Can Nurse Practitioners Sign Death Certificates?

We regularly hear from our nurse practitioners (NPs) that patients are often surprised to learn what they can do, especially those patients who initially demand to see a physician.

In most states, the authorized responsibilities of a nurse practitioner and a physician are remarkably similar. But like most questions pertaining to NP scope of practice, whether nurse practitioners can sign a death certificate depends on the state.

Even on a state-by-state basis, there are special exceptions and regulations, which can make navigating the question more difficult than it has to be. We broke down everything you need to know below. And if you have any questions about nurse practitioner scope of practice, check out our comprehensive wheel for a state-by-state breakdown of everything an NP can do. And if you’re looking for your next assignment, explore open nurse practitioner jobs with Barton today.

Can an Nurse Practitioner Sign a Death Certificate?

In most states, yes, nurse practitioners can sign death certificates. In 40 states and DC, NPs can sign death certificates in at least some situations, but several states only permit it in very narrow circumstances.

States Where Nurse Practitioners Can Sign Death Certificates:

NPs are authorized to sign death certificates in DC and 40 states: Alabama, Alaska, Arizona, Arkansas, Connecticut, Delaware, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wyoming.

In the majority of these 40 states, NPs have full authority to sign death certificates.  However, in several states, physician involvement varies. 

Special Exceptions:

 In three states, NPs can only sign death certificates under specific conditions:

• Alaska requires the physician to authorize an NP’s signing, and to certify the death certificate within 24 hours.
•  In Arkansas, only hospice-employed NPs can sign death certificates. 
• New Jersey only authorizes NPs to sign death certificates for patients for whom they were the primary care provider, if no collaborating physician is available.

The Impact of NP Scope of Practice on Signing Death Certificates

Importantly, full NP scope of practice does not have a direct correlation with the ability to sign death certificates. Several states that generally restrict what a nurse practitioner can do without a physician still allow NPs to sign death certificates. 

These states limit general scope of practice for nurse practitioners as reduced or restricted practice states, but still allow nurse practitioners to sign death certificates:

• Alabama,
• Florida,
• Illinois,
• Indiana,
• Kentucky,
• Missouri,
• North Carolina,
• Oklahoma,
• Pennsylvania,
• South Carolina,
• Texas,
• West Virginia 

On the flipside, Kansas and Colorado notably do not allow NPs to sign death certificates, despite allowing full practice authority.

Can a Nurse Practitioner Call Time of Death?

The ability to pronounce death and sign death certificates are two legally distinct privileges, although in most states, the ability to do one correlates with the other.

The most relevant distinction is in Georgia, where nurse practitioners may pronounce death, but not sign death certificates.

Can Nurse Practitioners Sign POLST/POST/MOLST/MOST/COLST Forms?

The National Physician’s Orders for Life-Sustaining Treatment (POLST) Paradigm was put into place to help honor a patient’s wishes during end-of-life planning and treatment. The acronym varies across states, with some referring to it as Practitioner Orders for Life-Sustaining Treatment (POLST), Physician Orders for Scope of Treatment (POST), Medical Orders for Life-Sustaining Treatment (MOLST), Medical Orders for Scope of Treatment (MOST), Clinician Orders for Life-Sustaining Treatment (COLST), and others.

NPs may sign their state’s form in 37 states. Several state programs are still developing.