No code changed to Full code
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Hi! The last couple days at work have been extremely stressful. I work midnights for LTC and we've had an actively dying 80+ yr old who's code status changed a couple months ago from no code to full code. I've heard there was a recent law that passed changing a lot of resident's code statuses, and another nurse explained to me it was because the resident had a guardian, not a DPOA.
This resident has been deteriorating over the past couple of months, refusing meals and medications. He is probably a little over 80 lbs. The other night at work, he went into unresponsive status and began the actively dying process. His physician and family knew and were in agreement, do not preform CPR. His physician left his cell phone number behind in the event he passes, so we can get him pronounced immediately. This same physician who doesn't like on-call doctors treating his patients explained for us to not only have a nurse calling his cell number, but to have us page the on-call at the same time so SOMEONE would pronounce him immediately.
So, I arrive to work the other night with all of this going on and I'm stressing out. I go in his room to check his status and his family is at bedside. They leave the room so the CENA's can do their cares, and one of the family members lets me know that she will throw herself across his body if I attempt to preform CPR on him. I tell her that it wont get to that point, I have the Dr.'s cell number at hand and will be calling the on-call Dr. if need be to avoid all of this. I, out of courtesy, let all the other nurses in our facility know the situation so they can be prepared if I called a code. Luckily, I didn't have to the first night.
The next morning I explain the situation going on to the charge nurse (his status changed after she left work that day so she wasn't aware he was actively dying). I tell her about the CPR situation with the family, and my agreement I had with them knowing that technically I couldn't do that. She didn't come out and say I was in the wrong, but did say that if he goes that day when she's there they have to initiate CPR while others are trying to get him pronounced. I warn her about the family and their statements and hope it doesn't have to go to that point. That night I'm scheduled to work and find out he's still with us, but in worse conditions then he was the first night. Of course, it's time change night so my usual 8 hr shift is 9 hrs and I'm figuring he's probably going to go on my shift. Same family members are at bedside and this time they seem relieved I'm there because I said the night before I wouldn't perform CPR. So, I again make my courtesy calls to the other nurses in the facility.
Later in the night, one of the other nurses comes down to my floor and chit chats with me on the situation. She asks me what my charge nurse said about the CPR thing, and I explained she didn't necessarily tell me I had to do CPR, but told me she would do it if he passes while she's there. This nurse then asks me if it's against the law to not initiate CPR on a full code Resident. Immediately I think, uh oh... here we go. I tell her my plan is that if he passes, I have the CENA's calling the code while I'm calling the Dr. because I do not see the point in battling in the room with the family about doing CPR. She then states, "I don't know if I'd risk my license doing that." So, the rest of my night was spent in his room every 30 minutes checking vitals to see if he's beginning to go downhill more so then he already was. He didn't pass on my shift and I've been off the last couple of nights, so I don't know if he passed yet and how they handled the situation.
My question is, I know technically what we're suppose to do with full codes, etc. But, what would you really do if you were in my shoes? Would you really go through the dramatics and the trauma to the family to begin CPR on a resident that you know isn't going to come back from it, and you're only injuring the body more. Was I in the wrong by saying I wouldn't initiate CPR and would call the Dr. first? Ethical dilemmas are not fun!