Supervisor ignored a DNR status

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Our ER supervisor watches over an elderly couple because they are old friends of the supervisor's family. The patient is 94 and is a DNR. Well, the ER supervisor decided to have the patient transferred for a pacemaker placement. She is NOT POA and has no legal connection to this patient other than being a friend. She is also the back-up DON. When asked why she did this, her response was: "At least they can't say I didn't try everything." This certainly seems like not only a legal issue but also an ethical one. Did she have a right to do this?

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Specializes in Gerontological, cardiac, med-surg, peds.

Since she is not POA or a first degree relative, legally the hospital should not regard what she has to say anyway. The hospital should have been informed, however, about the patient's DNR status at the rest home/ nursing home. Generally, DNR orders do not transfer from one facility to another and a new order will need to be written at the receiving facility. The physician or advanced practice nurse can do this by directly questioning the patient (as long as the patient is of sound mind) about his/ her preferences.

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Specializes in Geriatrics/Oncology/Psych/College Health.

DNR doesn't mean the pt can't have a pacemaker.

If the 94 year old is competent to make such decisions, the pt can do so. If not, and the supervisor has no legal standing (health care rep paperwork) then performing surgeries without legal consent is obviously an issue.

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No she did not have the right to do this. It is both legally and morally wrong. How dare she do such a thing? She should be fired!!! :angryfire

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DNR doesn't mean the pt can't have a pacemaker.

If the 94 year old is competent to make such decisions, the pt can do so. If not, and the supervisor has no legal standing (health care rep paperwork) then performing surgeries without legal consent is obviously an issue.

Regardless of code status, a pt has the right to be treated and is our obligation to treat the pt and not the 'status'. I should've worded the description differently. I'm sorry. As it turns out, the pt came back to our facility as skilled for pt/ot. The Heart Hospital's surgeons did not do any prcedures.

I wonder how many other health professionals instinctively imply DNR=Do Not Treat??

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Specializes in Geriatrics/Oncology/Psych/College Health.

Lol - now I'm confused :). So is the issue that there is a mentally compromised elder without legal health care representation? Or is the nurse calling the shots and the patient is just along for the ride?

Either way - I agree with you that the nurse is walking a fine line and risks mixing up her professional and personal roles. If that person is in her facility and the relationship is close or she otherwise has a conflict of interest, she should not be involved in the pt's care.

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Specializes in Education, Acute, Med/Surg, Tele, etc.

Thank you guys for pointing out that a DNR does not mean DO NOTHING REGARDLESS! A medic can ONLY honor a DNR if the patient is apnec and pulseless...no other time! Even if they are about to stop breathing...as long as there is a breath..we treat. If they have advanced directives..then we treat only as outlined or if the patient/POA says so verbally at the time.

Also I know that a supervising Doctor can recend these orders depending on circumstance. An advanced directive is a wish list basically (legal by notary only, but generally an outline of wishes if a patient is TO BECOME NONVERBAL or can no longer speak for themselves), and a POLST or DNR is a Physicians order that can be resended by another Physician if they feel it is in the best interest of the patient and is up to their professional clinical opinion. It is tricky because of the fact people do not understand this can occur and gets pretty messy so MD's normally will not mess with these..and if they do they better be able to really explain why they did it!

Many people feel Advanced Directives/POLSTS/DRN orders are a license NOT to treat..or feel they are written in stone...a serious mistake, and one that should be taught in schools and CME!

I started performing BLS on a DNR patient that was still breathing and had a heart beat..the admin had a cow! But my patient's family and her POA had no idea we had a POLST or DNR signed and it was from 1989! The patient wanted to live...and actually told me before she went unconscious (because I was smart enough to ask!) to "do everything..I am not done yet!". She lived, the family was very estatic that I did everything I could (including telling the paramedics what she said so they didn't give the POLST regard), and she is alive and happy! The family changed her code status that day. That piece of Pink paper almost killed someone who forgot she even had one at one time...thank goodness I was educated and knew the rules of the DNR.

I don't know too much about the above patient, but their could have been a reason..yeah sure, we are human and may do things that fall outside the old "ethics book" (which is subjective in the first place..ie the reason it certain issues are very contraversial in Ethics)...and maybe that was a spur for this order...but sometimes things that seem solid on the surface is like ice on a pond..you never know if it will hold weight as much as you think! Many times there are things under the surface you can't see or don't know about...and that is the real important part...means whether you sink or swim! Look and tread carefully with Advanced Directives/POLSTS/ and DNR's.

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