Can a nurse refuse to participate in a code?

5 I'm sure many of us have had patients that we felt it was just torture to code the person, but for whatever reason, the patient wasn't DNR.

We can refuse to hang blood for religious reasons.
We can refuse to participate in an abortion for ethical/religious reasons.

Can we similarly refuse to participate in a code?

ETA: Without getting fired/violating our nurse practice act/getting in some sort of trouble...
This is a post I want to be able to come back to so I'm putting my name in. As far as the question at hand, I really have no clue. This is something I have thought about numerous times working in the ICU.

Welcome to Medceu Found this as I was researching. I know this pertains to PCP but it is helpful to know Back to researching I go..

Sorry, that didn't work right..I will try againWelcome to Medceu

Physicians are not required to provide care they deem futile. So when an MD makes a patient a medically futile DNR, nurses are fairly safe in following that order. Physicians may deem a patient a medically futile DNR because that is within their scope, and while I might argue otherwise, I have a feeling most BON's would consider that a Nurse determining a patient to be a medically futile code to be out of their scope, even though questioning the appropriateness of a full code order is within our scope.(I'd argue that the determination of medically futile is well enough defined that an MD doesn't have to confirm that, but anyway). If the MD has not declared a patient to be a medically futile code, then the assumption is that they are not (though often this is just because the MD hasn't made that official for a variety of reasons). I have refused to code someone before (the patient was well known to us and had firmly established they were DNR, including on this admission, after the patient developed a decreased LOC the family made them full code, which the MD obliged). I'm quite sure my license and job were in jeopardy and I don't really think I could have put up much of a defense if I lost either of those. Luckily we now have much stronger policies about enforcing DNRs and the restrictions on NOK/POA decision making.

Quote from Sun0408This is a post I want to be able to come back to so I'm putting my name in. As far as the question at hand, I really have no clue. This is something I have thought about numerous times working in the ICU.

I think one could safely 'defer' in a code... that is, step aside and let other nurses perform the functions. However, if stepping aside were to delay care at all, I think the nurse could face sanctions. Even if it the deferral made no difference, it could certainly lead to termination for an at-will nurse and perhaps even for-cause as a refusal to perform assigned duties.

Interesting question. I'm sure you could step aside as long as there was adequate staff to participate in the code. You might lose your job or face punishment from your BON if someone wanted to make a stink about it.

I would think the better route would be to bring it up with the ethic's committee (if the attending physician route got you no where) before they actually coded. Obviously this isn't always possible.

I don't think so...I did have a patient once though who I was very close to, he was basically comfort care at that point but without the technicality of the DNR, his parents just couldn't agree to it yet though they knew there was no chance of him surviving. The morning we knew he was going to die my charge nurse came to me and told me that when he coded to call him (the charge RN) and he would come do compression's so I didn't have to, he knew how hard that would be for me (we have some great charge nurses). Luckily it didn't come to that and the parents agreed to withhold escalating treatment and the baby died peacefully in his parents arms while remaining maxed out on medical support...although since they were unable to withdraw anything it was a little unnerving to have a vent breathing into a dead body but certainly better than coding that poor child.

Quote from woohCan we similarly refuse to participate in a code?ETA: Without getting fired/violating our nurse practice act/getting in some sort of trouble...

Be prepared to lose your job. Honestly, I don't see the point of entering a profession or accepting a job if you (general "you") aren't willing to perform the tasks at hand. For example, I don't think pro-life/pro-abstinence nurses have any business working at a place like Planned Parenthood. You may not feel that a code is ethical, but if the PATIENT states in his/her advanced directives that he or she wants to resuscitated, who are you to say otherwise, even if it goes against your personal beliefs? If you are a Jehovah's Witness who is against blood transfusions, why would you take a job knowing that you will most likely encounter a patient who may need blood? I think it would be unprofessional for that JW to refuse to give blood transfusions to a patients who desperately need them and are NOT against receiving the procedure themselves. It is not as though the JW nurse is being tied down and forced to receive another's blood.As a patient, I would fire a nurse if I knew he or she was not willing to give me the blood transfusion or refused to participate in my coding. We have so many unemployed nurses out there who would take the job and do what needs to be done and they would leave their judgments / beliefs at the door...where it belongs.

Quote from ThePrincessBrideYou may not feel that a code is ethical, but if the PATIENT states in his/her advanced directives that he or she wants to resuscitated, who are you to say otherwise, even if it goes against your personal beliefs?