Forum posts made by naughtynurse

That makes sense in a hospice situation - but this patient wasn't in a hospice environment. My original comment was pertaining to someone who was in an independent or assisted living centre (like this patient) and the requirements of calling 911 if the patient became non-responsive. I assumed it was mandatory to do so (regardless of whether a DNR is in place or not, or whether the facility can provide interim CPR). When naughtynurse said 'no', it surprised me. I can understand not doing so in hospice, but independent/assisted living seems like a whole other scenario. Maybe we're all talking about different things on this one. That was more of a side issue anyway. If the patient and family were aware of the limitations of this particular facility and were fine with the arrangements, I don't really see any breach of conduct in a legal sense.

Hospice is not a facility, although some hospices have facilities. It is a way of managing end of life transitions and can be implemented anywhere including home environments.

CPR is a huge liability if implemented improperly, which is very easy. Once it has been initiated it cannot be stopped for any reason until the person has been revived or pronounced. It does not suprise me that an ALF would have this type of policy.

I don't know details. I just think that blanket judgements when we don't know the all facts is a bit harsh.

The second case you described sounds awful.

I assume each type of facility has their own procedure in place, maybe also related to how much care they are actually able to provide in that setting and what kind of medical personnel is there at the time. An assisted living centre like the one this woman was in really has limited means to treat. It's more 'carers' than registered nurses (compared to a hospice environment).



It was to be honest. What do you do? You know the pt wishes, but legally you have to do something else. I can't afford to lose my liscense!

That is exactly why I say we font have enough information to judge this case!

Yeah, but by virtue of the fact that the facility tells patient and family that they will not perform CPR in case of emergency - it's almost like an interim DNR on some level. I have to assume they can't be sued if the policy was explained and forms were signed showing understanding of procedure.

Our CNA's are NOT allowed to perform CPR. And they frequently call themselves nurses.

Really? So if a person is struggling or suffering, there is no requirement to call 911 or offer palliative care? To my understanding - all a DNR is that it alerts paramedics not to perform aggressive chest compressions, intubation or mechanical ventilation in case of an emergency. Other than that, I think everyone would agree that some degree of palliative assistance if the patient is still alive is mandatory. In those cases it's about relieving suffering rather than reviving. At least that's what happened with my family member at the assisted-living centre they were at. Maybe I'm not understanding what you're saying. Do places exist where the policy is just to shut the door and wait a few hours and check on them again until they're dead without any medical assistance? That doesn't seem right. :(

I didn't say that you shut the door and walk away. Here's an example:

I had a pt last week with a fib. She experienced periods of non responsiveness from time to time related to her disease process. We checked on her hourly, making certain she was comfortable, her o2 sats were good, she was turned, heels floated, changed her to an air mattress, preformed oral care, ect. She had a signed DNR in place, and her family was aware of the situation. When she passed it was quiet & peaceful. Death was pronounced by the RN, family was notified, MD was notified, & the funeral home was called.

I had a pt once who transferred to our facility. Her paperwork didn't all come appropriately at the time of transfer(happens more then you would think). I had a verbal report that she had a signed DNR in place but no physical yellow sheet. She coded within 8 hrs of her arrival. We were required to start CPR and call 911. In that case she ended up having her leg DRILLED into to start a line. Her chest compressions lasted for 30 minutes as we tried to reach business offices at 7a to get a copy of her DNR. I know from later speaking to the family that they were just as upset that we did the CPR then some others would be if we hadn't.

There are many courses on nursing ethics. It can be quite complex.

Actually they are mandated to call 911, even in cases where there is a DNR. The care delivered by medics may strictly be palliative (eg. oxygen, morphine etc.) in those cases however, until the person passes.

NOT true. (I deal with hospice patients daily)

I agree with one winged angel, I know so many people who call themselves a "nurse" CNA's, lab techs, even Vet techs. None of them are nurses but I hear it everyday. (by the way, to someone who has worked very hard to get her BSN, I find these kind of labels on unlicensed personal to be very insulting.)


Additionally in the state of FL, you might have signed a DNR, but if it isn't signed by the Dr & printed on the correct shade of yellow, it isn't legal, and would count as "no DNR signed." Not enough facts given to judge this case.

Because it's fun. And even when it's not brilliant, it's still pretty good. Like chocolate.

Or Pizza...

Call lights beeping, staff talking. Pts moving about.

Sorry Rump, I work Sundays.

It's freezing here this weekend and somehow that's doubly cruel since it was 80s all last week!

Happy Cake day!!!

On the floor, bent over the sink, or arm of the couch. Against the sink, or the wall of the shower.

Another bowl of cereal.

You asked for a nurse???

"Honky Tonk Women," the Rolling Stones

Stockings when it's cool, bare legs in summer

change purse when I don't have pockets.

hands free place to sit phone while chatting on speaker, portable table to sit plate whilst eating and working on computer.

Arm rest, I cross my arms over them occasionally.

Always convenient: best way to hide a bad hair day! (lower cut shirt)

"Walk," Pantera

i accept requests from everyone; i might never speak to them again OR i they might end up being my bestie. you never know. and really, not having friends from either gender or lifestyle or whatever? since i'm not looking for fuck buddies here, it makes no difference.

^^this^^

Although I love running, if it came to one, I'd have to stick with riding my horse.

Love is giving someone the power to completely destroy you, but trusting them not to.


True, the real trick is to find the one who when you give them that power, doesn't actually destroy you!

Bowl of cereal

The last of the Mohicans.

The book, while very good, was overly wordy and difficult to follow at times.

Not necessarily in this order :

1) m*a*s*h

2) The Simpson's

3) Big Bang Theroy

4) Scrubs

5) Family Guy

6)3rd rock from the sun

7) My name is Earl

8)South Park

9) Seinfield

10)Any old school loony tunes :)


Okay, in all fairness, I don't really watch TV. (I don't even own one)

Wilted lettuce salad(hot bacon dressing) with hard boiled egg and tomatos. Ice cold Yuenling

Lol! Hilarious.


Growing up, we had a neighbor who helped us bale hay from time to time. As we headed through the pasture one time he grabbed the metal gate in one hand, then closed his other around the electric fence wire. He ended up with burn marks on both hands, and complained it was my fault that he didn't grab the plastic gate handle. Sometimes you can't help stupid.

(grinds teeth) people.

That's all I'm going to say right now....

Yuengling, my favorite beer :)

Yes. It never ends well. Just look elsewhere.

The beef in my freezer was bottle fed by me. I know what they ate and how they lived.

For me, a true horror film has to contain a scenario or a story which is plausible, shocking and indeed - horrifying.

The last flick which contained those criteria and raised goosebumps - was 2005's Hostel.

Last horror movie I watched!

A cold beer, perfect for a warm evening!