DNR, DNI, and full code: what CNAs actually need to know

A CNA on r/cna posted this:

Had a resident code yesterday and I froze. I'd been told she was a full code, but when the nurse pointed to her wrist I saw the bracelet said DNR. The nurse said "go start CPR" and I just stood there for a second because I thought those meant opposite things. We got her back. Afterwards the charge nurse said I should have just followed what the bracelet said, but I don't even know who decides that. The family was yelling at me in the hallway. I still feel sick about it.

This post got a lot of traction, and a lot of CNAs in the comments said the same thing: I know what the letters stand for, but I don't know my actual job when it comes to code status. The state test doesn't really cover this. The floor does.

What the abbreviations mean

The ones you'll actually see:

Full code — if the heart stops or they stop breathing, you do everything: CPR, defibrillation, intubation, the works.
DNR — Do Not Resuscitate. If the heart stops, you do not do chest compressions. They can still get oxygen, suction, medication, and other comfort measures.
DNI — Do Not Intubate. Sometimes paired with DNR, sometimes not. No breathing tube down the throat, but compressions may still happen.
DNRCC — Comfort Care only. The team keeps them comfortable but does nothing aggressive. Most common hospice-style order.
DNRCC-ARR — Comfort Care with Allow Natural Death. Same idea, more explicit. Some states use this wording.
AND — Allow Natural Death. Newer phrasing, same as DNR.

In practice, when a nurse says "she's a full code" or "he's comfort care," those map to the labels above. If you don't know which one your resident is, you need to know before anything happens.

Who decides the code status

The resident decides while they still have decision-making capacity. They sign the form with their doctor after a long conversation about what they want at the end of life.

If the resident can't decide for themselves, the order goes in this priority, depending on your state:

The resident's healthcare power of attorney (the person they appointed when they could still decide)
The legal guardian, if there's no power of attorney
A surrogate by state law — usually spouse, then adult children, then parents, then siblings

You are not in the middle of that decision, but you will witness it.

What is absolutely your job as a CNA

Three things, no matter what:

1. Know the code status before you start care.

Before your first shift with a resident, you need to know if they are full code, DNR, or comfort care. If it's not written down clearly, you ask the nurse. You do not guess.

2. Find the resident fast.

If you walk in and they are unresponsive, not breathing, or have no pulse, you do not stand in the doorway. You call for help, hit the call light, yell down the hall. Time is tissue. The longer a person goes without oxygen, the less chance of recovery.

3. Start CPR if they are full code and you are the only one there.

If a resident is unresponsive and you are alone, and you have been told they are full code, you start chest compressions and you call for help. You do not wait. You do not stop to read the chart. You call the code, you start compressions, and someone else can verify the status while you work.

What is NOT your job

This is where CNAs get into trouble, because the lines can feel blurry:

You do not decide whether to honor a DNR. If the chart says DNR, you do not do compressions. Period. The nurse or the provider can override that order in writing, but you cannot.
You do not accept verbal family instructions. If a family member runs into the hallway and says "don't touch her, she has a DNR," you call the nurse. You do not take the family's word over the chart, and you do not take the chart's word over a family's verbal statement. The nurse verifies.
You do not read tattoos, faded wristbands, or pieces of paper taped to the bed. Real code status is a signed physician order, in the chart, on the official state form (POLST, MOLST, or whatever your state uses). If you cannot find that order, you start CPR and the code team sorts it out.
You do not stop a code once it's started. If compressions are happening and a family member runs in yelling "stop, she has a DNR," you keep going until the nurse or provider tells you to stop. This protects the resident and it protects you legally.

The gray zones you need to be ready for

The post above had a real gray zone: the nurse said full code, the wristband said DNR, and a family member was yelling. Most CNAs will face this kind of moment at least once.

The rule is: the chart, the signed form, and the wristband must all match. If they don't match, you call the nurse. You do not pick the one you think is right. You call the nurse, you say "the wristband says DNR and the chart says full code, I need clarification," and you keep doing what you were doing until the nurse tells you otherwise.

If you are alone, the family is screaming, the resident is unresponsive, and the chart says full code, you start CPR. A wrong call made in good faith is protected. A wrong call you made because you guessed is not.

What the resident experience is really like

A full code on a frail elderly person is violent. Ribs break. The patient often does not survive, or survives briefly with poor quality of life. Families who chose full code often did not understand what compressions look like on an 85-year-old body.
A comfort-care patient at the end of life is usually peaceful. The death looks like sleep. Your job is mouth care, repositioning, keeping the bedding clean, and giving the family space.
The most common mistake is treating a comfort-care patient like a full-code patient. Don't pound on the chest of someone who is dying naturally.

What NOT to do

Don't assume code status from the resident's age, their family, or their diagnosis. Read the chart.
Don't take a verbal DNR from a family member. Get the order from the nurse, with the paperwork.
Don't refuse to start CPR because the family is "probably" going to stop you. Start. Let the team sort it out.
Don't keep working on a resident after the provider calls the time of death. That part of the body is now a legal scene. Step back and let the nurse handle the family.
Don't carry the moment alone. If you froze, if you started compressions on someone you weren't sure about, if a family member screamed at you — talk to someone. The charge nurse, the DON, your preceptor, a counselor. This is the kind of moment that ends CNA careers if you don't process it.

The bigger picture

Code status is one of those things the state test asks you about in theory, and the floor tests you on in practice. The right answer comes from knowing the chart before the moment happens. If you know your resident's code status before your shift starts, and you know that "the chart is the source of truth," you will not freeze. You will move. That's the whole job.

The full clinical skills library on ExamReady walks through code status, post-mortem care, and other end-of-life scenarios with the same scope-and-voice approach as this post — practice questions with explanations, not just flashcards. The /exam section has timed practice that mirrors the actual state test format.

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