Saturday, 27 October 2007

Nurses to make end of life decisions

"Responsibility for decision-making

The overall clinical responsibility for decisions about CPR, including DNAR decisions, rests with
the most senior clinician in charge of the patient’s care as defined by local policy. This could be a consultant, GP or suitably experienced nurse. He or she should always be prepared to discuss a CPR decision for any individual patient with other health professionals involved in the patient’s care. Teamwork and good communication are of paramount importance. Where care is shared, for example between hospital and general practice, or between general practice and a care home, the health professionals involved should discuss the issue with each other and with other members of the healthcare team. There should be shared responsibility for deciding about the likelihood of a successful outcome from CPR, and discussing the issue with the patient or with those close to patients who lack capacity where a balance of benefits and burdens is needed. Nevertheless, one individual needs to take charge of ensuring that the decision is made properly, is recorded and is conveyed to all those who need to know it, including locum staff. Local policies should specify who that should be."

The empowerment of nurses gathers pace and is amazingly aided by the BMA, a union that now appears so politically driven that I wonder why any doctor in their right mind remains a member. This document explains the rationale, or lack of it, for the changes to procedure relating resuscitation decisions.

Decisions that relate to resuscitation are frequently badly managed but allowing nurses to make these decisions will only add mud to the waters of confusion. The public are generally poorly informed about what resuscitation actually is and how likely it is to succeed, while in hospitals the decision not to resuscitate often gets abused as a license for staff to not actively treat very treatable conditions. Making the decision requires a lot of medical knowledge and training, something that nurses, no matter of their experience, do not possess.

The BMA are a disgrace, their document uses the word health professionals endlessly without mentioning the word doctor. While nurses are now called 'clinicians' and despite their overt lack of training and examined knowledge, are being promoted to the same level as doctor 'clinicians'. Nurses are not clinicians, they are nurses; the government may have empowered them to have a rather amateur crack at diagnosis and doctoring but this does not make them trained clinicians, they are only trained at nursing. Doctors are clinicians, they have been to medical school and have had their skills and knowledge examined to a proper level.

The document also has a dumbed down protocol for DNAR decisions, the classic hallmark of a dumbed down nurse led procedure that will guarantee that common sense is cast aside routinely. Recently the hypocritical NMC also had the gall to accuse others of abusing the title 'maternity nurse'; this is while the NMC backs the empowerment of nurses and deception of the general public with nurses being called 'nurse consultants'. A 'nurse consultant' is simply an experienced nurse, so the tag of 'consultant' is nothing but a dishonest lie.

These new guidelines are the classic example of the dumbing down of medicine in this country. The suggestions at first do not appear that unreasonable, however it is the general tone of the document that fills me with fear; proper training and knowledge are being undermined as all healthcare staff are referred to as generic 'health professionals'. One does not need proper training or in depth knowledge to become a 'consultant clinician' anymore, anyone with a few years of service can have a crack. I would imagine that sensible nurses will not want to have this extended responsibility, however the growing cohort of 'chip on shoulder' wannabee doctors will be delighted that the line between doctor and nurse continues to be eroded.

Whatever happened to doctors doctoring after doctor training and nurses nursing after nursing training? We now have nurses doctoring after nursing training and doctors fuming with very good reason. The line between doctor and nurse continues to disappear, remind me again why I went to medical school? Because in my naivety I wanted to do my job properly.

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