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Nursing and Midwifery Council clarifies its position on nurses who do not start CPR

NMC has reiterated its support for current guidance following recent fitness to practise cases
Picture of nurse with DNACPR form

NMC has reiterated its support for current guidance, which emphasises a presumption in favour of beginning CPR when there is no DNACPR in place, following recent fitness to practise cases

In a new statement the Nursing and Midwifery Council (NMC) has emphasised that it will ‘fully support’ nurses who use their professional judgement to decide not to start cardiopulmonary resuscitation (CPR).

The regulator has moved to clarify its position after a recent controversial fitness to practise (FtP) case left some nurses concerned they could be penalised unfairly for not delivering CPR where no ‘do not resuscitate’ (DNACPR) notice is in place.

Presumption in favour of beginning CPR when there is no DNACPR

NMC has reiterated its support for current guidance, which emphasises a presumption in favour of beginning CPR when there is no DNACPR in place, following recent fitness to practise cases

Picture of the NMC building plaque
Picture: Barney Newman

In a new statement the Nursing and Midwifery Council (NMC) has emphasised that it will ‘fully support’ nurses who use their professional judgement to decide not to start cardiopulmonary resuscitation (CPR).

The regulator has moved to clarify its position after a recent controversial fitness to practise (FtP) case left some nurses concerned they could be penalised unfairly for not delivering CPR where no ‘do not resuscitate’ (DNACPR) notice is in place.

Presumption in favour of beginning CPR when there is no DNACPR

In the statement, Joint NMC/RCN statement regarding Decisions Relating to Cardiopulmonary Resuscitation (CPR), the NMC reiterated its support for current guidance for nurses from the British Medical Association, the Resuscitation Council (UK) and the RCN, which emphasises a presumption in favour of beginning CPR when there is no DNACPR in place.

The current guidance for nurses states that, in certain situations, such as where patients display irreversible features of death, they can depart from this presumption based on a ‘carefully considered decision’.

Now, the NMC has emphasised that the way healthcare professionals evidence their use of professional judgement to make this decision is key to getting its support.

Registrants must be able to articulate the rationale for a decision not to attempt CPR, demonstrate the evidence they used, and then formally record their decision-making process, the action they took and the outcome, the NMC states.

Nurses must use their professional judgement

NMC director of education and standards Geraldine Walters said: ‘We fully support nurses and midwives across the UK and nursing associates in England using their professional judgement to make careful and considered decisions when it comes to starting CPR.

‘But it’s also imperative that those professionals can explain their decision and demonstrate how they’ve come to it, using their professional judgement and guided at all times by principles set out in the Code.’

University of Hertfordshire principal lecturer in medical simulation Ken Spearpoint said: ‘It demonstrably supports a professional, informed position that includes the critical caveat of the necessity to document an evidence-based rationale.’

‘If understood and applied by registrants the statement should certainly safeguard them from being called to appear at an FtP panel in such circumstances.’

Mr Spearpoint, a former nurse consultant in resuscitation, also said the NMC's statement placed an onus on employers to ensure their policies and procedures are in line with the national joint guidance.


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