Authority of Nurse Practitioners Under Current NYS Law

As a result of 2017 amendments to the Family Health Care Decisions Act (FHCDA) and 2018 amendments to the Health Care Proxy Law, a nurse practitioner can exercise substantially the same authority as an attending physician to determine patient incapacity and to write do-not-resuscitate (DNR) and other orders to withhold and/or withdraw life-sustaining treatment pursuant to those laws.  Chapter 430 of the Laws of 2017; Chapter 342 of the Laws of 2018.

Specifically, Chapter 430 of the Laws of 2017 amended the Public Health Law to expand the authority of an “attending nurse practitioner” to align it with the authority of the “attending physician” under FHCDA to determine incapacity and to orders to implement end-of-life decisions. Under the Palliative Care Information Act, nurse practitioners are obliged to – and do – counsel patients and families about end-of-life options. The new law became effective on May 28, 2018.

More recently, Chapter 342 of the Laws of 2018 similarly expanded the authority of an attending nurse practitioner to align it with the authority of the attending physician under the Health Care Proxy law. This law became effective on February 3, 2019.

These laws do not amend the Surrogate Court Procedures Act (SCPA) 1750-b, which relates to individuals with developmental disabilities.

Nurse Practitioners and Capacity Determination

The following table clarifies current New York State Public Health Law and the nurse practitioner’s authority to do capacity and concurrent capacity determination. This table is accurate as of February 3, 2019.

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Nurse Practitioners and MOLST Process Beyond Signing MOLST Orders

The 8-Step MOLST Protocol was developed in 2005 to help physicians, nurse practitioners, physician assistants, and others who are engaged in end-of-life discussions develop a systematic approach to end-of-life discussions that worked for physicians prior to MOLST. Having a standardized approach to thoughtful MOLST discussions can help ensure best practices in shared medical decision-making. ECHO MOLST: Honoring Patient Preferences at End-of-Life provides valuable education to fulfill the demand for professional training and assistance on advance care planning, MOLST, and eMOLST admist the recent public health law changes.

The following table clarifies current New York State Public Health Law and the nurse practitioner’s authority to participate in the MOLST process and sign MOLST orders. This table is accurate as of May 30, 2018. The 2018 amendments to the health care proxy law do not impact this table.

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Adapted from tables created by Robert N. Swidler, V.P.  Legal Services, St. Peter’s Health Partners, Albany NY

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