title: The Role of Advanced Practice Registered Nurses in the Completion of Physician Orders for Life-Sustaining Treatment.
abstract: The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm records advance care planning for patients with advanced illness or frailty as actionable medical records. The National POLST Paradigm Task Force recommends that physicians, advanced practice registered nurses (APRNs), and physician assistants (PAs) be permitted to execute POLST forms.
  
  
  
  To investigate the percentage of Oregon POLST forms signed by APRNs, and examine the obstacles faced by states attempting to allow APRNs to sign POLST forms.
  
  
  
  Cross-sectional.
  
  
  
  226,101 Oregon POLST Registry forms from 2010 to 2015.
  
  
  
  POLST forms in the Oregon Registry were matched with signer type (MD, DO, APRN, PA).
  
  
  
  226,101 POLST forms have been added to the Oregon POLST Registry from 2010 to 2015: 85.3% of forms were signed by a physician, 10.9% of forms were signed by an APRN, and 3.8% of forms were signed by a PA. From 2010 to 2015, the overall percentage of POLST forms signed by an APRN has increased from 9.0% in 2010 to 11.9% in 2015. Physicians are authorized signers in all 19 states with endorsed POLST Paradigm programs; 16 of these states also authorize APRN signature, and 3 states (LA, NY, and GA) allow only physicians to sign.
  
  
  
  More than 10% of Oregon POLST forms are signed by APRNs. Given the need for timely POLST form completion, ideally by a member of the interdisciplinary team who knows the patient's preferences best, these data support authorizing APRNs to complete POLST forms.
authors: 1 School of Medicine, Oregon Health & Science University , Portland, Oregon.
authors: Sophia A
authors: SA
authors: Hayes
authors: 2 Center for Policy and Research in Emergency Medicine, Oregon Health & Science University , Portland, Oregon.
authors: Dana
authors: D
authors: Zive
authors: 3 Division of Nursing Research and Education, Department of Population Sciences, Beckman Research Institute of City of Hope , Duarte, California.
authors: Betty
authors: B
authors: Ferrell
authors: 4 Division of General Internal Medicine and Geriatrics, Center for Ethics in Health Care, Oregon Health & Science University , Portland, Oregon.
authors: Susan W
authors: SW
authors: Tolle
mesh_terms: D032722:Advance Care Planning / Q000592:standards*; D057179:Advanced Practice Nursing / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003657:Decision Making; D066275:Health Information Exchange / Q000592:standards*; D006801:Humans; D008020:Life Support Care / Q000592:standards*; D024802:Nurse's Role; D009922:Oregon; D010166:Palliative Care / Q000379:methods / Q000592:standards*; D019555:Physician-Nurse Relations; D012042:Registries; D013727:Terminal Care / Q000379:methods / Q000592:standards*; D000078329:Workforce
keywords: POLST; advanced care planning; advanced practice registered nurse; end-of-life care; scope of practice