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.
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.
If you can't understand what almost every poster saw wrong with the initial post, nothing I say will explain it to you.
I want to reiterate how impressed I was by the OP's willingness to learn.
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.
Once again, where did the OP say that he doesn't provide appropriate care for DNR patients? He presented his view on something, not an action.
Newboy, I know you have seen people whose attitudes shine through, whether they act on them or not. I would be horrified if a DNR patient thought that I was dreading caring for them.
It's really hard to mask that depth of feeling in front of a patient.
The OP has experienced a teachable moment here-which is excellent!
It also makes me pause on how people can filter through essential information that was learned from The Fundamentals of Nursing all the way to Acute Care Nursing and through all those clinicals where it has been emphasized DNR does not equal Do Not Treat; I am also aware that a percentage may slip through the cracks as well.
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.
There were a couple things that didn't go his way from the get-go. The OP's reaction to DNRs on his floor was understood in the context of his being a new nurse. In that context, his notion of DNR and what that means was fundamentally flawed. We cannot, therefore, assume that the OP could actually provide "quality, holistic care" to the patients he was talking about. The other thing is that the OP has no post history from which to gain an even superficial understanding of his practice.
Once again, where did the OP say that he doesn't provide appropriate care for DNR patients? He presented his view on something, not an action.
I don't know if you've noticed but the title of this thread is:
Taking care of DNR patients. The point? (
OP subsequently (after reading responses here) created a thread titled:
Taking care of DNR patients. The point!!!! (
No the OP didn't explicitly say that s/he doesn't treat DNR patients but that s/he doesn't realize what the point of treating a DNR patient who suffers from SOB is and that these type of patients make her/him instantly "get turned off".
Newboy, just a thought. I don't know how you prioritize your tasks but I know that when I'm in a time crunch I always do the most important ones first and postpone (sometimes indefinitely) the truly pointless ones. In these situations it certainly helps to know which tasks are indeed pointless.. and which ones aren't... Or it might make me prioritize in an unfortunate way.
I am very glad to see you post this. I found your first post to be arrogant- it read like "people who are dying are not worthy of my time" but I am glad that you took what those who have gone before you said to heart. I consider caring for the dying to be a privilege. I am a pediatric nurse, the youngest dying child I have cared for was only a few weeks old.
Speaking of the "point"- I have also known many dying children who attended school until they very end. I am sure many wonder what the point is at that stage- it certainly doesn't matter if a child whose death is imminent knows how to multiply. For that reason, if the child decided that school was no longer a source of joy for him and the parents no longer wanted to send him, no one would be filing any truancy reports or anything. However, children don't know how to live like they're dying. They just know how to be children and going to school is part of that. The dying should do whatever it is that brings them comfort- if that's attending school or not for my patients or being admitted to the hospital or not for yours, so be it.
That said, I don't think it's wrong to ask "why are we doing this?" at the end of life either. Telemetry monitoring may be over the top for an actively dying DNR patient. When I worked in the hospital, we usually tried to convince parents to let us take their kids off the monitors when the end was nearing. Some wanted to see what was happening, other agreed that their children had been confined to wires and tubes for far too long and it was time to turn them off. When the goal shifts from cure to comfort, it's different for staff who are used to "curing". Our goal was comfort at the end of life. We didn't need daily labs or VS q 4 hr or anything like that any more. For an acute care floor, it can be a difficult thing for staff to wrap their heads around, especially if they haven't done it before. By not doing what we do for everyone else, we are doing more for that patient. Poking him for labs or waking him q 4 hrs for vitals isn't going to comfort and it isn't going to change anything.
Everyone above expressed my own sentiments very well.
Here's another thing that you can learn from this, now that your perspective on DNRs and hospice patients has been altered. A few of us mentioned that tele monitoring may not be necessary for a hospice patient admitted for symptom management, and it may contribute to discomfort. Now you know you have something tangible to advocate for; now you know that nurses play an important role for hospice patients. In fact, I think hospice may be the most nurse-centered specialty out there, and strong advocacy is a must.
DNR does mean do not resuscitate. DNR does not mean do not treat. I'll leave it at that instead of saying what I really think about your post.
Gee Whiz...I'm actually quoting myself here. I posted this original reply after seeing your first post. I then read the full thread and saw you had an "a-ha!" moment after reading a few of the replies. Just wanted to say good for you! Not only for the change of heart after reading some differing viewpoints but on having the guts to come back and say so despite some less than kind remarks [my own included]. That shows some real maturity and grace.
I have cared for infants to older adults who were actively dying; I treated them based on how I treat all my patients; I focused on their needs. A big help is that first part of the nursing process-assessment; with you assessment you can advocate what your pts need more of or less of in order for them to be comfortable-the goal is for pts who are dying to be comfortable.
I am someone who is very comfortable with assisting with end of life care-I was a hospice volunteer and worked as a nursing assistant and spent time with pts that transitioned, and had the honor to give a few of my patients their final bath before that transition; as a nurse I found those moments to be the best moments to provide basic care and comfort-think Maslow and all that.
On the flip side, I have cared for pts who were very active individuals who made a conscious decision to be a DNR or a modified code-when I reported that off, an occasional oncoming nurse would be dismayed, which my reminder is to reserve expectations, and expect the unexpected. :)
Great thread. This is why I love AN; even though there is the drama you can always learn something. OP, I am glad you have learned from this and sorry you have to manage care for so many patients. That would be stressful enough. It is not your patient's fault, that is on management. We have 4 patients per nurse on my Med-Surg floor and most days that is very manageable. Good luck in your new career and always be open to learning. I hope this teaches you not to jump to conclusions too soon.
canigraduate
2,107 Posts
If you can't understand what almost every poster saw wrong with the initial post, nothing I say will explain it to you.
I want to reiterate how impressed I was by the OP's willingness to learn.