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Nursing Practice > You Asked Us Online
Last modified June 10 , 2005
Nursing Standards
Outreach Program
Pronouncing death
Q
I know a nurse who provides palliative care in a hospice. When a client dies in the hospice, she is able to pronounce death and move the deceased client to a private area to allow family and friends to visit. Can all nurses pronounce death in their practice?
A
The College’s practice standard Resuscitation states that a nurse may pronounce death in situations of expected death, meaning that the client is terminally ill and there is no available treatment to restore health, or the client refuses the available treatment. Pronouncing death is to declare that death has occurred. There is no legal definition of pronouncing death and no legal requirement that a physician pronounce death.
It is important to note that pronouncing death is different from certifying death, which occurs when a physician, or in cases of expected death, an RN in the Extended Class [RN(EC)], signs the Medical Certificate of Death. This certificate is a part of the death registration form and is a legal document detailing the facts and circumstances of death and statistics on the causes of death. General class RNs and RPNs are not authorized to certify death.
When deciding if it is appropriate for nurses to pronounce death within a particular setting, consideration must be given to the client population, the benefit to the client’s family and friends, and any potential restrictions in policy and legislation.
In some settings, such as a palliative care hospice where client death is expected, the facility may allow RNs and RPNs to pronounce death and move a deceased client to another location in the facility.
In other settings, such as a correctional institution, it may be inappropriate for nurses to do this. For example, the Coroners Act (1991) requires an inquest when a person dies while an inmate on the premises of a correctional institution or lock-up. Additionally, the Coroners Act includes other circumstances in which a nurse would need to report a death to the Coroner for investigation, such as those that may involve violence, misadventure, neglect or malpractice. In these situations, the nurse must not alter or interfere with the body or its condition in any way until the Coroner specifically grants permission. Employer policies can provide nurses with more detailed expectations of how to ensure that the body is not altered, and these may include sealing the room and leaving all tubes and monitoring equipment in place.
In a practice setting in which policies and legislation override the benefits associated with nurses pronouncing death, it would not be beneficial to include pronouncing death as part of the nurse’s role.
For more on the role of the RN(EC) in certifying death, see the Registered Nurses in the Extended Class practice standard at www.cno.org.
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