Advanced practice registered nurses (APRNs) have the potential to ensure that patients dealing with an advanced illness have optimal quality of life through timely access to end-of-life (EOL) care and counseling. The Physician Orders for Life-Sustaining Treatment (POLST) paradigm is a powerful tool for guiding conversations with patients about their EOL care preferences and incorporating those preferences into the medical record.
POLST programs are established or in development in 47 states, with each state defining its own program structure and policies. As such, the clinicians authorized to sign POLST forms into the medical record vary from state to state.
The National POLST Paradigm Task Force (NPPTF) recommends allowing physicians, advanced practice registered nurses, and physician assistants to execute POLST forms. However, nurse practitioners are not allowed to sign POLST forms into the medical record in all states with these programs. Of the 19 states with NPPTF-endorsed programs, 3 states’ are exclusive to physicians to only. As these programs mature and more states adopt such programs, decisions on which clinicians will be authorized to sign and execute POLST forms need to be made.
In this study, researchers evaluated data from the Oregon POLST Registry on which clinician signed the form to determine whether these programs should include APRNs among the clinicians allowed to complete the forms. They calculated the percentage of forms completed by APRNs each year over a 6-year period compared with physicians or physician assistants. Data were from 226,101 Oregon POLST Registry forms entered from 2010 to 2015.
Results demonstrated an increase in percentage of POLST forms executed by APRNs from 2010 (9.0%) to 2015 (11.9%), with a notable increase seen from 2010 to 2012 (11.4%).
The authors identify the relationship between nurse practitioner and patient as one of continuity and the ideal context for discussing goals of care. Furthermore, they report that these results demonstrate that APRNs should be included among the clinicians allowed to sign POLST forms.
“At its core, the POLST paradigm exists to facilitate and honor goals of care conversations between patients and the health care professionals who know them best,” the authors conclude. In some cases, that clinician may be a physician; in other cases, it may be an APRN. “It is important … that POLST policies recognize and honor the range of professionals who are best positioned to counsel patients and document their wishes.”
1. Hayes SA, Zive D, Ferrell B, Tolle SW. The role of advanced practice registered nurses in the completion of physician orders for life-sustaining treatment. J Palliat Med. 2016 Oct 21. doi: 10.1089/jpm.2016.0228. [epub ahead of print]