Do Nurse Practitioners Assist In "Pulling the Plug"?

TriciaJ, RN · Aug 3, 2016

I'm pretty sure it would be the family's decision, not yours. Everyone involved would have to be satisfied that there is no hope. Maybe you'll see situations where someone was kept on life support long after it was clear there was no life to support. That can be extremely painful for all concerned.

If you're worried about this, why don't you talk to people who are intimately involved with this type of situation? A hospital ethics committee, NICU nurses, hospital chaplains, etc. I think a better understanding of what is involved might help settle your concerns.

nutella, MSN, RN · Aug 3, 2016

NPs who work as hospitalists are involved in a lot of activity. What the full scope is depends on your state and there is also the question how the hospital utilizes NP. In my state, NP have to enter a working agreement with a physician. The hospital employs NPs as hospitalists but they do not get the sickest and most complex cases. There is an NP in the ICU but there are also intensivists. I am pretty sure that when it comes to "withdrawal of care" the NP would consult with an MD. Usually when a patient is in the iCU and the family considers the withdrawal of care, the rounding team discusses it with the HCP and often there is a family meeting (at least in my hospital).

If you are worried about withdrawal of care you should probably get more information on it. Back in the days when we did not have all the technology or not to the extent, a lot of patients would not even make it that long because of their illness. Now we can push the boundaries of what is possible, but it is not always enough or makes sense! For example - if a person has metastatic disease and now has respiratory failure - does it make sense for that person to be intubated or receive chest compression? It depends on the individual case, the patient wishes, and if it would constitute futile care.

In adult care, having serious illness conversations when a serious illness is diagnosed helps to explore wishes and goals and to come to a conclusion of what extent of treatment a person would want or would make sense.

When baby is born you do not have this kind of preparation in place unless the parents know that the child will be born with a huge defect.

EllaBella1, BSN · Aug 3, 2016

In my hospital it takes notes from two different providers stating that they feel that terminal extubation is a reasonable treatment plan for a patient due to prognosis before we can extubate. In my ICU the NPs can be one of the providers who agrees. If you truly feel that you could never order this or agree with this plan of care then working as a NP in any ICU might be a poor fit. There are many things worse than death- For example, sustaining life in a child who has no chance of ever recovering, and who will continue to decline on a ventilator until the vent is no longer enough to sustain them. A child dying a quiet, peaceful death with family at their side is 10000000000 times better than dying surrounded by a team of RNs and NPs and MDs pounding on your chest, shocking you, forcing air into your lungs, breaking ribs, etc. Remember that.

blondy2061h, MSN, RN · Aug 3, 2016

Are you an RN now? In NP school? Still in RN school but thinking about going to NP school next? I'm a little confused what your role is right now, and feel you may be premature in worrying about this issue. I suspect you have very little NICU, if any, experience, as nurses who have watched the "plug be pulled" typically just feel relief.

blondy2061h, MSN, RN · Aug 3, 2016

In fact, going back to your other posts I see you are a pre-nursing student. That makes this post pre-mature and clearer why you're worrying about things nurses don't see as issues. Also, it means your user name violates the TOS as you're not a nurse yet. You can request to have it changed to something like sunshinenurse2be.

Finally, since you have a very specific structure you want us to answer in at the end, this wouldn't by any chance be homework would it?

BittyBabyGrower, MSN, RN · Aug 4, 2016

In our hospital only attendings can place the order, but NNPs do assist and can pronounce with the fellow.

Sometimes there are are worse things than dying.

SunshineeStudent · Aug 4, 2016

In fact, going back to your other posts I see you are a pre-nursing student. That makes this post pre-mature and clearer why you're worrying about things nurses don't see as issues. Also, it means your user name violates the TOS as you're not a nurse yet. You can request to have it changed to something like sunshinenurse2be.
Finally, since you have a very specific structure you want us to answer in at the end, this wouldn't by any chance be homework would it?

Thanks for responding but no it's not a homework question. I genuinely have anxiety about this. Yes I'm a student as well.

NurseGirl525, ASN, RN · Aug 4, 2016

I'm confused on what you are wanting? Pulling the plug? Lol. That's not what really happens. What happens is MDs have discussions with families about prognosis and options. Then, they leave. Families discuss it, often with the RN. Then, they tell the RN of their decision. The MD may be far away but can put the orders in for comfort care. The RN calls the respiratory therapist because I'm guessing when you say pulling the plug you are talking about a vent. Respiratory extubates the patient. The patient then dies. In some states, 2 RNs can pronounce a death, some need an MD or an NP. Then, the RN handles the rest.

So, are you saying you don't think you put an order in for comfort care? I think you may be a little confused on the actual process of when a family decides to take their loved one off of support. There is so much that goes in it.

My last death, the MD who spoke with the family had pretty much nothing to do what went on the day the patient died. He didn't even speak with the family that day. He rounded about an hour before the family came to say their goodbyes. I paged when they were ready and one of his residents put the comfort orders in, but I called respiratory and held their hands and watched him die.

As a NP or Physician, you do have to have some hard conversations with families. It's part of the job. It's not all happy sunshine and roses in NICU if that's what you want to specialize in. There's a reason those babies are in NICU. They aren't real healthy.

la_chica_suerte85, BSN, RN · Aug 5, 2016

I ask this because I couldn't bring myself to order a child be taken off of life support. Although I am aware it isn't assisted suicide.

It seems that most of the other posts have answered your question fairly well, however, I want to bring attention to the two quoted statements. I don't understand why you're juxtaposing taking a child off of life support with assisted suicide at all. Also, if you've never seen what a child on life support that has been declared brain dead looks like, then you really don't know that you couldn't order life support removed, could you? It's not at all what you seem to think it is. :bored:

VioletKaliLPN, LPN · Aug 5, 2016

Since you are not a Nurse, but a student, I will cut you a little slack in my advice.

Being a Nurse is to advocate for your patients, to serve their healthcare needs at that time. This is not about what *YOU* like, what you do not like, or what you believe is sad or terrible. None of these matter because you are the Nurse, and at that moment the patient matters-not you. If you cannot be an advocate for your patients and families, and uphold dignity and quality of life, I question why you want to be a Nurse.

Some of my best Nursing moments, where I felt as if I really helped people, have taken place during the dying process. Sometimes good "health care" is not just about saving a life, but ensuring a painless, dignified death.

Chrissygraduatenurse, LPN · Aug 7, 2016

[Wow, a person asks a question and you pound on them.......QUOTE=blondy2061h;9140640]In fact, going back to your other posts I see you are a pre-nursing student. That makes this post pre-mature and clearer why you're worrying about things nurses don't see as issues. Also, it means your user name violates the TOS as you're not a nurse yet. You can request to have it changed to something like sunshinenurse2be.

Finally, since you have a very specific structure you want us to answer in at the end, this wouldn't by any chance be homework would it?