Resuscitation in general medical wards: who decides?

Aims and objectives. To investigate nurse experiences and attitudes regarding resuscitation while focusing on intentional avoidance of action during a futile cardiac arrest. Background. Nurses often lack the legal and clinical authority to make resuscitation decisions; however, in cases where they believe that resuscitation would be futile, they may elect to delay/avoid the initiation of resuscitation as a non‐confrontational method of achieving the desired endpoint, thus essentially transferring the final resuscitation decision from the physician to the nurse. Design and methods. An anonymous questionnaire survey conducted among a convenience sample of 122/142 nurses from five medical wards in two Jerusalem hospitals. Results. Nearly one‐fifth (19/117) of participants reported non‐initiation of a futile resuscitation. Nurses who chose not to initiate futile resuscitations were those who scored higher on the Support Do Not Attempt Resuscitation Questionnaire, those that had previously been consulted by a doctor regarding the initiation of resuscitation and those that expressed a desire to be a part of a multidisciplinary team focused on resuscitation decision‐making. No other variables seemed to affect this outcome. Conclusions. Nurses are often excluded from the resuscitation decision‐making process despite their desire to participate. Delayed initiation/avoidance of resuscitation is being actively practiced by some nurses. Relevance to clinical practice. Nurses should be given the opportunity to become an essential component of resuscitation decision‐making to avoid the pre‐emption of medical resuscitation decisions.