New LPN grad seeks advice about DNRs

[trixy005]

I'm a new LPN graduate (as in a month ago) and just landed my first nursing position at a LTC unit. The facility I work for has no RN or clincial lead, so all nursing decisions are made on the lpn's judgement at the time. When asking other staff during orientation about the DNR policies, I was met with very mixed answers about what to do incase of an emergency requiring transport to hospital. My question specifically was asking if a resident with DNR orders is suspected of experiencing a heart attack or a stroke, would I call an ambulance and transport them to hospital? Or would I treat them as best I could in facility without transferring them?

I realize if this resident had palliative orders I would obviously treat them in facility regardless, but if the resident was not actively dying and had DNR orders, would it be best practice to call an ambulance for a heart attack/stroke? Even if the probable outcome either way with no resuscitation, would be dying in hospital versus their home environment?

Any advice on what to do, or real life experiences would be a great help for peace of mind.

[TheCommuter, BSN, RN]

My question specifically was asking if a resident with DNR orders is suspected of experiencing a heart attack or a stroke, would I call an ambulance and transport them to hospital?

Unless we are managing a hospice resident, you would definitely call an ambulance and arrange for a clinically deteriorating resident to be sent to the hospital.

DNR means do not resuscitate. It DOES NOT mean do not treat.

[BuckyBadgerRN, ASN, RN]

How can there be NO RN's in the facility? In my state only an RN can do initial assessments so all admits are done by an RN. This must not be the case where you are?

in any event, DNR means just that---do not resescutate. You would treat a heart attack or stroke sx, but stop at CPR if it came to that. Frankly, this is something you should have been taught at some point during your education.

[TheCommuter, BSN, RN]

How can there be NO RN's in the facility? In my state only an RN can do initial assessments so all admits are done by an RN. This must not be the case where you are?

When I was an LVN in LTC, an RN was present in the facility for only 8 hours per day. The DON provided the RN coverage during the week, and an RN supervisor provided the RN coverage on weekends.

No RNs were present during the evening or night shift. The only licensed staff in the building consisted of LVNs. In the state where I live, LVNs are permitted to complete the initial assessment in extended care settings such as nursing homes, intermediate care, and group homes.

[lindseylpn]

When I worked LTC there was rarely an RN in the facility but, there was always one "on call".

Also, I know this wasn't the exact question asked but, I wanted to add.. When a DNR passed and there were no RN in the building we sent them to the ER to be pronounced but, if there was an RN he/she would pronounce.

"When in doubt, send them out!" It applies to both DNRs and full codes. Unless they are on hospice.. contact their hospice nurse for further instructions.