"Ask NE GAPNA Members" Question

Working in a long-term care and rehab facility, it seems somewhat ridiculous that as a nurse practitioner, I can assess, diagnose and treat patients, order labs, tests, and consults, prescribe medications including controlled drugs; but I can't write an order that reflects the patient's choice for end of life. Doctors often are not available or forget to write the order when they are in the facility, which is often only weekly. I am here 5 days a week and could insure that such orders are written and in effect so that last minute decisions could be avoided - making it better for the patient, family, and the nursing facility. I do think that there should be certain limitations as to what documentation needs to be in place for this privelege to occur i.e. documented in-person discussion with patient and/or responsible party, and when available, current Living Will that is in effect.

Thank you for your thoughtful response, Barbara. I could not agree more. I work at a facility where physicians are present daily, but despite this, I am usually the one who spends the time interacting with a patient's family and discussing such issues. When a patient makes a decision to change their code status to DNR, I have to convince a physician to come have a conversation with the patient so that they can document and then write the new order - all non-billable and therefore not a priority. Many times, it is a patient newly on hospice or considering palliative care that requests this change, yet it takes days to make the change official and it is always my fear (and often a reality) that they will be treated in a way that contradicts what they have stated their wishes are to me. It is so insulting that I am not deemed capable by the state to document a patient's decision, and so non-intuitive that I can treat their illness medically, but cannot make a change that fulfills their own reasonable wishes to drive their care. This needs to be changed.