Nurses to decide on resuscitation

RGN1 · Oct 27, 2007

Although it seems like "common sense" & I can understand why the Council is saying this I would like to see some legislation to protect the nurse who has made such a decision.

I can think of many a patient who we were petrified of going into arrest because we thought CPR was going to be awful, undignified & a waste because they were so ill & yet without that DNR on the notes we were going to be obligated to try. for those patients this will be great.

I think that only a senior nurse or above should make the decision and if possible I think it should still be something that is discussed with the relatives/patient. Then it can be more like an advanced directive & things would be on a better footing.

It's a can of worms I think, though - I will watch this story with interest.

nightmare, RN · Oct 27, 2007

I sincerely hope this becomes a reality because the DNR debate is becoming a real mine-field!

Silverdragon102, BSN · Oct 27, 2007

In a way I think it is a good thing as we do get to know patients and relatives better than doctors and we can hopefully support the family whilst they are going through this , but need to make sure adequate protection is there for the nurse and local policies written and adhered to. Would probably suggest proper counseling skills and seniority of nurse and also that the nurses want to do it not management making them do it

english_nurse · Oct 27, 2007

i have to ask this qustion, how many of us have either started resus on a patient which we knew shouldnt be for resus, but the doctors hadnt written in the notes, or been at a resus which has been sucessful? i would love to hear some experiances of this..

i can honestly say i dont think ive attended one which the outcome has been good

madwife2002, BSN, RN · Oct 27, 2007

I think that in principle this is a great idea, but I can imagine the doctors will be screaming and shouting about another loss of 'one of their jobs'. Another that they do badly-I think most nurses whould make a fair decision. I know that in nearly all cases when I mention to the doc's that we should be considering the resus status on a pt, I am right and this person needs a dignified death.

Now that does sound like I am being presumtious but after 18 years of experience you kinda know what, where, when and how. You can acurately predict the road the patient is travelling-and once the pt has given up then it is just a matter of time.

I think we should aim for a society where we write our living will and be following pt's wishes.

cheshirecat · Oct 27, 2007

Last Christmas Eve one of my patients arrested. I witnessed it. I started CPR and we got him back with all faculties intact. He lived another month after that, his family managed to get up from the South, and he was surrounded by family when he died.

But...on Christmas Day when I was bedbathing him, he asked if I was one of the nurses who had saved him. When I answered yes, he replied "I wish you hadn't bothered".

Sure made my Christmas.

allnurses Guide · Oct 27, 2007

I am really undecided on this subject. I will not argue that there are times that I have been with a patient that I know should have a not for resuscutation order but doesn't and sometimes nurses are well placed to assess and express this, I also think that NFR issues should be a multidisciplinary decision whenever possible taking account all professionals who are involved in the care - I do realise this is the ideal world and doesn't often happen.

Not sure if it is a decision that I would be able to take what a huge responsibility. I wonder what our collegues from overseas would think about this so I asked the question today https://allnurses.com/forums/f8/opinions-about-uk-nursing-issue-258220.html#post2467687

For anyone who is interested in the full guidence it can be found http://www.bma.org.uk/ap.nsf/AttachmentsByTitle/PDFCPRDecisions07/$FILE/DecisionRelatingResusReport.pdf

karenG · Oct 29, 2007

emotive subject.

I think this is where the arguement for a register for advanced nurse practitioners and other advanced roles comes into play. its very difficult to define who a senior nurse is.. who is going to make that defination? and how will that nurse be supported in her decision making?

for nurses involved in palliative care, this is a natural progression or developlement of the role they undertake so i can see how this fits in. not so sure for the ward based nurses though.

I have to say i object to some of the comments in the press about nurses and our training....... particulary about us being underqualified! so does my masters degree mean nothing??

Karen

RGN1 · Oct 29, 2007

A senior nurse is exactly that - old money "E" grade - new money band 6. I think that any nurse at that level or above should be capable of making this decision on a ward.

One of the consultants at work saw the newspaper article over the weekend & his comment was "nurses make the decision anyway!" He felt that it was usually the nurses on the ward who were the ones to bring up the subject & chase the doctors for the DNR to be written in the notes.In truth, he's right in my experience!

Unfortunately the press, as usual, doesn't understand how things work already - let alone what this is meant to lead to - ie better decisions on those patients for whom CPR would not be beneficial.

nyapa, RN · Nov 3, 2007

error, see below

nyapa, RN · Nov 3, 2007

The concept is good. But where would a nurse stand legally? Even if she is a senior? There would really have to be strict guidelines, consultation with family and good legal support.

Western society doesn't like to think about / plan death until it is almost upon them. They generally don't know the role of a nurse either. So to get them to accept this idea without consulting a doctor would be difficult.

I guess when you or a relative are dying, you may tend to grab at straws / try to find out as much as possible, so therefore you would go seek the person whom you perceive would have the greatest knowledge first about your condition; the doctor.

So while nurses may be given permission to do this, I can't see it as a common occurrence in the near future...