The debate around empowering nurses to make DNAR decisions is certainly a hot one, I have obtained permission from an experienced consultant geriatrician to publish this short piece he wrote on the topic, the opinion of a geriatrician is particularly useful as they are in my opinion amongst the best at understanding the complex issues that surround DNAR decisions:
" "In general senior nurses are well qualified and well placed to make these decisions."
No they are not
As a geriatrician end of life decisions are my bread and butter. I work with mostly excellent nurses. But in my time as consultant I cannot think of a single senior nurse who would have been capable of making complex decisions like this in complex patients.
That is NOT a criticism of nurses. It is a compliment to doctors. On this issue my firm belief is this is something that almost no nurse could be reasonably asked or expected to do. And that's before we get to the issue of bearing responsibility for that decision.
Some things remain firmly in the domain of "a doctor's job". This is one of them. And before anyone cries "protectionism" all I would say is demanding the right to retain this responsibility as a doctor must surely be professionalism and nothing else."
The nail has been hammered home. It also seems that many nurses agree with this sentiment.