Written up and confused.


I have been a nurse for 2 years now and have been fortunate enough to avoid any deaths on my shift until recently. Last week I had a hospice patient with a DNR who was exhibiting Cheyne-Stokes breathing, fixed pupils, and a thick green secretion in her mouth. She also was known to pocket food- I found bits of banana pocketed in both cheeks at the time. Without a second thought, I retrieved the suction machine from the crash cart and used a Yankauer to suction the pocketed food from her cheeks and some of the green secretion around her teeth. The family was present and was very grateful and surprised by the things coming out of her mouth. The patient hung in there until the next shift at which time she expired. The next morning my new unit manager wrote me up for suctioning without a physicians order. Her MD had a standing order to suction PRN and the only Hospice orders I could locate in the chart said to D/C all previous meds, not all previous orders. Her hospice has no standing order to suction, however. This supervisor threatened my license and basically called me a lousy nurse for my actions. Am I completely wrong here?

echoRNC711, BSN

227 Posts

Specializes in cardiac CVRU/ICU/cardiac rehab/case management. Has 27 years experience.

I am gob smacked.

DNR doesn't mean NO care or let's do our best to kill them quickest. I am also confused why any order was even needed to suction. It would be a serious breach of practice NOT to suction a pt whose airway is compromised.

I am a huge advocate for a pt right to die, however to not suction a pt is pretty close to actively smothering a pt.

I am not familiar with hospice orders but honestly I am a bit horrified


465 Posts

Has 2 years experience.

Agreed...WTH?? I would not want to work in that enviornment. I am a bad nurse for making my patient clean, comfortable, and safe while they're dying? Okay.

I can understand not wanting to deep suction someone who was hospice...very uncomfortable procedure, but just passing a yankeur around in someone's mouth? Please!


7,735 Posts

Specializes in retired LTC.

I too, would have suctioned. And in other cases when pts were gurgling in their last, I would not watch/hear them drown. I suction.

Some hospice programs feel contrary to this; but my feeling is to provide the care since I am there. Otherwise let others come in and be at the bedside and watch the struggle.


16 Posts

My action was called a "heroic measure" but I don't understand how it could be. This new unit manager even made a point to tell me that she had called HR to look at my file. I was appalled that she was trying to use my file as leverage against me and as a tool to intimidate. I personally don't think she has a right to look up anybody's history. Had something serious been in there I would've been reported to the state. I've left her a note challenging the write up and have received no response. Maybe my next step should be a visit with the DON.

BrandonLPN, LPN

3,358 Posts

Has 5 years experience.

I hope you didn't sign the write up.


1 Article; 2,188 Posts

Specializes in Home Care.

I'd go right to the DON about this one.

echoRNC711, BSN

227 Posts

Specializes in cardiac CVRU/ICU/cardiac rehab/case management. Has 27 years experience.

If you have a union take their advisement on how to proceed. Ask for representation .

nrsang97, BSN, RN

2,602 Posts

Specializes in Neuro ICU and Med Surg. Has 22 years experience.

Your manager is nuts. I would deffinately be watching my back and looking for other work ASAP! Mouth care should still be done for those on hospice. It is a comfort measure.


2,452 Posts

Specializes in ortho, hospice volunteer, psych,. Has 20 years experience.

You did the compassionate thing for your patient. Is your new unit manager even familiar with what is and is not a comfort measure? If she's never worked with hospice patients before, she may not know the difference between a comfort measure and active treatment.

When my mom was dying at home, we had hospice come in. The primary site had been her left breast but with mets to her liver and brain. Her liver and its tumor grew huge and really interfered with her comfort.

Hospice suggested one or two chemo treatments just to shrink the tumor and liver. It really made all the

difference in her comfort. She said she no longer felt nine months pregnant and her pain and nausea were

greatly lessened.

Sometimes, you just have to do what keeps your patient the most comfortable. Your suctioning kept her from

drowning in her own secretions.


664 Posts

Specializes in LTC.

Quit sister.


16 Posts

Unfortunately I did. Doesn't my signature just indicate that the write up was explained to me? Is it an admission of guilt?