Help Need advice!

[Sapphy, BSN, RN]

I am The ADON in a nursing home. My DON asked me today to do something which I feel is outside of my scope of practice. Without violating HIPAA, what I can tell you is.... we have a patient who is going bad... twice we have sent him out to the ER because he is a full code. My DON wants me to talk to the family about changing his code status. I told her I felt that it was the physicians job to explain the gravity of his condition and that he should address code status with them. I actually said to her that is out of my scope. She got angry with me and said that I need to make the family understand how bad off he is. I am so not sure what to do here. I have only been in this job 5 months and the DON and the administrator are pretty tight. (The DON has only been there 6 months and she is completely unreasonable and given some of the things I have heard come out of her mouth I don't think that I would trust her clinically either.)

Is there someplace that I can find information about my scope of practice in my state? I tried the Board of Nursing's website but it did not say anything about code status that I could find.

[classicdame, MSN, EdD]

If it is so danged impt. why don't THEY do it? That said, there may be an annotated version of the NPA in your state. I buy one with each revision because it has a little interpretation with each rule. In the hospital we get the social worker to contact the family to see if there are any revisions to be made to paperwork. I don't believe it would be outside your scope of practice to ask the family their intent, but it certainly would be to try and talk them in to anything. WORSE, when the resident dies, the family may suspect foul play. Seems like a risk issue to me for the facility.

[Sapphy, BSN, RN]

I have no trouble discussing the options with this family. But the way my DON is putting it to me... she wants me to convince this family to make him a DNR. As far as I see it, it is up to the physician to make the diagnoses and then discuss those options with the family. Also... when this man's sats are not in the 70's.... he's alert and oriented and he chose to be a full code on admission.

[chenoaspirit, ASN, RN]

I think its sad when a person's wishes are over-ridden once the option is given to someone else (family member). I think a person's wish should be granted. If this person wanted to be a full code, then that is what he should be, IMO. And if the DON thinks otherwise, then he/she should do it themself.

[LesMonsterRN, ADN, RN]

I think it could, especially in LTC, be within our boundaries to bring the option of a DNR up with families when it's appropriate. Sometimes it the LTC nurse that has the better rapport with the patient and family members that would make it more appropriate at times than having the physician talk to them. But, it's a case-by-case, individualistic thing. I have had that particular conversation with families maybe twice in my career but it was never to convince them, just make the suggestion that if they were to in any way consider making their loved one a DNR, it should be done sooner rather than later.

[RNStudent3]

You could talk to the family and just ask them what they are thinking in terms of future treatment. Ask them if they want to know some information on DNR/DNI. If they are interested, they will ask. Either way, you did what she asked. I dont know why this DON even cares if the guy gets sent out, or why she feels her opinion on the matter is relevant. I feel you could talk to the family, but I agree with you in that it really should be the doctor telling the family the circumstances and prognosis. Trying to "convince" a family to get a DNR seems pretty unprofessional. Do what you think is right, but dont make a big stink about it either way. Families will come to terms with the situation themselves. You could always say you talked to them as well.