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.