As a RN, which would you choose?

[GenieToBe]

Quite recently a friend (non clinical) asked me whether hypothetically if there was a medically critical situation would i choose a life saving intervention or otherwise? Instead i showed her my necklace which i always wear which states "Do Not Resuscitate in an emergency". She was shocked.

Now this decision was not done lightly. I have witnessed and performed many CPR's in my time. Personally i do think that CPR is an invasive, burdensome and punishing procedure. However, i would not deny anyone seeking this intervention.

Would you choose CPR or DNR? Kindly share your opinions.

[NutmeggeRN, BSN]

Yeah... "DNR" should also stand for "Dead N Ready"!

My DNR cites specific circumstances and my loved ones have been quizzed on and are aware of my wishes.

There really are no insurance polices, but I find comfort in proclaiming my desires.

Besides, as a kid, I learned from watching old Elvis movies that chicks really dig guys who are DNRs!

[ATTACH=CONFIG]27557[/ATTACH]

You never fail to amuse me!

[Have Nurse, ADN, RN]

That's a good question. I am 62, though I look 48. While prepping for shoulder replacement last year, I was asked if my "heart stopped, would you like to be resuscitated?" I gave them an immediate "no." He looked at me in surprise. For me it's non-medical. I miss those who have gone before me, and I am pretty much alone in the world except for me and my cat. I have lived a full life with a few regrets of course. I have joy in my life and I am not depressed or anything like that. My own experiences in life have taught me some valuable lessons that I try to pass on when it seems appropriate. But when God calls, let me go.

[cleback]

For me, having seen some of the people who were resuscitated and had poor neurological recovery, I'd rather not have cpr done. Death is hard on a family, but taking care of the incapacitated is hard too. Not sure if I would be OK with my kids being tasked with that for the rest of my not-so-meaningful-at-that-point life.

[Hoosier_RN, MSN]

The question is a bit simplistic.

Did I stop breathing after 3 minutes underwater, or has the cancer metastasized so thoroughly that I can't even make my wishes known?

If I needed a resuscitation for something that was reversible with a good recovery expected, go for it.

If it was likely that I would be significantly debilitated by resuscitation, let me go.

I am all for maintaining a high quality of life, and not prolonging death.

But, in your picture, you look young for a DNR. Question- you walk into the ER for a fairly benign complaint, and go into a lethal dysrythmia, easily correctable with a shock. Do you want the shock? What about an accidental overdose- want Narcan?

I voted, but had these questions as well

[BzyNL8]

My thoughts exactly.

I wrote my own POA and had it notarized by my local bank before a major elective surgery about 3 years ago. It lays out how long I agree to be intubated and how I should be extubated with comfort care if "x" amount of time has passed with no real progress as defined by specific criteria and two physicians. I even name what drug I want for comfort because I went through a hospitalization and found out that Morphine, even in high doses, does not work on me.

I am very specific about feeding tubes, hydration, etc. I keep it in my wallet. I also was very clear in my language that no one in my family has the right to override my well thought out decisions.

I've seen too many people be subjected to cruel interventions which only threw a painful, expensive, and very temporary roadblock towards their end of life. I watched a bad elective intubation on a 96 year, 95 lbs., frail old woman turn into two emergent chest tubes after her neck blew up like a cartoon character. That night the daughter asked me if it would be ok to let her mom go. After I educated her on her options, she made mom a DNR, and shipped her to hospice. She wrote me the most beautiful, heartfelt letter stating she was sitting peacefully at her mom's bedside at the hospice facility. It was the most beautiful letter I have ever received from a patient or family. It made me cry. She said no doctor would talk to her straight about the option of making mom a DNR prior to the bad intubation and her mom would never have chosen this for herself.

So many family members try everything due to lack of clear end of life education or a pure sense of their own guilt rather than what is best for their family member. I always say two things in my education. The first is "just because we have technology doesn't mean we should use it on everyone," the second is "whatever decision you make, try to think about what your mom (dad, husband, etc.) would choose if they had the ability, instead of what you want, and if you really don't know what they want, whatever decision you make is the right decision and we are here to fully support you." A few times I've seen the decision maker exhale with relief right before me, as if they have been relieved of a great burden.

As far as the DNR necklace... be careful and investigate your laws. Here is an interesting article regarding healthcare workers' obligations when they come upon something like a DNR tattoo. Not sure how a necklace would be interpreted.

The Problem with Actually Tattooing DNR across Your Chest

[emergenceRN17, ASN, BSN, RN]

Did you get this done through your state, if not fyi you will still be getting CPR! As an EMS provider we would never not do CPR because of a necklace a patient had on unless it was a legal for of DNR. Your necklace means absolutely nothing to EMS providers if it isnr legal.

If this were legal I would be getting one for my sister in law ans following her around with it!

I was just about to post the same thing! Jewelry means nothing unless there is a DNR

[broughden]

I agree with the others who have said that it depends on the situation.

Question for the group: As an ED nurse, would you take this necklace as a legal mandate? What happens if you are in the community, someone goes down. You see this necklace. Do you, in fact, not do CPR based on this? I'm not trying to invalidate the views of the OP, and I 100% respect the OP's decision. Just curious, however, what other nurses think about necklace.

I would completely ignore the necklace.

Generally in most states, under good samaritan laws, once you start providing aid to a victim/patient you must continue. So by the time I saw that necklace I would be in the midst of rendering aid and would ethically and legally be required to continue.

[applesxoranges, BSN, RN]

Probably no CPR. I am okay with dying. We all have to die sometime.

Which frustrated me when the ER ICU section creeped on my patient and flipped out that we didn't save a patient who was a dnr and did not want to be vented. They also were frustrating when the fellow was looking in through the window and motioning for us to put a pulse ox on the obviously dying patient. (ER ICU nurse's station has windows into the bays so the ER ICU nurses can see what ICU admit holds they may get). I ignored him.

[ms boogie, BSN, MSN]

Yes, if I am choking on a chicken bone....DNR....You must be kidding me. I think as nurses we have an active imagination and an image of self importance. We are nurses, therefore, we must know everything.... Doctors do not have these completely unfounded conversations. Some nurses on here need to stop being so dramatic and act like professionals when we have conversations. Of course we would not want to be artificially kept "alive" on a vent with tube feedings....but this goes without saying. There are some nurses whom need to just stop....stop with the "all knowing" DNR conversations.... no one wants this to happen to them. And until you have "prepared" patients for procurement you will never truly know the sacrifices made by other humans.

[Racer15, BSN, RN]

I am 33 and a DNR. I've been clear about my my wishes, but I doubt my family would honor them in the moment, which is annoying.

[Night__Owl, BSN, RN]

My husband and my parents know my wishes. As you all know, just about any form of "wishes" including a living will can be overriden by next of kin. So it's more important that they know what my wishes are than having formal documentation. My husband would be my next of kin, but if something such as as car accident happened and we were both incapacitated, my parents would be the next closest.

I'm under 30 and have no significant health issues. I'm sure that in most cases, my husband would choose to have every effort made for me, and at this point I am OK with that. If I get cancer or break my neck, then my wishes may change, which I will share with him at that point. But I see no reason to make a living will right now. When I am old and have fewer kin, or if I've outlived my husband, then it might be the right time to put things in writing.

[Tenebrae, BSN, RN]

Probably no CPR. I am okay with dying. We all have to die sometime.

Which frustrated me when the ER ICU section creeped on my patient and flipped out that we didn't save a patient who was a dnr and did not want to be vented. They also were frustrating when the fellow was looking in through the window and motioning for us to put a pulse ox on the obviously dying patient. (ER ICU nurse's station has windows into the bays so the ER ICU nurses can see what ICU admit holds they may get). I ignored him.

I had a doctor last week who looked at me sideways when I told him I hadnt done obs on a dying patient, nor had I taken a urine spec to see whether they had a UTI

I'm like "doctor this patient is dying, the patient does not want active treatment, nor does their NOK/EPOA, could you just go ahead and chart the palliative meds"