Who pronounces the death?

[NICU_babyRN]

The quote below is from another thread and it raised an eyebrow!

...The first time I had a patient die and I had to pronounce them...

I didn't think it was legal for an RN to pronounce anyone person dead. I do believe it is an MD or Paramedic (with more than a basic EMT) who has to pronounce the person dead and state the time. Is this not true in some states?

Thank you so much,

Addy:nurse:

[fusster]

I work at a hospital (acute care) in Michigan. RN's at my hospital can pronounce if the pt is a full DNR. 2 RN's have to do the death pronouncement, checking for heartbeat, carotid pulse, respirations, etc. Plus I work on telemetry, so we can record a rhythm strip showing asystole (although that isn't mandatory). The MD still has to sign the death certificate, though.

[DDRN4me]

in massachusetts, hospice rn's pronounce all the time.

leslie

Leslie is right; in home care and hospice the Rn can (and oftern does) pronounce.

but i do believe in other settings it has to be a doc...

[spider11]

I'm an LPN in Indiana and work in a hospital. All the nurses can pronounce as long as it's verified by another nurse and the pt is a DNR. We frequently have hospice pts or many other DNRs on the floor. Of course we don't pronounce in a code situation, the ER doc is called up for the code. We fill out all paperwork and the MD signs it.

[not now, RN]

Here an RN can pronounce if the MD has charted that "death is imminent, RN to pronounce." If they are DNR and die the MD still has to come up and pronounce if "death is imminent" wasn't charted.

When I worked LTC an RN could pronounce after talking to the MD, even on the phone.

[johnwaynehair, BSN, RN]

Concurr c Mianders; usually the MD writes an order "RN to pronounce" for the DNR pts. 2 RNs will palpate/auscultate for pulses; auscultate for respirations, confirm EKG asystole, call time of death, and document. If pt is vented then the MD must order for the pt to be placed on a T-piece-- we can't extubate. If no T-piece order is in place, then the ER doc has to come up to the Unit.

[sharlynn]

in the us, hospice rn's can pronounce an registered hospice pt, all others need an md, at least in fl and va where i've worked.

and arkansas

[caroladybelle, BSN, RN]

In hospice, in many areas, RNs can pronounce death.

In some states and facilities, RNs pronounce uncomplicated deathes. My current facility allows us to do so, but in others, the ER MD comes up at his leisure to do so....which can be a lapse of hours. In cases of PEA, I really to prefer to have the MD determine time of death, as it more "complicated", as are coroner's cases, codes, and cases with legal ramificatons.

Now, signing the death certificate/cause of death...that is generally reserved for MDs. As those requires a certain amount of medical diagnosis issues.

[Cardiac-RN]

This isn't an ethical issue, it's a legal one -- state law specifies who can pronounce, and, like everything else, the regs vary from state to state. It's important to be aware of what is and isn't within your scope of practice where you're practicing.

I believe there are a number of places where RNs can pronounce under lmited circumstances -- like, in LTC settings.

Agreed. Check your state law/ practice acts.

Cardiac-Rn