New Jersey APNs can sign death certificate, determine cause of death

By Stefanie Dell'Aringa A new law signed in May by New Jersey Gov. Chris Christie gives the state's advanced practice nurses authority to determine and certify cause of death and sign a patient's death certificate when the nurse is the primary care provider and a collaborating physician is not available. "Previously, they were able to pronounce death and provide the medical information required for the death certificate, but by New Jersey law, they were not authorized to sign the death certificate," said Suzanne Drake, PhD, RN, a psychiatric advanced practice nurse and director of public relations for the Society of Psychiatric Advanced Practice Nurses of the New Jersey State Nurses Association. According to the American Association of Nurse Practitioners, the legal authority to sign the certificate allows it to become a completed legal document to be used for vital records data collection and decedent affairs. Before the law taking effect, NPs were authorized to pronounce death and complete all the elements, including determining the cause of death, but the document was not officially completed without a physician's signature. Now NPs are authorized to sign the form and make it a legal document. A bill, A-1319/S-1152, was sponsored by state Assemblywoman Nancy F. Munoz, RN. Four other states -- Missouri, Ohio, Delaware and Texas -- considered similar laws this year, and 28 states, including New Jersey, have legislation in place that recognizes an NP's signature. According to the AANP, the Delaware law is on the desk of Gov. Jack Markell. The Ohio bill is still in an active legislative session, while the Texas and Missouri bills did not move forward during their most recent sessions. "Bills like this are absolutely nothing new," said Tay Kopanos, DNP, NP, RN, vice president of government affairs for the AANP. While some states' bills differ by additionally authorizing NPs to sign for things such as handicapped placards, New Jersey's law solely addresses death certification. "At the AANP, we see this as an overarching move to utilize the expertise that nurse practitioners bring to the healthcare arena," Kopanos said. The law will allow paperwork to be expedited and help families move forward with burial plans when they might otherwise be waiting on a physician's signature. "For many nurse practitioners, the need to sign a death certificate will be rare," said Grace Reilly, RN, APN, ACHPN, a palliative care nurse at Ocean Medical Center, Brick, N.J. "However, as more nurse practitioners serve as primary caregivers for geriatric patients and for patients in hospice and palliative care, this new law will make a significant difference to families of their patients." The law also may lower the number of unnecessary autopsies. "It reduces delays and reduces the hardships on the family bereavement process," Drake said. Updating statutes The AANP expects more states to recognize the need to update their statutes because of the nation's aging population and the larger role NPs are playing in geriatric, adult and palliative care. From urban to rural areas, the new law will be important for families in all settings, Reilly said. She indicated it might have a greater impact in inner cities such as Newark, Camden and Trenton, where many uninsured patients see APNs as primary care providers in clinics. The law also could yield more accurate data on death certificates, resulting in improved healthcare. "The APN knows the health history, the chronic disease history, and is the only one who can provide the most comprehensive information," Reilly said. "This new law should strengthen the accuracy of the information provided to vital statistics as required by the state and federal government which is used to inform, fund and guide public health efforts," Drake said. Stefanie Dell'Aringa is a freelance writer. READ THE FULL TEXT of the law.

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