Background The East Midlands DNA-CPR form may be completed by a ‘suitably experienced nurse’. The BMA and RCN statement (2007) indicated that nurses may make such decisions, but ambiguity about training and governance remains. Senior community nurses, with previous advanced communication skills training, attended training using the e-ELCA Discussing ‘do not attempt CPR’ decisions. Subsequently nurses could take on the role of signing DNA-CPR forms if agreed by their employer.

Aims To evaluate the impact of the training on practice and confidence. Methods: A questionnaire was sent 4 months after training and analysed descriptively.

Results 13 of 36 questionnaires were returned. Those with patients on the LCP now completed the DNA-CPR form unless there were difficult dynamics. All completed it for any patient requesting DNA-CPR and 77% completed it with some patients for whom there was no chance of success from CPR. Where such patients or relatives were not in agreement the nurse sought involvement of a doctor. All nurses felt more confident to discuss the topic of CPR and much more confident in discussing a DNA-CPR decision for a dying patient (‘informing’ not ‘asking’), and in dealing with the reactions. Only one nurse reported more difficulties, arising with GPs who were less confident. None of the nurses had had their signature queried by a colleague or relative and many GPs were appreciative of this role. Only two nurses wanted formal assessment of their competence. Some considered assessment to add value if it enhanced the confidence of others in them. 55% wanted on-going CPD, considering this more likely than assessment to quality assure their practice.

Conclusions The training increased confidence and has changed patient care. Senior nurses appear to assess the risk of their decision making role well and act appropriately. The role appears to have been well accepted.