RN can pronounce death if DNR >???

[HealinghandsRN]

:redlight: hello all, this "educator" at the facility i work at is now telling us that the rn can only pronouce death if there is a dnr.........does this sound a little unethical to any of you as it does to me?

[CapeCodMermaid, RN]

In my facility in Massachusetts, RN's can do the death pronouncement if the person is a DNR. If they aren't/weren't a DNR, we would be either doing CPR on them or would have sent them out rescue. We have to continue with CPR until rescue arrives or until an MD on the premises says to stop. In either of those 2 cases they are transported out of the facility to the hospital where they are pronounced. So, no, it doesn't sound unethical at all...sounds quite logical to me.

[snowfreeze, BSN, RN]

Nurses in the facility I work in do pronounce DNR patients. A doctor has to agree with futile measures on any others. One evening as supervisor I was called to a unit to a

cardiac arrest. The patient had not been seen by anyone for an hour. Lividity was present so we did not start CPR, we called the doctor and described the circumstances. I signed the death certificate and then our doc completed it the next day. Our policy is we start CPR and call 911 for full codes; families and the doctor are then called.

[KMSRN]

Whether or not an RN can pronounce death depends on the laws of your state and the policy of your facility. As practicing RN you should be familiar with both.

[HealinghandsRN]

Nurses in the facility I work in do pronounce DNR patients. A doctor has to agree with futile measures on any others. One evening as supervisor I was called to a unit to a

cardiac arrest. The patient had not been seen by anyone for an hour. Lividity was present so we did not start CPR, we called the doctor and described the circumstances. I signed the death certificate and then our doc completed it the next day. Our policy is we start CPR and call 911 for full codes; families and the doctor are then called.

I don't know if u read my earlier posts but this is the same educator that is saying to start cpr no matter what she don't care how hard they are how long they have been laying there....unless they have no head..........now according to the laws in this state.....u start cpr if not a dnr unless rigor mortis set in, lividity and a few other exceptions.....but i just thought this is a strange policy.....If it is against the law to do cpr in these type situations, Can the facility make it there policy to start cpr no matter what if there is a not a dnr? What is your opinion?

[snowfreeze, BSN, RN]

Utilize the protocol of your facility, do a quick assessment of the situation and contact the doctor. If the facility has a do CPR no matter what on anyone who is a full code then start CPR. Call 911 and the paramedics can assess and get orders to stop CPR if it is obvious. If you cannot easily contact a doctor then 911 is your best bet. And yes even if policy seems a little bit strange, you do have to follow it. Always document what you did and why, ie. resident found unresponsive and pulseless with no spontaneous respirations, CPR initiated due to full code status. (further assessment of patient condition here) 911 called, attempts to contact physician unsuccessful. Paramedics arrived and deamed patient CTB after contacting medical command physician at ****** facility. Family notified and physican attempt to contact again unsuccessful. Medical director notified of unsuccessful contact with patients current physician by self or nursing supervisor.

[Antikigirl, ASN, RN]

I was told a nurse in my state can NOT pronounce death, and that is why we don't have a RNDx of 'death'...only failure to thrive, which I have used with full details to prove death (yep...more writing..isn't that what we do best..grrr!).

We have to call the county coroner to have them pronounced dead, but we can call them with the s/sx and do a telephone order to transport to the funeral home where a cororner can go and pronounce them legally dead.

Long round about way to deal with this...but that is why we try so hard to get my residents on hospice services. We call hospice and tell them the s/sx and they do the rest so I can move on to my ever demanding living residents that won't wait for me to do all this backwards legal prounouncement of death stuff! (I had one scream and cuss at me saying "well I am alive and need you..not much you can do for them..then they ate crow when I said..."but what about their family...I must try to help make this work for their sake and peace of mind...they aren't here to do this, they depend on me...and they just suffered a great loss, please understand this duty of mine, and my hopes that you will never be put in the position those family and I am in right now...I wouldn't wish that upon anyone..just too sad!")

Lucky we have a great relationship with our county cororner, so we can despense with much of the legal junk and he will buzz on by (he lives near) and prounouce death so we can move on.

[HealinghandsRN]

utilize the protocol of your facility, do a quick assessment of the situation and contact the doctor. if the facility has a do cpr no matter what on anyone who is a full code then start cpr. call 911 and the paramedics can assess and get orders to stop cpr if it is obvious. if you cannot easily contact a doctor then 911 is your best bet. and yes even if policy seems a little bit strange, you do have to follow it. always document what you did and why, ie. resident found unresponsive and pulseless with no spontaneous respirations, cpr initiated due to full code status. (further assessment of patient condition here) 911 called, attempts to contact physician unsuccessful. paramedics arrived and deamed patient ctb after contacting medical command physician at ****** facility. family notified and physican attempt to contact again unsuccessful. medical director notified of unsuccessful contact with patients current physician by self or nursing supervisor.

i appreciate your response...however, if the law in nj is not to start cpr under certain circumstances.....rigor mortis then can a ltc facility policy say start cpr no matter what if pt not a dnr? what do u think on this?

[catlady, BSN, RN]

Here, for nurse pronouncement, the order must read DNR/RNP. DNR alone is not enough for RN pronouncement, and RNs can't pronounce death in the absence of a DNR order.