The first time a death certificate appears on your desk as a nurse practitioner is a nerve wracking moment. Are you allowed to sign death certificates as an NP? If so, what if you are unsure of the cause of death? What’s the liability involved with signing a death certificate? Naturally, there’s a lot of confusion and concern among nurse practitioners when it comes to signing death certificates so today we’re addressing some F.A.Q. to clear up the confusion. 

1. Are nurse practitioners allowed to sign death certificates? 

The ability of NPs to sign death certificates depends on state scope of practice laws. Some states allow NPs to sign, others do not. Overall, about half of states grant nurse practitioners the ability to sign. In some cases, NPs are allowed partial ability to provide this last act in patient care. For example, a nurse practitioner may be permitted to sign a death certificate but not to determine the cause of death. Check in with your state’s BON to better understand your scope of practice in this area. 

2. What’s the point of a death certificate?

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It seems obvious that a death certificate’s purpose is to formalize a patient’s passing. But, why? One primary purpose of this documentation is to settle family affairs. For example, a body may not be released to the family for burial until the certificate has been signed. Another purpose of the death certificates is for use by state and other governments as notice to stop benefits such as Medicaid or social security payments. Finally, death certificates are useful for record keeping when it comes to mortality statistics. The CDC, for example, closely tracks causes of death and collects this data for reporting and research

3. Who is responsible for signing a death certificate?

State laws may specify the responsibility for signing death certificates. For example, in some states it may be the last provider who saw the patient. In many cases, however, the primary care provider is held responsible. So, even if you were not present for the patient’s death or the provider responsible for treating the condition ultimately resulting in death, the responsibility for signing may fall on you as a PCP. It is common practice to examine an individual’s medical records to determine if he/she was established with a primary care provider and ask this provider to sign the certificate. The idea is that the primary care provider will have the best idea about a potential cause of death. 

4. What if I make a mistake? Will I be sued for filling out a death certificate incorrectly?

Understandably, nurse practitioners fear the legal implications of completing death certificates. After all, these forms seems like a weighty responsibility. Death certificates, however, are to be completed “with a reasonable degree of medical certainty”. It’s understood that you can’t possibly know the exact cause of an individual’s death without an autopsy. So, complete the certificate to the best of your ability. It’s also permissible to use the word “probable” where you’re unsure. 

All in all, the most likely issue you’ll have when it comes to death certificates is unhappy family members, upset by delays from an unsigned certificate. The risk of litigation is slim to none if you complete the paperwork in a timely manner to the best of your ability. 

5. What if I am uncertain about the cause of death?

Nurse practitioners may not decline to sign a death certificate due to uncertainty about cause of death. Rather, in these circumstances, NPs must simply give their best opinion. Keep in mind that a death certificate is a legal rather than scientific document so state the most likely condition responsible. Looking at a patient’s chronic comorbidities can help. For example, hypertensive cardiovascular disease or obesity-related heart disease may be listed as a cause.  

6. When should nurse practitioners refuse to sign a death certificate?

In some cases, NPs should decline to sign the death certificate and instead refer the case to the medical examiner or coroner. Keep in mind that this is rare. Sudden death without a known or suspected natural cause, circumstances that indicate a death was caused by unnatural means (trauma, surgical procedure, accident or injury) or unlawful means (drug related, criminal act). Avoid telling a patient’s family that the medical examiner or coroner will perform an autopsy as this is not always the case. 

7. How quickly must a death certificate be signed?

The timeline for signing a death certificate is determined by state law. Typically, this is a matter of a few days so nurse practitioners should complete the required documentation in a timely manner. 

8. What happens if a nurse practitioner refuses to sign a death certificate?

The consequences for unlawfully refusing to sign a death certificate depend on the laws in the state where you practice. In many states, refusing to sign a death certificate is a misdemeanor offense. The refusal may also be reported to your regulatory board, likely your state’s board of nursing, who may enact disciplinary action. 

Do you sign death certificates as a nurse practitioner? 


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