Why Many nurses are No-Codes

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There is a 50-something resident whom was brought back with CPR. Brain damage from anoxia was significant. Tube feeder, total care-bedridden, trach hole that would not close. On an LTC hall with 42 residents and one Lpn and one CNA on nights, the suctioning is almost constant. The stress on the nurse to pass out 2 1/2 hours of 6 AM meds (most are on narcs of one kind or another) and the CNA who is expected to get some residents dressed and up in a chair is mind-boggling. I doubt it if this resident is happy with the care he gets. Although he is a DNR every effort must be made in the meantime. Carrying around that kind of guilt while the slow process of hiring another CNA who will actually not call in once a week is crazy. LTC workers do the best they can with what they have. Yet, conditions such as these, show the writing on the wall to the caregivers. some of us would rather be gone to the here-after.

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About 7 years ago, before I was an RN, I was a CNA as a LTC. I just remember the pt load being crazy and the expectations unreal. LTC I worked for was for profit, so I remember the time they cut corners, and got rid of wipes. I would never work in a LTC ever again. Tough job.

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Specializes in Telemetry, Case Management.

You are preaching to the choir, pal! I would rather go on to my reward than live an existance like that - its surely not life as I would want to live it. I turn 50 this week and my living will has been signed and in the hands of my doctors and hospital and family members for the past 5 years. If I go, let me go.

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Mom is in her 80s and very fit. She will likely be active and happy into her 90s. She told me she's a DNR. I told her if I were in her place, I'd give a few trusted folks a copy of my DNR, and not put it on my chart but have them hold it until my health makes a code seem likely (this is what I will do for myself some day).

First, as fit as she is, if they need to intubate her, it would probably not be a long-term thing, but something to tide her over a short-term emergency, and anyway she has an advance directive to take care of the possibility of her being in a persistent vegetative state.

Second, DNRs have their code status taken into account when doctors make decisions, even though a DNR should be ignored until a person is actually in a code situation, which is the only time it is acted on. DNRs should be treated exactly like all other pts, but they are not.

For instance, a DNR will be downgraded out of ICU. They may be complex or unstable enough to require half of a nurse's attention for proper care, but they will go to a floor where they'll receive only a sixth of a nurse's attention, simply because they're a DNR.

I explained the above and she likes the reasoning. Anyway she knows I'll be around to enforce her wishes.

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Specializes in LTC, Psych, Hospice.

Oh heck yea! I've had all my papers in order for a while now and my kids and husband know it. I've gone as far as telling them that if they DO NOT respect my wishes, when I do die (and we all do) I'll come back as a haint. So important to have all this in writing and not leave those decisions to your family.

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Specializes in Acute Care, Rehab, Palliative.

As I, and many of my coworkers have said to each other many times "just shoot me if I get this bad ok?"

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Specializes in LTC, Home Health, Hospice.
Oh heck yea! I've had all my papers in order for a while now and my kids and husband know it. I've gone as far as telling them that if they DO NOT respect my wishes, when I do die (and we all do) I'll come back as a haint. So important to have all this in writing and not leave those decisions to your family.

I've told mine that when I take my last breath on earth I will be seeing Jesus for the first time....don't bring me back from paradise....I'll save you a seat at my table...I'll wait for you there.

Papers framed and on the wall for all to see. Not even temporary intubation, let me go.:redbeathe

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Why do families torture their ones? I know there is a fear of letting go and not doing "all that you can", but geez do they really want to live this way? I had a resident that had a CVA, but was alert and the family put her on hospice, NPO, nothing. I had a hard time with doing that to her, however if it were me I would want the same. Give me all the Roxanol ya can legally and let me live in lala land till I am gone. :smokin:

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Specializes in Peds Critical Care, Dialysis, General.

My wishes and paperwork are all filled out. Everyone in my family knows my wishes. Just let me go on and they can get on with their lives. I'll be in heaven and don't you dare try to get me back!

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Specializes in Med/Surg, LTAC, Critical Care.

You can never forget the 1st time you hear that sickening cracking sound from ribs breaking during chest compressions...

I always said, I intend to tattoo DNR in big letters across my chest.

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Specializes in OB.
Oh heck yea! I've had all my papers in order for a while now and my kids and husband know it. I've gone as far as telling them that if they DO NOT respect my wishes, when I do die (and we all do) I'll come back as a haint. So important to have all this in writing and not leave those decisions to your family.

Exactly!!! We all die. Period, end of sentence. I'm not ready to die. You might not be ready for mom or dad or grandma or grandpa to die. But guess what? Keeping someone alive because it makes us feel better because we can't deal with the concept of our loved one leaving us accomplishes nothing but further pain, for the patient, and as the OP pointed out, for the staff struggling to care for them. I go back and forth about how to politely express this feeling to family members a lot, but maybe there is no polite way.

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Specializes in ICU, CCU, OR, ER.

I will also tatoo DNR on my chest! I have shown my love for my family twice already. My dear mother lived with me until she passed away...quietly and in her own bed. Ditto my sweet husband, whom I just lost two months ago after a long battle with cancer. I cared for him here in our own home, because that was what he wanted. And I let him go as he wished.....NO tubes, needles or machines. Was it easy? God, no! But I can think of no greater love than this.....

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