DNR Policies in the School Setting

[beachynurse, ASN, BSN]

In our school division, if a student comes in with a chronic illness and has a DNR, and something happens to the student, per our policy we are obligated to initiate CPR and any other life saving measures that we are able to, such as calling 911, etc. The rationale we are given, is that the other students might be upset if they saw us not doing anything to help the down student. A group of us are reviewing policies and are troubled by this policy. We are concerned that by not following the order we can possibly be charged with assault and battery, and or have disciplinary action taken against our licenses. We are also concerned that ethically we are not doing the right thing by our patient by not following the DNR order. What are your school division's policies, and or your thoughts on this matter?

[BrisketRN, BSN, RN]

I would also be concerned about this policy. Given the rationale, wouldn't the nurse or staff--whether the student has a DNR or not--remove all other students from the area if there was a student in distress or cardiac arrest? If you belong to the NASN there are a few really good articles on DNRs in the school setting both on the NASN Journal and the Journal of School Nursing.

[beachynurse, ASN, BSN]

3 minutes ago, BrisketRN said:

I would also be concerned about this policy. Given the rationale, wouldn't the nurse or staff--whether the student has a DNR or not--remove all other students from the area if there was a student in distress or cardiac arrest? If you belong to the NASN there are a few really good articles on DNRs in the school setting both on the NASN Journal and the Journal of School Nursing.

We do remove students from the classroom in those circumstances. We are really questioning this policy, and want to challenge it.

[ruby_jane, BSN, RN]

I would have trouble even attempting to override a DNR that's real and something the parent wants. Especially if it's something the student wants. Having said that we have more actual kids where I wish they had DNRs but never will. In any kind of catastrophic or even non-catastrophic event like fainting or seizure, I always try to move the class out so I can attend to the kid on the floor.

[Flare, ASN, BSN]

If I had a student with a signed DNR in the chart, I'd feel hard-pressed to violate it simply to spare the feelings of the other students. My concerns would be the same - how would this affect my license, could the parents charge with assault, would this be viewed as some sort of negligence or malpractice to knowingly violate an order? Also - I would expect that this document needs regular renewal - annually or sooner (I don't remember how often it needs to be renewed under regular circumstances).

Now, I would imagine it may be handled differently if a different person or staff member were to encounter a student down and initiated CPR, ems, etc , not knowing about the dnr and while waiting for the SN.