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CPR decision making: NMC to explore how to clarify requirements

Nurse regulator moves to remove doubt over what it expects from registrants when there is no DNAR
Andrea Sutcliffe speaking in her office at the NMC

Nurse regulator moves to remove doubt over what it expects from registrants when there is no DNAR

The Nursing and Midwifery Council (NMC) said it will explore clarification of what constitutes 'careful, considered clinical decision making' by registrants who do not perform cardiopulmonary resuscitation (CPR), knowing no do not attempt resuscitation (DNAR) notices are in place.

This follows a recent high-profile fitness to practise ruling that experienced nurse Nahid Nasiri be suspended from the register after failing to attempt CPR on an individual in a care home who had stopped breathing.

The nurse failed to perform CPR on the 89-year-old woman, despite being aware there was no DNAR notice.

Stakeholders offers of help

Nurse regulator moves to remove doubt over what it expects from registrants when there is no DNAR


Andrea Sutcliffe, NMC chief executive. Picture: Barney Newman

The Nursing and Midwifery Council (NMC) said it will explore clarification of what constitutes 'careful, considered clinical decision making' by registrants who do not perform cardiopulmonary resuscitation (CPR), knowing no do not attempt resuscitation (DNAR) notices are in place.

This follows a recent high-profile fitness to practise ruling that experienced nurse Nahid Nasiri be suspended from the register after failing to attempt CPR on an individual in a care home who had stopped breathing.

The nurse failed to perform CPR on the 89-year-old woman, despite being aware there was no DNAR notice.

Stakeholders’ offers of help to clarify the issue

Ms Sutcliffe told an NMC council meeting on 29 January that the regulator had been approached by stakeholders offering to help contribute to future work on the issue.

‘People are asking what actually constitutes careful, considered decision making? What does that look like?’

Andrea Sutcliffe, NMC chief executive

‘What we’d like to do is pick up some of those offers of help and think about convening a roundtable… for us to explore what further we can do in this,' she said.

She added her own blog published earlier this week in response to concern had helped explain some of the issues. 

Expression of support for best practice guidance

The blog states the NMC supports best practice guidance written by the British Medical Association, the RCN and the Resuscitation Council (UK).

This emphasises a presumption in favour of beginning CPR when no DNAR is in place. But the guidance gives healthcare professionals discretion to depart from this default position after 'careful, considered clinical decision making'.

In Ms Nasiri's case, the NMC panel said it had not found evidence of such an approach.

Ms Sutcliffe told the council meeting: ‘We have had some positive responses to it [the blog] but there have been further issues raised as a consequence, so people are asking what actually constitutes careful, considered decision making? What does that look like?'

The blog follows debate on social media and in a Nursing Standard article by nurse and academic lawyer Marc Cornock that addresses the potential practice dilemmas facing nurses in light of such cases.


Further information

Decisions relating to CPR: guidance from the British Medical Association, RCN and Resuscitation Council (UK)


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