DNR Does Not Mean Do Not Treat

Nurses and the meaning of DNR.

I recall a patient I had as a very new nurse who was designated as do not resuscitate, or “DNR.” The patient had suffered an intracranial bleed and because of his advanced age and untreatable cancer, his family had agreed that no CPR should be used. I remember the nursing supervisor asking me why the patient didn’t have a footboard and foam heel protectors on (that’s what we did back then); my answer was that he was a DNR patient. She basically handed me my head and said that his DNR status had nothing to do with good nursing care.

I never forgot that incident, and when I spoke with the authors of a mixed methods study with direct care nurses on three different units that found that “varying interpretations of DNR orders among nurses were common,” I immediately said yes. Their article is the original research article in AJN‘s January issue, “Nursing Perspectives on Caring for Patients with Do-Not-Resuscitate Orders.”

Families and providers may understand DNR differently.

And it’s not just nurses who may have different ideas and think differently about what should or shouldn’t be done for these patients who hover between life and death—other health care providers and families need to be clear on what […]

2021-01-27T11:35:45-05:00January 27th, 2021|Nursing, nursing research|1 Comment
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Health Care Terms and Words To Retire and Replace?

This week, two bloggers posted lists of words or terms they felt should no longer be used when referring to health professionals or patients.

2017-01-11T12:45:05-05:00January 10th, 2017|healthcare social media, Nursing, nursing perspective|0 Comments
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Workplace Bullying: One Medical Center’s Nurses Assess and Respond

photo by Ronald Keller photo by Ronald Keller

Bullying against or by nurses has gotten a lot of attention in recent years. Aside from the suffering bullying inflicts on its victims, research tells us that bullying (which takes a number of forms, from overt insults to more subtle acts that undermine and demoralize) can also endanger patient safety and quality of care.

As described in our February article, “A Task Force to Address Bullying“ (free access until March 1), recently a large Magnet-designated academic medical center in the Northeast developed an initiative to evaluate and address the issue at their institution. In order to first measure the problem, the task force developed a confidential online survey.

The survey had a 38% response rate. Here are some of the findings about who’s doing the bullying, who’s suffering it, and how its victims are affected by it:

 . . . . two-thirds (66%) of respondents reported having experienced or witnessed bullying in the workplace; and ‘bullies’ were most frequently identified as staff nurses (58%), followed by physicians (38%), patient care technicians (34%), and nurse managers (34%). Among the individuals who reported having been bullied, more than half experienced the following personal consequences: loss of confidence (63%), anxiety (59%), and diminished self-esteem (50%); and more than half experienced the following work consequences: decreased job satisfaction (83%), […]

2016-11-21T13:01:29-05:00February 9th, 2016|career, Nursing, nursing perspective|2 Comments
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Recent End-of-Life Care Links of Note, by Nurses and Others

nature's own tightrope/marie and alistair knock/flickr creative commons nature’s own tightrope/marie and alistair knock/flickr creative commons

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

End-of-life care and decision making have been getting a lot of attention lately. The Institute of Medicine released a new report earlier this year, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life (available for free download as a PDF).

Nurses who write often write about end-of-life matters. A couple of recent examples:

On the Nurse Manifest Web site, a look at the realities and challenges of futile care in America. Here’s a quote:

“I am currently teaching a thanatology (study of death and dying) course for nurses that I designed . . . to support students to go deeply in their reflective process around death and dying, to explore the holistic needs of the dying, and to delve into the body of evidence around the science and politics of death and dying.”

Or read another nurse blogger’s less abstract take on the tricky emotional territory nurses face when a patient dies.

Elsewhere on the Web
Vox reporter Sarah Kliff collects five strong end-of-life essays that recently appeared in various sources.

And here’s something very practical that might catch on: according to a recent […]

2016-11-21T13:02:42-05:00April 13th, 2015|career, Nursing, nursing perspective, patient engagement|0 Comments
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“They Call Us Doctor, and We Call Them By Their Names”

Just stumbled on a blog post written by a first-year resident who calls himself “Anonymous Doc.” He raises a good question about why nurses and doctors are referred to in such different ways:

I don’t think I’ve talked about this before, but the doctor/nurse divide is weird. One of my intern friends called me the other night and said there’s a nurse he likes, and in theory wants to ask her out, but doesn’t think he should. It would be awkward, he’s like her superior… he doesn’t feel comfortable doing anything. And maybe he’s right. But the whole dynamic is weird. They call us doctor, and we call them by their names– and sometimes not even. At one of the hospitals, there’s this strange custom where the nurses all go by Miss or Mister and their first names. So I’m Dr. Lastname and they’re Miss Jenny or Mister Steve. It’s bizarre. Miss Jenny sounds like a kindergarten teacher. Maybe. And some of the residents use these names when they talk about the nurses to each other, like– “did you give the order to Miss Amber?” “did you tell Miss Jeanette?” Are we children? I feel like we’re colleagues, and we should all just call each other by our first names. Like colleagues do. Patients can call us Dr. Whatever, but I don’t feel like I need the nurses to treat me like a superior, and I also don’t want to treat them like they’re my nursery school teacher.

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2016-11-21T13:20:10-05:00January 15th, 2010|career|10 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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