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Nurses must make ‘considered decision’ on CPR in wake of NMC case concerns

  • 7 Comments

The Nursing and Midwifery Council has been urged to take national guidelines into consideration when deciding if nurses have made correct decisions on attempting cardiopulmonary resuscitation.

In addition, professional bodies have called on employers to protect their staff from a perceived obligation to attempt CPR in situations where a patient has “died and whose death is irreversible”.

The Resuscitation Council (UK), Royal College of Nursing and British Medical Association have issued a joint statement on CPR in response to concerns raised by a recent NMC case.

As reported last month by Nursing Times, an experienced 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.

The incident occurred in November 2014 at Moorland Nursing Home in Poulton-le-Fylde, Lancashire, where Jane Frances Kendall was employed.

According to the NMC case notes, a resident was found to be unresponsive by a care assistant, who called Ms 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”.

“We urge regulatory bodies to consider any similar event with regard to its individual circumstances”

Joint statement

The resident did not have a DNAR (Do Not Attempt Resuscitation order) in place and the NMC noted that 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 subsequently determined that Ms Kendall’s fitness to practise was impaired because of misconduct.

The RCN, BMA and the Resuscitation Council said they were “aware” that the ruling has “caused concern and considerable debate” among nurses and other healthcare professionals.

It had sparked “fear that they may be at risk of similar criticism or disciplinary action should they make a considered decision not to attempt CPR on a person who has features of irreversible death, or a person for whom CPR would offer no realistic prospect of benefit”, said the three bodies.

In a statement, they highlighted the current wording in their jointly authored national guidance – Decisions relating to cardiopulmonary resuscitation.

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”.

“When making a decision a panel will take into account all the evidence which they feel is relevant”

NMC spokesman

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”.

They highlighted that their guidance stated that there would be “cases where healthcare professionals discover patients with features of irreversible death”.

The guidance said that, 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 three organisations added that, while death could be certified only by a registered doctor or by a coroner, it may be “confirmed” by other health professionals, including nurses.

In their statement, they suggested there were responsibilities in such situations for registrants, employers and regulators.

“We urge regulatory bodies to consider any similar event with regard to its individual circumstances and, when doing so, to take the national guidance into consideration,” they said in the statement.

Employers had a duty to protect staff from a “perceived obligation” to attempt CPR on those “who may not have wanted it but had been offered no chance to discuss their wishes, people who have died and whose death is irreversible, or people who have no realistic prospect of benefit”, they said.

Employers should also provide their staff with appropriate education and training to enable them to discuss with people their “wishes for their future care and on the guidance about decisions relating to CPR and the responsibilities of nursing staff”.

In addition, they said they believed health and care providers had a “duty” to put policies and procedures in place to protect residents and patients by ensuring their “wishes are known and respected”.

Meanwhile, they said nurses working in an environment where they may encounter death or cardiac arrest should “ensure” they have the “necessary competence to recognise when CPR may be beneficial”.

For example, in restoring a person to a “duration and quality of life that they would value and when, realistically, CPR would be of no benefit to the person and would deprive them of a dignified death or could potentially do them harm”.

In response, an NMC spokesman said: “When making a decision a panel will take into account all the evidence which they feel is relevant to the individual case in order to help them reach a decision.

“Any review of a panel’s decision would have to be undertaken by the Professional Standards Authority and this can only be done where they think that the original decision is not sufficient to protect the public,” he said.

The spokesman added that the regulator recognised that making decisions around whether or not to administer CPR “can be very complex” for nurses and midwives.

He highlighted that it was important to recognise that registrants “may only certify death where they have in place the appropriate training to do so and nurses and midwives should take this into consideration when making any decisions around the administering of CPR”.

But he also said was not the NMC’s role to provide specific guidance on administering CPR and that every decision should be made “based on careful consideration of the individual circumstances”.

He noted, however, that the NMC code set out a number of key areas “for which nurses and midwives should have regard in this area”, including:

1. Treat people as individuals and uphold their dignity

4. Act in the best interests of people at all times

5. Always practise in line with the best available evidence

13. Recognise and work within the limits of your competence

20. Uphold the reputation of the profession at all times

 

  • 7 Comments

Readers' comments (7)

  • Decisions like the one taken by the NMC in this case will only result in the wrongful application of CPR especially in settings such as older people's care homes. People have a mistaken idea that CPR is a lot more successful than it actually is and don't realise the additional trauma it can cause. I'm not against CPR just in favour of nurses being given the autonomy to make a clinical decision on wether or not it is a viable treatment option and clearer information being available to all on the facts of CPR. NMC once again punishes without giving clear guidance on what we as nurses can and can't do ...

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  • I agree with the above person, nmc don't give clear support hence as nurses we end up in their door with words "impaired practice". If l have known nursing is about blame l would've under taken another course.

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  • CPR is to save life,and while morally and leagally acting in the best interests of the patient we as nurses are always placed with "the right thing to do".
    I can not decide who dies,but if unsure, morals and the right thing to do always float in the sea of law with the finger pointed at the person who makes the decision whether (NFR) has been completed of not. I am trained to save live.
    Must be a team decision with appropriate TEP form in place.
    This protects all staff I hope.

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  • That joint statement is really reassuring to me as a nurse. However I love the NMC's response - they look at evidence *they* feel is relevant and reiterated that nurses are not able to certify death...even though the joint statement by the BMA, Resuscitation Council and RCN acknowledged this and said registrants are able to confirm death has occurred.

    It seems to me, yet again, that the NMC merely wish to be punitive towards registrants and not enable us to use common sense, experience and autonomy within the confines of safe practice.

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  • The nurse concerned should now take legal action against the NMC for unreasonable punitive action. Had the NMC consulted the National Council for Resuscitation prior to hounding this poor nurse and ruining her reputation (and an unblemished career) they might have reached a more reasonable conclusion. They should do the decent thing and remove the sanction from this nurse's registration and provide a written and public apology. Scandalous.

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  • Roberta McDonnell

    The wrongly blamed nurse would surely now have evidence to support an appeal and a demand for a retraction of the NMC decision (as well as demanding an apology)? One point that struck me in the discussion is the importance of 'a dignified death' when there would be no evidence-based benefit to be had from attempted CPR. Excellent article, very well explained and clarified a number of issues for me. Thank you.

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  • There is no appeal to the NMC for this nurse . They would have to go to the High court to get a judgement to have the case reheard by the NMC .

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