Nurses withholding CPR need to demonstrate ‘considered clinical decision making’, says NMC

There is a presumption in favour of commencing cardiopulmonary resuscitation.

Ian Snug
28 January 2020
CPR

The regulator was criticised following a decision to suspend a nurse who failed to commence cardiopulmonary resuscitation.

The Nursing and Midwifery Council (NMC) has openly responded to public criticism of a recent Fitness to Practice (FtP) case.

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The nursing regulator has been criticised following a decision to suspend Mrs. Nahid Nasiri, a registered nurse, from the register for failing to commence cardiopulmonary resuscitation (CPR) on an 89-year-old resident in a care home who deteriorated rapidly.

While there was no ‘Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)’ order in place, it has been discussed previously and a Consultant Histopathologist confirmed during a Coroner’s Inquest that resuscitation was unlikely to have been successful.

Mrs. Nahid Nasiri was not charged with contributing to the death of the patient.

The NMC states that while there is a presumption in favour of commencing CPR, nurses are able to depart from this. But, only on the basis of careful, considered clinical decision making.

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Careful, considered clinical judgment.

As the NMC panel did not find any evidence of careful, considered clinical judgment by Mrs. Nahid Nasiri to justify failing to preform CPR a 12-month suspension from the register was imposed by the regulator.

This decision prompted confusion and anger throughout the nursing community, with many stating the outcome of the case drew doubt over guidance that developed jointly in 2016 by the Resuscitation Council, BMA and RCN called ‘Decisions relating to cardiopulmonary resuscitation’.

The NMC clarifies the situation further by saying; “If, as a health and care professional, you are faced with making a decision about CPR when an explicit DNACPR decision is not available, you should be supported if you make a careful, considered decision not to start inappropriate CPR.

Emphasising; “You will always need to demonstrate that this is what you did.”

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Adding; “this case highlights the responsibilities of those in charge of running health and care services to ensure difficult conversations about end of life care take place at the appropriate time, and are clearly understood.”

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