Registered Nurses have their clearance, duties, and responsibilities expanded.
They were first considered as physician handmaiden, while they are now part of a clinical partnership with a great role in supporting patients.
The process of gaining more responsibilities and permissions included the act of pronouncing death.
Nowadays, in 20 states in the USA, RNs are allowed to pronounce death, including Ohio, New York, California, Kentucky, etc.
The circumstances in which an RN can do that are defined by law.
Let’s take Alaska for example.
In this state, a registered nurse can pronounce death if the situation met the next criteria:
- When there is a medical record which proves that physician anticipated death because of factors such as disease, age, or illness. The record cannot be older than 120 days.
- The documentation that guarantees that a specific registered nurse, for example, hospice nurse, or an RN with clearance to determine death, must be reviewed by physicians.
- To pronounce death, a registered nurse must have the documentation of the criteria that lead to death in clinical records.
- A registered nurse is obliged to inform the physician was in charge of anticipating death documentation.
- To sign the death certificate, an RN must include information such as patient name, the date and time of death, and information about the presence or absence of contagious decease.
- In 24 hours after the RN pronounce death, a licensed physician must certify the death pronouncement.
The determination of death usually occurs after several factors.
Those include the absence of spontaneous breathing, no breath sound on the auscultation, no pulse, no heart sounds, and no pupillary response.
Additionally, the factors include no response after painful stimuli.
There is a clear assessment procedure for death pronouncement in all facilities in which the RN is allowed to pronounce death.
Nowadays, where facilities and organization rely on electronic medical records (EMR), a software has pre-fabricated documentation tools which make the process standard and simple.
Tools will ensure the required documentation has been completed as well as all the necessary steps.
Since 2004, RNs were allowed to sign the medical documentation of the death certificate, after the Public Act No. 04-255 was passed.
The facilities in which RNs can pronounce death are nursing home, hospice, and home-care facilities.
The law came as a result of challenges and physician shortage which lead to delays for funeral activities and Vital Record terms od patients whose death was anticipated.
The ability to pronounce death in hospice or inpatient hospital settings depends on the local regulations.
Every nurse should first check the local Board of Nursing regulations and required procedures to make sure they are supporting physicians and patient family in during the death pronouncement.