so much."
I mean IDK its a little morbid I guess, but hey its an idea and it JUST MIGHT WORK.
The location is perfect.
Everyone will see it.
And chances are, you probably will die within 3 hours of waking up, on that day. Statistically, people die of heart related issues within 3 hours of waking because thats when the blood is the stickiest. Or so I read in a study a while back.
I really want to help people to get their people, their rescuers, to recognize their DNR status at the time of their emergency.
I really honestly think that as long as one is at work, they will likely have to put some extra effort in, to make that choice clear to others so that they CAN more easily abide by the order.
Im really just trying to help here. Sorry for ticking everyone off, BTW, and for the name calling. I was so mad. I was so upset. And I am TRULY sorry for my language.
Until I started researching the state by state legislation, last night, I never realized how incredibly vague some other states language was on this issue. So the best way to address that is to get super creative and make sure everyone knows at the time what to do.
Well, I mean, I really think this is a good question, and it really is the meat and potatoes of this entire post.
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.
And talking about it is never a bad idea either. ?
Your post on the subject was a very well thought out and informative response. But I think the passion and confusion on this thread is partly because Silver Bells has said that they themselves are a full cor. So a lot of emotions brought up around this post that actually ties in to a different post they made about a hospice patient. And so this feels like first class bamboozling and hornswaggling for secondary gains and not out of real interest or compassion for patients. Looks like the hospice patient died so thankfully that thread was cut short. I guess we'll be thrashing it out over here, but seems exploitative.
Your post on the subject was a very well thought out and informative response. But I think the passion and confusion on this thread is partly because Silver Bells has said that they themselves are a full cor. So a lot of emotions brought up around this post that actually ties in to a different post they made about a hospice patient. And so this feels like first class bamboozling and hornswaggling for secondary gains and not out of real interest or compassion for patients. Looks like the hospice patient died so thankfully that thread was cut short. I guess we'll be thrashing it out over here, but seems exploitative.
Sorry for the confusion. Unsure where the hospice thread ties in as they weren't created to be related to or associated with each other. Yes, currently I am technically a full code, but it is not my desire. I am currently having many difficulties obtaining one, but hopefully will eventually. This thread is meant for when I am successful in obtaining one. And hopefully I don't code until then.
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
1 hour ago, Gillyboo said:
Yeah I am hearing you on the difficulty factor 100%.
I wonder if, and hear me out.. because IDK how well this could work, but as long as you have a DNRO and its official, and most of your coworkers are aware, if you could wear a reminder pin on your chest, that says, "My DNRO is in my pocket. Thank you so much."
I mean IDK its a little morbid I guess, but hey its an idea and it JUST MIGHT WORK.
The location is perfect.
Everyone will see it.
And chances are, you probably will die within 3 hours of waking up, on that day. Statistically, people die of heart related issues within 3 hours of waking because thats when the blood is the stickiest. Or so I read in a study a while back.
I really want to help people to get their people, their rescuers, to recognize their DNR status at the time of their emergency.
I really honestly think that as long as one is at work, they will likely have to put some extra effort in, to make that choice clear to others so that they CAN more easily abide by the order.
Im really just trying to help here. Sorry for ticking everyone off, BTW, and for the name calling. I was so mad. I was so upset. And I am TRULY sorry for my language.
Until I started researching the state by state legislation, last night, I never realized how incredibly vague some other states language was on this issue. So the best way to address that is to get super creative and make sure everyone knows at the time what to do.
Thank you for this post and your apology. It reaffirms what I said in my very original response to you which was that your passion on this subject is very clear, and we need passion like that. Also that this thread, and your research as you said, has also highlighted the needs for more education and standardization for such an important topic. Thank you again.
Your post on the subject was a very well thought out and informative response. But I think the passion and confusion on this thread is partly because Silver Bells has said that they themselves are a full cor. So a lot of emotions brought up around this post that actually ties in to a different post they made about a hospice patient. And so this feels like first class bamboozling and hornswaggling for secondary gains and not out of real interest or compassion for patients. Looks like the hospice patient died so thankfully that thread was cut short. I guess we'll be thrashing it out over here, but seems exploitative.
The confusion is that she WISHES to be a DNR. Thats her end of life wishes, as she just stated in the previous comment.
I was unaware that she was still a full code, but Im not her coworker, am I? And if she is a full code, then it doesnt matter what she wants, shes going to have to wait until shes got an order or some way to deliver her wishes to her coworkers that works well within her facility. Even without a DNR form, its entirely POSSIBLE to have her coworkers, who would then be her "emergency response team" to simply CEASE BLS once a medical proxy is called and they confirm shes a DNR.
So really she could get a health care surrogate or proxy form signed, at least, and have a button on her shirt in the middle with her DNR WISHES and her medical proxy's phone number.
The proxy could potentially keep a medical proxy form of hers on their phone and email it over to her coworker that calls. Or she could carry that proxy form on her as well. If she is making her wishes loud and clear on her person, then there is no reason for her DNR wishes to NOT be granted.
Thats where the confusion is.
Its just the WHOLE WAY THAT IT WORKS that people are obviously completely and utterly confused about.
It HAS to be respected. If someone has a dang bracelet that says DNR on it, check their wallet or purse for a DNRO or medical proxy phone number. No DNR available? Call 911 and start BLS but also have a secondary person call the NOW KNOWN proxy immediately for further instruction, and STOP BLS when they instruct you that the person wishes to be a DNR.
You may even be able to have a HIPAA authorization form drafted, that allows health care workers (rescuers, co workers, emts) to get authorization by phone.
So, theres a LOT more to it than just checking for a DNRO.
Some of that was just a matter of thoughts building up into ideas and (LOL) my thought process.. but at least I figured something helpful out and I genuinely hope it helps. ?
If I want my DNR wishes to be respected, I'll need to have documentation. That's legitimate, however are there any tips on obtaining a DNR/DNI?
The forms that I have found that I could potentially use present some difficulties. First, they require "two witnesses." What happens when one does not have anyone to be a witness? I personally do not have anyone who is willing to be a witness to a DNR/DNI order. Also, is there any chance to have a DNR/DNI without a doctor's signature? I say this due to difficulties in finding a doctor willing to provide a signature.
Any help greatly appreciated. This way I can provide my coworkers the information they need in the event an unexpected emergency occurs at work.
Also, just another thought. Say I’m successful in obtaining a DNR/DNI. Would it also help to provide coworkers with the name and number of a funeral home to call should an unexpected emergency occur during the work day?
If I want my DNR wishes to be respected, I'll need to have documentation. That's legitimate, however are there any tips on obtaining a DNR/DNI?
The forms that I have found that I could potentially use present some difficulties. First, they require "two witnesses." What happens when one does not have anyone to be a witness? I personally do not have anyone who is willing to be a witness to a DNR/DNI order. Also, is there any chance to have a DNR/DNI without a doctor's signature? I say this due to difficulties in finding a doctor willing to provide a signature.
Any help greatly appreciated. This way I can provide my coworkers the information they need in the event an unexpected emergency occurs at work.
Well, imho you are really going to have some issues with this aspect.
Maybe you can do like a little umm anonymous post on craigslist in search of people whose doctors signed their DNROs out of a sheer respect for a patients right to make health care choices. You could at least find a health care surrogate and maybe at least keep in touch via email or something, to make a clear and saved trail of what your choices are. This way, if you don't get a DNRO signed, at the very least you can have a health care surrogate that can advocate for you. You would want a HIPAA authorization allowing your coworkers to call them and discuss your issues and what your needs are, of course. Hell, I will do THAT. I mean, geez if I know what you want, I can easily say "Yeah do NOT resuscitate that person!"
Additionally, this physician who signs the DNRO would, in many cases, have to be your personal physician.
So if all this stuff is out, you are kinda stuck with having a surrogate/proxy and pray that people see your little shirt button, see your surrogate paper, and call the surrogate.
I mean, Im really trying to find a way to help you get your personal choices known and respected, in any way that is legally possible, so these could all really work, even without an official DNRO. The big dnro for someone whose doctor won't sign one, is really going to be via the surrogate (because your opinion matters less somehow than your surrogate's retelling OF your opinions, at least in all these places where they are somewhat restrictive about issuing DNROs).
Ooh FYI.. Arkansas has penalties for all sorts of misdeeds with DNROs. From pretending it isn't there, to making a fraudulent one, .. it all ranges in charges from a misdemeanor to a felony. Kinda nice to finally see that.
Also, just another thought. Say I’m successful in obtaining a DNR/DNI. Would it also help to provide coworkers with the name and number of a funeral home to call should an unexpected emergency occur during the work day?
I answered your previous question, just before this.
No you should discuss funeral home arrangements with your family, husband, children, just whomever is actually planning your funeral.
Your health care surrogate loses any say in anything *after* you die. But it might be a good idea to just put all that stuff in writing and maybe leave it in your desk, and let people know.
The more you tell people, the better your chances of having your wishes protected will be.
You could even say "Look I know you are going to full code me until I have a DNRO or a surrogate to speak for me, but can you AT LEAST kinda just half *** it? For my sake, I hope you do."
LOL
CPR can be low quality. I have yet to see a statute that declares that all CPR efforts should be high quality. So they will be safe from liability.
If it helps, remind them of the average 10.6% actual live discharge rate of people who had CPR, and also, the obvious: If you are dead, then CPR is really only about THEM having an argument with God/the universe about when to take you. Ask them to simply understand that you cant REALLY win that argument. Death isn't optional.
Ooh and OMG I just realized that if needed, you can also petition the courts to assign you a partial (limited) guardian ad litem to solely be your health care surrogate, to help you get the voice you need to confirm to those caregivers what your DNR/ advanced directive wishes happen to be.
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
20 minutes ago, Gillyboo said:
Ooh and OMG I just realized that if needed, you can also petition the courts to assign you a partial (limited) guardian ad litem to solely be your health care surrogate, to help you get the voice you need to confirm to those caregivers what your DNR/ advanced directive wishes happen to be.
Ooh la la, Im on a ROLL!!
Oh I am SO making a website on this. Yaaaah
I think you should definitely continue to advocate for this. Because above all else, I think ANYONE regardless of their age or health issue should be able to chose to be a DNR. Even myself as a healthy-ish person in their late 30s is a DNR due to personal choice.
Surfin USA
105 Posts
Yeah I am hearing you on the difficulty factor 100%.
I wonder if, and hear me out.. because IDK how well this could work, but as long as you have a DNRO and its official, and most of your coworkers are aware, if you could wear a reminder pin on your chest, that says, "My DNRO is in my pocket. Thank you so much."
I mean IDK its a little morbid I guess, but hey its an idea and it JUST MIGHT WORK.
The location is perfect.
Everyone will see it.
And chances are, you probably will die within 3 hours of waking up, on that day. Statistically, people die of heart related issues within 3 hours of waking because thats when the blood is the stickiest. Or so I read in a study a while back.
I really want to help people to get their people, their rescuers, to recognize their DNR status at the time of their emergency.
I really honestly think that as long as one is at work, they will likely have to put some extra effort in, to make that choice clear to others so that they CAN more easily abide by the order.
Im really just trying to help here. Sorry for ticking everyone off, BTW, and for the name calling. I was so mad. I was so upset. And I am TRULY sorry for my language.
Until I started researching the state by state legislation, last night, I never realized how incredibly vague some other states language was on this issue. So the best way to address that is to get super creative and make sure everyone knows at the time what to do.