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Nurses - question about DNR

I am an LPN working toward my RN. I will graduate in December of this year and take my board exam. I had a patient in clinical recently with a situation that got me thinking about this. Her family member who had power of attorney had arranged for a DNR order for this patient who had some pretty serious health problems. Upon this most recent admission to the hospital the patient had stated that she wanted to be resuscitated. I talked to my instructor about this, because it really bothered me. She said that I could lose my nursing license if I performed CPR with a DNR order in place, regardless of the patient's stated wishes. I would have complied with the DNR order, but I was praying that nothing would happen during my shift.

Has anyone else had something similar come up? How did you feel about it?

 
Iamgr8teful

Asked by Iamgr8teful at 6:11 PM on Jun. 2, 2010 in Health

Level 25 (23,279 Credits)
This question is closed.
Answers (11)
  • i am an LVN, working in LTC and deal with OOH DNR's all the time.

    In Texas, a POA goes into effect when the patient can no longer make decisions for him/herself, as the pp's indicate. That line can be a thin one sometimes considering dementia, etc. If the patient is still alert and oriented x3, they are considered capable and the POA is not yet in effect.

    If that patient has a LEGAL GUARDIAN, however, the guardian makes ALL decisions for the patient, regardless of the patient's perceived ability to make those decisions. A court has decided that they are no longer competent to make those choices for themselves.

    You may be able to find more/better answers at allnurses.com wonderful forum of nurses from all over. :)
    inkydorei

    Answer by inkydorei at 7:04 PM on Jun. 2, 2010

  • if it is in writing then yes you could lose your job if you do cpr on her i know it's hard im a firefighter i see it every day
    Anonymous

    Answer by Anonymous at 6:15 PM on Jun. 2, 2010

  • Your job is to follow the patients wishes, and speaking from personal experience a DNR isn't worth the paper it's written on. I have DNR papers, and let my doctors know when I was admitted to have my son, in the event that something happened I did not want to be brought back. I was informed that while in a hospital DNR papers do not matter, that they are legally required to do everything in their power to "save me" regardless of my wishes. Now, in a case like what you have, your patient is saying she doesn't want you to listen to the DNR, and you should be abiding by HER wishes, not that of a family member, even if they have power of attorney. If I were you, I would take action to prevent anything from happening to your job by getting HER to sign the proper paperwork negating the DNR of her own free will... Your hospital should have it. If you don't, and she dies, and someone in her family finds out she wanted... cont...
    Anonymous

    Answer by Anonymous at 6:21 PM on Jun. 2, 2010

  • to live, you could be facing law suits as well as a malpractice suit. If on the other hand you do save her life and the DNR is in place the person with POA could also file a wrongful life suit. Personally I don't think he would win, but it does happen.

    Protect yourself by having this woman either sign paperwork or speak to a doctor above you. And make it clear to the family that due to this woman's wishes you will do everything in your power to help her...
    Anonymous

    Answer by Anonymous at 6:23 PM on Jun. 2, 2010

  • Doesn't a POA, especially for medical care, only go into effect should the patient be unable to make a decision for themselves? Like if they go into a coma? As long as the patient has a mental capacity to make decisions for their own care, they should be able to do so. Now, if that patient "died", was resuscitated and was living in a coma, then "died" again, I could understand the DNR having validity, but until that point, it seems unethical that someone else is making the calls.
    Anonymous

    Answer by Anonymous at 6:25 PM on Jun. 2, 2010

  • I'm an RN, both of my parents have Living wills, but neither has a DNR. I have POA papers for both of them, in the event they can not make their own decisions, so I would like to agree with a PP, ....depending on what the POA says, the family member should not have a DNR drawn up.....if the patient is "in her right mind". That "in her right mind" should be determined by a doctor, or in a conflict, by the court. It gets very, very complicated. Ask if you can speak to someone on the ethics committee of the hospital, to help you understand what would have been the right thing to do, in case this patient arrested.
    kjrn79

    Answer by kjrn79 at 6:35 PM on Jun. 2, 2010

  • I am a former Paramedic and worked in the Boston area from 1986-1998. I attended to a large number of emergency calls, where arriving at the scene I was presented with a DNR order. We were NOT allowed to perform ANY lifesaving measures by law, as long as the DNR was still valid.

    If the DNR order is NO LONGER VALID, then we were REQUIRED to perform whatever lifesaving measures were necessary.

    The rules may have changed since then, but at the time, a DNR was typically only valid for about 2 weeks. The point was to allow a terminally ill patient to be surrounded by loved ones in a comfortable home environment as opposed to a "cold" hospital setting. It was expected that the person would die within those two weeks.

    However, most of the calls we received were from spouses or adult children who "freaked out" when their spouse or parent died and instinctively called 911. We still had to abide by the order.

    LoriKeet

    Answer by LoriKeet at 6:43 PM on Jun. 2, 2010

  • This patient was very confused and not able to make decisions for herself. She'd had brain damage due to radiation therapy for periorbital cancer (it had metastasized there). For example, I asked her if she'd ever had a mastectomy because I was sent in to take blood pressure before I had a chance to look at her chart. She told me she didn't think so. It turned out she'd had a double mastectomy.

    My instructor saw me frowning and asked me what was wrong. That was when I told her about the DNR and the patient's statement upon admission. Everyone said that since she wasn't in her right mind and daughter had POA with an active DNR, I was not to resuscitate if anything happened.

    I was very bothered by that and was relieved when I got through the clinical shift without having to make that decision. She did have malignant hypertension, which was scary, but the doctor ordered meds that corrected it.
    Iamgr8teful

    Answer by Iamgr8teful at 6:55 PM on Jun. 2, 2010

  • Just read your most recent post. If she was confused, then the POA was in effect, and the decision had been taken out of your hands.
    inkydorei

    Answer by inkydorei at 7:06 PM on Jun. 2, 2010

  • My husband works in a nursing home, and has been in a similar situation. A patient quit breathing on his shift, and right when he went to start CPR the DON came running in the room screaming for him not to perform CPR. That morning the family had finished signing the DNR papers that where offically in effect. And my husband could've lost his liscences. He said its not easy knowing you might be able to save them, but at the same time you have to look at it from a perfessional not personal view. These families that do DNR truly think its best for their family members. I worked on a head trauma unit, and I know the one things families want is no suffering anymore. You are going to see this more than once as a nurse, but sad as it might sound you need to learn to be perfessional about a families decision. If its something your not sure you can do then maybe nursing is not the right career for you.
    Apple_Pie2010

    Answer by Apple_Pie2010 at 7:38 PM on Jun. 2, 2010

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