I work on a very busy Tele floor and can have up to 5-6 patients a night. What kills me...is when I have a patient that is DNR. Seriously? Like what is the point? So far, the DNR's are usually on their last leg, disease processed has moved to the final stages, yet you come to the ER with SOB, and admitted to my busy floor, and I have to now treat you as if I would treat one of my patients whose a full code - but, if you suddenly become pulseless, I cannot do anything anyway...grrrrrrrrr. How time consuming - why? I had a patient admitted from HOSPICE onto my floor for SOB - seriously?
Please help me understand you all. I am a new graduate nurse - 3 months - and when I get a DNR patient, I instantly get turned off. Sometimes these are the most time consuming patients with overbearing family members and in my mind I am like, the hospital is for saving lives if something lethal happens, I am not doing anything anyway. sigh.
Honestly, don't let the "follow the leader" posters get to you. That seems to be the culture here. It's all opinions anyway and I did value yours.
I actually find your post insulting. Correct me if I'm wrong but it seems to me that you're implying that posters don't think for themselves but take their cue from some leader figure. My opinions are my own.
I think that in this particular thread most posters happen to have the same/similar opinion, it's not about following someone's lead.
During my time here on AN I think I believe I've agreed with most frequent posters on some issues and at some point in time have disagreed with most on other topics.
Thanks newboy. I appreciate that. I can't let people steal my joy.
I thought you were deleting your account?
I'd hate to see you go, but you really came across like a child throwing a fit. I have been "spanked" before on AN, and I deserved it. Take a few deep breaths. It helps to do it a few times before you post.
As far as the OP, I was really shocked by the initial attitude. Then, my faith in humanity was revived by his turnaround after he realized his error.
Good luck, OP. You will come across a lot of ethical dilemmas, and I think you learned a valuable lesson on this thread.
Ok, so OP, you have read, and learned and will incorporate whatever you took from the previous posts and incorporate it into your practice. But along with that, what you need to be doing is educating yourself on what a "DNR" means, that you have an order for DNR, and what specific symptom management you will be treating the patient with.
I am sure that in your job on a tele floor, you may see many patients who have advanced directives that state they are to be or not to be a DNR. It is not just reserved for the end of life patients. And make sure you know code status, because the time to find out a patient is a DNR is not in the middle of coding them. Tele floors are can be cardiac nightmares--so absolutely know where all of your patients stand.
DNR is a status, not a treatment plan. Disease process needs treatment and/or symptom management. I am sure that you would not stop giving your patients their cardiac meds because they are DNR's, correct? In the same thought process, a nurse would not stop treating symptoms of end of life patients solely based on code status.
USE YOUR RESOURCES! If they are not hospice patients, get a consult. Know that end of life brings weird family dynamics. Palliative care can help you with that. Some family members get all up in arms that they can not handle everything at home. Some family members are really not comfortable with their loved ones dying at home. And even more are divided right down the middle. SOB/anxiety can be eased with medications that are best effective through an IV.
It is so important that you keep a cool head, and a calm attitude. If you don't know how to handle a situation, ASK. It is the same thing as your cardiac patients who are very scared about what this diagnosis is going to mean for them going forward. Much like end of life patients are scared about what this is going to mean to them at the end.
Your integrity and character as a nurse is being formed as you begin your career. Be sure that you are mindful, careful, and keep on refining your practice.
It's great to see the maturity you've handled the replies to this thread with. I have faith with experience you'll grow to be a great and compassionate nurse.
I work step down and get plenty of DNR patients...some are in their 50's they generally have several co-morbidities. The vast majority of them are not dying, they simply don't want the violent nature of a code inflicted upon them. The statistics of coming back from being coded are very low and personally if I didn't have school aged children I'd probably make myself a no code (and I'm 41). My grandmother was a no code for 25 years. She was in and out of the hospital and at one point shattered her femur in a fall. The orthopedic surgeon gave her a 50% chance of surviving the surgery(severe CAD). Should he have just not operated and let her die from sepsis or fat emboli? He knew enough not to code her on the table if her heart did stop but she lived for 2+ years after the reconstruction.
I'm glad you had an "aha" moment. I find I get the best education around these parts!
Though the person who wrote the original post had a misunderstanding of what DNR means in terms of patient care, I think she or he now knows the different perspectives that experience RNs hold when they care for DNR patients and hopefully has come up with the right understanding now. I find it more alarming, however, and frankly no one has commented on, is that how a new nurse with only 3 months of experience could possibly feel this burned out. This saddens me, because if her heavy work load of 5-6 patient could be reduced just to four, she or he will have more time to spend with her patients, making him/her feel like they are actually doing their job well. I have been a RN for four years, and I'll admit, I have had thoughts similar to her, where I for a moment think, "Why bother?" I don't let these thoughts change how I treat these patients in any way, but I think many new and old RNs are burned out and this is a result of horrible, stressful working environments. RNs have no control anymore of their workplace environment and are at the mercy of cripsy, old hospital administrators that are absolutely clueless what being a bedside nurse is like today. I feel for you and I encourage you to stay positive and know that you can and do make a difference in those patients who are approaching the end of their lives. We are privileged to help them and provide them relief of their symptoms so that they may live the remaining days or weeks with dignity. Take care!
As far as the OP, I was really shocked by the initial attitude. Then, my faith in humanity was revived by her turnaround after she realized her error.
This is what I have a hard time understanding. What error? The OP never came here and said, "I treat DNR patients differently than patients who I can actually save." The OP expressed his thoughts toward DNR patients and that is NOT an error. If I held the OP's views, why wouldn't it be okay for me to be a nurse, do my job, and still hold my same views. No one knows exactly what they're coworker thinks about bed 23A who comes in all the time asking for his dilaudid. But if the nurse is able to perform quality, holistic care without letting their feelings take over, why does it matter? Why is it so hard to understand that nurses are people who do have judgmental thoughts at times without it ever being a problem work-wise.
I don't think that they are rude, but I'll agree that they are direct. To be honest with you my post doesn't reflect the moral/ethical outrage I felt when I read OP's initial post. I was deliberately phrasing it more calmly than I was feeling. I did that because I noticed that the OP was a recent graduate and because my main motivation was to get through to her/him, not to tear her/him down. I felt that it was necessary to be direct because the consequences of the OP failing to hear us all are very serious for her/his patients. There's a lot at stake.
Nobody is perfect and this person is asking us for our opinion so how dare you frown upon them because they came to this site to seek help.
Most of us who've responded to OP have been nurses for some time. We've likely witnessed more suffering and death than both you and OP. The thought of a patient not receiving appropriate treatment because his or her nurse doesn't understand the meaning of DNR horrified me. So before deciding that we're all just a bunch of rude meanies, consider for a moment where we're coming from.
I apologize for the nurses above me who answered so rudely.
There's no need. I apologize for my own behavior when I feel it's warranted.
I don't think I would like for any of you to be my nurse...EVER.
Why not? There are a lot of experienced nurses here and the responses you've seen ought to indicate to you that we are passionate patient advocates.
OP, I mentioned this in one of my previous posts but I would like to say it again. I'm impressed by the maturity, intelligence and poise you've shown when responding to us. Your initial post caused me concern, but the way you've processed the feedback given to you makes me feel confident that you'll do right by your patients.
macawake, MSN
2,141 Posts
I actually find your post insulting. Correct me if I'm wrong but it seems to me that you're implying that posters don't think for themselves but take their cue from some leader figure. My opinions are my own.
I think that in this particular thread most posters happen to have the same/similar opinion, it's not about following someone's lead.
During my time here on AN I think I believe I've agreed with most frequent posters on some issues and at some point in time have disagreed with most on other topics.