Beliefs and attitudes of nurses and physicians about do not resuscitate orders and who should speak to patients and families about them

Objective: Both physicians and nurses play important roles in discussing do not resuscitate (DNR) orders with patients and surrogates. However, the beliefs and attitudes of health professionals about the role nurses should play in this process have received little systematic study. Design and Settingp: An anonymous survey was conducted of 217 attending internists, 132 medical house officers, and 219 staff nurses working on the medical floors and units at two teaching hospitals about their beliefs, attitudes, and confidence regarding DNR discussions. Results: Attendings and house officers were more likely than nurses to believe that nurses should never initiate DNR discussions (p <.001). Nonetheless, 69% of both physician groups agreed that nurses should be allowed to do so. Nurses were the most likely of the three groups to consider DNR discussions rewarding clinical experiences (p <.001). In a multivariate ordinal regression model controlling for sex, attitudes about DNR discussions, and confidence in discussing consent for medical procedures, nurses were less confident than attendings (p =.04) but more confident than house officers in their ability to discuss DNR orders (p =.02). Conclusions: Staff nurses were more likely than their physician colleagues to believe they should be allowed to initiate DNR discussions, were more confident in their ability to discuss DNR than house officers, and had more positive attitudes. These results suggest further exploration of the role nurses should play in the DNR process.