DNR Orders

[smartnurse1982]

I just started a new case(maybe a month ago).

Baby is 9 months old trach/vent/tpn.

Needs to be Ambubag a lot(maybe 2x a week)

Anyway,she has a DNR order. It says DNR to be followed at parent's discretion,meaning if her heart or breathing stops,and parents want us to do CPR,we must do it.

He(the nursing supervisor) says because its a child that parents can do whatever they want.

Has anyone heard of similiar situations?

[smartnurse1982]

The first a few weeks ago I acually did "revive" the child(pulse was 28,02 sat was 0),Mom called the Ambulance.

The EMT's looked at me as if I was from outer space because the DNR order is above the bed.

They really didn't want to take her to the hospital.

I had to show them that it said"To be followed at Parent's discretion".

They couldn't understand. They thought it was weird.

[Esme12, ASN, BSN, RN]

It is weird...however as per NJ law the parents/healthcare proxy/POA at any time may revoke the DNR.....I suggest you familiarize yourself with NJ law. http://www.state.nj.us/health/ems/dnr_introduction.shtml

[smartnurse1982]

Which means,if the parent wanted me to Cpr despite the order,I have to do it?

But what if they turn around and say"we didn't want her to do cpr".

Ii would have nothing to stand on but my nurses notes.

[classicdame, MSN, EdD]

agree with smartnurse1982. The written word is stronger than the spoken one. I would certainly want witnesses. And I would want a case manager for that state to explain it to me - not othe parents

[LakeEmerald]

Yes, if the parents say they want you to CPR you have to do it. Your nurses notes are legal documents and will back you up. Which is worse? Not acting when they ask you to and letting the baby die (which can't be undone), or saving the baby's life because the parents had an understandably weak moment? Happens in the ER occasionally. Family members cave in at the last minute, hoping for a miracle.

It sometimes helps if the family witnesses the resuscitation. Also, further education helps prepare for next time. You did the right thing under the circumstances, in my opinion.

[Esme12, ASN, BSN, RN]

Which means,if the parent wanted me to Cpr despite the order,I have to do it?

But what if they turn around and say"we didn't want her to do cpr".

Ii would have nothing to stand on but my nurses notes.

Yes you would....read the link I gave you.

Specifically this one.....http://www.state.nj.us/health/ems/documents/emspolicy.pdf

[classicdame, MSN, EdD]

Thanks, Esme12

[KelRN215, BSN, RN]

This is how it goes in pediatrics. I've seen DNRs written to say things like "intubate for respiratory failure if parents are not at the bedside. Call parents, they will come to the hospital and make decision as to how to proceed."

[smartnurse1982]

Nj has some really,really weird laws.

I better hurry and get back to Delaware.

[caliotter3]

Irrespective of the DNR scenario, my agency supervisors have always supported the parent's right to tell us what to do and how to do it. At the point where I feel pressured to go too far against my better judgment, I would find another case. As often as family members contradict themselves on the little everyday matters, it is not out of the realm of possibility that they would do so in this situation, to the detriment of the nurse.

[smartnurse1982]

Irrespective of the DNR scenario, my agency supervisors have always supported the parent's right to tell us what to do and how to do it. At the point where I feel pressured to go too far against my better judgment, I would find another case. As often as family members contradict themselves on the little everyday matters, it is not out of the realm of possibility that they would do so in this situation, to the detriment of the nurse.

I guess I just don't understand the point of having a DNR if the parents can change their mind at any time.