Nurse Practitioners in Florida Cannot Sign DNR Forms
In Florida, nurse practitioners are not authorized to sign Do Not Resuscitate (DNR) forms; this authority is specifically limited to physicians. 1
Legal Framework for DNR Orders
- DNR orders must be completed, signed, and dated by a physician after a documented discussion with the patient and/or family or legal representative 1
- The American Heart Association guidelines explicitly state that a licensed physician's order is necessary to withhold CPR in the hospital setting 1
- DNR orders (also called DNAR - Do Not Attempt Resuscitation, or AND - Allow Natural Death) are legal orders written either in the patient's file or on a legal form to respect the wishes of a patient not to undergo CPR 1
Requirements for Valid DNR Documentation
- DNR orders should clearly state either full resuscitation or no attempt at resuscitation 1
- Oral DNR orders are not acceptable - they must be written 1
- The order should provide explicit instructions for specific emergency interventions that may arise 1
- Documentation must include the rationale for the DNR order and discussions with the patient, surrogate, and family 1
Scope of DNR Orders
- A DNR order does not automatically preclude other interventions such as administration of parenteral fluids, nutrition, oxygen, analgesia, sedation, antiarrhythmics, or vasopressors 1
- DNR orders should specify which interventions are to be withheld 1
- DNR orders carry no implications about other forms of treatment, and other aspects of the treatment plan should be documented separately 1
Best Practices for DNR Documentation
- Electronic ordering systems with automated printing processes for resuscitation status armbands have been shown to reduce discrepancies between patient wishes and DNR status labeling 2
- Procedure-specific DNR order forms can improve documentation of DNR decisions and reduce uncertainty about the use of specific procedures 3
- DNR orders should be reviewed periodically as per local protocol, particularly if the patient's condition changes 1
- DNR orders should also be reviewed before surgery by the anesthesiologist, attending surgeon, and patient or surrogate 1
Terminology Evolution
- The American Heart Association moved from the traditional "Do Not Resuscitate" (DNR) terminology to "Do Not Attempt Resuscitation" (DNAR) in 2005 4
- "Allow Natural Death" (AND) is recommended in some settings to make the meaning clearer 4
- Despite these recommendations, most hospitals still use the DNR term 4
Common Pitfalls to Avoid
- Failure to document physician agreement with DNR orders can lead to confusion about patient wishes 3
- Miscommunication of DNR orders between healthcare providers can lead to errors in honoring patient wishes during cardiac arrest events 2
- Requiring signed consent for DNR orders may create barriers to discussions about end-of-life care 5
- Lack of clarity in limitation of resuscitation orders can complicate care, especially for patients with special healthcare needs 1
In conclusion, while nurse practitioners play a vital role in patient care and advance care planning discussions, in Florida, the legal authority to sign DNR forms remains exclusively with physicians.