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The signing powers of RN(EC)s

Q

Our hospital just hired an RN in the Extended Class to care for in-patients. Last night, one of our clients died, and there was a discussion about who should fill out the Medical Certificate of Death. I know that RN (EC )s have the authority to perform extra functions, but are physicians the only ones authorized to complete this certificate?

A

In certain situations an RN(EC) can sign a Medical Certificate of Death. This permanent legal document outlines the facts and circumstances of a death. The government uses the information to help identify public health issues, develop health education and promotion curricula, determine a need for medical research and assist with health planning. The certificate is also used to facilitate the funeral by issuing a burial permit and to settle the person’s estate.

The Vital Statistics Act, which outlines the requirements for completion of this document, has indicated that an RN(EC) is able to sign this document if she/he has met specific criteria, including the following:

  • has had primary responsibility for the care of the deceased during his/her last illness;
  • the death was expected;
  • there is a medical diagnosis of a terminal illness made by a medical practitioner;
  • there was a predictable pattern of decline; and
  • there were no unexpected complications.

However, in the situation you describe, an RN(EC) would not be able to sign the Medical Certificate of Death. The Public Hospitals Act states than an RN(EC) employed by a hospital is authorized to diagnose and prescribe for, or treat, outpatients. This authority, though, does not extend to in-patients.

In providing care for in-patients, RN(EC)s must work under medical directives, which are written orders for a group of clients who meet specified criteria. This restriction means that an RN(EC) cannot be the primary person responsible for the care of an in-patient; therefore, an RN(EC) cannot fill out a Medical Certificate of Death for an in-patient in a public hospital.

For more information on RN(EC) scope of practice, see the College’s Registered Nurses in the Extended Class practice standard at www.cno.org.

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