There's a knock on your door. Your neighbour is on the doorstep. Her husband has collapsed. What do you do? This happened to me and I immediately provided assistance. Before discussing the finer aspects of the Nursing and Midwifery Council (NMC) Code (2018), it is worth remembering that upwards of 33 000 people in the UK each year experience a sudden cardiac arrest, but less than 10% survive (Resuscitation Council, 2017). This is a dismal outcome especially when compared with other countries (Berdowski, 2010). Therefore, all nurses should feel confident in providing the key resuscitation skills and in performing these skills to a high standard (Resuscitation Council, 2017),.
However, when I subsequently discussed this incident with my colleagues, a number said they ‘could not’ or ‘would not’ have helped. This I found professionally challenging as the Code is very clear on this matter. It states that a nurse should ‘always offer help if an emergency arises in your practice setting or anywhere else’ (section 15) and, furthermore, the Code stipulates that all nurses must have indemnity insurance (section 12) (NMC, 2018).
So, it is clear that you must help. Or is it? The Code also states, ‘only act in an emergency within the limits of your knowledge and competence’ (section 15.1) and further states ‘complete the necessary training before carrying out a new role’ (section 13.5). What should a nurse do?
Let's look at the issue of ‘could not’ have helped. This is mainly an issue of an individual nurse feeling unprepared to deal with an emergency. In part, this is a failing of the UK education system. The ‘Resuscitation to recovery’ project (Resuscitation Council, 2017) is calling for greater public training (to include children) in basic life support and use of public access defibrillators. I would argue that first aid is an essential nursing skill and, as such, it should be covered during basic nurse training. Furthermore, as in my situation, all nurses must be competent in delivering basic life support. So, the argument that ‘I couldn't have helped’ is a poor one. If you feel ‘unprepared’ to provide initial support during an emergency then you are beholden to rectify this identified weakness by completing a first aid course.
What about ‘I wouldn't have helped’? This falls into three categories. One, there is a reason such as you are looking after your own child, resulting in a direct conflict of responsibilities or, two, where you are unable to safely assist either due to possibly having drunk alcohol or if there is obvious danger. It could be reasonably argued that these first two reasons are actually reasons why they ‘couldn't have helped’ and not ‘I wouldn't have helped’. This leaves the third reason—these nurses did not feel that they were obliged to assist in an emergency. This would be in direct violation of the NMC Code (NMC, 2018).
What are the key things to remember? First, never act outside of your area of competence and remember that simple things save lives. Often just the presence of a calm, focused clinician can rapidly bring a difficult situation under control. Second, ensure a 999 call is made. The ambulance service will ask scripted questions that prioritise your call while allocating the resources that your case requires. These questions can be frustrating for clinicians to follow but they are essential for getting the help needed. Delegating the 999 call to a lay person can allow you to concentrate on the patient but it is important to brief the person making the call, highlighting the seriousness of the case. Finally, make sure help can find you—turn on house lights, and delegate bystanders to attract the attention of the responding ambulance crew. All these actions can save vital minutes that can improve patient survival, especially in a cardiac arrest.
Is using a public access defibrillator a step too far? I would argue it is not, especially if you are already trained. But what if you are not trained? The fear of doing harm will result in doing no good. To this end, it is worth remembering that public access defibrillators are designed to be no more difficult to use than a fire extinguisher and have both written and verbal prompts to assist the untrained rescuer.