DNR Status

Published

There seems to be a general disparity in how nurses in my unit view patients with DNR status. Most feel like a DNR being admitted to the ICU is inappropriate period, even if they are sick enough to be in the ICU if they were a full code. I've heard a nurse say...."Well, she's a DNR. I'm going to give the whole 1mg Dilaudid and not worry about the BP." Even my preceptor and other senior nurses whom I respect seem to have adopted this attitude. Our ANM has even refused to accept a patient to our unit who was a DNR.

I just don't agree with this viewpoint. To me, DNR means if someone's heart stops beating or they stop breathing, we are not going to try to restart the heart or breathing. If the patient requires antibiotics, fluids, blood pressure meds, blood, etc., I feel those are reasonable treatments even if a DNR. Unless, of course, if the patient refuses, then that's their choice. If they're sick enough to be in the ICU, I feel like we should accept them. I know it's a fine line, but I guess I view this as an ethical dilemma and I don't really have a good answer for it. I'm also new (5 months) to the ICU, so am I just too naive?

What is your viewpoint? What do you feel about giving blood to a DNR? Does your hospital have a policy on how to treat a DNR patient? Should I just accept this as the way it is?

If that is the way DNR's are treated, I don't ever want me or my loved ones to become a DNR!

Up Vote Up Vote ×

Depends on what the DNR order states! There are many different ways to write a DNR order.

Often times ICU nurses don't want to admit DNR patients. It's also damn near impossible to get anything done for them when you DO try and fix things. The physicians often have the same attitude.

Up Vote Up Vote ×

DNAR orders can be nice but also a pain, ESPECIALLY if the family doesn't quite understand what the point is.

I had a patient die last week who was vented and on pressors, had been on antiarrythmics, for days, even though his wife made him DNR. She just kept changing her mind, and in the end the guy died a pretty dragged out death. I am really against these types of DNR cases, but if someone comes up with bad sepsis, needs lots of fluid, blood, etc. but doesn't look like they're absolutely knocking on death's door, that's fine.

Seems quite often we throw tons of blood products and 1:1 patient care on DNR patients who are bound to die in a week anyways. That's why most nurses don't like DNR patients I think. I've seen that attitude too, you'll get a call for a platelet count of 5,000 and they say "Well time for more platelets, not like it's gonna help anyways." Some times they're right, some times they're not. I've seen DNR patients leave I never figured would make it, but it's often easy to spot out the people who gain no benefit from treatment in an ICU.

Up Vote Up Vote ×
Specializes in ICU, Research, Corrections.

I think it's inappropriate only when you are using your last bed to admit a DNR

patient. I have seen this happen before.

What about the next person that codes on the floor; where will you put them

if they live? You can't put them in the hallway.

Up Vote Up Vote ×

DNR doesn't mean "Do Not Treat".

If there is a viable chance of recovery to the pt's previous quality of life then I have no problem with having a DNR patient in the ICU.

However, if there is no hope of recovery and we are just aiding a long, drawn-out, tortuous, painful ending (thanks to families either in denial or uneducated as to the pt's realistic prognosis and/or docs who refuse to tell the truth and sugar-coat what is going on) then I am against it.

A DNR patient with "comfort measures only" orders has no business being bombarded with labs, q whatever v/s, and invasive treatment...imho. They should be send to a giant private room where all the family can gather and be with them in their last hours without being busted in on every 15min.

Up Vote Up Vote ×
Specializes in Critical Care, ER.

This is an issue that comes up frequently in our hospital as well. I am attaching a link to an excellent article about DNR status. DNR does not and should not be inferred to a refusal of care of treatment!!! Every major group of care providers, including the ANA, have issued statements to this effect regarding DNR orders. The American Nurses Association’s position statement on DNR states: “There should be no implied or actual withdrawal of other types of care for patients with DNR orders.”

http://www.annalsoflongtermcare.com/article/3421

Up Vote Up Vote ×
Specializes in icu/er.

the point is that there are often many icu admissions that dont meet any criteria of icu care. the reasons for their admittance vary, but most of what i have found from my exp. are 1) md tired of getting phone calls from floor nurses. 2) md tired of getting calls from family 3) md wanting critical care charge to help pay off 3rd divorce.

Up Vote Up Vote ×
the point is that there are often many icu admissions that dont meet any criteria of icu care. the reasons for their admittance vary, but most of what i have found from my exp. are 1) md tired of getting phone calls from floor nurses. 2) md tired of getting calls from family 3) md wanting critical care charge to help pay off 3rd divorce.

Yes, I started a thread on Inappropriate ICU Admissions a while back because it was happening often where I work. The joke about our ICU is that it is a "gero-psych" unit with old codgers who pull out everything and won't stay in bed!! We fight over who gets the real ICU patients!!

Up Vote Up Vote ×

The hospital I used to work for, which was my first nursing job, did an excellent job of distinguishing between being a DNR and "comfort care." It was actually two different forms. It was discussed with patients/families exactly what would be done differently between the two as well.

DNR: the patient was fully treated but was not resuscitated if their heart stopped.

Comfort Care: nothing was done, no lab work, no meds other than pain meds if needed, no xrays... Nothing was treated and they were allowed to die if their heart stopped.

The next place I worked was not like that at all! I was shocked really. If the patient was a DNR, the doctors halfway treated them and basically waited for them to die. It was horrible.

I do not agree at all with being upset about giving up ICU beds for DNRs. Patients that are DNRs should be fully treated. Also, if they do code, it is better to have a nurse that only has one other patient to be able to be more available to the dying patient and the family. I wouldn't want my family member dying and unable to get prompt care because the nurse has 6 other patients to pass meds to. Dying patients need attention to be made comfortable and their families need attention. This is something the families will never forget and inadequate nursing care at that time will make their memory of the already upsetting event even worse.

Up Vote Up Vote ×
Specializes in ER, progressive care.

DNR does not mean "do not treat." If the patient requires ICU-level care, pressors, whatever...I personally don't have a problem with it. There was recently a patient who was terminal and had a DNR/DNI order...they actually could have been moved but because the docs wanted CVP measurements, the patient had to stay in ICU.

Now if they don't really meet the criteria and you just filled up your last ICU bed, then that's a problem...

Up Vote Up Vote ×
+ Join the Discussion