Scope of Practice

Role of the Registered Professional Nurse in the Pronouncement of Death

This compilation of laws and information is provided by the New York State Nurses Association to offer clarification in response to the numerous inquiries regarding the role of the registered professional nurse (RN) in the pronouncement of death.

Definitions

Pronouncement of death by a registered professional nurse: The determination made after an assessment that there is an absence of human responses, spontaneous breathing and heart beat.

Pronouncement is not to be confused with, or construed as certification of death. According to the New York State Attorney General’s office, there is no law or regulation either authorizing a person to pronounce death or prohibiting a person from pronouncing death (Atty. General, 1980). However, individual county laws may be more restrictive.

Certification of death: Defined in New York State Public Health Law, Article 41, Death Certificate. The death certificate identifying the patient and the cause of death must be dated and signed by the physician last in attendance on the deceased (Gould’s, 2004).

Medical death: “the end of life; the permanent cessation of vital bodily functions, as manifested in humans by the loss of heartbeat, the absence of spontaneous breathing, and brain death” (Stedman’s, 2002).

Brain death: “Irreversible brain damage and loss of brain function, as evidenced by cessation of breathing and other vital reflexes, unresponsiveness to stimuli, absence of muscle activity, and a flat electroencephalogram for a specific length of time. (Stedman’s, 2002) Guidelines for determination of brain death can be found in New York Title 10 section 400.16.

Background

The New York Nurses Association and the Councils on Ethical Practice and Human Rights support the following actions for professional registered nursing with regard to pronouncement of death and recognize that:

  1. There are situations in which the death of a patient is expected and can be anticipated and the patient’s primary provider cannot be present within a reasonable time to determine death; it is in these situations that a registered professional nurse may pronounce death, if allowed by facility policy.
  2. A registered professional nurse is both qualified, by education and experience, and authorized in New York State Education Law to diagnose the absence of human responses and therefore can diagnose the absence of responsiveness, spontaneous breathing and heart beat as identified in the Department of Health Guidelines cardiopulmonary criteria (NYCRR, Title 10, 400.16).

Nursing Role and Responsibilities

Registered professional nurses may encounter a variety of situations involving death and dying and the New York State Nurses Association provides the following to clarify the role of the registered nurse (RN) and responsibilities in these situations:

  1. Anticipated Death

    The care of a patient whose death is anticipated and for whom prolongation of life by extraordinary measures is not desired by the patient, family or healthcare team and advance directives and/or DNR (Do Not Resuscitate) orders have been written.

    RN Role and Responsibilities:

    Provide physical and psychological supportive measures to the patient and family. When death occurs, the RN present may be responsible for diagnosing the absence of human responses, the absence of spontaneous breathing and heart beat if the primary provider is unavailable. Document the time and date of the event and communicate the pertinent information to the appropriate individuals.

  2. Unanticipated Death

    The patient unexpectedly ceases to respond.

    RN Role and Responsibilities:

    Diagnose the absence of human responses, initiate emergency measures and secure the assistance of other health professionals in completing a life support system. Evaluate the client’s response to such intervention. The decision to continue or terminate those measures is a shared responsibility among family, nursing, medicine, and other related professions, i.e., pastoral care, risk management, legal counsel, medical social workers, etc.

  3. Life Sustained by Artificial Means

    Life is essentially maintained by artificial means and the patient’s potential for regaining any degree of independent functioning is not anticipated.

    RN Role and Responsibilities:

    Evaluate the client’s response to the artificial supports and communicate that information to other members of the healthcare team. Provide counseling to family members in order that they may be continually apprised and encouraged to express their concerns, beliefs and wishes. The decision to continue or terminate the use of such treatment modalities must be made through collaborative input from family, significant others, nurses, the primary provider and related professions. The RN should be familiar with NYCRR, Section 400.15, Determination of Death, which recognizes the total and irreversible cessation of brain function as a basis for determining death in New York State (NYCRR, Title 10, 400.16) and the state laws and facility policies related to Do Not Resuscitate and Health Care Proxy. Advance Directives materials are available from the Association.

  4. Organ and Tissue Donor

    The patient is a potential donor for organ and/or tissue transplantation and death is imminent.


    RN Role and Responsibilities:

    Monitor the patient’s status and provide physical and psychological support to the patient and family. Work cooperatively with members of the healthcare team as well as the organ procurement organization (OPO) and/or tissue bank, and the facility in the identification and recovery of viable organs and tissue for transplantation. The RN may be present at the time of death, but pronouncement is certified by the physician who attends the potential donor. The state law governing anatomical gifts states, “The time of death shall be certified by the physician who attends the donor at his death and one other physician, neither of whom shall participate in the procedure for removing or transplanting the part” (Gould’s, 2004).

References

American Nurses Association. (2001). “Code for nurses with interpretive statements.” Washington, DC: Author.

Attorney General Opinion (Informal). (1980, July 18th).

Gould’s Consolidated Laws of New York (2004 ed.) (Vol. 4) - Public Health Law, Title IV - Registration of Deaths; Burial Permits, Section 4141 Death certificate; form and content. Binghamton, NY: Gould Publications.

Gould’s Consolidated Laws of New York (2004 ed.) (Vol. 4) - Public Health Law, Article 43 - Anatomical Gifts, Section 4306 Rights and duties at death. Binghamton, NY: Gould Publications.

Official Compilation Codes, Rules and Regulations of the State of New York, Title 10 (Vol. C) – Health, Part 400 Medical Facilities – minimum standards, Section 400.16 Determination of death.

The American Heritage Stedman’s Medical Dictionary. (2002). Retrieved March 21, 2005 from http://www.houghtonmifflinbooks.com/catalog/titledetail.cfm?titleNumber=H01872