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Pronouncing patient’s death should be timely, respectful

An RN’s or APRN’s authority to pronounce a patient’s death has increased over the past few years. At least 20 states, including Ohio, New York, California and Florida, have passed legislation allowing RNs and/or APRNs to do so.

However, the laws vary, and the variances deal with many factors, such as where the death occurred (e.g., hospital, nursing home, home), who the RN or APRN must notify before pronouncing a patient’s death (e.g., medical examiner, attending physician), the requirement that the RN or APRN was caring for the patient, and whether the RN or APRN can fill out and sign the death certificate.

Clearly, the pronouncement of an individual’s death is a significant obligation and it must be carried out with grace, respect and a concern for the family of the deceased. The obligation also must conform to the RN’s or APRN’s legal and ethical mandates.

Sometimes such mandates are not always adhered to or may be difficult to determine what is required. As an example, a reader once shared her unfortunate experience with her father-in-law’s death that took place at home. The patient was under hospice care and when he died, the family immediately called the hospice nurse. The nurse told the family she could not get to the home to pronounce him dead for four-to-five hours.

As an RN, she wanted to declare her father-in-law’s death but did not have the legal authority to do so. Understandably, this situation was appalling and very stressful for the entire family, including the RN.

In another instance, a reader who was house supervisor reported to work and was told that a patient, who was a DNR, had died several hours before and the primary physician was out of town. The physician who was covering was unable to come to the facility to make the pronouncement. Following facility policy, the RN contacted the ED physician, but he also refused to make the pronouncement because he was too busy. By now the patient had been dead for at least five hours and the family remained in the patient’s room.

After contacting the chief of staff for help with no results, the RN pronounced the patient dead and documented her assessment in the medical record. The RN was suspended and accused of practicing medicine without a license. A meeting with the director of nursing was next on the agenda.
In both of these instances, policies, procedures and regulations were in place for the pronouncement of death to occur in a timely manner. But it did not happen. Both RNs were courageous and ethical in their respective situations, one heeding her helplessness and the other taking action.

If you have the authority to pronounce death, be certain to know the requirements of this obligation and maintain those boundaries, not only in the process of pronouncement itself, but also by carrying out your responsibilities in a timely manner.

NOTE:  Nancy Brent’s posts are designed for educational purposes and are not to be taken as specific legal or other advice.

 

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By | 2018-08-30T15:40:35-04:00 April 6th, 2016|Categories: Nursing careers and jobs|11 Comments

About the Author:

Nancy J. Brent, MS, JD, RN
Our legal information columnist Nancy J. Brent, MS, JD, RN, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Her posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.

11 Comments

  1. Avatar
    arp42 April 8, 2016 at 4:34 pm - Reply

    i think it would be helpful if you listed all 20 states where nurses can do this.

  2. Avatar
    Lynnette Shimmin April 8, 2016 at 10:12 pm - Reply

    I was so very fortunate when my stepfather was on hospice with his glioblastoma. We had made arrangements with the hospice company, dotted all of the “i’s” and crossed all of the “t’s” in the event he would expire at a time when it would be an aide or other non-licensed person in my mother’s home, I would pronounce him. I had been an Emergency Department/Trauma, ACLS/PALS, ENPC, TNCC Instructor for over 20 years with flight and field experience so to put it plainly, I’ve seen dead and I know what it looks like pretty clearly.

    When my stepfather was diagnosed early in the month of May, he was given roughly 8-12 weeks without treatment which is the option he took. Christmas Day (roughly 7 MONTHS later) he was there…still, after promising early on to spend my mother’s favorite holiday with her. But…once the festivities were over and we had given him “permission” to go, my mother and entire family found it very peaceful and reassuring for me to walk them through his dying process in a clinical but familiar fashion and then be able to pronounce him at the end when we all said our “Goodbyes”.

    There are always ways to make things work in your favor within the law when circumstances require it and you prepare and plan. It turns out the aide that was there that day and had been there off and on was new to the US from the Ukraine and we were his first hospice case or death…ever…so it was a very educational and caring experience for him as well.

  3. Avatar
    Janet Marquez April 8, 2016 at 11:06 pm - Reply

    Pronouncing death article was very informative. Love the updates.

  4. Avatar
    Juanita Miller April 10, 2016 at 8:28 pm - Reply

    Where can I find information on the hospice nurse responsibility for cleaning the pronounced patient prior to the funeral home coming to pick up the body?

  5. Avatar
    Juanita Miller April 10, 2016 at 8:36 pm - Reply

    Please tell me where I can find the legislation you mention, I live in CA. I would like to know what requirements there are specifically relating to your statement of carried out with grace, respect and a concern for the family of the deceased. The obligation also must ” carried out with grace, respect and a concern for the family of the deceased.”

  6. Avatar
    Nursing instructor April 11, 2016 at 4:20 pm - Reply

    Please elaborate more on this topic.

    I train paramedics in Los Angeles County, CA. Please cite the CA code related to ‘Pronouncing death” As I have researched it any competent person over the age of 18 can “pronounce death”. ‘Pronouncing death’ is a worthless expression. Assessing and DETERMINING death has meaning and certainly signing a death certificate is something else entirely, only an MD or coroner can do that.

    In the prehospital setting paramedics can “determine” death after an assessment that reveals among other findings; decapitation, incineration, evisceration of heart or brain and either rigor mortis or post mortem lividity. When paramedics have ‘determined’ death they can stop treatment and are not required to transport.

    Two of your examples need elaboration.
    The home hospice death where the hospice nurse could not arrive for a few hours. The death was expected. I will assume that funeral plans had been made. After the person ‘died’ why didn’t the family call just the funeral home to remove the body? Funeral homes remove ‘dead’ bodies all the time. They do it without paperwork like death certificates. Who has ‘pronounced death’ in these cases? Why was the home/family RN worried about ‘pronouncing death’? If the hospice patient was pulseless and apneic and he was ‘not dead’ then the family should have called 911 for resuscitation.

    In the inpatient situation you describe a patient who had been ‘dead’ for several hours. The oncoming RN could not get an MD to pronounce death. So she documented her findings in the medical record, and ‘pronounced death'(?) I will assume that she documented that the patient was pulseless and apneic. Per most any hospital policy this means that that the patient is either ‘dead’ or in full arrest and requires resuscitation. If the patient is dead the body needs post mortem care, if the patient is not dead she should have called for a code team to begin resuscitation. Calling a code team and demanding medical intervention WOULD have brought an MD to the bedside! Then (if required) the MD could have pronounced death.

    If hospital policy dictated that until an MD declares death the patient is not dead, then all treatments must continue! The IV cannot be shut off and any prescribed meds must continue. Your story says the inpatient had been “dead” for several hours before the new nurse began her shift. Any medications or treatments NOT provided during that time (to a patient that had not been ‘declared dead’) must be reported as medical errors. Were reports filed reporting these medication and treatment errors?

    Your situations just don’t add up for me. Please provide additional details.
    Thank you.

    • Avatar
      JB April 11, 2017 at 7:52 pm - Reply

      The one very important detail you are leaving out in your rant is a yellow piece of paper called a DNR. You don’t call rapid response for a patient with a dnr. Also, funeral homes will not pick up a dead body just because you have made future arrangements with them. There is paperwork involved and they must have a time of death and who pronounced. Imagine the shenanigans if people could call funeral homes to pick up bodies without any documents, regardless of prearrangements. What if the patient had had a recent fall and was now a medical examiner’s case but the family didn’t understand this detail or process?
      I have been a critical care paramedic for almost a decade as well as a current hospice RN on an in patient unit at a trauma hospital. Fortunately we nurses are able to determine and pronounce the death of our patients. The stories above are very unfortunate situations that I hope were valuable learning experiences that, in light of,the companies used to change policies to improve their care.

  7. Avatar
    Doris Heine April 12, 2016 at 4:45 pm - Reply

    Is South Dakota one of the states where RNs in Nursing Homes/Care Centers have the legal right to pronounce death of a resident?

  8. Avatar
    Heather Sabol April 14, 2016 at 6:55 pm - Reply

    As a certified Hospice/Palliative NP through NBCHPN, with the upcoming severe shortage of geriatricians, ect. I would think that this would be a need that should be pursued for all states. What recommendation would you have to get this issue/need more recognized and accepted?

  9. Avatar
    Beth Hawkes August 4, 2016 at 11:46 pm - Reply

    Hello,

    Can you please tell me where to find the legislation in CA that allows RNs to pronounce? I am a NPD Practioner in acute care.

    Thank you,

    Beth Hawkes

  10. Avatar
    Barbara Lang June 14, 2020 at 3:23 pm - Reply

    What can you do if the neglect of response changed the date of death? The most important dates in your life are your birth date and the day of your death. The hospice nurse lived approximately 38 miles away yet it took her an hour and half to arrive. This had been extremely upsetting for me because I want the correct date.

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