Ahn

Sounds alot like my situation. At least you got some feedback from the MD to clarify why this situation was not a "resuscitation," but a correction of an emergent situation. Thanx! ------------------ Keeping the Faith

This may have seemed like a frivolous exercise, but in my experience as an agency nurse, I have been told everything from withholding CPR to withholding suctioning, insulin, and enteral feeding when they had already had a PEG tube placed. It is very frustrating to walk into a situation where a swift, rational decision needs to be made, and that decision is misinterpreted as challenging an institution's standard of practice. In one particular situation, I was working as a RN Shift Supervisor. A resident with a PEG tube, in a semi-vegetative state began to aspirate feeding solution, secondary to not having the head of the bed elevated after being turned by the NA's on care rounds. When I found this resident, she was ashen, gasping, and struggling for breath. I suctioned her aggressively, and supplemented oxygen by bagging her for two to three breaths. She began to breathe on her own, and a nasal cannula was applied with oxygen until her color returned to normal. Another nurse working on a separate floor began to be very vocal, and very critical of my decision to "resuscitate" a DNR, which divided the staff. The Nursing Director of the institution did not criticize my performance. But as a result of the incident, I have elected not to return to this particular institution, as their policy was unclear, and this had not been the first time that as a nursing supervisor, my interpretation of an ambiguous policy was neither exonerated nor corrected. ------------------ Keeping the Faith

So if the person is suctioned and their airway is cleared, their heart continues to beat - would applying O2 and bagging them until they begin to breathe on their own be a violation of a DNR order?

So if they stop breathing, or need suctioning to breathe, does that mean that you would not suction them? CPR - Cardio Pulmonary Resusitation. As long as you are not "bouncing" on their chest in an effort to re-start their heart, would you consider that "artificial" resusitation? Devil's Advocate [And I'm not being stupid], if the pt choked on something, and only needed their airway cleared, would that be a violation of a DNR?

I would like to hear what everyone's understanding of what "Do Not Resusitate" means to them personally, as well as in workplace policy. Also, are there other terms used to confuse such as: Do not transport; Do not intubate; No CPR; No antibiotics; No artifical ventillation; No hydration; No enteral feeding; ect.?

Addictions Nursing and Behavioral Health Nursing are my nursing specialties [spelling is not!]. Although I am working in other areas presently [i hit the perverbial glass ceiling, since most CD programs are financed through gov't grants], I love addictions nursing. I am at ease in the CD sub-culture, which is the complete opposite of we are taught to do and act in a patient environment - It's mentally stimulating - minus the chemicals [sorry - had to say it,I'm goofy enough on my own] I am not in recovery, nor do I have personal experience in addiction per se other than as a nurse [my mother was an addictions nurse in the 60's and 70's, I followed her lead]. . but I DO KNOW that most CD residential and out-patient programs have Impaired Professional Programs - it is there you can network. I personally know a Pharmacist who was impaired, and who the state [confidentiality issue] decided to make an example of. Ten years after detox [several], ITP, living in a half-way house, 12-step meetings, and working as a "community counselor (CC)" in a treatment center, almost broke this man and his family financially - FINALLY proved that he could continue to work with narcotics without diverting. He remains clean and sober to this day as a pharmacist AND part-time CC. He said it keeps him humble, and reminds him from where he came. He also takes in fledgling addicts and makes sure they get to meetings, and go to work. I also know a Master Carpenter who does expensive woodwork in million-dollar houses, who works part-time in an ice cream freezer/factory - this keeps him humble also. Unfortunately, you are going to have to pay your dues, and frankly one year hasn't been very long. Confrontation time - how long were you using? Diverting? How many people were hurt by your addiction including your family and yourself? Total-up the cost, and then ask yourself if you were a patient, would you trust your care to someone with your background? Just from the tone of your statement, and I can be totally off-base here, but you appear to me to have lost your connection to your "home" group - they would be able to direct you to a program. Are you working your program (steps)? If you worked 1-12, then you start again at Step 1 on a higher level.[ I admit I am powerless over {substance} - and that my life has become unmanageable (AA, pg. 59, 3rd ED.)] CD is a justifyable disease state that cannot be cured (yet), until then use what works - remember Bill?. Obviously your life remains unmanageable, begin again at Step 1 my friend. I hope at this point you have not been put-off, if you are still with me, that is a plus in your favor. "It works if you work it, so work it 'cause your worth it"! Press on my friend! ------------------ Keeping the Faith