1. Raffensperger, Amy BSN, RN, CMSRN
  2. Blair, Meg PhD, MSN, RN, CEN
  3. Gast, Judi BSN, RN

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Withholding CPR: A matter of policy?

I was disappointed by the tone of your editorial, "Refusing to Give CPR: Should Policy Trump Common Sense?" (May 2013),* where you condemned the actions of a nurse who refused to give CPR to a resident who collapsed in an independent living facility. The nurse said that facility policy prevented her from providing CPR to any resident. I'd hoped that Nursing2013 would do some credible reporting on the ethics and policy issues in the case-for example, explore why any facility would have a "No CPR" policy-and that your legal consultants would shed some light on what legal recourse a nurse in that situation would face if he or she chose to administer CPR against policy. Given that the patient's daughter, said to have been an RN, stated that she was satisfied with the care her mother received, perhaps she'd be willing to discuss the situation with Nursing2013 and your publication could give facts about a media controversy that has generated more heat than light.


Editor's note: I agree with a "no CPR policy" as long as all of the residents and/or their family members/legal decision makers (in the event the patient is incapable of decision making) are clearly aware of the DNR facility policy and are on board with it. It wasn't clear whether the patient in this case had DNR status when the story broke.

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I respect DNR status. In fact, all emergency medical services (EMS) agencies and health facilities that serve the organization should be aware of every resident's DNR status and respond accordingly. Why did the nurse from this facility even call EMS if their role was to do nothing? What would the EMS service or hospital have to offer in this case? Unless this has been clarified, CPR should not be withheld-in a situation where an error of omission is deadly, there's no room for error.


I enjoyed your editorial about the CPR refusal case. The assisted living facility where my dad once lived and the long-term-care facility where he lives now both require the resident and the family to sign documents stating that no one at the facility will perform CPR. For medical emergencies, staff will only call 9-1-1. If anyone objects to this policy, the resident is advised to move elsewhere.


My dad is 89 and can't even turn himself in bed, so we're all okay with the policy. But I wonder how prevalent this is and how many residents/families are in facilities with a similar policy. What happens if they don't agree with it but have no other options for moving? I think you started a great dialog on the topic and appreciate the way you approached it.


Believe me, I'm in total agreement with your editorial, but on the flip side of the coin, let's just say that the staff member did perform CPR and something went wrong. Is she no longer covered under her hospital/facility insurance policy because she went against policy? Just a thought.


Kristopher T. Starr, JD, MSN, RN, responds:So that we avoid any confusion, a DNR is a medical order whereas an advance medical directive is a personal choice. An individual's advance medical directives should be available in a central location for any nursing facility. Physicians, NPs, and other advanced providers will place a medical DNR order on a chart where appropriate. For independent living, unless there's medical oversight, knowledge of an individual's advance medical directive status may not be mandatory unless required by facility policy, local ordinance, or statute. That said, however, it makes sense that, upon admission to an independent living facility, residents be required to declare their advance medical directive status so the facility can respond appropriately to any emergency treatment situations.


In Delaware, where I practice, a nurse who undertakes emergency life-saving action, even in the face of an advance directive, is granted immunity from civil or criminal liability if the action was performed in good faith. However, each state has its own legislation. All nurses should make sure they're well informed about what laws and policies apply in their states and in the healthcare facilities where they work. As I frequently say to my nursing colleagues in the area of nursing practice issues-"check your local listings."




Elizabethtown, Pa.




Omaha, Neb.




Waycross, Ga..


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