Nurse refuses to perform CPR.

So I ran accross this Article this morning. I scrolled down, and read the comments, and was appalled at the general concensus of public opinion. At least as represented by the readers.

The article is about a nurse that did not perform CPR on an 87 year old woman who collapsed in an assisted living center. Evidently the 911 operator pleaded with her, but she was following corporate policy.

At face value the article is a drama piece at best. There is not enough information to base judgement on. Yet there were plenty of people calling for a lynching of the nurse. As a nurse myself I can tell you there is a 99.9% chance the nurse did exacty as she should. The woman's daughter who is a nurse even said she was happy with her mother's care.

The outrage expressed by the readers I believe comes from one of several misconceptions: First that CPR "saves" people, and had it been performed the outcome would have been different. Not true. The average long term survival rate for someone that has CPR administered is about 3%-5%. So CPR saves about 5 in 100 on a good day. With youth drownings being the only exception to that rule. CPR definitely saves lives in healthy drowning victims. The survival rate of 87 year olds with multiple comorbidities is essentially zero. CPR would have made no difference.

The next misconception is that CPR is like on TV. No, No, No... Blood, urine, feces, and other wonderful body fluids fly everywhere, it is painful, it is invasive, it is not dignified, and it's a hell of a bad way to go. If CPR is done correctly you break ribs, and it hurts! When EMTs arrive, and begin advanced support the endotracheal tube shoved down your throat hurts, and makes you gag. The big bore needles we shove in your arm, or groin, or neck hurt. You get a tube in your pee hole, and sometimes a tube through your nose into your stomach. Does that sound like a peaceful, dignified way to go?

When you are 87, and ready to accept your fate as a mortal human will you really want a society that demands we torture you with whatever is necessary to extend the length of your life regardless of how miserable that life is?

The next misconception is that 911 operators are medical personel, they are not. They deal with any, and everything. They are Jack's of all trades, but masters of none. They are also human, and have emotions. Just because a 911 operator pleaded with the nurse does not make those pleas reasonable when the nurse likely had intimate knowledge of the situation, and the operator was isolated in a call room with very little information, or risk to themselves.

Had the nurse performed CPR she would have violated policy. Which was there for a reason, and obviously agreed with by the resident, and her family. She would have lost her job, and the resident would have more than likely died anyway.

What scares me is the public's cavalier attitude about our jobs, and responsibilities as nurses. Does the general public really want nurses to throw away a stable job to appease their arbitrary feelings? Even though no real good would come of it? Torture an 87 year old woman during her final moments, just so public opinion can be appeased?

I even heard people saying they thought the nurse should be tried for murder. Ridiculous!!! She obvioulsy did as her patient, and the family wanted, and followed company policy. Yet all the armchair commentators who have never waded in blood, and feces are screaming for her head. 87 isn't old enough? If she was satisfied with her life she deserves the right to die with comfort, and dignity. If that pisses off the average american idiot, SO WHAT!!! We as nurses advocate for our patients first. It is patient centered, patient focused, and if public opinion doesn't like it. Get over it.

When it's your turn your opinion will change. I have seen it a thousand times before. I have seen family members yell, and scream for everything to be done for a loved one. Then a year or two later get a terminal diagnosis themselves, and immediately go on hospice care, and die in comfort. HYPOCRITES!!! The ultimate selfishness to demand a loved one die in pain so YOU can have a little more time with them. Then want comfort for yourself when dying. All people deserve the right to die in comfort, and with dignity, and have their wishes respected. Just because we can bring someone back for a little while doesn't mean it is the ethical thing to do.

No mention was made of the resident's resuscitation status. Frankly it is none of our business. Her family also has the right to privacy, and dignity while grieving the loss of a family matriarch. If the family, and facility have no issue with the nurses actions, she acted appropriately, and personal opinion about it is irrelevant. If you want to be pounded on, stabbed, and tortured in your last few moments in a vain effort to kick your corpse back to life for a 5% chance at a few futile, painful days, or weeks then you can do that on your way out, and waste a couple hundred thousand dollars in medical funding if you want. It seems these people had their heads, and hearts in the right place at the right time. Were she 27 with a good chance of recovery then the story would be completely different. When I'm 87 and ready to go don't you dare bring me back. Death is the result of life. Our immaturity as a species should not rob people of making the transition naturally, and smoothly. Life is precious, and should be defended, and that includes dignity when life ends, as all life does.

Money is more important than human life. If the nurse couldn't revive the woman then the company might have been sued now we can't have that can we?

reply to post by buster2010


I don't think money was an issue here. Would you be happy with a loved ones care if you felt the living center with held care based on money? The daughter who is a nurse was happy with the facility. The article would have been a non-issue, but for the 911 operator. Plenty of money is spent daily on futile care. You can definitely pursue it if you want.

Thank you. That was an eye-opening post. I knew there were issues with CPR, but I did not understand how pervasive they were. I hope everyone gets a chance to see the other side of this. As laymen we tend to view CPR as some sort of magical procedure. Clearly, it isn't.

I wonder of you might address another issue that has been bothering me: chemotherapy. My mother-in-law was diagnosed with pancreatic cancer. As you know, that is most often fatal, yet these guys went through the whole chemo bit. She died about six months later--of a heart attack. I know you;re supposed to retain hope and all, and her dfaughter insists he rmother's fatalistic attitude made it a foregone conclusion, but was chemo even necessary? It's expensive, invasive, sickening, and didn't change a damn thing.

reply to post by schuyler


Not magical at all. It's traumatic, physical, and messy. When used appropriately it does indeed save lives. When used to allay emotions, and family denial it is torture.

The patient might have had a DNR. The cpr could have been caused damage to the patients' frail body...broken ribs from chest compressions, etc could have punctured the heart or lungs...or both.

87 years old is a good, long run.

Originally posted by Binder
reply to post by buster2010

 

I don't think money was an issue here. Would you be happy with a loved ones care if you felt the living center with held care based on money? The daughter who is a nurse was happy with the facility. The article would have been a non-issue, but for the 911 operator. Plenty of money is spent daily on futile care. You can definitely pursue it if you want.

Why do you think they have that policy? Nurses are trained in CPR.

Originally posted by buster2010

Originally posted by Binder
reply to post by buster2010

 

I don't think money was an issue here. Would you be happy with a loved ones care if you felt the living center with held care based on money? The daughter who is a nurse was happy with the facility. The article would have been a non-issue, but for the 911 operator. Plenty of money is spent daily on futile care. You can definitely pursue it if you want.

Why do you think they have that policy? Nurses are trained in CPR.

Because experience has shown that it does more harm than good.

reply to post by Binder


I work at two of these places my friend...

That is called a DNR order... "Do Not Resuscitate"

And its not the company that issues this order... Only the family can give such orders....

And while I do not agree with the DNR order in most cases... don't blame the company, or the nurse because im sure she likely didn't agree with it either... but, not only would she lose her job if she did perform CPR... She would lose her licence...

They have nothing to do with it... blame the families

Originally posted by Akragon
reply to post by Binder

 

That is called a DNR order... "Do Not Resuscitate"

And its not the company that issues this order... Only the family can give such orders....

And while I do not agree with the DNR order in most cases... don't blame the company, or the nurse because im sure she likely didn't agree with it either... but, not only would she lose her job if she did perform CPR... She would lose her licence...

They have nothing to do with it... blame the families

Or maybe the patient herself? My mother did a living will that specifically had a DNR clause in it. The question is, who gets to decide? You say above that you do not agree with the DNR in most cases and speculate that the nurse didn't either. I'm not disagreeing with you, but the question is, who gets to decide and why do you think it should be done in the face of a DNR order?

My father became incapacitated to the point I had to put him in a nursing home at age 87. he had held out on his own far longer than anyone expected. He was incontinent and I couldn't even lift him. He lasted about four days. What he did was refuse to eat. The law in my state says you can try to him to eat three times, then you must not force food on him. It was sad to see him spit out his food, but he'd made a decision. He knew he was close to death anyway.

I hate death panels and medical care based on life expectancy as much as the next person. (My grandmother got a hip replacement at 90 and lived to be 100.) But at some point I think we have to agree that the patient ought to have some say in the matter, and if a DNR order is in place, we absolutely must honor it.

reply to post by schuyler

Or maybe the patient herself? My mother did a living will that specifically had a DNR clause in it. The question is, who gets to decide?

The patient decides, or if said patient is incapable of making that decision the burden falls on the power of attorney...

Unfortunately in many cases as another member said... the motivation for the DNR order is money... its disgusting and sad... but it happens a lot.

My father became incapacitated to the point I had to put him in a nursing home at age 87. he had held out on his own far longer than anyone expected. He was incontinent and I couldn't even lift him. He lasted about four days. What he did was refuse to eat. The law in my state says you can try to him to eat three times, then you must not force food on him. It was sad to see him spit out his food, but he'd made a decision. He knew he was close to death anyway.

In my experience I can tell you one thing about this... Unless the person is completely incoherent... they always know when its time to leave... Always

Im sorry for your loss... but I can assure you, death of the body is not the end of life... its just another step in the processs...

I hate death panels and medical care based on life expectancy as much as the next person. (My grandmother got a hip replacement at 90 and lived to be 100.) But at some point I think we have to agree that the patient ought to have some say in the matter, and if a DNR order is in place, we absolutely must honor it.

Well yes... we have no choice in that matter. Especially when it comes to legal action if one chooses not to honour it...

Its honestly not always a bad thing though... In many cases performing CPR on an elderly person can do more harm then Good... IF said person has osteoporosis which is a deterioration of the internal structure of the bones... While performing CPR on that person might keep him alive, the likely result would be broken ribs, which would make breathing nearly impossible... especially in a compromised state where the organs are already weak.

Its a hard topic to deal with, especially for people such as myself who are the ones who must respect the DNR order regardless of my opinion

Why is it policy to call 911? It seems they could have all stood around and sang "When the Saints go marching in " or something. It served no purpose to waste the dispatchers time and cause her stress.

reply to post by Akragon


I am very familiar with advanced directives, and living wills. They are not subject to outside speculation, thank God. They are usually initiated by the person, and represent their wishes for end of life care. There is a great lack of respect for the dying.
The live at all cost mentality is robbing us of natural death. I am currently working hospice and it is a beautiful thing. Our patients love us. We get very attached, and it is emotionally draining, but it gives a great quality of life at the end. DNR does not mean Do Not Treat. It just means we don't bring you back from the big one.
Yes there is profiteering in medicine and no one is more disgusted by it than most nurses. At the end of the day though you have to make compromises in an imperfect system in an imperfect world. Doctors and nurses aren't the money grubbers, look a bit higher.
As far as agreement with DNR orders... First it is the patients decision in most cases, and not open to speculation whether a clinician agrees or not. They are to be respected regardless. I am 37 and have an advanced directive already. If my chances of meaningful recovery drop below 30% in 2 doctors individual prognosis, I want them to let me go. I fear pain, and debilitation far more than death. If it happened tomorrow I would miss everyone immensely, but I have lived a great 37 years, and would already consider my run a good one. If I can make a meaningful recovery and have 37 more years that would be even better, but you don't always get what you want. I refuse to live a miserable, tortured life because others can't or won't let go when it is time. There are fates worse than death, and I have been part of them, and it's far worse than letting go when it is time.

reply to post by Gridrebel


You have to call 911 in accordance with state and local laws. It is to eliminate possible foul play, and properly manage the body. EMS carriers do not consider it a waste of time it is part of their job. Hospitals do it different because they have a morgue to hold the body until the funeral home guys arrive.

reply to post by Binder


My guess is that the patient had a binding DNR (Do Not Resuscitate), so the nurse's hands were tied by the patient's wishes. No outrage here. I get it.

the motivation for the DNR order is money

Not always. Every case is different. My wife had to sign one for her mother, who was comatose, with zero chance of recovery (according to 4 different docs and neurologists). (and her mother had good insurance and money, so it would have been more financially beneficial for the facility to keep her alive and charging for it....)

As a fellow nurse I get very frustrated with the way the media portrays some practices, I suppose it must be like what it feels for a Solider when someone who has never seen war says “could you not just shoot him on the leg”.

I have done CPR more times that I care to count, and I haven’t been doing the job that long.

I once done it on an older guy because we had no DACPR form in place and broke his ribs, he survived but spent 3 days in ICU and then died a very undignified death. I have also not done CPR on people who don’t have a DACPR form because there wasn’t much point it would have not really been appropriate.

I also agree on the way that it is portrayed in the media as being some magic touch that we have that can jump start a heart. I laugh when I watch medical shows, with shouts of “HE’s Flat-lined, Commence CPR STAT!”….. yeah your leads have come off your patient’s chest. And then after 2 minutes of CPR the guy who should be dead (or have his leads put back on) miraculously wakes up again. They never show the vomit spewing form his mouth and all the other body fluids or the continuous CPR that lasts for ages giving me a sore back and burning my shoulders and they never bother with the ethics of anything. It’s a joke really but it has created this unrealistic expectation form the public about the success rate and simplicity of CPR.

If you have never had training in Advanced Life Support then don’t second guess the actions of health care professionals because you firstly don’t know what you’re talking about and secondly don’t know anything about the specific situation unless you where actually present.

reply to post by OtherSideOfTheCoin

They never show the vomit spewing form his mouth and all the other body fluids or the continuous CPR that lasts for ages giving me a sore back and burning my shoulders and they never bother with the ethics of anything. It’s a joke really but it has created this unrealistic expectation form the public about the success rate and simplicity of CPR.

or the likely brain damage for being gone for a period of time....

reply to post by OtherSideOfTheCoin


You got it. If you've never been there you can't even imagine. The last facility I worked at started letting family members watch us code loved ones from outside the room. It was a good thing it made for far shorter codes. After about 5 minutes the family was pale and begging us to stop. Many comments about how it wasn't anything like TV.

I think part of college and community service should be to ride an ambulance for a week then volunteer in an ER or ICU. It would be great perspective for our upcoming generation.