Clarification and Implications for California Nurse Practitioners
By Karen Ayers, ACNP
CANP North Coast Chapter
AB 637 (Campos) was passed by the Legislature late in the 2015 session, and was subsequently signed and chaptered into law by Governor Brown. This law amends the existing POLST law by authorizing the signature of a nurse practitioner (NP) or a physician assistant (PA) acting under the supervision of the physician and within the scope of practice authorized by law to create a valid POLST form.
POLST stands for Physician Orders for Life Sustaining Treatment. The POLST is a bright pink form that carries with it actionable medical orders for healthcare providers that convey the patient’s wishes for the intensity of treatment they want for themselves when they are seriously ill or frail.
POLST At a Glance
- As of Jan. 1, 2016, NPs and PAs who are under the supervision of a physician and acting within their scope of practice are authorized under California law to sign POLST forms.
- Previous versions of POLST are still valid, but NPs and PAs should only use the revised POLST form (with an effective date of 1/1/2016) when signing because previous versions do not contain the necessary signature lines or clarifying language and instructions.
- In the space for Physician/NP/PA License #, list your California NP certificate number.
- The name of your supervising physician should be noted in the space provided on the back of the POLST form. The physician’s signature is not required.
- As always, NPs are cautioned to carefully document their work, including with whom they had the POLST conversation, the content of the conversation, etc.
- Completion of a POLST form is always voluntary for the patient.
- POLST should be completed as part of a rich conversation that includes the patient’s current medical condition, goals of life, goals of care and treatment wishes.
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What does AB 637 mean for NPs in California?
This new law (effective January 1, 2016) authorizes NPs and PAs to sign the POLST form. In previous forums, questions have been raised about the legality of NPs signing “Do Not Resuscitate” (DNR) orders in California. To clarify, the Coalition for Compassionate Care of California (CCCC), which leads the POLST program in California, met with representatives of the California Board of Registered Nursing (BRN). The BRN supports the POLST form as a valid medical order and foresees no issues with regard to implementation of AB 637. The completion of a POLST form by an NP in California, who is working under the supervision of a physician and within the scope of practice authorized by law, is legal.
The POLST form is a symbol of a patient-provider relationship that permits and encourages sacred and rich conversations about wishes and goals. It is important that NPs carefully document the details of these conversations, including decisions reached, in the medical record. While these conversations can be difficult, they are important in guiding patients – along with their families and caregivers – to what matters most to them. The conversations that result in a POLST being created help to assure that patients receive the care that is right for them.
Where to Access POLST Forms
The 2016 POLST form is now available for individual download from CCCC and bulk purchase through Med-Pass. CCCC has frequently asked questions, talking points and a free webinar available on their website to bring NPs and other providers up to speed on the POLST conversation and the new law.