I. Just. Can't....

JennRN423 · Sep 2, 2014

While giving report on a lovely 80+ year old woman (who was a retired RN) she asked me why I was reporting off she was a full code when she stated she had a signed DNR. Said form was not on the chart but I promised her I'd speak to the doc about changing her status. Doc walks into the station next morning, I informed him of her wishes - he stated he'd talk to her about it. 5 minutes later walks back into the nurses station and says "we're not changing her code status". I walk down to the room to talk to her about it (since not an hour before she was adamant she was NOT to be coded) and she said the doc walked into the room and stated "well do you FEEL 84 years old?" and that was the discussion about code status.
Death is the ultimate failure and insult for doctors, so yeah, lets just code everyone!

This happens at my hospital. A pt will verbally state he/she doesn't want to be resuscitated and/or have a signed copy of his/her advanced directives on the chart, but as long as the code status in the computer says 'Full Code', then by golly that's what we have to go with. It makes me uncomfortable and I've tried discussing it with my manager.

It also makes me uncomfortable that a hard form, paper copy with the pt's (or POA's) signature isn't needed when we do have someone listed as DNR (or in my hospital AND - Allow Natural Death). I understand everything is computerized so when the MD enters code status it's an order just like all the rest, but it seems to me that we should have some sort of signature for something this important.

workinmomRN2012, BSN · Sep 2, 2014

This is beyond true. One of the patients I care for has late stage Alzheimer's, and it was very hard for his family to accept the decline. They wanted to try everything under the sun to fight it and wanted to push his regular eating and drinking habits even after serious aspiration scares had occurred. They would get mad at the pettiest things, but the whole time I wondered if it was just easier for them to be mad at nothing than to grieve over something so heartbreaking. Once the fam let go of denial and began accepting the disease, they all became so much nicer. It's a definite process. Unfortunately, the patient is the one who suffers as the family tries to sort things out in their heads.

This is so true... it reminds that anger comes from fear or pain. Anger at the illness/disease and fear of the end/death

PMFB-RN, RN · Sep 2, 2014

If I had my way anyone over a certain age, and anyone with certain diagnosis would automaticaly be DNR and they would have to opt in to be full code.

RunBabyRN · Sep 2, 2014

What's the point of having an advanced directive if your nitwit family members can override it? Shame on hospital administration for caving in to such stupidity. Their duty was to their patient, not the family and not their fear of lawsuits. Advanced directives need to be as iron-clad as possible, so there is no suing for honouring them. Just my 2 cents.

Unfortunately, because our healthcare system is for-profit, and because we live in a litigious society, this will remain the #1 reason we do half of the crap we do every single day.

BrianLPZY · Sep 2, 2014

The sad part is, everybody with two brain cells to rub together thinks they're a doctor because they can just run over to Web MD and "diagnose" themselves / others. They'd be too full of themselves to even bother caring what an actual medical professional would have to say in this kind of situation. Common sense says "Oh look, she's 90-something years old. She's going to get injured when a 150-200 LB person starts slamming on their chest." But no. No common sense here. It's just another example of "Oh, She died, WE CAN GET MONEY OUT OF THIS." and like somebody before said, some scatterbrained lawyer will roll out from under the sewers and try to back their "Sad, emotional case up against that big old abusive,EVIL hospital. How DARE they try to save her life!?". People need to stinkin' grow up already and get over this whole "Well we'll SUE" phase already. It's old hat.

RNsRWe, ASN, RN · Sep 2, 2014

The sad part is, everybody with two brain cells to rub together thinks they're a doctor because they can just run over to Web MD and "diagnose" themselves / others. They'd be too full of themselves to even bother caring what an actual medical professional would have to say in this kind of situation. Common sense says "Oh look, she's 90-something years old. She's going to get injured when a 150-200 LB person starts slamming on their chest." But no. No common sense here. It's just another example of "Oh, She died, WE CAN GET MONEY OUT OF THIS." and like somebody before said, some scatterbrained lawyer will roll out from under the sewers and try to back their "Sad, emotional case up against that big old abusive,EVIL hospital. How DARE they try to save her life!?". People need to stinkin' grow up already and get over this whole "Well we'll SUE" phase already. It's old hat.

That's all well and good, but unless something changes drastically, an elderly patient will nearly always be at the mercy of their well-intentioned (usually) family member(s). Well-intentioned is not the same as well-informed, however, and their ignorance in most cases is what causes these messes to start with.

They don't know what is entailed in "do everything". Even if we tell them, it's more common than not to have them NOT have that info sink in. Details explained, odds of survival--and MEANINGFUL survival--are given, and still family can't get their heads wrapped around the idea that Grandma is just GONNA DIE before she leaves this hospital. And not only IS it going to be soon, it SHOULD be.

When or if you get into nursing, you'll see how this kind of stuff really plays out. People can and do refuse to participate in a valid code; sometimes they are off the hook, and sometimes there are disciplinary actions to face. A full-code status patient you DON'T code, dies....family is now up in arms...and the nurses don't have a leg to stand on. "She SAID she didn't want to be coded" doesn't go too far.

In the scenario I described in which a DNR patient WAS put through the full wringer upset everyone. Nurses were angry, doctors were angry, and they were directly faced with the family member's wrath and insistence. The relative was the HCP and DID know the legal implications of BEING a HCP, and that was why she threw out the "she's not competent right now, is she? She can't make any medical decisions now, so *I* say DO IT". Wrong? You betcha. And it happened. And it happens. I'm only glad that I wasn't expected to participate, and got to stay on my side of the unit.

We can hate it, but until people lose their right to sue over such things....it will KEEP happening.

sistrmoon, BSN, RN · Sep 2, 2014

It also makes me uncomfortable that a hard form, paper copy with the pt's (or POA's) signature isn't needed when we do have someone listed as DNR (or in my hospital AND - Allow Natural Death). I understand everything is computerized so when the MD enters code status it's an order just like all the rest, but it seems to me that we should have some sort of signature for something this important.

We are all computerized but DNR/DNI requires a bright pink MOLST form to be valid. It's one of our few paper holdouts.

MassED, BSN, RN · Sep 2, 2014

I have worked at hospitals that believe in bringing in a family during CPR and others that don't. I think for children, parents should definitely be there, as nothing should hold a parent back from being with their child. I do think that CPR is difficult to see, it's barbaric to the lay person, and often times they don't understand what we're doing. It does seem abusive, if you are to take a step back and look from a non-medical personnel approach. It takes a special person to explain everything AHEAD of time to the family what they will see. I, personally, don't think it's good for families to see what we do, unless aforementioned children.

NightOwl0624 · Sep 2, 2014

If I had my way anyone over a certain age, and anyone with certain diagnosis would automaticaly be DNR and they would have to opt in to be full code.

Absolutely, I couldn't agree more!!! I have said the exact same thing myself. Sadly it will never happen.

I think the only thing that will make difference is when the patient/family is financially responsible for all costs incurred with care that is deemed futile. I know that would open a whole new can of worms (death panels?) so that probably would never happen either.

PMFB-RN, RN · Sep 2, 2014

Absolutely, I couldn't agree more!!! I have said the exact same thing myself. Sadly it will never happen.
I think the only thing that will make difference is when the patient/family is financially responsible for all costs incurred with care that is deemed futile. I know that would open a whole new can of worms (death panels?) so that probably would never happen either.

I used to work as an RN in New Zealand. They do it much differently there and I didn't see the kinds of things that we have been talking about in this discussion happening there.

When I first heard about "Death Panels" I was very excited! I thought that is exactly what we need! I was kind of bummed to learn they were nothing more than right wing propaganda.

TheCommuter, BSN, RN · Sep 3, 2014

Now they want to sue the hospital for battery and ABUSE because we broke the pts ribs during cpr....

Families can sue healthcare workers for battering a clinically dead person? Gee, I seem to learn something new everyday.

icuRNmaggie, BSN, RN · Sep 3, 2014

If I had my way anyone over a certain age, and anyone with certain diagnosis would automaticaly be DNR and they would have to opt in to be full code.

It is time for the American Heart Association and ILCOR to study the outcomes of CPR in patients with osteoporosis and advanced age.

A simple dexa scan of the hip or wrist should be required to be a full code in patients with osteoporosis.

It is barbaric to do CPR on an elderly person and fracture their ribs. I refuse to do it.