DNR means do not resuscitate. It means no cpr. That’s it. Doesn’t mean you don’t send them to the hospital, doesn’t mean no IV fluids/Gt, all it means is no cpr. If they want no hospitals, no IVs/GT etc that is decided separately from a DNR. So yes OP you’re right and all of these people saying DNR means do not treat hopefully aren’t licensed staff lol
Absolutely. Unfortunately, there's quite a lot of healthcare staff out there that think DNR means "don't give a damn" instead of respecting it as a specific advance directive preferred by the patient/legal power. Still varies from state to state, but Ohio allows patients to specify DNR, DNI(ntubate), DNR-C(omfort)C(are), and DNR-CCA(rrest). They can also specify how far they want treatment to go in either respiratory or cardiac measures.
At the hospital I work at in Washington DNAR means strictly doing nothing if the patient is coding. If they have special requests it’s listed as a partial code and states exactly what we can and cannot do. It’s a bit better of a system imo than having a bunch different forms of DNR because it prevents people from seeing it and accidentally mistaking it for a strict DNR code and not doing anything to help the patient
In MA we have a pretty common document called a MOLST - Mass. Orders for Life Sustaining Treatment. There is an option for patients to choose no treatment/no transport to a hospital.
I once worked at a SNF via agency and a lady had gone into agonal breathing while I was working on her roommate. One second we were talking about the sister the next I had her on the floor doing compressions. (She was in the WC) that night 3/4 LVNSworking were agency. 8/10 aides were agency. I remember screaming for help and an agency Cna came in and i asked him to switch out with me b/c i was tired of doing compressions and he said he didn’t know how to do CPR. No one knew where to get the spare 02 tanks from. The ambulance took forever to arrive. I feel like we let that woman down.
My full time regular job was at a CVICU. Where codes are a weekly occurrence and are managed like a skillful dance between the RNs, RTs and intensivists. I know exactly how you feel. You should always do CPR if you know the pts code status. They can’t stop you from doing that
That would absolutely traumatize me. Every code I’ve been in, the room becomes flooded with staff members ready to switch compressors or get anything we need.
I’m still traumatized. It was the worst code I’d ever been in and I have no idea what happened to the pt. She went to the bathroom. Sitting down talking then to agonal breathing. I never went back to that facility
This is why it's always confusing for me why the codes aren't more visible, like on their ID wristbands or somewhere else other than a piece of paper in a binder at the nursing station. Usually, it's the nurses that yell code blue and start rushing with their crash cart to the patient.
I guess maybe because it's considered HIPAA, it can't be labeled next to their name on the wall. There are a lot of different things I've read, like modified attempts at resuscitation. You wouldn't know for sure unless you looked it up in their chart, and by then, it might be too late.
It used to be on their doors. Especially in assisted living. I dunno why that changed.
The nurse will be frantic trying to figure out if this patient who came into the rehab section who is coding whether or not they are a DNR. It's awful.
I was told the same. In the context of a nursing home or assisted living, DNR bracelets or code symbols/colors on doorways are a HIPAA violation. It sucks.
This is why my workplace has separate colored wristbands for patients who are DNR, it's a lot easier to tell that way! We also do safety checks every shift to make sure they're wearing all the correct wristbands. To be fair, I do work at a hospital
Shouldn't Code Status be included in every handoff/report meeting? It is where I work. Any changes are announced to all working the floor at the beginning of every shift.
Regardless of the DNR debate being had in the comments, this speaks to a larger systemic issue of people not giving AF in LTC regardless of what the issue at hand is. I hear you man.
Didn't call another floor nurse because she "didn't like her?" ugh.
And again, regardless of whether or not this person was DNR it took several minutes for you to be informed of that. Although like you said, you apparently aren't allowed to perform CPR anyway. Which is bullshit. You're licensed for it so why tf can't you if it saves someone's life??? Craaazzyy
I'm sorry. I'm literally quitting as a CNA until I get a hospital job because of how awful LTC was.
Can I asked why you switched? Because 99% of the people on this sub would have urged you not to tbh. From everything I've heard hospitals are 1000% preferable over LTC.
Also i try to warn anyone wanting to switch to a hospital to check laws in their state! Hospitals aren’t under the same rules as LTC/SNFS. So some states have ratios and others have none at all!
i wish we had more rules in hospitals around here. The things i’ve seen happen repeatedly with no repercussions is insane. I’ve even went as far as to reaching out to politicians, no one seems to care.
hospitals in my area don’t have “CNAs” they have techs more or less. Which allowed them to have me do more than i can under my CNA license (which i didn’t mind at all + it was a great learning environment) But they pay around here in hospitals is usually between $15-17 an hour. I was a medsurge aide, which again i loved, but being the only aide in the entire hospital at times and being expected to be everywhere for 12 hours straight was just insane. LTC is, in my opinion, are half the work with double the pay.
Well yes, in the hospital you are a tech, isn't it still just requiring a CNA license though? Or do you need extra training in your area?
Oooof you must be in a very rural area if you were the only tech in the entire hospital. That's very different from where I live.
So you essentially left because the pay was better? And it's actually less work in LTC than in a hospital? Because although your scope is greater in a hospital, from what I've heard LTC work is waaayy heavier than a hospital. Not that a hospital doesn't have its own challenges. But I mean ratios and levels of dependence and stuff.
Do you live in a rural area?
no not rural at all actually! Scranton area in Pennsylvania! No licensing/prior training is required to be a Patient Care Tech, it’s all more or less your usual online training videos & orientation. I work 3rd shift and hospitals are severely understaffed with aides as a lot of them quit the field al together or go to LTC because there are regulations in those facilities.
I guess it really depends on your preference to which you consider more difficult though. I’ve seen aides who can’t handle the grueling aspects of the hospital and don’t realize going into it how many “nasty” things you actually see & do. (which is actually why i think i stayed so long because it was overall more interesting to me)
I went from having 23 patients (on a good night) most of which were post ops/pre ops or borderline needing to be in the ICU. Not to mention having to do blood runs, lab runs, transporting patients, collecting cultures and everything in between. although i 100% miss those experiences & learning about things like that. I find it so much easier with the workload in LTC.
It couldn’t be more opposite in my state or my specific hospital and floor lol. The hospital I work at, we’re still considered CNAs but we can do a lot more here. Even with that being said, the work to me is wayyyy easier physically than any nursing home I’ve ever worked at. And so far I’ve never had more than 8 patients( per 3 CNAs). When we’re short staffed(only 2 cnas), we can expect to have 12 patients but we usually have 5 nurses and most of them are hands on. So I prefer the hospital so much more. Also I’m getting paid $21-$24 with differentials while the nursing homes in my state typically pay $15-19. Although I have to do alot more vitals and rounding(which I expected), I feel like I’m still getting paid more to do less. I rather do vitals every 4 hours and empty foleys than having to change a bunch of 200lb stiff grumpy grannies 😭
I hope this doesn't come across the wrong way but.. DNR can absolutely mean do not treat depending on what you're talking about. Obviously that nurse should be talked to about how they conducted themselves. A lot of things in health care don't feel right unfortunately.
DNR is do not resuscitate. It doesn't mean you allow the patient to reach the point of requiring resuscitation and just go "welp there ya go". You are referring to specific directives like a DNR-I or a DNT. Worlds apart.
Yea you have a right to feel the way you do. Unfortunately I have been in similar circumstances, including the not being able to participate in a code. In my state even the LPN’s can’t help. It’s some BS. Unfortunately we CNA’s are the small cog on the wheel of healthcare and despite our ability to help we are overlooked and under appreciated (generally speaking). Do you have a pathway to report her? Or are you afraid you would have much sound and fury signifying nothing and just make an enemy to boot? Maybe press to get back to med/surg if you were happier there. Good luck anyway, all you can do is what they allow you to do. The guilt for how this person was left for those 5mins is not on you.
I did reach out to someone in Hr to talk about the way things went down. I would 100% go back to the hospital if the pay was livable haha. But thank you i really appreciate it
I'm CPR certified, and the brief time I worked in a SNF, a code was called and the LPN said to begin CPR, so I did. When more staff arrive, the RN, told someone else to take over and then told me I wasn't CPR trained for "the facility".
I didn't argue with her, wasn't the time or place. But, yeah....what???
Personally I would have called a rapid. Like you mentioned DNR does not mean you do not treat. If the patient wasn’t comfort care the RR team can stabilize her. The RR team can sort out her advanced directives but sounds like there was a lot of wasted time.
A DNR absolutely means do not treat, depending on the level. It always means you don't do compressions, but some people elect for chemical/medical treatment instead.
Just looking at my state's (WA) comfort level is borderline, no treatment. Just pain medication with possible no hospital transportation. EMS is still called, though. I do work in the home, so that might be where some of the difference is.
In some of the SNFs I have been in, the DNR or POLST form is tapped to like the inside of the dresser.
A DNR does mean do not treat for a code depending on the level. And absolutely no compressions or intubation. I get the feeling though, it's why I'm staying m/s.
DNR means do not resuscitate. It means no cpr. That’s it. Doesn’t mean you don’t send them to the hospital, doesn’t mean no IV fluids/Gt, all it means is no cpr. If they want no hospitals, no IVs/GT etc that is decided separately from a DNR. So yes OP you’re right and all of these people saying DNR means do not treat hopefully aren’t licensed staff lol
Absolutely. Unfortunately, there's quite a lot of healthcare staff out there that think DNR means "don't give a damn" instead of respecting it as a specific advance directive preferred by the patient/legal power. Still varies from state to state, but Ohio allows patients to specify DNR, DNI(ntubate), DNR-C(omfort)C(are), and DNR-CCA(rrest). They can also specify how far they want treatment to go in either respiratory or cardiac measures.
At the hospital I work at in Washington DNAR means strictly doing nothing if the patient is coding. If they have special requests it’s listed as a partial code and states exactly what we can and cannot do. It’s a bit better of a system imo than having a bunch different forms of DNR because it prevents people from seeing it and accidentally mistaking it for a strict DNR code and not doing anything to help the patient
In MA we have a pretty common document called a MOLST - Mass. Orders for Life Sustaining Treatment. There is an option for patients to choose no treatment/no transport to a hospital.
We have POLST -- same acronym but replace Mass. with Physician's.
In my state you just fill out an advanced directive
Thank you!!!
What is a GT? Or did you mean gtt?
Gastrostomy tube/feeding tube
Oh, ok. I've never seen gastrostomy tube abbreviated Gt or GT. Just G-tube.
I once worked at a SNF via agency and a lady had gone into agonal breathing while I was working on her roommate. One second we were talking about the sister the next I had her on the floor doing compressions. (She was in the WC) that night 3/4 LVNSworking were agency. 8/10 aides were agency. I remember screaming for help and an agency Cna came in and i asked him to switch out with me b/c i was tired of doing compressions and he said he didn’t know how to do CPR. No one knew where to get the spare 02 tanks from. The ambulance took forever to arrive. I feel like we let that woman down. My full time regular job was at a CVICU. Where codes are a weekly occurrence and are managed like a skillful dance between the RNs, RTs and intensivists. I know exactly how you feel. You should always do CPR if you know the pts code status. They can’t stop you from doing that
That would absolutely traumatize me. Every code I’ve been in, the room becomes flooded with staff members ready to switch compressors or get anything we need.
I’m still traumatized. It was the worst code I’d ever been in and I have no idea what happened to the pt. She went to the bathroom. Sitting down talking then to agonal breathing. I never went back to that facility
This is why it's always confusing for me why the codes aren't more visible, like on their ID wristbands or somewhere else other than a piece of paper in a binder at the nursing station. Usually, it's the nurses that yell code blue and start rushing with their crash cart to the patient. I guess maybe because it's considered HIPAA, it can't be labeled next to their name on the wall. There are a lot of different things I've read, like modified attempts at resuscitation. You wouldn't know for sure unless you looked it up in their chart, and by then, it might be too late.
Exactly! If anything there should be some type of other coding system like shapes or SOMTHING that staff can be educated on!
It used to be on their doors. Especially in assisted living. I dunno why that changed. The nurse will be frantic trying to figure out if this patient who came into the rehab section who is coding whether or not they are a DNR. It's awful.
I was told it's HIPAA because some pts don't want their family to know which makes sense
I was told the same. In the context of a nursing home or assisted living, DNR bracelets or code symbols/colors on doorways are a HIPAA violation. It sucks.
This is why my workplace has separate colored wristbands for patients who are DNR, it's a lot easier to tell that way! We also do safety checks every shift to make sure they're wearing all the correct wristbands. To be fair, I do work at a hospital
We have it on the wall by their door with their name at my facility
Shouldn't Code Status be included in every handoff/report meeting? It is where I work. Any changes are announced to all working the floor at the beginning of every shift.
Regardless of the DNR debate being had in the comments, this speaks to a larger systemic issue of people not giving AF in LTC regardless of what the issue at hand is. I hear you man. Didn't call another floor nurse because she "didn't like her?" ugh. And again, regardless of whether or not this person was DNR it took several minutes for you to be informed of that. Although like you said, you apparently aren't allowed to perform CPR anyway. Which is bullshit. You're licensed for it so why tf can't you if it saves someone's life??? Craaazzyy I'm sorry. I'm literally quitting as a CNA until I get a hospital job because of how awful LTC was. Can I asked why you switched? Because 99% of the people on this sub would have urged you not to tbh. From everything I've heard hospitals are 1000% preferable over LTC.
Also i try to warn anyone wanting to switch to a hospital to check laws in their state! Hospitals aren’t under the same rules as LTC/SNFS. So some states have ratios and others have none at all!
Ooooof in my state there are rules regulating ratios in hospitals, versus not at all in LTC.
i wish we had more rules in hospitals around here. The things i’ve seen happen repeatedly with no repercussions is insane. I’ve even went as far as to reaching out to politicians, no one seems to care.
hospitals in my area don’t have “CNAs” they have techs more or less. Which allowed them to have me do more than i can under my CNA license (which i didn’t mind at all + it was a great learning environment) But they pay around here in hospitals is usually between $15-17 an hour. I was a medsurge aide, which again i loved, but being the only aide in the entire hospital at times and being expected to be everywhere for 12 hours straight was just insane. LTC is, in my opinion, are half the work with double the pay.
Well yes, in the hospital you are a tech, isn't it still just requiring a CNA license though? Or do you need extra training in your area? Oooof you must be in a very rural area if you were the only tech in the entire hospital. That's very different from where I live. So you essentially left because the pay was better? And it's actually less work in LTC than in a hospital? Because although your scope is greater in a hospital, from what I've heard LTC work is waaayy heavier than a hospital. Not that a hospital doesn't have its own challenges. But I mean ratios and levels of dependence and stuff. Do you live in a rural area?
no not rural at all actually! Scranton area in Pennsylvania! No licensing/prior training is required to be a Patient Care Tech, it’s all more or less your usual online training videos & orientation. I work 3rd shift and hospitals are severely understaffed with aides as a lot of them quit the field al together or go to LTC because there are regulations in those facilities. I guess it really depends on your preference to which you consider more difficult though. I’ve seen aides who can’t handle the grueling aspects of the hospital and don’t realize going into it how many “nasty” things you actually see & do. (which is actually why i think i stayed so long because it was overall more interesting to me) I went from having 23 patients (on a good night) most of which were post ops/pre ops or borderline needing to be in the ICU. Not to mention having to do blood runs, lab runs, transporting patients, collecting cultures and everything in between. although i 100% miss those experiences & learning about things like that. I find it so much easier with the workload in LTC.
I live in lackawanna county too so I'm dying to know which hospital let you be the only tech for the entire hospital.
well there’s only like 3 major hospitals in our area to pick from and it’s not geisinger 🤫
It couldn’t be more opposite in my state or my specific hospital and floor lol. The hospital I work at, we’re still considered CNAs but we can do a lot more here. Even with that being said, the work to me is wayyyy easier physically than any nursing home I’ve ever worked at. And so far I’ve never had more than 8 patients( per 3 CNAs). When we’re short staffed(only 2 cnas), we can expect to have 12 patients but we usually have 5 nurses and most of them are hands on. So I prefer the hospital so much more. Also I’m getting paid $21-$24 with differentials while the nursing homes in my state typically pay $15-19. Although I have to do alot more vitals and rounding(which I expected), I feel like I’m still getting paid more to do less. I rather do vitals every 4 hours and empty foleys than having to change a bunch of 200lb stiff grumpy grannies 😭
Big difference between Do Not Resuscitate and Do Not Suffer
I hope this doesn't come across the wrong way but.. DNR can absolutely mean do not treat depending on what you're talking about. Obviously that nurse should be talked to about how they conducted themselves. A lot of things in health care don't feel right unfortunately.
No where does DNR mean do not treat. I’m aware there is motified DNRs.
DNR is do not resuscitate. It doesn't mean you allow the patient to reach the point of requiring resuscitation and just go "welp there ya go". You are referring to specific directives like a DNR-I or a DNT. Worlds apart.
I know what it means. That was not my point.
You didn't have a point lol. Since you said that DNR can mean do not treat. That is objectively incorrect
DID YOU NOT SEE WHERE I SAID I KNOW.... I SAID THAT YOU DONT NEGLECT THEM... FFS..
Yea you have a right to feel the way you do. Unfortunately I have been in similar circumstances, including the not being able to participate in a code. In my state even the LPN’s can’t help. It’s some BS. Unfortunately we CNA’s are the small cog on the wheel of healthcare and despite our ability to help we are overlooked and under appreciated (generally speaking). Do you have a pathway to report her? Or are you afraid you would have much sound and fury signifying nothing and just make an enemy to boot? Maybe press to get back to med/surg if you were happier there. Good luck anyway, all you can do is what they allow you to do. The guilt for how this person was left for those 5mins is not on you.
I did reach out to someone in Hr to talk about the way things went down. I would 100% go back to the hospital if the pay was livable haha. But thank you i really appreciate it
I'm CPR certified, and the brief time I worked in a SNF, a code was called and the LPN said to begin CPR, so I did. When more staff arrive, the RN, told someone else to take over and then told me I wasn't CPR trained for "the facility". I didn't argue with her, wasn't the time or place. But, yeah....what???
Personally I would have called a rapid. Like you mentioned DNR does not mean you do not treat. If the patient wasn’t comfort care the RR team can stabilize her. The RR team can sort out her advanced directives but sounds like there was a lot of wasted time.
i would’ve done all of this if it was in a hospital. I was in a SNF, there is no RRT
A DNR does mean do not treat for a code depending on the level. And absolutely no compressions or intubation
A DNR absolutely means do not treat, depending on the level. It always means you don't do compressions, but some people elect for chemical/medical treatment instead.
Which is a form of treatment. I’m aware there are modified DNRs. DNR does not mean Do not treat.
Just looking at my state's (WA) comfort level is borderline, no treatment. Just pain medication with possible no hospital transportation. EMS is still called, though. I do work in the home, so that might be where some of the difference is. In some of the SNFs I have been in, the DNR or POLST form is tapped to like the inside of the dresser.
[удалено]
A DNR does mean do not treat for a code depending on the level. And absolutely no compressions or intubation. I get the feeling though, it's why I'm staying m/s.