The nursing regulator has attempted to clarify its position on decisions to attempt cardiopulmonary resuscitation, in the wake of several hearings involving nurses.
It has now stated that it supports guidance warning against the “indiscriminate application” of cardiopulmonary resuscitation, following several controversial case outcomes.
“We felt it was important to clarify the current position”
But the Nursing and Midwifery Council also highlighted it was the responsibility of employers to ensure appropriate policies and training were in place for CPR decisions.
The NMC yesterday issued a statement jointly with the Royal College of Nursing on the issue, in the wake of concerns from nurses about recent fitness to practise (FtP) hearings.
“Following recent publicity relating to fitness to practise cases regarding resuscitation we felt it was important to clarify the current position,” said the statement.
As reported by Nursing Times in April, a nurse received a 24-month caution after failing to give CPR to a care home patient “who was almost cold” when she arrived on the scene.
A Lancashire nursing home resident was found to be unresponsive by a care assistant, who called Jane Kendall to attend, as she was the nurse in charge on the date of the incident.
On attending, Ms Kendall described the resident as “waxy, yellow and almost cold”, and “having checked the resident, found that there was no pulse or vital signs of life”.
The resident did not have a DNAR (Do Not Attempt Resuscitation order) in place and Ms Kendall admitted she subsequently failed to attempt CPR or call the emergency services.
At a hearing in January, an NMC conduct and competence committee determined that Ms Kendall’s fitness to practise was impaired because of misconduct.
However, the decision by the FtP panel attracted a lot of media attention and debate on social media sites among nurses.
It also led to professional bodies urging the NMC to take national guidelines into consideration when deciding if nurses have made correct decisions on attempting CPR.
The Resuscitation Council, RCN and British Medical Association issued a joint statement on CPR in response to concerns raised by the Kendall case.
The three organisations said they were “aware” that the NMC ruling has “caused concern and considerable debate” among nurses and other healthcare professionals.
They noted that “where no explicit decision about CPR has been considered and recorded in advance there should be an initial presumption in favour of CPR”.
However, they said they wished to “emphasise” that the initial presumption in favour of CPR “does not mean indiscriminate application of CPR that is of no benefit and not in a person’s best interests”.
As a result, they called on the regulator to consider any similar event on its individual circumstances and urged to take the national guidance into consideration.
Meanwhile, a further case took place in May, involving a nurse who failed to dial 999 or try resuscitation after finding a patient had turned blue and stopped breathing.
According to a BBC report, Paul-Iulian Dicu said he “panicked” after discovering the patient at Hassingham House Care Centre in May 2016. Mr Dicu, who admitted two failings, was given a three-year caution.
In its new statement, the NMC announced that it was “supportive” of what it described as the “clear new guidance” developed by in 2016 the Resuscitation Council, BMA and RCN.
“It is the duty of health and care provider organisations to have appropriate evidence based policies in place”
It said it backed the warning in the guidance – Decisions relating to cardiopulmonary resuscitation – that “initial presumption in favour of CPR… does not mean indiscriminate application of CPR that is of no benefit and not in a person’s best interests”.
It also noted that section 8 of the guidance stated: “There will be cases where healthcare professionals discover patients with features of irreversible death – for example, rigor mortis. In such circumstances, any healthcare professional who makes a carefully considered decision not to start CPR should be supported by their senior colleagues, employers and professional bodies.”
The regulator went on to remind all registered nurses and midwives that they must uphold the standards in the NMC code, which include always practising in line with the best available evidence and keeping their knowledge and skills up to date.
It added that it was the duty of health and care providers to “have appropriate evidence based policies in place, and to provide the appropriate education and training for nurses working in an environment in which they may encounter death or cardiac arrest”.